gynecology
oj
kk
Total Lectures :16
Dr. Maad
GENITAL TRACT
INFECTION
Lec . 1
Done by :
Ali Faleh
2016-2017
مكتب اشور لالستنساخ
GENITAL TRACT INFECTION Dr. Maad
24\11\2016
1
By : Ali Faleh
GENITAL TRACT INFECTION
Lower genital tract infection
At birth the vagina is lined by stratified squamous epithelium due to the
influence of maternal oestrogen. This lining is changed to simple cuboidal in young
females with neutral PH. Then this lining changes again to become stratified squamous
epithelium with low PH at puberty under the influence of oestrogen. Atrophic changes
occur at menopause with a rise in PH.
Vaginal discharge can arise from upper or lower genital tract. Causes of lower genital
tract discharge include:
1. Physiological
2. Bacterial vaginosis (BV)
3. Candidiasis
4. Trichomonas vaginalis
Normal flora of genital tract:
The normal flora include multiple aerobic, facultative and anaerobic species. They
exist in a symbiotic relationship. However, the function and reason of their existence is
not known.
Aerobic
o GM+VE (Lactobacilli, Staphylococcus auerus)
o GM-VE (E-coli., Proteus)
Anaerobic
o GM+VE (Clostridium, Peptostreptococcus.)
o GM-VE (Bacteroids, Bacteroid fragills)
Yeast (Candida albicans, other species)
GENITAL TRACT INFECTION Dr. Maad
24\11\2016
2
By : Ali Faleh
Vaginal PH:
Vaginal PH is acidic (4-4.5). This acidity arises from the production of lactic acid,
fatty acid and other organic acids by lactobacilli from the glycogen in the mucosa. This
glycogen content decreases in menopause resulting in a decreased acidity and a higher
PH.
Altered flora:
1. Young girls and postmenopausal females have lower prevalence of lactobacilli
compared with reproductive age females.
2. The menstrual cycle may alter the flora especially during first half
3. Broad spectrum antibiotics may result in symptoms due to Candida spp.
4. Hysterectomy and removal of the cervix result in increase of anaerobic spp.
Vaginal discharge:
1. Physiological: The normal discharge is white and becomes yellowish upon contact
with air due to its oxidation. It consists of:
Desquamated cells from vagina and cervix
Mucus from cervical glands
Bacteria (95% lactobacilli)
Fluid transudate from the vaginal wall.
Its PH is acidic. This discharge increases normally at midcycle, pregnancy and in
females using combined oral contraceptive pills (COCP).
2. Bacterial Vaginosis:
BV is the COMMONEST cause of abnormal discharge in females of child
bearing age. Its prevalence is (12%). It is not considered to be an STD. When BV
develops the anaerobic bacteria become more predominant and increase up to a thousand
fold accompanied by an increase in PH (4.5-7) and disappearance of lactobacilli.
GENITAL TRACT INFECTION Dr. Maad
24\11\2016
3
By : Ali Faleh
Commonest organisms involved are (gardenella vaginalis, bacteroids, mobiluncus
spp., and mycoplasma hominis).
We don’t know what triggers these changes but certain risk factors are
contributable to BV e.g. vaginal douching, black race, smoking, IUCD, and multiple sex
partners.
The main symptoms of BV is an offensive fishy smelling discharge that is thin,
homogenous, and adherent to vaginal wall with whitish or yellowish color. The smell is
mainly noticed around menstrual cycle and following intercourse.
The diagnosis is commonly made in clinical practice using AMSEL CRITERIA
AMSEL CRITERIA:
1) Alkaline Vaginal ph (more than 4.5)
2) A strong fishy odor is produced upon addition of alkaline (10%) KOH to a sample
of vaginal discharge (whiff test)
3) Special discharge on examination
4) Presence of CLUE CELLS on microscopy.
A sample of vaginal discharge is taken with a cotton swab and mixed with few
drops of normal saline on a slide. Microscopically we see the vaginal epithelial cells
covered with bacteria to the extent that the cell borders are blurred and the nuclei are not
visible.
Treatment of BV:
3 regimens of treatment are proposed for BV in non pregnant female, cure rate is
(80-90%) at one week but 30% recur within 3 months.
Metronidazole 500mg orally and twice daily for 7 days.
Metronidazole (0.75%) gel --- 5gm intravaginally once daily for 5 days.
Clindamycin cream 2% --- 5gm intravaginally for 5 days
Implication of BV in gynecology and obstetrics:
GENITAL TRACT INFECTION Dr. Maad
24\11\2016
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By : Ali Faleh
o Increase risk of second trimester miscarriage.
o Increase risk of preterm labor.
o Increase risk of endometritis following termination of pregnancy.
o Increase risk of pelvic infection after hysterectomy.
Treatment of recurrent BV:
The patient is kept on oral or topical metronidazole once or twice a month.