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infections offemale reproductive system
1. vulvitis and infections of bartholin gland2. vaginitis3. cervicitis4. pelvic inflammatory disease (PID)5. pelvic tuberculosis
vulvitis andinfections of bartholin gland
1. vulvitis2. abscess of bartholin gland3. bartholin cyst
vulvitis
etiology a. increased vaginal discharge b. lack of vulvar hygiene c. stimulation of menstrual fluid d. glycouria of diabetes woman
clinical manifestation
vulvar pruritus, pain, burning sensation,congestion and swelling of vulva
treatment a. keep vulva clean and dry b. remove the cause c. 1/5000 kMnO4 solution bath d. antibiotics ointment
abscess of bartholin gland
etiologystaphylococcus, e.coli, streptococcus, enterococcus,gonococcus, polymicrobial infection is common
infection of gland duct -> block the drainage of pus ->formation of abscess
clinical manifestation
a. pain, swelling of vulva, fever b. red, swelling, hot, tender, fluctuant sensation c. rupture of abscess
treatment
a. rest b. antibiotics c. local hot compress or bath d. operation: incision and drainage marsupialization
bartholin cyst
etiology obstruction of gland duct block the drainage of secretion
clinical manifestation vulvar cyst
treatment marsupialization
vaginitis
* trichomonal vaginitis* candidal vaginitis bacterial vaginosis (BV) senile vaginitis childhood vulvitis and vaginitis
trichomonal vaginitis
etiology trichomonas vaginalis optimal PH value: 5.1-5.4 reduce the glycogen of vagina and reduce the lactic acid
infectious way sexual infection indirect infection
clinical manifestation
symptom tiny, frothy leukorrhea vulvar pruritus
sign congestion of vaginal mucosa petechiae grey, yellow, tiny and frothy leukorrhea yellow, green purulent secretion
carrier
diagnosistrichomonas in vaginal discharge
treatment oral drug Flagyl, 0.2, tid po (7 days) side-effect: nausea, headache contraindication: pregnant and lactating women local drug Flagyl, 0.2, Qd (10 days) 1% lactic acid, vaginal perfusion
candidal vaginitis
etiology candida albicans optimal PH value: 4-5 high risk population: pregnant women diabetic women antibiotics for long time
clinical manifestation
symptom vulvar pruritus and burning pain white, thick and cheesy discharge
sign congestion and swelling of vulvar mucosa small white patches adhering to vaginal wall
diagnosis
candida albicans in vaginal discharge
treatmenttreat the causechange the PH value of vagina 2-4% NaHCO3 perfusionlocal drugoral drug
cervicitis
acute cervicitis *chronic cervicitis
acute cervicitis
etiology gonococcus
clinical manifestation increased purulent leukorrhea congestion and swelling of cervix purulent leukorrhea from cervical orifice
treatment general antibiotics
chronic cervicitis
etiology
after delivery, abortion or cervical laceration pathogen: staphylococcus, streptococcus, et al
pathology
cervical erosion types: simple ~, follicular ~, papillary ~ degree: mild, moderate, severe cervical hypertrophy cervical polyp Naboth cyst endocervicitis
clinical manifestation
symptom increased leukorrhea blood staining leukorrhea contact bleeding infertility
sign
diagnosis cervical smear or biopsy to rule out cervical carcinoma
treatment physical therapy electrocauterization laser therapy cryosurgery drug conization
pelvic inflammatory disease(PID)
*acute PID chronic PID
acute PID
etiology infection after delivery or abortion infection after operation in uterine cavity poor hygiene habit in menstrual period secondary to appendicitis acute attack of chronic PID
pathology acute endometritis or myometritis acute salpingitis, pyosalpinx, abscess of ovary-salpinx acute pelvic paramitritis septicemia, septicopyemia
clinical manifestation
symptom pain in lower part of abdomen, fever general symptom: high fever, headache, nausea peritonitis: nausea, vomiting, abdominal distension formation of abscess
sign
tenderness and rebound tenderness of lower abdomenpelvic examination: large amount of purulent discharge tenderness on motion of cervix tenderness of uterus and adnexal portion adnexal mass
diagnosis blood, uria test culture of cervical secretion
differential diagnosis appendicitis ectopic pregnancy torsion of ovarian cyst rupture of ovarian cyst
treatment
general therapy antibiotics penicillin 8 million units gentamycin 160 thousand units flagyl 1g Qd Chinese herbal medicine
operation
indication: ineffective drug therapy persistent abscess rupture of abscess
principle: remove the abscess for young patients, conservative therapy for old patients, hysterectomy + bilateral adnexectomy incision + drainage
chronic PID
pathology chronic salpingitis and hydrosalpinx infection of salpinx and ovary, tubo-ovarian cyst chronic pelvic paramitritis
clincal manifestation
symptomgeneral symptom: fever, malaise,weaknesspain in lower abdomenmenstruation change and infertility
signthickening of parametrial areaadnexal masstenderness of uterus and adnexal mass
diagnosis
differential diagnosis ectopic pregnancy endometriosis appendicitis ovarian cyst or neoplasm
treatment general therapy Chinese herbal medicine physical therapy drug operation: unilateral adnexectomy hysterectomy + bilateral adnexectomy
pelvic tuberculosissecondary to primary TB of bodycan occur in salpinx, endometrium, cervix, ovary, pelvic peritoneum
clinical manifestation
menstruation changes pelvic pain general symptom infertility sign
diagnosis pathology of endometrium X-ray laparoscopy TB culture
treatment
general therapy anti-TB therapy rifampicin + isoniazid operation