Female genital

infection
By
Mohamed Taman
Assistant professor of obstetrics and gynecology
Mansoura university hospitals

1 March 2024
 Female genital tract

PID

STD

Cervicitis
vulvovaginitis
 Normal barriers protection
A) Vulva:
1) Closed introitus.
2) Thick & highly vascular vulval skin.
3) Presence of hymen in virgins.
4) Antimicrobial activities of Bartholin’s glands secretions.
B) Vagina:
1) Vaginal epithelium is stratified squamous (resistant to organismal invasion).
2) Acidic vaginal discharge (acidity destroys most of pathogens).
3) Vaginal flora (the commonest is lactobacilli).
4) Absence of glands (glands are important reservoir of infection).
C) Cervix:
1) Narrow cervical canal.
2) Cervical secretions contain IgA.
3) Thick cervical mucus plug closing cervix.
D) Upper genital tract:
1) Monthly shedding of endometrium.
2) Continuous ciliary movement of tubes towards uterine cavity.
 STD
 Definition
 STDs are diseases that the patient can get by having sexual contact
(vaginal, oral, or anal) with someone who already has a STD.

 STD’s are caused by viruses, bacteria, bacteria like organism, protozoal,

parasites, fungi and

 20 STD’s affect both men and women.

 Types of STDs
1. Bacterial and bacteria like:
1. N. Gonorrhea (gonorrhea) 2. Treponema pallidum (syphilis).

3. Hemophilus Ducreyi (Chancroid). 4. Chlamydia trachomatis (chlamydia).

5. Genital mycoplasma (mycoplasma). 6. Granuloma inguinale.

2. Viral:
1. HSV. 2. HPV. 3. HBV and HCV.

4. CMV 5. HIV. 6. Molluscum contagiosum.

3. Protozoal:
1. Trichomonas vaginalis. 2. Giardia lamblia.

4. Parasitic:
1. Scabies. 3. Pediculosis (pubic lice).
 Gonorrhea
• Causative organism:
It is a gram –ve intracellular diplococci

(Niesseria gonorrhea).

• IP: 2-8 days.

• Sites affected:
It attacks thin (columnar or transitional
epithelium) NOT attacking thick stratified
squamous (vaginal epithelium).
 Gonorrhea
• Symptoms:

 Asymptomatic (carrier state).

 Purulent vaginal or urethral discharge.

 Dysuria and frequency.

 PID symptoms (FAHM; lower abdominal pain,….).

 Arthritis with heamatogenous spread.

• Signs: Urethritis, bartholinitis, cervicitis, signs of PID.

• Investigations: gram stains, culture and sensitivity.

 Gonorrhea
• Treatment:
Treat Gonorrhea and chlamydia at the same time.

 Norfloxacin 800 mg oral as a single dose + Doxycycline 200 mg.

 Ciprofloxacin 500 mg as a single dose + Doxycycline 200 mg.

 Cefotaxime 250 mg IM as a single dose + Doxycycline 200 mg.

 Azithromycine 1 gm as a single dose.

 During pregnancy: Erythromycin 4 times daily for 7 days + Cefotaxime.

The husband or sexual partner should be treated at the same time.

 Chlamydia infection
Commonest STD among sexually active women.
Organisms: obligate intra-cellular bacterium (bacteria like),
15 serotypes;
 L-strain causes LGV & strains from D-K genital infections.
 Diagnosis:
 Symptoms and signs: FAHM, yellowish mucopurulent
discharge, dysuria and frequency.
 Investigations: AB serology & by tissue culture.

 Treatment: the sexual partner should be treated.

o Doxycycline 100 mg twice daily for one week.
o Erythromycin 500 mg 4 times daily for one week.
o Azithromycin 1 gm as single dose.
 Lymphogranuloma venereum(LGV)
Causative organism: Chlamydia Trachomatis.
- It is chronic infection of lymphatic tissues in the genital region.

Diagnosis: there are three phases of infection:

 1ry phase: → Shallow painless ulcer on labia.

 2ry phase: → Painful inguinal & perirectal lymphadenopathy → if

untreated, LNs adhere together & to overlying skin to form buboes
("groove sign" which is characteristic for LGV).

 3ry phase: → Rupture of buboes → formation of multiple sinuses &

fistulas discharging pus.

2-Investigations: by PCR for C. Trachomatis.

Treatment: Oral Tetracyclines or Erythromycin for 2- 3 weeks.

 Granuloma inguinale
● Organism: → Campylobacter granulomatis.

● Pathology: → Painless vulval nodule that progresses to ulcer + no

lymphadenopathy.

● Diagnosis:

1) Direct demonstration of organism: → After staining by Gram

or Wright stain(presence of Donovan bodies inside macrophages
are essential for diagnosis).

2) Culture: → Difficult & not practical.

● Treatment: → Tetracycline.
 SYPHILIS
• Causative organism:

 It is caused by spirochetes called "Treponema Pallidum".

 It may be congenital or acquired STDs.

 IP: 2-6 weeks.

• Diagnosis: there are three clinical phases

1. Primary syphilis or hard chancre:

- Painless ulcer with indurated base.

- It may appear on genital or extra-genital regions (mouth- anus).

- Associated with lymph nodes enlargement.

