Vaginal Infection

1
Vaginal Infection

1. Bacterial vaginosis
2. Trichomonas vaginitis
3. Vulvovaginal candidiais
4. Inflammatory vaginitis
5. Senile vaginitis

2
Bacterial vaginosis

• alteration of normal vaginal bacterial flora
• loss of hydrogen-peroxide-producing
  lactobacilli
• overgrowth of predominantly anaerobic bacteria
• anaerobic bacteria--gt 1 of the flora of normal
  women
• women with BV
• concentration of anaerobes, as well as
  Gardnerella vaginalis and Mycoplasma hominis
• 100-1000 times higher than in normal women
• Lactobacilli--gt abscent
• not known what triggers the disturbance of normal
  vaginal flora
• postulate---gt alkalinization of the vagina
• frequent sexual intercourse
• use of douches

3
The normal vagina

• Normal vaginal secretions
• Secretions from sbaceous, sweat, Bartholin, and
  Skene glands
• Transudate from the vaginal wall
• Exfoliated vaginal and cervical cell
• Cervical mucous
• Endometrial and oviductal fluids
• Microorganisms and their metabolic products
• Increase in the middle of the menstrual cycle?
  increase amount of cervical mucus
• Except oral contraceptives
• Vaginal desquamative tissue?- responsive to
  varying amounts of estrogen and progesterone
• Superficial cell---reproductive age---estrogen
  stimulation
• Intermediate cell---luteal phase----progesterone
  stimulation
• Parabasal cell---postmenopausal womenabsence of
  hormone

4
Normal vaginal flora

• Six different species of bacteria
• Predominantly aerobic
• Hydrogen peroxide producing lactobacilli(mc)
• Survival of bacteria
• Vaginal pH
• Lower than 4.5
• Availability of glucose
• Glycogen?monosaccharide? lactic acid
• Gram stain
• Normal superficial epithelial cell
• Gram positive rods(lactobacilli)

5
sequele

• BV with significant sequelae
• increased risk of pelvic inflammatory disease
• postabortal PID
• postoperative cuff infections after
  hysterectomy
• abnormal cervical cytology
• pregnant women with BV
• risk for premature rupture of the membranes
• preterm labor and deliver
• Chorioamnionitis
• postcesarean endomentritis

6
diagnosis

• 1. fishy vaginal odor
• 2. gray vaginal secretions and thinly
• coat the vaginal wall
• 3. higher than 4.5(usually 4.7 to 5.7)
• 4. clue cell-gt increased(advanced cases 20),
  leukocytes-gt abscent
• 5. fish amine-like odor lt- KOH

7
treatment

• drug of choice Metronidazole
• excellent acivity against anaerobes
• poor against lactobacilli
• avoid using alcohol during treatment and for 24
  hours thereafter
• 500mg twice a day for 7 days(95)
• single, 2-g oral dose(84)
• clindamycin 300mg twice daily for 7 days
• metronidazole gel 0.75, 5g twice for 5 days
• clindamycin cream 2 5g twice for 7 days
• side effecs
• mild-to-moderate gastrointestinal upset and
  unpleasant taste

8
Clue cell
9
Clue cell
10
Trichomonas Vaginitis

• STD
• high transmission rate (70 of males after a
  single exposure)
• anaerobes-gt ability to generate hydrogenO2
• accompanies bacterial vaginosis(60)

11
diagnosis

• profuse, purulent, malodorous vaginal discharge
  with vulvar pruritus
• vaginal secretions may exude
• patch vaginal erythema and strawberry cervix
• The pH of the vaginal secretions gt 5.0
• motile trichomonads and increased numbers of
  leukocytes
• clue cell may be present
• whiff test positive

12
sequele

• postoperative cuff cellulitis
• PROM and preterm delivery

13
treatment

• metronidazole drug of choice
• single-dose 2g orally and 500mg twice daily
  for 7 days(95)
• sexual partner should also be treat
• metronidazole gel not effective
• not respond-gt repeat multidose regimen
• -gt single 2-g dose once daily for
  3-5 days

14
strawberry
15
trichomonad
16
Wet trichomonas
17
tricho
18
trichomonas
19
Vulvovaginal candidiasis

• 75 of women experience at lease one
• Candida albicans(85-90)
• Candida glabrata and Candida tropicalis
• dimorphic fungi
• blastosporestransmission,asymptomatic
  colonization
• mycelia colonization, tissue invasion
• antibiotic use, pregnancy, diabetes
• ?? ? ?? ???? ?? ?? ?? ??
• ??? ? ??? ?? ? ???? ??? ? ?? ?? ?? ??? ?? ??
• ?? ? ??? ?? ?? ?? ??
• ???? ???? ??

20
symptoms

• homogenous thick discharge(cottage cheese)
• vaginal soreness, dyspareunia, vulva burning
  and irritation
• external dysuria
• erythema and edema of the labia and vulva skin
• discrete pustulopapular peripheral lesion
• pH normal

21
treatment

• flunazole single 150mg
• 1 hydrocortisone-adjunctive treatment
• fungal culture

22
candida
23
Candida vulvovaginitis
24
candida
25
Wet candida
26
Wet candida
27
chronic VVC

• persistent irritative symptoms
• burninglt itching
• direct microscopy of the vaginal secretion and
  fungal culture
• chronic dermatitis or atrophic dermatitis
• flunazole 200mg/day until symptoms resolve
• prophylatic doses
• flunazole 150mg/week for 6 months

28
Inflammatory vaginitis

• diffuse exudative vaginitis
• epithelial cell exfoliation
• profuse purulent vaginal discharge
• cause unknown
• relative abscence of lactobacilli
• replacement with gram positive cocci, usually
  streptococci
• SX purulent vaginal discharge, vulvovaginal
  burning or irritation and dyspareunia
• P/Evulvar erythema, vulvovaginal eccymotic
  spots, and colpitis macularis
• pH gt 4.5
• 2 clindamycin creamm 5g once daily for 7 days

29
??
30
Atrophic vaginitis

• menopause
• surgical removal of the ovaries
• Sx
• develop inflammatory vaginitis--increase
  purulent vaginal discharge
• dyspareunia , postcoital bleeding
• P/E
• atrophy of the external genitalia
• a loss of the vaginal rugae
• friable vaginal mucosa
• Tx
• topical estrogen cream for 1-2 weeks
• systemic estrogen replacement therapy--to prevent
  recurrence.

31
Senile vaginitis
32
Senile vaginitis