Candidiasis
More than 75% of female had at least one episod of candida ,few had recurrent(more than 4 /year).-organism carried under nail,gut ,vx and skin.
--80% caused by c.albicans,
-classical presentation:
Itching ,soreness of vagina and vulva with cheesy like white discharge which may smell yeasty.vulvar erthyema ,oedema and excoriation are common findings.
--PH of vagina normal
Microscopic exam. Reveal the presence of pseudohyphae and mycelia.
Culture is not routinly recommended except in those with failed empric treatment.RISK FACTORS:
--immune suppression
--HIV-- ---underlying dermatosis
--DM ----broadspectrum AB
--vaginal douching
--pregnancy
--cocp and increase oestrogen
CLASSIFICATION :
Uncomplicated --complicated
-sporadic -recurrent
-mild to moderate - severe
-caused by albicans spp. -- non albicans spp.
-non immune suppressed --immne suppressed
Treatment:
Local treatment is better than systemic to decrease side effect.differrent doses and durationIntra vaginal agents:
--clotrimozole:1% cream ,5 gm vaginally 7-14 days:100mg tablet vaginally for 7 days
--miconazole :2% cream,5gm vaginally for 7 days
:100mg supp.for 7 days
:200mg supp.for 3 days
:1200 mg once only
nystatin :100 000 unit tablet vaginally for 14 days
Oral agent 150mg oral. Treatment of recurrent is with once or twice per month for 6 months.
Trichomoniasis:
It is a STD-can be asym.for several months
In men it is often asym.but may present as non gonococcal urethritis.(70% of male are asym.)
C/F
In female present with severe vulvovaginitis ,purulent and s.t offensive vx discharge and in many case BV develop as well.the parasite is a marker of high risk sexual behaviour and co infection with other STD is common esp.N.G.
The parasite has prediction for sq.epith.
Exam;
Yellow-green vx discharge with inflammation s.t extend out to the vulva and adjacent skin.punctate haemorrhage occur on the cx giving the appearance of STRAWBERRY CX (due to subepith.haemorrhage.)
Dx:
Incubation of T.vaginlis require 3days -4 wks(vx,urethra,cx,UB)can be infected.no symp.may be present for up to 50% of female.and such colonization may persist for months or years .
In those with compliant:
1-c/f(discharge+signs of vulvovaginitis)2-strawberry cx on exam.
3-microscopic identification of the parasite in saline prepration .parasite is ant. Flagellated ,motile,an aerobic protozoa.they are oval in shape slightly larger than WBC and become less mobile with cooling ,so the slide should be read within 20 min.sensitivity is 60%
Vx PH RISE.
NAAT ----sensitive and specific
Screen for other STD AND THE PARTNER.
TREATMENT:
Metronidazole single 1 gm oral= 500 mg *2 for 7 days
Tinidazol 2g oral single dose
Rx partner
BARTHOLIN ABSCESS:bartholin glands situated on either side of vaginal opening .if the opening of the gland closed –cyst----if infected---abscess
Treatment AB +marsupilisation.
UPPER GENITAL TRACT INFECTION(PID):
Term used to describe upper GT infection(endometritis,parametritis,salpingitis,oophoritis).these infection usually spread from the cx and vx , through lymphatics,bowel,blood born.80% of microorganisms are STD either GC or chlamydia+secondary invadors such as bacteroids and mycoplasma.
PID is an important condition because it result oin tubal damage and infertility and ectopic preg and chronic pelvic pain .
Chlamydia trachomatis:
It is the commonest bacterial STD in the developed country esp. in female less than 25 years.many infection are asym.(50% in male,80% in female).in male it is the most common cause of non gonococcurethritis.in female it cause cervivisitis and PID.genital strains can colonize the throat and can cause conjuctivitis.Chlamydia T. :
Small bacterium ,obligate intracellular pathogen .serotypes (A—C) cause trachoma,D—K cause genital ,L1—L3 lymphogranuloma venereum.
The infectious particles are the elementary bodies that infect the columner epith. They gain entry to the cells by binding to specific surface receptors .once they enter the cell ----inclusion bodies which contain metabolically active reticulate bodies .these divide by binary fission .after 48 hours reticulate bodies condens into elementary bodies which are released from the cells.heavily infected cells die but it is the inflammatory response to infection that cause most of the damage.cell mediated immunity is the important type of immunity in controlling infections ,antibodies are serovar specific.