Lactobacillus species.

Aerobic species: Staphylococcus aureus.

Escherichia coli.

Gardnerella vaginalis.

Vaginal Ecosystem: Microorganisms: Anaerobic species: Bacteroides species.

Peptostreptococcus species.

Candida albicans.
Yeast:
Candida tropicalis.

Vaginal Flora and pH Lactic acid → Maintains pH (3.8–4.5).

Produces:
Hydrogen peroxide → Inhibits pathogens.
Role of Lactobacillus acidophilus:

Nourished by vaginal glycogen.

Normal pH: 3.8–4.5.

Alterations in pH: Menstrual blood (alkaline).

Elevated pH Causes: Seminal fluid (during intercourse).

Menopause (low estrogen → reduced

glycogen).

Vaginal pH: Acidic environment inhibits pathogens.

Defense Mechanisms Vaginal Epithelium: Stratified squamous lining acts as a barrier.

Cellular Immunity: Lymphocytes, macrophages.

Immune Defenses:
Humoral Immunity: Secretory IgA in vaginal secretions.

Altered pH (menstruation, intercourse,

menopause).
Physical Factors:
Foreign bodies (tampons, pessaries, IUDs).
Predisposing Factors for Vaginal
Infections Antibiotic use disrupting normal flora.
Biological Factors:
Immune suppression (diabetes, HIV).

Gardnerella vaginalis.
Organisms:
Mycoplasma hominis.

Thin, malodorous discharge.

Symptoms:
"Fishy odor" (positive Whiff test).
Bacterial Vaginosis (BV):
Amsel’s criteria (discharge, pH >4.5, clue
Diagnosis:
cells, Whiff test).

Oral: 500 mg BID for 7 days.

Metronidazole:
Gel: 0.75% vaginally for 5 days.
Treatment:
Clindamycin cream: 2% vaginally for 7 days.

Organism: Candida albicans.

Thick, white, cottage-cheese discharge.

Symptoms:
Intense itching, vulvar redness.

Vaginitis in Reproductive Age Candida Vaginitis (CV):

Microscopy: Budding yeast, pseudohyphae.
Diagnosis:
Culture for recurrent cases.

Fluconazole (150 mg single dose).

Treatment:
Vaginal antifungal creams (Clotrimazole,
Miconazole).

Organism: Trichomonas vaginalis.

Frothy yellow-green discharge.

Symptoms: Vulvitis, dyspareunia.

Trichomonas Vaginalis (TV):
Cervical strawberry spots.

Diagnosis: Wet mount: Motile protozoa.

Metronidazole (2 g single dose or 500 mg

Treatment:
BID for 7 days).
- lower genital Vaginal Infections
Foreign bodies (toilet paper, toys).
Tract Infections Causes:
Poor hygiene, pinworms (Enterobius
vermicularis).

by: Vulvovaginitis in Children Symptoms:

Foul-smelling discharge.

aysha al shami Vaginal irritation, itching.

Hygiene education.

Management: Removal of foreign objects.

Anti-helminthic therapy.

Postmenopausal women, breastfeeding

Population:
mothers.

Low estrogen → Thinning of vaginal

Causes:
epithelium.
Atrophic Vaginitis
Vaginal dryness, pruritus, dyspareunia.
Symptoms:
Leukorrhea, spotting.

Treatment: Vaginal estrogen cream: Applied daily for 2 weeks, then weekly.

Chlamydia trachomatis.
Causes: Infections:
Neisseria gonorrhoeae.

Mucopurulent discharge.

Symptoms: Post-coital bleeding.

Acute Cervicitis Fever, lower back pain.

Microscopy: Inflammatory cells.

Diagnosis:
NAAT: Confirms Chlamydia or Gonorrhea.

Azithromycin 1 g single dose.

Cervicitis Treatment:
Doxycycline 100 mg BID for 7 days.

Causes: Untreated or recurrent infections.

Persistent discharge.

Chronic Cervicitis Symptoms: Chronic pelvic pain.

Infertility (advanced cases).

Antibiotics tailored to culture results.

Treatment:
Cryotherapy or cauterization for persistent
inflammation.

Normal: Clear, semi-fluid, acidic (pH 3.8–4.5).

Types of Discharge: Colored (yellow/green): Seen in BV, Trichomoniasis.

Abnormal: Muco-purulent: Associated with cervicitis.

Blood-stained: Suggests cervical erosion, malignancy.

Vaginal Discharge
History: Onset, menstrual and sexual history.

Inspection of vulva, vagina, cervix.

Examination:
Diagnostic Approach: Bimanual examination.

Microscopy: Wet mount, KOH test.

Investigations: Culture: Identifies causative organisms.

Imaging: Detects foreign bodies or pelvic pathologies.

BV: Metronidazole or Clindamycin.

Treat underlying infections: Candida: Fluconazole or topical antifungals.

Trichomoniasis: Metronidazole.
Management of Vaginal and General Principles:
Cervical Infections Maintain genital hygiene: Avoid unnecessary douching.

Treat sexual partners: For sexually transmitted infections.