Reproductive tract infection

Seminar presentation

1. Reproductive tract infections BSC(H) NURSING RAKCON

2. Reproductive tract

3. Reproductive tract infections Reproductive tract infection are recognized as a public health problem and ranking second after maternal morbidity and mortality as the cause of loss of healthy life among women of reproductive age in developing countries They can have serious consequences including infertility ,ectopic pregnancy, chronic pelvic pain, abortion ,cervical cancer, menstrual disorder, pregnancy loss,

4. Defenses of genital tract Cervical defense Mucus plug effects of mucus Uterine defense Cystic shedding of endometrium Tubal defense Integrated mucus and epithelial cilia Peristalsis of tube and also the movement of the cilia are towards the uterus

5. Defense of genital tract Vulval defense Apposition of cleft by labia Bartholin gland Fungicidal apocrine gland secretion Resistance of Vulval and perineal skin Vaginal defense Apposition of the anterior and posterior wall with its transverse rugae Estrogen Doderlin’s bacilli

6. REPRODUCTIVE TRACT INFECTIONS The vaginal area of the female reproductive system is protected against infection by its normally low PH (3.5-4.5), which is maintained by the actions of doderlein’s bacilli (a part of normal flora) and hormone estrogen.

7. RTI RTI refers to three different types of infections affecting the reproductive tract; endogenous infection are probably the most common infections includes candidiasis and bacterial vaginosis . Iatrogenic infections occur when the cause of infection(bacteria or other microorganism)is introduced into the reproductive tract via a medical instrument. Sexually transmitted disease are caused by viruses ,bacteria or parasites that are transmitted through sexual activity

8. REPRODUCTIVE TRACT INFECTIONS Lower reproductive tract infection- it affects the outer genitals and reproductive organs . Infections in the area of the vulva , vagina , cervix, e.g. vaginitis, cervicitis, Upper reproductive tract infection- infections in uterus, fallopian tube, and ovaries

9. Vulvovaginal infections These are the common problems. The epithelium of the vagina is highly responsive to estrogen ,which includes glycogen formation. The subsequent breakdown of glycogen into lactic acid produces a low vaginal PH when estrogen decreases during lactation and menopause glycogen also decreases and infection may occur. when patients are treated with antibiotics the normal vaginal flora are reduced this result in altered in PH and a growth of organisms. other potential factors that may initiate infection include sexual intercourse with an infected partner and wearing tight, non absorbent and heat retaining clothing.

10. Vulvovaginal infections Causative agent- candida albicans(fungus) Manifestations- pruritis, thick white curd like discharge. management Medical management- antifungal agents like miconazole, clotrimazole, fluconazole. Clean undergarments . Maintain hydration .

11. Reproductive tract infections Vulvitis- inflammation of the vulva ,may occur with other disorders ,such as diabetes , dermatologic problems, poor hygiene or STDs Vulvodynia- it is an intense burning and inflammation of the vulva may be relation to high level of calcium oxalate crystals in the urine

12. vaginitis Vaginitis is inflammation of vagina occurs when candida or trichomonas species or other bacteria invade the vagina . Normal white discharge becomes more profuse in vaginitis. Urethritis may accompany vaginitis because of proximity Clinical manifestations are itching , bad odor , redness , burning sensations or edema which may aggravate by voiding or defecation. Drug of choice hydrocortisone ointment

13. INFECTION OF CERVIX Infection of cervix can be caused by a variety of pathogens ,particularly sexually transmitted infections, such as gonorrhea, chlamydia, and human pappilloma virus Infections of the cervix are considered more serious than vaginitis they are often asymptomatic

14. candidiasis Candidiasis is a fungal or yeast infection caused by strains of candida . Like C albicans or C glabrate Clinical manifestation – vaginal discharge that causes pruritis and possible irritation . The discharge may be watery thick and tenacious white . A burning sensation which may follow urination Diagnosis is made by microscopic identification of spores and hyphae on a glass slide prepared from a discharge specimen

15. Management of candidiasis Goal of treatment is to eliminate symptoms treatment include antifungal agents such as miconazole , nystatin , clotrimazole and terconazole. These agents are inserted into the vagina with an applicator at bed time . There are one night , three night , or seven night treatment course available. oral medication is also available (fluconazole)

16. BACTERIAL VAGINOSIS It is caused by an overgrowth of bacteria normally found in vagina . Characterized by an odor that patient describe as flesh like and particularly noticeable after sexual intercourse or during menstruation Under the microscope the vaginal cells are coated with bacteria and are described as ‘clue cells’ Vaginal PH is above 4.7 drug of choice is metronidazole orally twice a day for one week and clindamycin vaginal cream

17. Trichomoniasis Trichomoniasis is caused by a one-celled protozoan organism called  Trichomonas vaginalis . It travels from person to person through genital contact during sex. In women, the organism causes an infection in the  vagina , urethra, or both. In men, the infection only happens in the urethra. Once the infection begins, it can easily be spread through unprotected genital contact. Trichomoniasis is not spread through normal physical contact such as hugging, kissing, sharing dishes, or sitting on a toilet seat. In addition, it can’t be spread through sexual contact that doesn’t involve the genitals.

