9.1 Inflam Conditions Of Female GT Flashcards
Vaginitis definition
General term for disorders of vagina caused by:
- infec
- inflam
- changes in normal vaginal flora
What cells in the female GT does vaginitis affect?
- columnar epithelial cells of endocervical glands
- squamous epithelium of ectocervix
Genitourinary syndrome of menopause
Etiology
Clinical features
Etiology
- ⬇️ estrogen
- atropy of: epithelium in vagina; vulva; urethra and bladder
Clinical features
- ⬇️ labial fat pad
- vaginal soreness, dryness
- dyspareunia
- urinary sym
- receding pubic hair
Aerobic vaginitis
Etiology
Clinical features
Etiology
- non-infec microbiome disturbance
- ⬇️ Lactobacillus
- sec bac overgrowth with gram ➖ & gram ➕
- vaginal immune reaction
Clinical features
- yellow, odourless vaginal discharge
- dyspareunia
- pruritus
- burning sensation
Allergic vulovaginitis
Etiology
Clinical features
Etiology
- contact allergy
Clinical features
- typically prepuberscent girls
- inflam
- pruritus
- burning sensation
Mechanical vulvovaginitis
Etiology
Clinical features
Etiology
- pruritus and itchiching
- due to atopis dermatitis
- friction
Clinical features
- postmenopausal women (history of lichen sclerosis)
- pruritis
- signs of inflam
- urinary symptoms
- dyspareunia
Differential diagnosis of Vaginal discharge
Infective
Non-infective
Infective
Non-STI
- bacterial vaginosis
- candida albicans
STI
- trichomonas vaginalis
- chlamydia trachomatis
- meisseria gonorrhoea
Non-infective
- Foreign body
- cervical polyp
- atropy
- irritants / allergens
List the infectious causes of vaginal discharge
- Bacterial vaginosis
- trichomoniasis
- vaginal yeast infec
- gonorrhea
- chlamydia infec
Bacterial vaginosis
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH
Risk factors
Pathogen - Gardnerella vaginalis
Discharge - gray/milky, fishy odor
Vaginal inflammation - absent
Cervicitis - absent
Vaginal pH- >4.5 (⬆️pH)
RF - preg, vaginal douching, intrauterine devices
- Non-STI, polymicrobial
- mild erythema
Trichomoniasis
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH
Pathogen - Trichomas vaginals
Discharge - Frothy, yellow-green, foul-smelling
Vaginal inflammation - present
Cervicitis - present
Vaginal pH - >4.5
- STI
- strawberry cervix
Vaginal yeast infection (Vulvo-vaginal candidiasis)
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH
Pathogen - Candida albicans
Discharge - white, crumbly and thick (cottahe cheese-like); oderless
Vaginal inflammation - present
Cervicitis - absent
Vaginal pH - 4 - 4.4
Gonorrhea
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH
Pathogen - Neisseria gonorrhoeae (sexually transmitted)
Discharge - purulent, creamy, malodorous
Vaginal inflammation - absent
Cervicitis - present
Vaginal pH - variable
- columnar and transitional epithelium
Chlamydia infections
Pathogen
Discharge
Vaginal inflammation
Cervicitis
Vaginal pH
Pathogen - Chlamydia trachomatis serotype D-K (sexually transmitted); intracellular parasite
Discharge - purulent, bloody, malodorous
Vaginal inflammation - absent
Cervicitis - present
Vaginal pH - variable
Pelvic infalm disease (PID)
Pathophysiology
Sites of infec
- infec from lower GT (vagina, cervix) asecnds to infect upper reproductive tract (endothelium, fallopian tubes, ovaries) & peritoneal cavity
Sites of infec
- endometrium: endometritis
- fallopian tubes: salpingitis
- ovaries: oophoritis
- uterine adnexa: andexitis
- surrounding pelvic structures (parametritis)
- peritoneum (rare): peritonitis
Pelvic inflam disease
High risk factors
Protective factors
High risk factors
- new multiple or symptomatic partner
- previous STD, PID
- concomitant sexually transmitted diseases
- instrumentation of uterus
Protective factors
- barrier contraceptive
- tubal ligation
- preg
Pelvic inflammatory disease
Mild vs. Severe disease Pathogenesis
Mild disease
Primary infective agent - Neisseria gonarrhoea, chlamydia trachomatis, gardnerella vaginalis
- acute inflam response (cervicitis, endometritis, salpingitis)
Severe disease
Secondary invaders - streptococcus, escherichia coli, haemophilus influenza, pseudomonas species
- tissue destruction (pyosalpinges, TOA)
- rupture of TOA ➡️ pelvic abscess
- generalised peritonitis
Pelvic inflam disease
Mild vs. Moderate vs. Severe signs
Mild
- fallopian tubes swollen
- serosal surface hyperaemic
- freely mobile
- tubal ostia patent
- sticky, sero purulent exudate at fimbrial end
Moderate
- fibrin deposits cover serosal surfaces of fallopian tubes
- not freely mobile
- adhere to ovaries, broad ligament of bowel
Severe
- pelvic peritoneum involved
- tubal ostia sealed
- pelvic anatomy distored
- TOA
Gainesville classification of PID
Stage 1
- early salpingitis (infec of fallopian tubes)
- tenderness localised to adnexa
Stage 2
- late salpingitis
- pelvic peritonitis
Stage 3
- evidence of pyosalpinx
- TOA
Stage 4
- ruptured TOA
- generalised peritonitis
- septicaemia
Clinical features and clinical diagnosis of PID
General
- ill looking
- dehydration
- tachycardia
Abdominal
- diffuse tenderness in lower quadrants
- rebound tenderness
- generalised peritonitis
Pelvic ➡️ mucopurulent enodocervical discharge
- CET
- adnexal and uterine tenderness
Clinical diagnosis
Triad
1. Uterine tenderness
2. CET
3. Bilateral adnexal tenderness
- temp >38.3
- WBC on saline microscopy of vaginal secretions
- muco purulent cervical discharge
PID complications
Short-term
- Pelvic peritonitis
- Fitz-Hugh-Curtissyndrome (perihepatitis)
- Tubo-ovarian abscess
Long-term
- Infertility:caused by adnexitis,adhesions of the fallopian tubes and ovaries, and tubal scarring, which result in impaired ciliary function and tubal occlusion
- Ectopicpregnancy
- Chronic pelvic pain
- Hydrosalpinx/pyosalpinx: accumulation of fluid/pus in the fallopian tubes due to chronic inflammation and consequent stenosis
- Chronic salpingitis
