Lecture of genital inflammation

2021-03-18 12:00 AM

Parasites such as Trichomonas vaginalis, Candida fungi. These pathogens change the vaginal environment, changing the normal pH of the vagina

General perception

Female genital infections are infections of the female genital tract. The disease is quite common donation, 80% of people with gynecological diseases are genital inflammation. Genital inflammation has an important mistake in gynecological pathology because it is the cause of many disorders in the life and sexual performance of a woman. Currently, in family planning, genital infections affect the ability to use an intrauterine device to prevent pregnancy and that is also a favorable factor in the increase of sexually transmitted diseases including HIV infection.

special points

Genital inflammation has the following characteristics:

Commonly seen in the age of sexual activity.

Parts of the lower and upper genital tract can become infected.

Both acute and chronic morphology are folded and chronic morphology is ineffective.

Early detection of the disease, treatment will be completely cured and bad complications such as tubal obstruction, pain in chronic adnexitis will be avoided.

 Reason grace

Sexually transmitted (having sex with an infected person).

Procedures such as suspension of pregnancy, quadrilateral implantation, oviductal inflation ...

Post-miscarriage bacteria, after chestnut.

Poor hygiene during sex, after menstruation.

Pathogens

The bacteria Gr (-), Gr (+) all have soil present in genital infections such as staphylococcus, E.coli, Klebsiella pn., Pseudomonas, Enterobacter, streptococcus, Mycoplasma genitalis, Gardncrclla vaginalis, Chlamydia, Neisseria gonorrhae and anaerobic bacteria.

Parasites such as Trichomonas vaginalis, Candida fungi. The above pathogens change the vaginal environment, change the normal pH of the vagina (3.8 - 4.4). Populations of non-pathogenic bacteria such as Lactobacillus (Dodcrlcin) are reduced or destroyed, creating favorable conditions for pathogens to grow.

Normally, in the cervix, the vagina has a milk-like discharge, in a thick gas, a little amount does not flow out of the vulva, does not cause any light on the woman's activities.

When the secretions are a lot, burning out of the vulva makes a woman uncomfortable to pay attention to it is unusual, it is bad gas.

There are ha of bad gases:

The bad gas, stick like egg whites, sometimes as thin as water. Damaged gas test: no bacteria, white blood cells, only epithelial cells. This damage is from the uterine lining, from uterine tumor, quadruple polyps, or in hyper estrogenic people. Treatment of causes such as removing fibroids, helix polio, or injecting atropine will clear the damaged gas.

White spoilage like whey, assay without white blood cells and bacteria. The cause is nervous vegetative disorders in patients with anxiety, or congestion of the uterus. Treatment must explain to the patient peace of mind, elation or secretion drugs such as atropine.

Turbulent gas: a common symptom of genital inflammation. The gas is cloudy, thin or thick due to grouper. The heavier the bacteria, the more damaged the gas, the greenish yellow color, the smell of association, fishy.

Types of genital inflammation

Rarely has vulvitis alone, often combined with vaginitis.

Vaginitis

Vaginitis caused by Trichotnonas vaginalis (parasitic whip) Trichomoniasis ranks second after fungal causes.

The route of transmission from the urethra in men carrying parasites is the main route of transmission. In addition, it may also be due to the bath and laundry water that the patient has used.

Symptoms: Itching, burning sensation in the vagina, vulva, sometimes itching in the anus. If the patient has long-term illness, or recurrence, this symptom may not be present. Damaged gas is thin, cloudy, light yellow, often foamy.

Examination by speculum, the patient was very painful.

The vaginal mucosa is red, lumpy, due to the reaction of the vaginal mucosa to inflammation, neutrophil islands are formed. Image of inflammation spreading to the cervix. Apply the lugol solution to the vagina, cervix will see white spots, or white pieces scattered on a dark brown background.

Damaged gas test: fresh microscopy shows parasites, protozoa, cell, parasites are rare, or a small number in the ovulation period, common before and after menstruation. Staining specimen with Fuschin, parasitic pattern with not clear margin, is more difficult to identify.

Treatment: The disease is persistent, or recurring, even if the clinical treatment is reduced, the parasitic test is negative, it is still advisable to continue treatment.

Often used two types: arsenic and nitro-5 imidazole family. Brand name Gynoplix, tablets with 0.25g. Vaginal placement at night while lying down. Treat for 10 - 20 days.