18. trichomanias

19. TRICHOMONIASIS Trichomoniasis often has no symptoms. The CDC reports that  only 30 percent of people with trichomoniasis Trusted Source   report any symptoms at all. In one study,  85 percent of affected women Trusted Source   did not have any symptoms. When symptoms do occur, they often begin five to 28 days after a person is infected. Although for some people it can take much longer. The most common symptoms among women are: vaginal discharge , which can be   white, gray, yellow, or green , and usually frothy with an unpleasant smell vaginal   spotting   or bleeding genital burning or   itching genital redness or swelling

20. trichomoniasis frequent urge to urinate pain during urination  or  sexual intercourse the most common symptoms in men are: discharge from the urethra burning during urination or   after ejaculation an urge to urinate frequently

21. Treatment of trichomoniasis Trichomoniasis can be cured with antibiotics. metronidazole (Flagyl) or tinidazole ( Tindamax ). Do not drink any alcohol for the first 24 hours after taking metronidazole or the first 72 hours after taking tinidazole. It can cause severe nausea and vomiting. Sexual partners are properly tested and take the medication, too. Not having any symptoms doesn’t mean they don’t have the infection. A void sexual contact for a week after both the partners have been treated.

22. HUMAN PAPPILOMA VIRUS Human papillomavirus (HPV) is a viral infection that’s passed between people through skin-to-skin contact. There are over 100 varieties of HPV,  more than 40   of which are passed through sexual contact and can affect your genitals,  mouth , or throat. According to the  Centers for Disease Control and Prevention (CDC) , HPV is the most common   sexually transmitted infection (STI) . It’s so common that most sexually active people will get some variety of it at some point, even if they have few sexual partners. Some cases of genital HPV infection may not cause any health problems. However, some types of HPV can lead to the development of  genital warts   and even cancers of the cervix, anus, and throat.

23. Clinical manifestation of HPV Common symptoms of some types of HPV are  warts , especially  genital warts .  Genital warts  may appear as a small bump, cluster of  bumps , or stem-like protrusions. They commonly affect the vulva in women, or possibly the cervix, and the penis or scrotum in men. They may also appear around the anus and in the groin. Treatment Warts often go away without treatment, particularly in children. However, there's no cure for the virus, so they can reappear in the same place or other places. Salicylic acid. salicylic acid work by removing layers of a wart a little at a time. . Imiquimod.  This prescription cream might enhance immune system's ability to fight HPV. Podofilox.   topical prescription, podofilox works by destroying genital wart tissue.. Trichloroacetic acid.  This chemical treatment burns off warts on the palms, soles and genitals.

24. Treatment of HPV Surgical and other procedures Freezing with liquid nitrogen (cryotherapy) Burning with an electrical current (electrocautery) Surgical removal Laser surgery

25. HERPESVIRUS TYPE 2 INFECTION (HSV) Herpes simplex virus type 2 (HSV-2) HSV-2 infection is widespread throughout the world and is almost exclusively sexually transmitted, causing genital herpes. HSV-2 is the main cause of genital herpes, which can also be caused by herpes simplex virus type 1 (HSV-1). Infection with HSV-2 is lifelong and incurable. SIGNS AND SYMPTOMS   genital herpes is characterized by one or more genital or anal blisters or open sores called ulcers. In addition to genital ulcers, symptoms of new genital herpes infections often include fever, body aches, and swollen lymph nodes. After an initial genital herpes infection with HSV-2, recurrent symptoms are common but often less severe than the first outbreak. The frequency of outbreaks tends to decrease over time but can occur for many years. People infected with HSV-2 may experience sensations of mild tingling or shooting pain in the legs, hips, and buttocks before the appearance of genital ulcers .

26. TREATMENT Antivirals, such as acyclovir, famciclovir, and valacyclovir are the most effective medications available for people infected with HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.

27. CHLAMYDIA AND GONORRHEA Chlamydia and gonorrhea are sexually transmitted bacterial infections. A person can contract one of these infections if they have unprotected sexual contact with someone who has it. It can be hard to tell the difference between the two, as the symptoms can be similar . According to the  CDC , some males, and most females, with gonorrhea may not experience any symptoms at all.

28. Signs and symptoms person does experience symptoms , or they might not appear for  several weeks . As the symptoms can be similar and may overlap, it is important for a doctor to test for the infections before prescribing any treatment. females may experience a burning sensation during urination and abnormal or increased discharge from the vagina.

