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Genital Tract Infections

Genital tract infections can be caused by bacteria, fungi, parasites, or viruses. Bacterial vaginosis is caused by an overgrowth of anaerobic bacteria in the vagina. Candidiasis is usually caused by Candida albicans and causes a thick, white discharge with itching. Trichomoniasis is caused by the parasite Trichomonas vaginalis and results in a malodorous discharge. Herpes and HPV can cause genital ulcers or warts, respectively, and are sexually transmitted.

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184 views4 pages

Genital Tract Infections

Genital tract infections can be caused by bacteria, fungi, parasites, or viruses. Bacterial vaginosis is caused by an overgrowth of anaerobic bacteria in the vagina. Candidiasis is usually caused by Candida albicans and causes a thick, white discharge with itching. Trichomoniasis is caused by the parasite Trichomonas vaginalis and results in a malodorous discharge. Herpes and HPV can cause genital ulcers or warts, respectively, and are sexually transmitted.

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Genital Tract Infections

Genital tract introduction :

The normal vaginal flora is predominately lactobacilli (aerobic organisms)


The normal PH is range from 3.8 to 4.5 due to the H+ peroxide producing
lactobacilli.
The vagina is lined by nonkeratinized stratified squamous epithelium, which is
powerfully influenced by estrogen and progesterone.
The normal vagina epithelium is strongly estrogenized and rich in glycogen,
which supports growth of lactic acid–producing lactobacilli. This results in a low
pH (<4.7), which provide some protection in the lower reproductive tract from
STIs, including human immunodeficiency virus (HIV).
Infections of the vulva, vagina, and cervix are called (lower reproductive tract)
and the uterine corpus, fallopian tubes, and ovaries are called (upper reproductive
tract).

Vaginal discharge :

Types of Vaginal discharges :

 Physiological ( • Mid-cycle • Watery • No odor • No irritation (


 Pathological multiple causes: • Mainly due to infection of lower genital tract
(vulva, vagina, cervix (

Causes of Pathological Vaginal discharge :

 Infection: • Vulvitis • Vaginitis • Cervicitis


 Tumor: (• Mostly cervical tumors or polyps • Usually mixed with blood (
 Trauma
 Foreign body: ( • Tampons, which is inserted in the vagina • Condoms •
Spermacedic creams)
 Atrophic vaginitis: (• Due to low estrogen • usually in menopause Treated by
estrogen (primarin (

Lower genital tracts infection:

• Bacterial : H.Influenza, gardnerella vaginilis, mycoplasma hominis ( B.V )

• Fungal : Candida

• Parasite : Trichomonas vaginitis

• Viral : Herpes, HPV

 Bacterial vaginosis [BV[

Previously known as Hemophilu vaginalis or Corynebacterium vaginale, Gardnerella


vaginalis.
Causes : Caused by over-growth of anaerobic bacteria or replacement of normal
lactobacillus with mixed e.g.

• Gardnerella vaginills

• mycoplasma homlnls

• H.Influenza

•Bacteroides species due to alteration of the normal flora & ↑ pH of the vagina .

Risk factors: include a new sexual partner, smoking, intrauterine device (IUD) use,
and frequent douching.

Symptoms: Asymptomati, Recurrences are common

Discharge: profuse Homogenous grey white, malodor, nonadherent discharge with


no pruritus .

Diagnosis: requires at least three of the clinical

Features in Schedule.

Treatment:

 Flagyl (metronidazole): 500 mg orally twice for 7 days


 Or Clindamycin: 300 mg BID for 7 days )more safe for pregnancy so it
use in first trimester rather than flagyl)
 Treatment of the partner is generally not recommended.
 Candidiasis

 75%of women will have at least once during their life.


 90% of yeast infections are secondary to Candida Albican.

Predisposing factors: (high glycogen, low PH, low immunity)

 Diabetes (↓immunity(.
 Antibiotics (disrupting the normal flora by ↓ lactobacilli).
 Pregnancy (↓ cell-mediated immunity).
 Pt. on OCP ( mainly combined type)
 Immunocompromised Pt (HIV/ AIDS, transplantation, steroid use).

Symptoms and Discharge: Thick, white Cheesy discharge with pruritus, vulvar
burning, vaginal soreness, dyspareunia and dysuria

Signs : Itching is hallmark symptoms, red, swollen, tender vulva†

Diagnosis:

- Clinical symptoms + identification of budding yeast on a wet mount


• in wet preparation (KOH): See the hyphae of the candida (thread like structure)

• in swab :Growth in acidic media

- (See table(

Treatment:

Intravaginal : )not use in virgin)


 Canestine: 100mg BID for 7 days
 OR Nystatin: 100,000 U vag. Tab x 7 day
 OR Miconazole: 3 2% cream x 7 days
Oral: ) use in virgin)
 Fluconazole (Diflucan) 1 tab (150 m PO once a day)
If it was recurrent:
• The male partner must be treated
• Prolonged course of Antifungl.

 Trichomonas Vaginalis
 It is an anaerobic parasite. 60% of patients also have BV.
 Patients should be tested for other STDs (HIV, Syphilis).

Caused by :Trichomonas vaginalis, which favors vaginal pH > 4.5

Symptoms and Discharge : Profuse, malodorous, often frothy, yellow or green


discharge with vulvar irritation . May have: urinary symptoms, dyspareunia

Characteristic by : Strawberry cervix = multiple red spot due to subepithelial


hemorrhage

Diagnosis: (see table)

Wet preparation (NS) :

See motile Trichomonas vaginalis = oval,

larger than WBC, have flagella

Treatment:

 Metronidazole (flagyl ) , 500mg BID for 7 d OR Metronidazole 2g (one dose)


 Tinidazole, 2 g orally in a single dose (for resistant cases)
 Male partner must be treated b/c it is a STD.
 Genital ulcer disease(Herpes infection)

Mostly caused by:

 HSV (Herpes simplex virus) or Syphilis, then chancroid,


 Other causes: abrasions, drug eruptions, cancer and behcet’s disease.
 It is a Sexually transmitted disease .

Symptoms :

 HSV:
o Severe burning sensation& multiple viscles
o Painful ulcer in vulva that may coalesce
o Speculum Examination : Multiple vesicles (very painful)

Diagnosis:

1. Clinical pic

2. Swab: Culture the organism from the vesicles (gold standard)

Pap smear is indicated to rule out CIN b/c herpes infection is a predisposing for CIN .

3. Polymerase chain reaction PCR

Treatment: Acyclovir (locally) and Keep the area dry and clean.

 Genital Warts

 Caused by : HPV infection (usually 6 & 11), these are non-oncogenic types.
Usually at areas affected by coitus (posterior fourchette).
 HPV is the most common sexually transmitted infection .
 There are over 100 different types of the HPV virus more than 20 types infect
genital
 In women, genital warts can appear on the urethra, vagina, anus or thighs type
(6, 11(
 High risk types of the HPV virus are link cervical cancer specially (type
16,18)
 Recurrences after treatment are secondary to reactivation of subclinical
infection.
 Characteristic by soft pedunculated lesion , burning on vulva , contact
bleeding.
 Treatment: 1. podophyllin resin 25 2. CO2 laser excision 3. cryotherapy
(liquid N2)
 Pap smear is two type: Ectocervix and Endocervix , Use to diagnose cervical
neoplasia

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