1. IN THE NAME OF GOD
IN THE NAME OF GOD

2. Genital Infection

3. -Normal vaginal secretion : sebaceous- sweat
Bartholin-Skene- exfoliated
vaginal cell- cervical mucous
endometrial & oviduct fluids
product of microorganism
- Normal flora in vagina is predominant aerobic
with an average 6 different bacteria.
- PH of normal vagina is < 4.5
- Normal secretion is floccular white & in post fornix

4. - The most common form of vaginitis in USA
Bacterial vaginosis
- Gardnella vaginitis
- The most common form of vaginitis in USA
- etiology is G. vaginalis
Diagnosis:
1- fishy vaginal odor following coitus
2 - vaginal secretion are gray
3- PH is > 4.5
4- Mic : increased clue cell – absent WBC
5- Whiff test is positive
- Culture of G.vaginalis is not recommended

5. 1- Metronidazol is choice for B.V
Treatment:
1- Metronidazol is choice for B.V
500 mg Bd for 7 days
avoid using alcohol during & 24h after treatment
2- Metronidazol gel 0.75% 5g/d or Bd for 5 days
3- singel 2g dose of metronidazol
cure rate 75%-84% for above regimen
1- Clindamycin cream 2%
2- Tab clindamycin 300 mg Bd for 7 days
3- Clindamycin ovules 100 mg intravaginal for 3days
Treatment of partner not recommended

6. Complication: - PID - postabortal PID
- Post operative cuff infection after hysterectomy
- abnormal cervical cytology
-PROM
-preterm labor
- chorioamnionitis
- post C/S endometritis

7. Trichomonal Vaginitis
- The parasite is anaerobe only in trophozoite form
- transmission rate is high infected female to male is
70% male to female is higher.
- T. vaginitis often acompanies BV (60%)
- Local immune factor & inoculum size influence of
symptoms.

8. Diagnosis: 1- profuse, purulent, malodor vaginal discharge
and vulvar pruritus
2- patchy vaginal erythema &colpitis macularis
( strawberry cervix)
3- PH >5
4- Mic : motile trichomonads –increase WBC
5- Clue cell
6- Whiff test

9. single dose 2g – 500 mg Bd for 7 days
Treatment:
1- Metronidazol is choice
single dose 2g – 500 mg Bd for 7 days
cure rates is 95%
- partner should be treated
- Metronidazol gel should not be used
- If not respond to initial therapy:
- repeated 500 mg Bd for 7 days
- singel dose 2g for 3-5 days
- Cultures of parasite

10. - post operative cuff cellulitis - preterm labor - PROM
Complication:
- post operative cuff cellulitis
- preterm labor
- PROM
- women with T. vaginitis should be tsted:
- N. gonoria
- Chlamydia
- Syphilis
- HIV

11. Vulvovaginal Candidiasis(vvc) - 75% women experience 1 episode of vvc
- 45% will experience 2 or more episode
- Etiology : Candida albicans
C. glabrata
C. tropicalis
- Extra cellular toxin or enzyme play role
hypersensitivity especially in chronic recurrent
disease.
Patient with symptomatic disease >104 /ml concentration of microorganism
- Risk factors : AB use – pregnancy - diabetes

12. Diagnosis: 1- sign & symptom :vaginal soreness- dysparonia
vulvar burning- irritation-
external dysuria –erythema
edema of labia & vulvar skin
2- PH is normal
3- Mic: normal in sever increase WBC
4-Whiff test is negative
5-Culture is recommended to confirm diagnosis

13. Treatment: 1 - azole drugs more effective than nystatin
- cure rate is 80% - 90%
- symptom take 2-3 days to resolve
2- oral fluconazole single 150mg /d
- in sever 150mg given 72h after first dose
3- Adjunctive treatment topical steroid
- 1% hydrocortisone
-In chronic v vc: ketoconazole 400mg/d
fluconazole 150mg/3d
- prophylactic doses: keto 100mg/d
fiuco150mg/w for 6 m.

