Lecture inflammation of the vagina, cervix

2021-03-22 12:00 AM

When the vagina is inflamed, the secretions are a lot, causing discomfort, making the woman worried. In this case, no matter how white or yellow in colour, odour or not are pathological.

Outline

Genital infections are a fairly common disease in a woman's life, with a variety of causes and complex developments leading to difficult treatment, sometimes with complications such as pyelonephritis, infertility, ectopic pregnancy, miscarriage, premature birth, infant eye conjunctivitis...

Vaginitis is the most common manifestation. The vagina is a place close to the outside and is also a place where there are frequent conflicts in everyday life. Bad gas is the prominent symptom that makes women come to see a doctor.

Discharge

Normally in the cervix and vagina, there is a slightly thick white fluid, or like egg whites, a little amount does not flow out, does not make the woman notice, it is physiological, this fluid pH # 3.8 - 4.6 creates a protective environment for the vagina against infection but can also be a favorable factor for the growth of pathogens, this pH is due to the metabolism of glycogen in the cell. vaginal-cervical mucosal cells into lactic acidosis by Doderlein bacillus.

When the vagina is inflamed, the secretions are a lot, causing discomfort, making the woman worried, in this case, no matter how white or yellow in color, odor or not are pathological.

Types of factors in the vagina

The bacteria do not cause disease:

Bacillus Doderlein.

Staphylococcus epidermidis.

Opportunistic bacteria:

Aerobic coccidiosis:

Streptococcus alpha.

Streptococcus hemolysis A, C, G.

Staphylococcus aureus.

Streptococcus agalactia.

Anaerobic bacilli:

Colibacille.

Coliforms.

Proteus, pseudomonas.

Klebsiella.

Enterobacter.

The anaerobic bacteria:

Streptococcus beta.

Bacteroides.

Clostridium.

Fusobacterium.

Bacteria, viruses, and parasites always cause disease:

Neisseria Gonorrhea.

Trichomonas vaginalis.

Candida albicans: fungi can be a symbiotic type but will cause disease in abnormal proliferation.

Chlamydia trachomatis.

Treponema pallidum.

Gardnerella vaginalis: can be a symbiotic type, causing disease during abnormal proliferation.

Herpes simplex virus.

Human papilloma virus.

H.I.V

Common pathogens:

Yeast causes inflammation of the vulva - vagina.

Whip causes vaginitis.

Bacteria cause bacterial vaginosis.

Gonorrhea causes purulent cervicitis and urethritis.

Chlamydia trachomatis causes purulent cervicitis and urethritis.

Clinical forms of vaginitis

Vaginitis caused by whip (Trichomoniasis: Trichomonas vaginalis)

Is a common disease in women. The sexually transmitted disease is the main thing, in addition, it can also be spread through bathtubs, wet towels.

Symptom:

The incubation period is from 1-4 weeks. About 25% of people infected do not have any symptoms.

Damaged gas: large quantity, thin with foam, yellow-green, foul. The characteristic of the bad gas caused by the genital whip has a distinct property, so it can be distinguished from the bad gas caused by fungus and other agents.

It may be accompanied by itching, difficulty urinating, and pain during intercourse.

Examination: Inflammation of the vulva, vagina, cervix, red inflammation, edema, with a lot of yellow-green, dilute-green damaged gas and foam in the same map.

Test:

Taking the damaged gas and put in saline, it is revealed that there is a moving lemon-seed-shaped vagina.

Sniff test (Whiff test): add a drop of 10% KOH in the spoiled air and see the smell of rotting fish and disappear quickly.

Measure pH> 4.5.

Treatment of vaginitis caused by whip infections:

Vaginal hygiene, clean underwear, must be exposed to the sun or before use.

Do not have sex during treatment.

Metronidazole 2g orally as a single dose

Metronidazole 500mg orally 2 times / day for 7 days.

It is possible to combine vaginal suppositories.

Need treatment for your husband or partner:

Metronidazole 2g single dose.

Attention: Metronidazole is not used for pregnant women in the first 3 months and advises patients not to drink alcohol while taking the drug and until 24 hours after stopping the drug.

Vaginitis is caused by a fungus

It is caused by an infection with a fungus called Candida (mainly Candida albicans).

Account for about 20% of vaginitis cases. There are favorable factors such as taking antibiotics for several days, diabetes, pregnancy, autoimmune disease, wearing too-tight pants, or changing products for feminine hygiene.

Patients often itch a lot.

Damaged gas is milky white in color, does not smell bad, more or less.

May be accompanied by difficulty urinating, pain during intercourse.

Examination:

The vulva - the vagina is red inflammation, can be scratched, infected by scratching, in severe cases, it will be inflamed both the episiotomy and the groin thighs. The damaged gas is often much, white as milky white, thick plates sticking to the vaginal wall, below there is a red slit.

Test:

Fresh smear or stain gram for yeast. Cultured in Sabouraud medium.

Whiff test (-).

Measure pH <4.5.

Treatment: 

You can use one of the following methods.

Vaginal hygiene, clean underwear, must be exposed to the sun or before use.

Do not have sex during treatment.

Itraconazole (Sporal) (100mg orally 2 capsules / day for 3 days.

Fluconazole 150mg is taken as a single pill.

Miconazole or Clotrimazole 200mg, vaginal tablet, 1 tablet at bedtime x 3 days.

Clotrimazole 500mg, vaginal tablets, 1 single tablet.

