GYNAECOLOGICAL INFECTION.pptx. .

Medical infection

1. GYNAECOLOGICAL INFECTION DR CHISHIMBA KALANDANYA

2. DEFINITION A wide range of infection involving the reproductive tract. Defenses of the genital tract. Both Anatomical and physiological defense's Vulva ; I Apposition of the cleft by the labias II] Bartholins glands III]PHYSIOLOGICAL; Fungicidal actions of the secretions ii] Natural high resistance of infection of the vulva and perineal skin

3. Vaginal Anatomical Apposition of the anterior and posterior walls of the vaginal Ii]Stratified epithelium devoid of glands Physiological; Effects of hormones estrogen, the acidic environment created with the action of the Doderleins Bacili(PH 4 – 4.5) is a highly effective media against bacterial , fungus and viral infections

4. Cervical defences Anatomical ;i) Racemose type of glands ii) mucus plug provide an effective mechanical and physiological , immunological barrier. Physiological; bactericidal effect of the mucus Uterine defences ; cyclic shedding of the endomentrium ii)closure of the uterine ostium of the fallopian tubes with inflammation in the endometrium.

5. Fallopian tubes defences Interrated mucus plicea and epithelial cilia. i e anatomical . physiological ; peristaltic movements of the tubes and cilia are towards the uterus.

6. ORGANISMS Pyogenic 50% cases Aerobes ; gram +ve organisms e.g staph, Gram –ve e.g E.coli , pseudomonas , klebsiella and N.gonorrhaea e.t.c 2)Anaerobes strep spp clostridium .

7. TYPES OF VAGINAL DISCHARGES IN GYNACOLOGICAL INFECTIONS. I) Gonorrhorea.N ;Description ,Excessive irritant vaginal discharge. . Mucopurulent (whitish-green discharge) Diagnosis Nucleic acid amplication(NAAT) OF URINE/ENDOCERVICAL DISCHARGE. II)Bacterial vaginosis Causative agent ;Gardnerella vaginalis (Haemophilus vaginalis)

8. cont And other anaerobic organisms-bacteriods spp, Description of discharge;malodorous vaginal discharge.homogenous gleyish whitish and adherent to vaginal walls.its creamy and has a characteristic fishy smell. Dsis; WHIFF TEST which give a fishy smell when a drop of discharge is mixed with 10% KOH solution. Clue cell test.

9. Candida vaginitis-moniliasis A gram-positive yeast-like fungus. Discharge;is thick,curdy,whitish and in flakes (cottage cheese type)often adherent to the vaginal wall.it is associated with intense pruritis / itchyness . DSIS;Wet smear of discharge with 10%KOH produces-Filamentous form of mycella , pseudo hyphae under the microscope.

10. Other significant genital tract infection HIV/AIDS TRICHOMONOUS VAGINITIS SYPHILIS GENITAL WARTS HERPES GENITALIS CHLAMYDIAL INFECTION TB OF THE GENITAL TRACT.

11. PELVIC INFLAMMATION DISEASE DEF;It is an ascending,spectrum of infection and inflammation of theupper genital tract organs typically involving the uterus,endometrium,fallopian tubes,ovaries, pelvic peritonium and surrounding structures NOTE;The clinical syndrome is not related to pregnancy and surgery.

12. EPIDEMIOLOGY 1-2% of sexually active females per year are affected. RISK FACTORS Mentruating teenagers , multiple sexual partners , lack of use of contraception , previous history of acute PID.IUCD users , high prevalence of STIs.

13. PROTECTIVE FACTORS Contraceptive use especially barrier methods Menopause Oral contraceptive use Vasectomy in sexual partner Pregnancy Vaccination against HPV ,HEPATITIS

14. CAUSATIVE AGENTS Acute PID is polymicrobial . primary organism involved is N.gonrrhaeae (30%),chlamydial trachomatis (30%), mycoplasm Horminis (10%) secondary organisms ; normal flora in the vagina e.g strep ,staph, Anaerobes, bacteriods e.t.c

15. CLINICAL FEATURES OF ACUTE PID Bilateral lower abdominal pain and pelvic pain Fever ,lassitude and headaches Irregular and excessive bleeding Abnormal vaginal discharge which becomes purulent/copious Nausea and vomiting , dyspareunia Pain , discomfort in the right hypochondrium- perihepatitis(Fitz-hugh-curtis syndrom)

16. SIGNS OF ACUTE PID Raised temperature-38.5 Abdominal tenderness in both lower quadrants Abnormal vaginal discharge; urethral, bartholin , congested cervix Bimanual vaginal examination – cervical motion tenderness.

17. INVESTIGATIONS HVS/Endocervical swab-m/c/s Laparoscopy-(Gold standard method) Bloods-FBC/RPR/HEPATITIS PROFILE Pelvic U/S CULDOCENTESIS-m/c/s Male partner involvement important in investigations.

18. Differential diagnosis of acute PID Acute Appendicitis Ruptured ectopic pregnancy Torsion of ovarian pedicle Hemorrhagic/ruptured ovarian cyst Endometritis UTI

19. COMPLICATION OF ACUTE PID IMMEDIATE Pelvic peritonitis leading to generalized peritonitis,A surgical emergence Septicaemia-producing arthritis or myocaditis LATE COMPLICATIONS Dyspareunia , chronic pelvic pain Formation of adhesions

20. cont Infertility 12-25% Tubo-ovarian abscess Chronic PID with recurrent pyogenic infection Increased risk of ectopic pregnancy by (6-10) fold.

21. Management of acute PID The aim is to control the infection aggressivelly/Energetically To prevent infertility and other late sequelae To prevent a reinfection Because of its polymicrobial in nature,a combination of antibiotics regime is advised

22. In mild cases Levoflaxacin/ciproflaxacin Metronidazole Doxycycline all for 10 to 14 days except doxy is given for 1 month In severe cases-admit patient Cefoxitin,cefuroxime,ceftriaxone Clindamycin IV,/gentamycin In our environment-metronidazole IV and doxycycline are vital components of the regime

23. INDICATION FOR ADMISSION Development of TUBO-OVARIAN ABCESS it’s a surgical emergency , patient need exploratory laparatomy due to peritonitis Severe illness with fever 38.5 and vomiting Unresponsive to oral antibiotics Patients with severe immunosuppresion Coexisting pregnancy(very rare)

24. cont zikomo