29. Signs and symptoms Males may experience: a burning sensation during urination discharge from the penis painful swelling of the testicles and penis, though this is   less common A person may also experience symptoms in the rectum. Symptoms in the rectum may include: pain or soreness ,discharge, bleeding A person can also experience chlamydia and gonorrhea in the throat.  Most  oral infections of this nature will have no symptoms, but a person may experience a sore throat.

30. Treatment for chlamydia In 2006, the  American Academy of Family Physicians  recommended the antibiotics azithromycin or doxycycline to treat chlamydia. A person may only require one dose, or they may have to take the antibiotic  every day for 7 days . Treatment for gonorrhea The  CDC  recommend a single injection of ceftriaxone and an oral azithromycin. Antibiotic resistant gonorrhea has become  more common , so it is important that people take the entire treatment course.

31. PELVIC INFLAMMATORY DISEASE Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. PID usually is contracted through sexual contact. PID can damage the uterus, ovaries, fallopian tubes or other parts of the female reproductive system. It also can cause severe pain and make it difficult to become  pregnant . Women with sexually transmitted diseases — especially gonorrhea and chlamydia — are at greater risk for developing PID. Women with many sexual partners are at greater risk for sexually transmitted diseases and PID. Women who have already had PID are at higher risk for another episode. Sexually active teenagers are more likely to develop PID than are older women

32. PELVIC INFLAMMATORY DISEASE Normally, the cervix prevents bacteria that enter the vagina from spreading to the internal reproductive organs. If the cervix is exposed to a  sexually transmitted disease  — such as  gonorrhea  and  chlamydia   — the cervix itself becomes infected and is less able to prevent the spread of organisms to the internal organs. PID occurs when the disease-causing organisms travel from the cervix to the upper genital tract. Untreated gonorrhea and chlamydia cause about 90% of all cases of PID. Other causes include abortion, childbirth, and pelvic procedures.

33. PID The symptoms of PID can vary, but may include the following: Dull pain or tenderness in the stomach or lower abdominal area, or   pain in the right upper abdomen (though this is much less common ). Abnormal   vaginal discharge   that is yellow or green in color and has an unusual odor. Irregular periods . Spotting or cramping throughout the month . Chills or high  fever . Nausea and vomiting . Pain during sex .

34. PID treatment Antibiotic treatment The first kind of treatment is with antibiotic. It is important to follow the doctor’s instructions and complete all of the prescription. A course usually lasts 14 days. PID often involves more than one type of bacteria, so the patient may take two antibiotics together. If tests show which bacteria are causing the disease, more targeted therapy is possible. Antibiotics for PID include: cefoxitin metronidazole ceftriaxone doxycycline If the antibiotics do not make a difference within 3 days, the patient should seek further help. She may receive intravenous antibiotic therapy or a change of medication.

35. Prevention of PID PID can become a serious condition, but there are some ways to minimize the risk: having regular screening, especially for those who have multiple sex partners ensuring sexual partners are tested for infections and STIs not douching, because this increases the risk using a condom or cervical cap and practicing safe sex not having sex too soon after childbirth or a termination or loss of pregnancy

36. TOXIC SHOCK SYNDROME T oxic shock syndrome is a rare but serious medical condition caused by a bacterial infection. It is caused when the bacterium  Staphylococcus aureus   gets into the bloodstream and produces toxins. Although toxic shock syndrome has been linked to superabsorbent tampon use in menstruating women, this condition can affect men, children, and people of all ages I nfection usually occurs when bacteria enter your body through an opening in your skin, such as a cut, sore, or other wound. Experts are not sure why tampon use sometimes leads to the condition. Some believe that a tampon left in place for a long period of time attracts bacteria. Another possibility is that tampon fibers scratch the vagina, creating an opening for bacteria to enter your bloodstream.

37. Symptoms of toxic shock syndrome Symptoms of toxic shock syndrome can vary from person to person. In most cases, symptoms appear suddenly. Common signs of this condition include: sudden  fever , early septic shock low blood pressure headache muscle aches confusion Elevated BUN level nausea Vomiting and diarrhea rash redness of eyes, mouth, and throat Seizures

38. TREATMENT OF TOXIC SHOCK SYNDROME Toxic shock syndrome is a medical emergency. Some people with the condition have to stay in the intensive care unit for several days so that medical staff can closely monitor them. An intravenous (IV) antibiotic therapy is given to help you fight the bacterial infection. Patient will receive 6–8 weeks of antibiotics based on result of blood , urine and other culture Respiratory distress – oxygen therapy medication to stabilize blood pressure IV fluids to fight  dehydration gamma globulin injections to suppress inflammation and boost your body’s  immune system If acidosis appear sodium bicarbonate is administered