Medicines belonging to the Nitro-5 imidazole family have Flagyl, Klion (metronidazole) 0.25 g orally 0.500 - 0.750 g / day for 10 days, accompanied by Flagyl tablets, vaginal Klion. Take 10 days off, continue the second treatment.

Fasigyne 500 mg orally, or Naxogyn 1000mg (Nitro - 5 imidazole family), a single dose of 2000mg can be taken, 30 days after repeated oral administration.

Must be treated simultaneously for both men, for oral metronidazole.

Inflammation  vaginosis fungal

Fungi that cause diseases of the vaginal mucosa are mainly Candida Albicans, tropicalis, krusei (also known as monilia). Common disease in pregnant, diabetes.

Symptoms: very itching (vulva, vagina). Little spoiled gas, like powder, or thick, sometimes looks like a small scale.

The vulva, the vagina is dark red, the vaginal discharge is white, like grape-like scales.

Apply lugol solution, dark brown vagina, small patches or less stained with lugol.

Using the bad gas for sale, staining Fuschin, you will see the fungus and the spores like paddy. Or on the specimen there is spoilage, the basket of 5% KOH solution and then fresh examination will see the dissolved cells, and the mycelium shape. To determine the "motif" of the Candida fungus, it is necessary to inoculate the specimens in a separate medium.

Treatment: Nystatin 100,000 units vaginal tablet, inserted into the vagina in the evening for 20 days or Gynopevaryl 150 mg, (Econazole) or Gynodaktarin 400 mg, (miconazole) inserted into the vagina. The bullets were on for three days in a row. Along with the drug must be combined with measures for hygiene outside the genitals, hygiene of underwear (with cloth).

Inflammation â m usually bacterial vaginosis

The disease is common in people who are postmenopausal, have 2 ovaries removed, in girls before puberty.

Symptoms: yellow discharge like pus, may contain little blood. Vaginal congestion, redness.

Treatment: placing antibiotics in the vagina, combined with vaginal estrogen such as Colposeptine, which has both antiseptic and estrogenic effects in the vaginal mucosa. Treatment for 20 consecutive days.

Inflammation â m gonorrhea bacterial vaginosis

Often accompanied by vulvitis, uterine inflammation.

Symptoms: a lot of damaged gas, thick white or opaque green.

Urticaria: vaginal visit: pain, the vaginal wall is red, lumpy, the disease is easy to turn to a chronic morphology, urethritis, Bartholin's gland inflammation.

Testing the damaged gas, Gram stained, showed coffee bean spheres.

Men must be treated.

Inflammation vaginosis ( G ardnerella and gi NALIS )

Is of type Gr (-), rod-shaped.

Symptoms: gas damage, many, meeting, cloudy, increased around the ovulation period, before menstruation. Damaged gas has a bad smell. Itching.

The vaginal mucosa is normal, turbid gas sticks to the vagina.

Taking the damaged gas, it was clear to see that the group showed that there were many stick-shaped bacilli.

Or there is spoilage on the specimen, the wind with 10% KOH solution has a fishy smell.

Treatment: Ampicillin 2g / day for 10 days or Amoxicillin 1g / day for 10 days.

Pancreatitis Bartholin

The pathogen is usually caused by gonorrhea bacteria, other bacteria such as streptococci, staphylococci or Chlamydia bacillus from infectious vulvitis spread to the Bartholin's gland, sometimes the secretory is blocked, the gland turns into a follicle and becomes a secondary infection. , the disease can be found in the case of episiotomy.

Bartholin's gland inflammation has two forms, acute and chronic.

Acute Bartholin's gland inflammation:

Patients with pain in the vulva area, often pain on one side, painful walking. Inflammation is localized at first, after spreading, developing with pus.

Examination by manipulating the small lips between the thumb and index finger will find a mass that is sometimes the size of a solid egg, evenly round. If you feel pain, squeeze, you will see pus discharge at the portal, on the inside of the small lips.

Chronic Bartholin's gland inflammation:

The morphology usually occurs after treatment of acute Bartholin's gland inflammation, inadequate treatment or injection.

Circumstances appear after menstruation, or fatigue, gland enlargement after intercourse, firm, painful (not much) and little discharge.

Cysticization:

Glands are encapsulated after acute inflammation, or after chronic inflammation or blocked secretions. Once encapsulated, hard, localized mass can be felt, the cyst may be in a shallow, deep position. If infected, the cyst becomes a purulent abscess.