Econazole 150 mg, vaginal tablet, 1 tablet inserted into the vagina at bedtime x 2 days

Nystatin 100,000 units, vaginal tablets, 1 tablet inserted into the vagina at bedtime x 14 consecutive days (including menstrual days).

The recurrence rate is 15%.

Bacterial vaginosis

As nonspecific vaginitis, the patient has a lot of damaged gas but no pain, no vulvovaginitis - vaginitis. The disease is not transmitted through sexual intercourse so it is not necessary to treat the husband or partner. The main cause is caused by bacteria Gardnerella vaginalis, Mycoplasma Hominis, Prevotella, Mobiluncus can be combined with some other anaerobic bacteria.

Symptom:

A lot of bad gas, a bad smell like fishy smells is the reason why patients go to the doctor.

Examination:

The bad air smells like rotting fish, white-gray, uniform like cream, spreads evenly into the vaginal wall in a thin layer, without vaginitis.

Test:

Diagnostic criteria are based on Gram staining or there are 3 out of 4 criteria of Amsel: damaged gas, pH> 4.5, with Clue cells and Sniff (+) test.

Gram smear or stained vaginal cells with bacteria, (clue cells).

Test Sniff  (+).

Vaginal pH> 4.5.

Treatment:

Metronidazole is the most effective.

Vaginal hygiene, clean underwear, must be exposed to the sun or before use.

Do not have sex during treatment.

Metronidazole 2g orally as a single dose, or

Metronidazole 500mg orally 2 times/day for 7 days, or

Clindamycin 2% cream applied topically for 7 days, or

Clindamycin 300mg orally 2 times / day for 7 days.

It is possible to combine vaginal suppositories

Attention:  Metronidazole is not intended for use in pregnant women in the first trimester. While taking the drug do not drink alcohol, do not have sex.

Purulent cervicitis caused by gonorrhea and/or Chlamydia trachomatis

Gonorrhea in women (cervicitis and gonococcal urethritis):

Symptom:

Acute manifestations: painful urination, pus coming from the urethra, pus from the cervix, thick yellow or greenish-yellow pus, and a foul odor. Patients with pain during intercourse, lower abdominal pain.

Platypus examination found: cervical redness, edema, touching bleeding. Pus oozes from the cervical canal. Red urethral opening, pus coming out from the inside, or sometimes only cloudy fluid.

Chronic form: clinical symptoms are not clear but often inconspicuous, even do not show symptoms (over 50% of cases), so they do not know they are sick, so they easily spread to others and to babies. born.

Test:

Usually take the specimens at 2 positions, the urethra and the cervix. The anus, Skène, Bartholin glands are also common places where gonorrhea is common.

Gram Staining: Coffee bean-shaped cocci, gram-staining (-), inside and outside of polymorphonuclear leukocytes, pus cells.

Treatment:

There is a choice of the following drugs:

Cefixime 400 mg orally as a single dose.

Ceftriaxone 250mg intramuscularly single dose.

Spectinomycin 2g intramuscularly as a single dose.

Cefotaxime 1g intramuscularly single dose.

Attention:

In Vietnam, streptococcal gonorrhea is resistant to Quinolone, Penicillin, and Kanamycin groups.

Vaginitis caused by gonorrhea is often accompanied by other pathogens, so it often requires combination therapy.

Must treat your partner.

Inflammation of the cervix and urethra caused by Chlamydia trachomatis:

Genital Chlamydia trachomatis infection - the female urinary often shows no symptoms (70%), usually detected when a sexual partner has urethritis.

Symptom:

There is a discharge from the cervix: yellow or green in color, not much in quantity. The cervix is ​​red, swollen, and bleeding easily to the touch.

Vaginal itching, difficulty urinating.

Also can damage urethritis, Bartholin gland, anus or higher infection in the uterus, fallopian tubes - ovaries.

Test:

Need to get specimens from the cervix, urethra, anus, Bartholin gland.

Treatment:

There is a choice of the following drugs:

Doxycyclin: 100mg orally 2 times / day for 10 days.

Erythromycin 500mg orally twice daily for 10 days.

Azithromycin 1g orally as a single dose.

Attention:

Doxycycline is not used in pregnant and lactating women.

Prevention of gonorrhea in newborns: Right after the baby is born, it is necessary to administer the 1% silver nitrate solution to the baby. If the mother has untreated gonorrhea, the child can be prevented (need referral).

Assess the risk of cervical vaginitis

A person is at risk for a sexually transmitted infection (purulent cervicitis caused by gonorrhea and/or Chlamydia) when:

Have at least one of the following 4 factors:

Your partner has symptoms of a sexually transmitted infection.

Having unsafe sexual behavior.

Having sex or sexual partners who have sex with a group of people with high-risk sex acts such as prostitution or drugs.

There are two of the following three factors:

Young people under the age of 20, unmarried and sexually active.

Have more than one sex partner or a sexual partner who has sex with many other people.

Just changed your partner in the last 3 months.

Safe sex counseling 

All cases of vaginal discharge syndrome must be counseled about safe sex. Issues that should be consulted are:

Consequences of diseases such as pyelonephritis, infertility, ectopic pregnancy ... Risks of infection to infants such as in the case of purulent cervicitis can cause eye conjunctivitis, leading to blindness. , infant pneumonia or other diseases caused by gonorrhea (arthritis, meningitis).

Adhere to treatment regimen even though symptoms have disappeared and follow up as scheduled.

Possibility to infect sexual partners.

Treatment of sexual partners for cases of purulent cervicitis and trichinosis.

Safe sex, use condoms correctly and often.

Risk of HIV transmission HIV counseling and information on HIV testing sites.