39. treatment Other treatment methods for toxic shock syndrome vary depending on the underlying cause. For example, if a vaginal sponge or tampon triggered toxic shock, Remove this foreign object from your body. If an open wound or surgical wound caused your toxic shock syndrome, drain the pus or blood from the wound to help clear up any infection I/V dopamine to treat shock

40. MALE REPRODUCTIVE TRACT INFECTIONS EPIDIDYMITIS Epididymitis is an inflammation of the epididymis. The  epididymis  is a tube located at the back of the  testicles   that stores and carries sperm. When this tube becomes swollen, it can cause pain and swelling in the testicles. Epididymitis can affect men of all ages, but it’s  most common   in men between ages 14 and 35. It’s usually caused by a bacterial infection or a   sexually transmitted disease (STD) . The condition usually improves with antibiotics. Acute epididymitis lasts six weeks or less. In most cases of acute epididymitis, the testes are also inflamed. This condition is called epididymo -orchitis. According to the  Centers for Disease Control and Prevention (CDC) , gonorrhea and chlamydia are the most common causes in men 35 years old or younger. Chronic epididymitis, on the other hand, lasts six weeks or more. Symptoms include discomfort or pain in the scrotum, epididymis, or the testicles. This may be caused by granulomatous reactions, which can result in cysts or calcifications.

41. Sign and symptoms - EPIDIDYMITIS Epididymitis may begin with only a few mild symptoms. When it’s left untreated, however, the symptoms tend to get worse. People with epididymitis may experience: low-grade  fever chills pain in the  pelvic area pressure in the testicles pain and tenderness in the testicles

42. Sign and symptoms - EPIDIDYMITIS redness and warmth in the scrotum enlarged lymph nodes in the groin pain during sexual intercourse and ejaculation pain during urination   or bowel movements urgent and frequent urination abnormal penile discharge blood in the semen

43. TREATMENT Treatment for epididymitis involves treating the underlying infection and easing symptoms. Common treatments include: antibiotics, which are administered for 4 to 6 weeks in chronic epididymitis, and can include doxycycline and ciprofloxacin pain medication, which can be available over-the-counter (ibuprofen) or can require a prescription (codeine or morphine) anti-inflammatory medication like piroxicam ( Feldene ) or ketorolac (Toradol) bed rest

44. Treatment Additional treatments may include: elevating the scrotum, for at least two days if possible applying   cold packs   to the scrotum wearing an  athletic cup   for support avoiding lifting heavy objects In cases of an STI, abstain from sexual intercourse until completed course of antibiotics .

45. Treatment … These methods are usually successful. It can sometimes take several weeks for the soreness or discomfort to go away completely. Most epididymitis cases clear up within 3 months. However, more invasive treatment may be needed in some cases. If an abscess has formed on the testicles, your doctor can drain the pus using a needle or with surgery. Surgery is another option if no other treatments have been successful. This involves removing all or part of the epididymis. Surgery may also be necessary to correct any physical defects that may be causing epididymitis.

46. PROSTATITIS Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.. Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn't identified. If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics. Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment. Some types of prostatitis last for months or keep recurring (chronic prostatitis).

47. Signs and symptoms Prostatitis signs and symptoms depend on the cause. They can include: Pain or burning sensation when urinating (dysuria) Difficulty urinating, such as dribbling or hesitant urination Frequent urination, particularly at night (nocturia) Urgent need to urinate Cloudy urine Blood in the urine Pain in the abdomen, groin or lower back Pain in the area between the scrotum and rectum (perineum) Pain or discomfort of the penis or testicles Painful ejaculation Flu-like signs and symptoms (with bacterial prostatitis

48. Treatment Antibiotics.  Taking antibiotics is the most commonly prescribed treatment for prostatitis based on the type of bacteria that might be causing your infection.(trimethoprim sulfamethoxazole) In severe symptoms, intravenous (IV) antibiotics administered. take oral antibiotics for four to six weeks but might need longer treatment for chronic or recurring prostatitis. Alpha blockers.  These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment might ease symptoms, such as painful urination. Anti-inflammatory agents.  Nonsteroidal anti-inflammatory drugs (NSAIDs) might make you more comfortable.

49. Prevention of RTI A comprehensive approach to RTIs includes  prevention  of sexually transmitted, iatrogenic and endogenous  infections . R TI  prevention  means reducing exposure—by using condoms reducing numbers of sex partners. Condoms must be used correctly and consistently to prevent STI.

50. Nursing diagnosis Pain , discomfort and distress r/t burning , odor or itching from the infectious process. Anxiety r/t severity and suddenness of symptoms and to concern about recovery Risk for reoccurrence of infection or spread of infection Fluid volume deficit r/t vomiting and diarrhea Fatigue r/t severity of illness and of shock Knowledge deficit about risk factor and behaviour