For all forms during physical examination, pus should be taken to determine the type of bacteria, and at the same time take specimens both in the urethra, cervix to test for bacteria.

Treatment: crib.

Due to Gr (+), Gr (-) bacteria, treated with antibiotics of the beta Lactamin family, Cephalosporin group (1-2 g / day for 7 days).

For Gr (+), Gr (-), or gonococcal anaerobic bacteria: penicillin pocaine 5 x 10 6 Ul / day for 7 days, or Spectinomycin 2 g / day, 1 time. It is also possible to treat with quinolone antibiotics such as pefloxacin 800 mg / single dose, or Floxacrine 200mg twice daily for 05-7 days.

With Chlamydia: doxycycline 200 mg / day for 10 days.

Surgery: Inject, widen the secretory, destroy the septum, drain in 2-3 days.

With chronic or cystic form: Peeling off the shell, pay attention or bleed because it can touch the onions, causing hematoma. After surgical treatment, sequelae is painful intercourse.

Quarticitis

There are 2 forms of cervicitis: inflammation of the uterus and inflammation in the cervix. Inflammation of the cervix is ​​more common.

The pathogen in the ectopic inflammatory disease is the same as in vaginitis (caused by vaginal trichomoniasis, fungi, bacteria, gonorrhea) alone inflammation in the quadrant, the main pathogens are gonorrhea, Chlamydia, due to common bacteria, less herpes virus.

Inflamed neck t outside a weak provision:

Inflammation of the cervix caused by Trichomonas, fungi, bacteria often: symptoms and diagnosis as in vaginitis.

In the case of cervicitis caused by pathogens and progression more severe, there will be a shallow or deep ulcer in the cervix, the sliced ​​epithelium is lost, the lesion is redder than the normal place. The ulcer surrounds the uterus, the sores bleed to the touch.

Smear with 3% silver nitrate will reveal white edge and bottom of the ulcer. Inflammation of the outside of the cervix is ​​often combined with the cervical route.

Inflammation of the outside of the cervix caused by gonorrhea:

Inflammation of the outside of the cervix due to streptococcal gonorrhea after causing acute inflammation in the vulva, bacterial vagina spread to the quadrilateral, the quadrilateral becomes red, rough or ulcerated. Many bad gas, green combined with pus. Accompanying the general symptoms are omission, hypotension, back pain, urination. Damaged gas test found gonorrhea.

Inflammation in the cervix caused by bacterial gonorrhea: excess gas, cloudy, blue, blind (may be bloody), enlarged cervix, red cervical canal lining, cervical pair between two branches the speculum sees the discharge of spoiled gas.

Damaged gas test: many leukocytes, more than 10 leukocytes in a field, have gonorrhea.

Neck t-inflammatory in a weak supply due to Chlamydia:

Inflammation in the cervix caused by chlamydia. There may be no symptoms, but usually purulent discharge, is spread from men with Chlamydia urethritis.

ELISA test with monoclonal antibody (chloride), which is specific, but less sensitive to mild infections.

Diagnose:

Differential diagnosis:

With the cervical route: The route of the uterus is an injury in which the cylindrical epithelium of the cervical canal develops and replaces the paved epithelium of the outside of the cervix which is damaged, roughly, seeing the route. as an ulcerative lesion, the 3% acetic acid test results in a white, grape-like lesion.

With tuberculosis and cervical cancer. In cervicitis, ulcerative morphology is generally difficult to distinguish from ulcers caused by tuberculosis or ulcers caused by cancer. The area of ​​tuberculosis, cancer is often uneven, lumpy, or small, prone to burn of blood. For a definitive diagnosis, it is necessary to diagnose tumor cytology and biopsy for pathological anatomy.

Consequence:

Cervicitis is also one of many causes of primary infertility. Due to inflammation, cervical mucus can become thick and thick, blocking sperm penetration. Treatment of cervicitis is pregnant.

With cervical cancer. Cervicitis is one of the factors favorable for cervical cancer development. In the cervical gland, inflammation has altered epithelial cells, causing disorders of cell maturation and differentiation during the regeneration phase of the gland. One of the positive measures to prevent cervical cancer is to treat inflammatory lesions of the cervix.

