Académique Documents
Professionnel Documents
Culture Documents
(-): Ecoli, Klebsiella spp, Proteus spp, Enterobacter spp, acinetobacter spp, citrobacter spp,
pseudomonas spp
Anaerobes
(+) bacilli: Lactobacillus spp, Propionibacterium spp, Eubacterium spp, Bifidobacterium spp
(-): Bacteroides spp, Prevotella spp, Bacteroides fragilis group, Fusobacterium spp, Veillonella
spp
Within this vaginal ecosystem, some microorganisms produce substances such as lactic acid and hydrogen
peroxide that inhibit nonindigenous organisms (Marrazzo, 2006). In addition, several other antibacterial
compounds, termed bacteriocins, provide a similar role and include peptides such as acidocin and lactacin.
Moreover, some species have the ability to produce proteinaceous adhesions and attach to vaginal epithelial
cells.
For protection from many of these toxic substances, the vagina secretes leukocyte protease inhibitor. This
protein protects local tissues against toxic inflammatory products and infection.
Vaginal pH:
4.0 - 4.5, it is believed to result from
- lactobacillus species production of lactic acid, fatty acids, and other organic acids.
- anaerobic bacteria produce amino acid fermentation, organic acid production.
- Glycogen as the food for the normal flora.
RF: new/multiple sexual activity, oral sex, douching, black race, smoking, sex during menses, IUD, Early age
of sexual intercourse
DX: wet prep- use cotton swab to take vaginal discharge sample and mix it with few drops of saline
Result: Clue cells, Squamous cells are covered with bacteria to the extent that cell borders are blurred and
nuclei are not visible
Whiff test: add 10% KOH to fresh sample vaginal secretion⇒ release volatile amines that have a fishy
odor
Outcome: Vaginitis, endometritis, postabortal endometritis, pelvic inflammatory disease unassociated with
Neisseria gonorrhoeae or Chlamydia trachomatis, and acute pelvic infections following pelvic surgery,
especially hysterectomy
Treatment:
Metronidazole gel 0.75% 5 g (1 full applicator) intravaginally once daily for 5 days
There are two types of herpes simplex virus, HSV-1 and HSV-2. Type 1 HSV is the most frequent cause of
oral lesions. Type 2 HSV is found more typically with genital lesions.
Infected patients can shed infectious virus while asymptomatic, and most infections are transmitted sexually
3 stages of lesions are: (1) vesicle with or without pustule formation, which lasts about a week; (2)
ulceration; and (3) crusting.
DX:
- gold standard = tissue culture, high specificity but low sensitivity. 50 % + in recurrent disease.
- PCR
- Serologic type-specific glycoprotein G–based assays ≈ detect HSV 1 and 2 antibody; >96%
specificity
Treatment:
Syphilis
is a sexually transmitted infection caused by the spirochete Treponema pallidum, which is a slender
spiral-shaped organism with tapered ends
RF: low socioeconomic groups, adolescent, early sexual activity, large number sexual partners
- it is an isolated nontender ulcer with raised rounded borders and an uninfected but integrated base
- Commonly found on the cervix, vagina, or vulva, but may also form in the mouth or around the anus
- This lesion may develop 10 days to 12 weeks after exposure, with a mean incubation period of 3
weeks
Secondary Syphilis
- Hallmark= maculopapular rash of palms, soles, and mucous membranes. In warm, moist body areas,
this rash may produce broad, pink or gray-white, highly infectious plaques called condylomata lata
- Viremia +
DX: dark-field examination/ direct fluorescent antibody testing of lesion exudate. treponemal-specific tests
may be selected: (1) fluorescent treponemal antibody-absorption (FTA-ABS) or (2) Treponema pallidum
particle agglutination (TP-PA) tests
Treatment :
Chief None Bad odor, increased Itching, burning, Frothy discharge, bad Thin, watery
complaint after intercourse discharge odor, dysuria, pruritis, discharge, pruritis
spotting
Discharge White, clear Thin, gray or white, White "cottage Green-yellow, frothy, Purulent
adherent, often increased cheese like" adherent, increased
discharge
Microscopic N/A "Clue cells", slight Hyphae and buds Trichomonads Many WBCs
findings increase in WBCs, clumps in 10-percent KOH (protozoa with 3-5
of bacteria (saline wet solution (wet flagella) may be seen
mount) mount) moving on saline wet
mount
E coli = Escherichia coli; KOH = potassium hydroxide; N/A = not applicable; WBC = white blood cell.
Fungal Infection
RF: warmer climates, obese, imunosupres, diabetes mellitus, pregnancy, sexual transimited, orogenital sex.
Treatment
Terconazole 0.4% cream, 5 g intravaginally for 7 days Or 0.8% cream, 5 g intravaginally for 3 days
Oral agent
Trichomoniasis
Women>men; in men asymptomatic; 70 percent of male partners of women with vaginal trichomoniasis will
have trichomonads in their urinary tract.
DX: incubation 3-4 weeks, vagina, urethra, endocervix, and bladder can be infected
Symptoms: liat table atas Additionally, dysuria, dyspareunia, vulvar pruritus, and pain may be noted.
Treatment :
Primary therapy
Alternative regimen
In women is asymptomatic
Symtomps
- if infect the bartholin and skene glands, lead to ascending to upper Reproductive tract infection.
DX: Coccobacillus (-); invade columnar and transitional epithelial cells, becoming intracellular.
Treatment:
Ceftriaxone 125 mg IM
- basil (-)
- leukorea: putih keabu-abuan; kadang kuning, dan disertai bau tidak sedap
- gejal; gatal-gatal
- DX: pada sediaan ditemukan basil, dengan leukosit jarang, banyak epithel yang ada bintik-bintiknya= clue cell
Treatment :
- keep the skin dry
- 1 or 2 x/day sitz bath (+ baking soda 2 sdm in warm water and soaking for 20 min)
- Topical creams, lotions, and ointments
- If itching is severe →
oral hydroxyzine hydrochloride 2 mg/kg/d divided in four doses
or 2.5-percent topical hydrocortisone cream twice daily for 1 week.
Vulvitis
Improve
The dose may be lowered to 1 % continue for 4-6 weeks
Infection → Vulvitis
A β-hemolytic Streptococcus→ bright beefy-red vulva and introitus, dysuria, vulvar pain, pruritus, or
bleeding
Treatment : 1 generation penicillin/cephalosporin or other for 2-4 weeks
st
Bartholinitis
•Penyebab: gonorhea, streptokokus dan Coli.
•Bartholinitis akut: kelenjar kemerahan, nyeri, penangangan dengan pemberian antibiotik.
•Abses Bartholin: kelenjar Bartholin berisi pus, penanganan dengan insisi abses.
•Jika infeksi berulang-ulang kista Bartholin, penanganan dengan ekstirpasi kista atau marsupialisasi.