14. - Cause inflamation of ectocervix: - HSV
Cervicit
- Cause inflamation of ectocervix: - HSV
- candida
- Trichomona
- Cause inflamation of endocervix: - N. gonorrhoea
- clamydia
Diagnosis:
1- Gram stain: increase of N
intracellular gram negative diplocci
2- Culture on Thayer Martin for gonorrha
PCR – direct fluoresent Ab for chlamydia

15. Treatment: - For Neisseria: cefixime 400mg/d ceftriaxon 125mg IM
ofloxacin 400mg/d
ciprofloxacin 500mg/d
- For Chlamydia: Azitromycin 1g/d
Doxycycline 100mg Bd
ofloxacin 300mg/ Bd for 7d

16. PID Diagnosis is clinical Caused by: N.gonorrhea- chlamydia- BV
respiratory pathogen
Diagnosis:
- Clinical
- in sever PID endometrial biopsy
sonography
laparoscopy

17. Treatment: Gentamicin 2mg/kg Regimen A: Ofloxacin 400mg Bd for 14d or
Levofloxacin 500mg /d for 14d _+
Metronidazole 500 Bd for 14d
Regimen B ; Doxycycline 100mg Bd for 14 d_+
Metronidazole
Regimen A: Cefoxitin 2gq6h or cefotetan 2g BD
+ Docycycline 100mg BD
Regimen B : Clindamycin 900mg q8h +
Gentamicin 2mg/kg

18. Genital Ulcer Disease - HSV - siphilis - Chancroid - LGV - granuloma inguinal - abrasions - fixed drug eruption - carcinoma - Behjet disease

19. Chancroid:
1-3 extremely painful ulcers + tender inguinal lymphadenopathy
Adenopaty is fluctuant
Treatment :
- azithromycin 1 g orally single dose
- ceftriaxone 250 mg IM single dose
- ciprofloxacin 500 mg Bd for 3 days
- erythromycin 500 mg q 6 h for 7 days
Patients should be reexamined 3-7 days after initiation of therapy
can be expected to heal within 2 w unless is unusually large

20. Lymhogranuloma venereum ( LGV)
- an inguinal bubo + no ulcer
- this disease is rare and increased risk for HIV
infection
Granuloma inguinal ( donovanosis)
- nonpainful ulcer + no lymphadenopaty
- this ulcer is very vascular with contacted bleeding

21. Treatment :
- Doxycyclin 100 mg 2-3 time daily for 2 w
- Co- trimoxazol for 2 w
- Erythromycin 30 mg/kg/d for 3 w in pregnancy

22. Syphilis :
- nonpainful and minimally tender ulcer
- no inguinal lymphadenopathy
- ulcer is indurated
Diagnosis:
- nontreponemal test :
- rapid plasma reagin (RPR ) test
- VDRL
- treponemal test :
- FTA ABS ( fluorescent treponemal antibody
absorption )
- MHA TP ( microhemagglutinin T. pallidum)

23. Treatment :
- Parenteral penicillin G is perferred treatment of all stage
of siphilis
- Benzathin penicillin G 2.4 million unit IM in a single dose
in primary, secondary, early latent syphilis
- latent syphilis : period after infection when patients are
seroreactive but no other evidence of disease
- latent syphilis longer than 1 yr or unknown duration :
benzathin penicillin G 7.2 million unit total

24. Genital warts :
- HPV type 6 & 11 are usually responsible for EGW
- Posterior fourchette & lateral areas on the vulva ,in the vagina ,cervix
- EGWs are highly contagious , more than 75% sexual partners develop
HPV
Management :
- The goal of treatment is removal of the warts
- It is not possible to erasicate the viral infection
- It has not been determined Whether treatment of EGW reduces
transmission of HPV
- Cryotherapy , cautery , laser , podophyllin ,Trichloroacetic acid

25. Tank You For Attention