Treatment:

Treatment of cervicitis must determine the pathogen, the cause of the cervicitis. An etiology treatment has been presented in the section for vaginitis or Bartholin's inflammation.

Inflammation endometrium

In gynecology, inflammation of the endometrium is uncommon, pathogens caused by gonorrhea (N. Gonorrhea) and Chlamydia.

Gonorrhea bacteria from the cervix spread from the external genital tract into the uterine lining. In general, endometritis is often accompanied by cervicitis and acute adnexitis.

Clinical symptoms: after intercourse a few days after intercourse, a lot of gas damage, such as pus, thick, blue. The uterus is enlarged, squeezing into the uterus of the patient complaining of pain. Testing or culture of damaged gas shows gonorrhea bacteria.

Treat according to the cause. Chronic endometritis is uncommon.

Chlamydia endometritis usually causes only mucus, cloudy or asymptomatic gas, which is confirmed by a test of damaged gas taken from the uterine cavity, often difficult to perform.

Adnexitis

Adnexitis is a fairly common bacterial infection. The ovaries, ovaries, and ligaments can all be infected, but the damage to the fallopian tubes is important. Lesions in the ovaries are usually cystic fibrosis.

Determining the rate of adnexitis is often difficult, especially in cases of adnexitis caused by chlamydia, on the other hand, sexually transmitted diseases are a form of transmission and increase the rate of adnexitis. The quadruple instrument, animal magic in the uterus are also the causes of adnexitis.

The diseases: Streptococcus, Staphylococcus, Coli bacillus, Gardnerella vaginalis, Mycoplasma, Neisseria gonorrhea, Chlamydia...

Treatment for acute morphology thoroughly, to avoid switching to chronic morphology. The chronic morphology often results in secondary infertility and reduced labor power.

Inflammatory ph ầ n sub-acute :

Clinical symptoms are similar for gonorrhea or other bacteria, but neisseria gonorrhea's adnexitis develops and the prognosis is worse.

Symptom:

Mechanical symptoms: pain and fever.

Pain: pain in the hypotenic region, often painful on both sides of the pelvic fossa, but always pain is more dominant than the other. Pain is constant, sometimes more severe pain. When a female patient has pain in the epigastric region and has a ruptured gas, it is necessary to think of adnexitis, because in cervicitis never pain in the lower genitalia.

Fever: moderate increase in temperature, rarely high fever, rapid pulse.

Physical symptoms:

Manipulation: patient feels pain when manipulating the hypotenic region, on the guard.

Visit the two sides of the same bag, patient has dazzling pain, one side may hurt more than the other.

Vaginal examination combined with abdominal manipulation will see:

Parenchymal mass, an important symptom. When the inflammatory process has not spread, you can feel the tubes stretch into a block with a boundary, which is very painful to press. When the infection spreads, the surrounding parts sticking to the oviduct, forming a large, unbounded, very painful mass, then the abdominal wall reacts.

Another sign of uterine mobility is difficult and very painful because the organs in the subframe have stuck together.

Diagnose:

Confirmed diagnosis: based on a history of sexually transmitted disease, or infection following a procedure in the uterus and symptoms of hypotension, fever, uterine bulging, pressure pain.

Differential diagnosis with:

Appendicitis: Inflammation of the appendix is ​​often painful both, the pain of the right appendix is ​​lower than the pain point of appendicitis. In appendicitis, pain-free manipulation of the side map. Lie down, apply ice, the symptoms of adnexitis will lessen.

Subframe peritonitis: usually occurs after miscarriage, postpartum. The state of infection is clear, the fever fluctuates, the pelvic fossa reacts to the abdominal wall.

Inflammation of the peri-frame structure: occurs only due to subsequent infection, in case the cervix is ​​pulled up high, after drying the fetus. Infection spreads from the bottom to the base of the broad ligament. Three or four days postpartum, miscarriage of patient with fever, epigastric pain, groin area, signs of perineal muscle inflammation. Hard mass was found, at lower than adnexitis.

Twisted ovarian cyst: in this case, the pain is sudden, more severe. Examination of the appendage is a rounder mass, with painless lateral fitting. There is no history of genital tract infections.

Ectopic pregnancy: history such as pregnancy. Pain is usually on one side of the pelvic fossa. Examination of an unknown shore mass next to the uterus. Positive hCG test, no signs of genital tract infection.

Progression: depends on whether treatment is urgent, aggressive or not.

