现代妇产科学课件：研究生课件-女性生殖道感染性疾病的诊治(英文)

ReproductiveTractInfection（RTI）

ReproductiveTractInfection（RTI）CommongynecologicaldiseasesAffectthehealthofthefemaleGloballysignificanthealthyproblemReproductiveTractInfection（RTI）Highincidence--50%Highrecurrencerate—30%Undesirableconsequences

Infertility,Ectopicpregnancy,Abortion，fetaldeathprematuredelivery，congenitalinfection，etc.NaturaldefensesCunnusVaginaCervixEndometriaFallopiantubeImmunesystemofReproductivetractReproductiveTractInfection（RTI）Vulvitis,vaginitis,cervicitisPelvicinflammatorydisease（PID）GenitaltuberculosisVaginitisNormalmicroflorainvaginalG+aerobeandFacultativeanaerobesG-aerobeandFacultativeanaerobesObligateanaerobesMycoplasmaandCandidaBalanceVaginitisTrichomonalvaginitisVulvovaginalCandidiasisBacterialVaginosisAtrophicvaginitis

TrichomonalvaginitisPathogensTrichomonasvaginalis→Growthtemperature:25℃~40℃

pH5.2~6.6Transmission：DirectandindirectSymptomsVaginaldischarge

（profuse,purulent,malodorous）VulvarpruritusFrequentmicturition，odynuria，hematuriaInfertilityGynecologicalexaminationpatchyvaginalerythemacolpitismacularis(“strawberry”cervix)DiagnosisTypicalsymptomsGynecologicalexaminationLaboratoryexaminationTreatmentMetronidazole：

single-dose(2gorally)multidose(500mgbid×7days)ThesexualpartnerCriterionofcureTrichomonasvaginitiswithpregnancyVulvovaginalCandidiasis(VVC)VulvovaginalCandidiasis

Pathogens：Candidaalbicans（85%to90%）Pathogenicmechanism

1.blastospores：asymptomaticcolonization

2.mycelia：tissueinvasion→VVCPredisposingfactor

antibioticuse，pregnancy,diabetes，etcTransmission：

endogenousinfectiondirectandindirecttransmissionSymptomsVulvarpruritusandburningVaginalsoreness,DyspareuniaDysuriaVaginaldischarge（cottagecheese）GynecologicalexaminationErythemaandedemaofthelabiaandvulvarskinDiagnosisTypicalClinicalmanifestationGynecologicalexaminationLaboratoryexamination

FungalelementsCandidaalbicansTreatmentEliminatepredisposingfactorsAntifungaldrug（topicallyandorally）ThesexualpartnerRecurrentvulvovaginalcandidiasis(RVVC)VVCwithpregnancyCriterionofcureBacterialVaginosis(BV)BacterialVaginosisDysbacteriainvagina1.AbsenceofnormallongG+bacilli(lactobacilli)2.Multi-bacterial

infections：G+cocci,usuallystreptococciSymptoms10%-40%asymptomaticPurulentvaginaldischargeVulvarpruritus，vulvovaginalburningorirritationDyspareuniaDiagnosisPurulentvaginaldischargeCluecell（+）Whifftest（+）PH>4.5TreatmentAntianaerobicdrug

MetronidazoleorclindamycinTopicallyandorallyThesexualpartnerBVwithpregnancyAtrophicvaginitisAtrophicvaginitisMenopauseNaturallySurgicalremovaloftheovariesEstrogen↓SymptomsPurulentvaginaldischargeDyspareuniaPostcoitalbleeding

GynecologicalexaminationAtrophyoftheexternalgenitaliaLossofthevaginalrugaeDiagnosis1.TypicalClinicalmanifestation2.Gynecologicalexamination3.Laboratoryexamination

TreatmentTopicalestrogenvaginalcreamAntibiotics(Topically)CervicitisAcuteCervicitisChronicCervicitisAcuteCervicitisInfectedabortion,puerperalinfection,cervicalinjury,etc.Pathogens:EctocervixTrichomonas,candida,andHSV2.

Glandularepithelium

N.gonorrhoeae,C.trachomatis(CT)

AcuteCervicitisSymptomsandsignsVulvarpruritusPurulentendocervicaldischarge（yelloworgreen）Cervicalhyperemia,edema,erosionDiagnosisSymptomsandsignsLaboratoryexaminationWBCPathogen(N.gonorrhoeae,CT,Trichomoniasis）Treatment

AntibioticsagainstpathogensChroniccervicitisChroniccervicitis

AcuteCervicitis(delivery，abortionandinjury)BadhealthhabitsorlackofestrogenchroniccervicitisPathogens

BacterialOthersStaphylococcusStreptococcusEscherichiacoliAnaerobesN.gonorrhoeaeCTHSVCervicitisrelateddiseases(1)CervicalErosion×ColumnarectopyColumnareversion

Cervicitisrelateddiseases(2)cervicalpolyp(3)Endocervicitis(4)Nabothcyst(5)cervicalhypertrophyCervicitisrelateddiseasesTreatmentPhysicalTherapy

Electrocautery,Microwave,LaserMedicineSurgery

Cervicalconization(LEEP)CervicalpolypPelvicInflammatoryDisease(PID)PelvicInflammatoryDisease(PID)UppergenitaltractinfectionandinflammationEndometritis,Salpingitis,Tubo-ovarianabscess(TOA),PeritonitisPathogensExogenous(sexuallytransmitted)

N.gonorrhoeae,CT,UUEndogenous

BVmicro-organisms(AerobicandAnaerobes)Routeofinfection1.Ascendinginfection2.LymphaticsystemRouteofinfection3.Bloodsystem4.DirectspreadRiskfactorsAgeSexualactivityLowergenitaltractinfectionSurgeryBadhealthhabitsAppendicitis,peritonitisRecurrentPIDSymptomsandsignsPelvicpainFeverVaginaldischargePelvicorgantendernessLeukorrheaand/ormucopurulentendocervicitisDiagnosisSymptomsandsignsB-UltrasounicLaboratoryexamination

Vaginalsecretions;bloodRT;CRP;ER;PathogensDiagnosisMinimumcriteriaCervicalliftingpainorUterinetendernessorAdnexaltendernessDiagnosisAdditionalcriteriaT>38.3℃（Oraltemperature）CervicalorvaginalmucopurulentdischargeWBCinvaginaldischarge

ER↑CRP↑N.gonorrhoeae,CT,UU(+)DiagnosisSpecific

criteriaEndometrialbiopsyB-ultrasonic，MRILaparoscopyTreatmentAntibioticSurgerySexualpartnerSequelaeofpelvicinflammatorydiseaseInfertilityEctopicPregnancyChronicpelvicpainRecurrentpelvicin