 SYPHILIS
• Diagnosis:
2. Secondary stage syphilis (latent S):

occurs with hematogenous spread -- systemic manifestations e.g.:

- Macules and papules on the palms and soles of the feet.

- Condyloma lata or large raised gray areas on the vulva or other mucus membranes.

- Lymphadenopathy is also common in the second stage.

3. Third stage syphilis (latent S):

- It is associated with cardio-vascular, liver, eye, bone and joint or neurological

manifestations.

- The characteristic lesion is Gumma (necrotic abscesses) of the skin and bones.
 SYPHILIS
Diagnosis:
4. Fourth Stage:

• The results of the internal organs damage from the 3rd stage
may shows up many years later.

• There may be sudden heart attack, failure of vision, loss of

motor coordination or mental disturbances.
 SYPHILIS
2- Investigations:

• The diagnosis is by "dark field microscopy" of the discharge

to reveal the spirochetes.

• Serologic screening tests:

1- Non specific test: e.g. VDRL and RPR.

2- Specific tests e.g.:

- Flourescent Treponema Antibody Absorption test (FTA-ABS).

- Treponema Pallidum Immobilisation test [TPIT].

 SYPHILIS
• Treatment:
- According to CDC; PENICILLIN is the drug of choice and
there are different regimens for the different stages of the disease.

- In the presence of penicillin allergy, Doxycycline 100 mg orally

twice daily for 2 weeks.

- During pregnancy Erythromycin 500 mg orally / 6 hours for 2

weeks.
 CHANCROID = SOFT SORE
Causative organism:
- It is “HAEMOPHILUS DUCREYI”; a gram stained strepto-bacilli.

Diagnosis:
1- Clinical:
- There is acute painful ulcerative lesion on the vulva.
- It may be single or multiple with bilateral or unilateral lymphadenopathy.
- Lymph nodes may suppurate to form single sinus.
2- Investigations:
1) Direct demonstration of organism: → After staining by Gram stain.
2) Culture: → On Chocolate agar..
Treatment:
1. Sulfamethoxazole + Trimethoprim (orally).

2. Erythromycin or Doxycycline.
 GENITAL WARTS = CONDYLOMATA ACCUMINATA
Causative organism: the most common STDs.
- It is caused by the highly contagious DNA Human Papilloma Virus (HPV).
- Types 16 &18 cause flat warts with the risk of CIN.
- Types 6 &11 cause exophytic warts with no malignant potential.
Diagnosis:
1) Direct demonstration of virus: → Electron microscopy, detection of viral Ag
& PCR.
2) Viral isolation: → On tissue culture.
3) Serology: → Detection of viral Abs in patient's serum.
4) Pap smear: → Koilocytosis (cells è perinuclear halo surrounded by
amphophiliccytoplasm)..
Treatment: may be prevented now by HPV vaccine
1- Small warts: topical application of Podophyllin, trichloroacetic acid and 5-
fluorouracil.
2- Large warts: cryotherapy, electrocautery and laser therapy.
 GENITAL HERPES SIMPLEX VIRUS (HSV)
Causative organism:
- It is DNA highly contagious HSV [type II is more than type 1].
- The skin is infected then the virus travels to the lumbo-sacral dorsal
root ganglia that become affected by persistent subclinical infection that
later on may cause (herpetic neuritis).
Diagnosis:
1- Clinical:
- General symptoms like malaise and fever….etc.
- Multiple vesicles which may coalesce together to form superficial
painful ulcers on the vulva, vagina and the cervix with
lymphadenopathy.
-Urine retention may occur secondary to severe vulval pain.
2- Investigations: by cytological smear and viral culture.

Treatment: keep the lesions dry and giving analgesics.

2- Specific: Anti-viral (Acyclovir) orally or 5% topical ointment.

3- Follow-up with Pap smears

 AIDS = HIV
Causative organism:

- It is human immunodeficiency virus (HIV), which are retroviruses.

- HIV attacks CD4+ T-lymphocytes --- opportunistic infections.

- Infection of T lymphocytes by HIV impairs ability of the host to fight

invading organisms.

- Mode of infection:

1. Via body fluids: semen, discharge, milk and blood.

2. Contaminated needles (as in addicts).

3. Homosexuality and abnormal sexual behavior.

4. Vertical transmission to the fetus (transplacental-lactation).

 AIDS = HIV
Diagnosis:

1- Clinical:

- History: of STDs, homosexuality, blood transfusion, addicts.

- Asymptomatic carrier for many years

- AIDS related complex e.g. Lymphadenopathy, oral candidiasis, pneumonias, recurrent viral
infections like HSV or cytomegalovirus, T.B., toxoplasmosis.

- Persistent lymphadenopathy, fungal, bacterial and viral infections.

2- Investigations:
- ELISA test for antibodies of HIV (high rates of false positive results).
- Western blot test for antibodies to HIV-specific protein.
- Viral culture.
 AIDS = HIV
Treatment:

It is mainly prophylactic to avoid acquiring infection:

1- Health education.

2- Safe sexual practice.

3- Test for AIDS before blood transfusion.

4- Fight addiction & drugs abuse.

 HIV vaccine : under trials

 Antiviral : zidovudine
Vaginal swap procedure

Chlamydia
microorganism