Progressing well: clinical recovery, fever and pain relief, and overall body improvement. Anatomically, however, there are often chronic lesions of the uterus.

Progression to a chronic morphology: Symptoms subside for a while, then recur a subacute episode following cervical electrocautery, uterine-tubes, tubal aspiration, or after one labor heavy. Therefore, doing animal arts in patients with adnexitis must be very careful.

Progresses into a subframe abscess or a sacral tube of the ovary. Examination of a predatory mass, painful pressure.

Sequelae:

Tubal obstruction or narrow narrowing causes secondary infertility or ectopic pregnancy.

Chronic abdominal pain: increased pain after menstruation, after intercourse, heavy work. Shrinking with bleeding between menstrual cycle.

Treatment: the main medical treatment.

Antibiotics: As an antibiotic, note that staphylococcal strains are now resistant to penicillin family antibiotics. Can be treated with antibiotics of Cephalosporin family or Lincosanid antibiotics combined with an aminosid. Antibiotics last for 3 - 5 days after normal temperature.

Systemic treatment: rest, cold compresses in the hypotenic region, high dose vitamin C, good nutrition and anti-constipation.

Surgical treatment for complications such as apxe Douglas, incision and drainage through the same pour Douglas.

Chronic adnexitis :

After the treatment of supplementary inflammation, although the clinical symptoms are lessened, but in the oviduct there are foci of latent infection, pathological anatomical lesions exist. Chlamydia is usually latent in the oviduct, and often has no clinical symptoms.

Tubular lesions can have the following morphologies:

Ovarian obstruction in the interstitial, waist.

Clogged oviduct, with or without tap water stasis.

Tubitis attached to the ovaries, with the pelvic fossa.

Symptom:

Mechanical symptoms:

Pain: this is the most common symptom. Pain in the hypotenic region, or pain in both sides of the pelvic fossa. Pain varies in intensity, duration, attacks, or continuity. Pain increases with heavy work and walking a lot. Resting pain less.

Pain affects labor productivity, forcing patients to be off work for a while.

Damaged gas: during pain or discharge (discharge from the ovary to the uterus and then out in each pain).

There may be irregular bleeding before and after menstruation, or menorrhagia. This is due to the existence of oocyte cysts in polycystic ovaries.

Sometimes there are symptoms like oocyte-burn syndrome: pain, bleeding, gas damage. Maybe all three symptoms or not. Usually there is no fever.

Million entities of entities:

Vaginal examination in coordination with abdominal manipulation will find: the uterus is limited, when mobility is painful. The inflammatory mass can be seen in the appendages, because the ovaries stick to the ovaries to form a mass, this block position next to the uterus, the boundary is unknown. Press on the painful patient mass. Or manipulate a solid cord next to the uterus, pocket and masonry.

Hysteroscopy can show an enlarged ovary. The scan must be taken with extreme caution to avoid causing paroxysmal and widespread inflammation.

Diagnose:

Physical diagnosis: based on an adjunct inflammatory progenitor, based on the aforementioned symptoms plus physical examination with paranasal pain, and poor uterine mobility.

Differential diagnosis:

Ovarian cyst: When adnexitis contains tapioca, the physical symptoms are very similar to the small ovarian cyst.

Pregnancy outside the uterus (unbroken form). During ovulation period, sometimes hCG (-) adnexitis has pain, abnormal bleeding, so the symptoms are similar to ectopic pregnancy. In adnexitis if the patient is rested with ice, the symptoms will decrease.

Progression: often prolonged, patients often experience relapsing pain after heavy labor, frequent walking.

Sometimes the recurrence becomes acute after the procedure in the cervix, or in the uterus.

Treatment: the main medical treatment: rest, light work, avoid walking a lot, living in moderation.

When pain is much, damaged gas: treatment with Lincosanid antibiotics combined with Aminosid.

Get local treatment with shortwave therapy. The waves generated at high-frequency currents stimulate cell metabolism, enhancing cellular resistance. Running tiring waves from 10 to 12 sessions, each time from 15 minutes to half an hour, and without shortwave treatment in subacute form, during menstruation.

Surgical treatment: very rarely. Apply when adnexitis has complications of much pain, continuous mass, markedly affecting the ability to work, the patient has no desire to give birth anymore. Partial hysterectomy and also the mass of adhesions including the ovaries, ovaries.