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ReproductiveTractInfection(RTI)
ReproductiveTractInfection(RTI)CommongynecologicaldiseasesAffectthehealthofthefemaleGloballysignificanthealthyproblemReproductiveTractInfection(RTI)Highincidence--50%Highrecurrencerate—30%Undesirableconsequences
Infertility,Ectopicpregnancy,Abortion,fetaldeathprematuredelivery,congenitalinfection,etc.NaturaldefensesCunnusVaginaCervixEndometriaFallopiantubeImmunesystemofReproductivetractReproductiveTractInfection(RTI)Vulvitis,vaginitis,cervicitisPelvicinflammatorydisease(PID)GenitaltuberculosisVaginitisNormalmicroflorainvaginalG+aerobeandFacultativeanaerobesG-aerobeandFacultativeanaerobesObligateanaerobesMycoplasmaandCandidaBalanceVaginitisTrichomonalvaginitisVulvovaginalCandidiasisBacterialVaginosisAtrophicvaginitis
TrichomonalvaginitisPathogensTrichomonasvaginalis→Growthtemperature:25℃~40℃
pH5.2~6.6Transmission:DirectandindirectSymptomsVaginaldischarge
(profuse,purulent,malodorous)VulvarpruritusFrequentmicturition,odynuria,hematuriaInfertilityGynecologicalexaminationpatchyvaginalerythemacolpitismacularis(“strawberry”cervix)DiagnosisTypicalsymptomsGynecologicalexaminationLaboratoryexaminationTreatmentMetronidazole:
single-dose(2gorally)multidose(500mgbid×7days)ThesexualpartnerCriterionofcureTrichomonasvaginitiswithpregnancyVulvovaginalCandidiasis(VVC)VulvovaginalCandidiasis
Pathogens:Candidaalbicans(85%to90%)Pathogenicmechanism
1.blastospores:asymptomaticcolonization
2.mycelia:tissueinvasion→VVCPredisposingfactor
antibioticuse,pregnancy,diabetes,etcTransmission:
endogenousinfectiondirectandindirecttransmissionSymptomsVulvarpruritusandburningVaginalsoreness,DyspareuniaDysuriaVaginaldischarge(cottagecheese)GynecologicalexaminationErythemaandedemaofthelabiaandvulvarskinDiagnosisTypicalClinicalmanifestationGynecologicalexaminationLaboratoryexamination
FungalelementsCandidaalbicansTreatmentEliminatepredisposingfactorsAntifungaldrug(topicallyandorally)ThesexualpartnerRecurrentvulvovaginalcandidiasis(RVVC)VVCwithpregnancyCriterionofcureBacterialVaginosis(BV)BacterialVaginosisDysbacteriainvagina1.AbsenceofnormallongG+bacilli(lactobacilli)2.Multi-bacterial
infections:G+cocci,usuallystreptococciSymptoms10%-40%asymptomaticPurulentvaginaldischargeVulvarpruritus,vulvovaginalburningorirritationDyspareuniaDiagnosisPurulentvaginaldischargeCluecell(+)Whifftest(+)PH>4.5TreatmentAntianaerobicdrug
MetronidazoleorclindamycinTopicallyandorallyThesexualpartnerBVwithpregnancyAtrophicvaginitisAtrophicvaginitisMenopauseNaturallySurgicalremovaloftheovariesEstrogen↓SymptomsPurulentvaginaldischargeDyspareuniaPostcoitalbleeding
GynecologicalexaminationAtrophyoftheexternalgenitaliaLossofthevaginalrugaeDiagnosis1.TypicalClinicalmanifestation2.Gynecologicalexamination3.Laboratoryexamination
TreatmentTopicalestrogenvaginalcreamAntibiotics(Topically)CervicitisAcuteCervicitisChronicCervicitisAcuteCervicitisInfectedabortion,puerperalinfection,cervicalinjury,etc.Pathogens:EctocervixTrichomonas,candida,andHSV2.
Glandularepithelium
N.gonorrhoeae,C.trachomatis(CT)
AcuteCervicitisSymptomsandsignsVulvarpruritusPurulentendocervicaldischarge(yelloworgreen)Cervicalhyperemia,edema,erosionDiagnosisSymptomsandsignsLaboratoryexaminationWBCPathogen(N.gonorrhoeae,CT,Trichomoniasis)Treatment
AntibioticsagainstpathogensChroniccervicitisChroniccervicitis
AcuteCervicitis(delivery,abortionandinjury)BadhealthhabitsorlackofestrogenchroniccervicitisPathogens
BacterialOthersStaphylococcusStreptococcusEscherichiacoliAnaerobesN.gonorrhoeaeCTHSVCervicitisrelateddiseases(1)CervicalErosion×ColumnarectopyColumnareversion
Cervicitisrelateddiseases(2)cervicalpolyp(3)Endocervicitis(4)Nabothcyst(5)cervicalhypertrophyCervicitisrelateddiseasesTreatmentPhysicalTherapy
Electrocautery,Microwave,LaserMedicineSurgery
Cervicalconization(LEEP)CervicalpolypPelvicInflammatoryDisease(PID)PelvicInflammatoryDisease(PID)UppergenitaltractinfectionandinflammationEndometritis,Salpingitis,Tubo-ovarianabscess(TOA),PeritonitisPathogensExogenous(sexuallytransmitted)
N.gonorrhoeae,CT,UUEndogenous
BVmicro-organisms(AerobicandAnaerobes)Routeofinfection1.Ascendinginfection2.LymphaticsystemRouteofinfection3.Bloodsystem4.DirectspreadRiskfactorsAgeSexualactivityLowergenitaltractinfectionSurgeryBadhealthhabitsAppendicitis,peritonitisRecurrentPIDSymptomsandsignsPelvicpainFeverVaginaldischargePelvicorgantendernessLeukorrheaand/ormucopurulentendocervicitisDiagnosisSymptomsandsignsB-UltrasounicLaboratoryexamination
Vaginalsecretions;bloodRT;CRP;ER;PathogensDiagnosisMinimumcriteriaCervicalliftingpainorUterinetendernessorAdnexaltendernessDiagnosisAdditionalcriteriaT>38.3℃(Oraltemperature)CervicalorvaginalmucopurulentdischargeWBCinvaginaldischarge
ER↑CRP↑N.gonorrhoeae,CT,UU(+)DiagnosisSpecific
criteriaEndometrialbiopsyB-ultrasonic,MRILaparoscopyTreatmentAntibioticSurgerySexualpartnerSequelaeofpelvicinflammatorydiseaseInfertilityEctopicPregnancyChronicpelvicpainRecurrentpelvicin
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