女性生殖系统炎症

妇产科学

第26章女性生殖系统炎症

INFECTIONSOFTHEFEMALEGENITALTRACTANDVENEREALDISEASES

Prof.DrmedhabilZi’nengWangJinanUniversityVulvitis[E]Notaspecificdisease,arisinginconnectionwitha.Systemicdisease(Diabetesmellitus,dermatologicdisorders.etc).b.Sec.toaspecificvaginitis(Trichomona

orcandidavaginitis).c.Inflammatoryreactionsofamoreseriousvulvalesion(Leukoplakia,Paget’sdisease,vulvarepithelialdystrophy,carcinomas).d.Contamination(Urine,stool,menstrualblood,etc).

[S]Pruritus,pain,swelling,ulcerationoreczematization〔湿疹化〕.ChronicvulvitisThickeningorfissuration〔裂开〕ofvulvarskin.[T]Antibiotics,fungicide.Localsitzbath(KMnO41:5000,etc)Antibioticorfungicidecream.(Mycospor.Kenacomb)Batholin’scyst

Bartholin’sabscess

[E]InfectionObstructionoftheglandductBartholin’scyst～(secinfection)Abscessformation.[S]Pain,tenderness〔触痛〕,swelling,feve,evenmakingsittingandwalkingimpossible.[T]Antibiotics,incisionanddrainageLocal:SitzbathVaginitis

TrichomonasVaginitis

Candidavaginitis[E]Infectionusuallyviacandidaalbicans.OptimalenvironmentpH5.5~6.5(Pregnancy,contraceptiva,antibiotics,etc).[S]Pruritus,burningandpainful,pollakisuriadysuria,dyspareunia,reddeningandswellingofvaginalwallwithwhitedeposits.[D]Candidaseeking[T]Ketokonazole200mgbidfor5d,Fluconazole150mgqd.Lokal:Clotrimazoleornystatinsupp,SitzbathNonspecificbacterialvaginitis(Vaginosis)

[E]90%duetohemophilus嗜血杆菌vaginitis,oftenaccompaniedwithanaerobes.Undernormalvaginalph3.8~4.5,nocoli,streptoc.staphyloc.andanaerobesexist.Infection,whenpH↑,viacoitus,STDs*(1)Lactobacilli

H2O2

prevotella

andmobiluncus

andotheranaerobes

succinicacid琥珀酸

chemotoxisofWBC

(2)Lacticacid

,amonia

vaginalpH

(3)Sialidaseproduction

Mucincleaving

bacterialadhesin

WBClysing

(4)Psychosocialstressglucocorticoidandcatecholamines

immunefunction

[S]Grayishorcreamy-yellowtograygreendischargewithmalodor,pruritus,burningandpain.[D]Clue-cells(Bacteriaontheepithelialcells)pH5.0~5.510%KOH

FishlikeodorSTDs?[T]Doxycycline100mgbid,Metronidazole200mgtidLokal:Polyvidon-jod-vaginalsupp(Betaisodona),1~3%AgNO3Senilevaginitis

(Atrophicvaginitis)

[E]Estrogenproduction↓(Postmenopause,Castration,etc)

Noproliferationofvaginalepithelium

Atrophy

Infection↑Glycogenandlactoseproduction↓

pH↑

Infection↑.

[S]Reddeningofvaginalwall,pyorrhea,bleeding(CA?),pruritus,burning.

[T]Antibiotics,estrogenoralorlocalapplication.Cervicitis

Endometritis

[E]Pathogens:Anaerobes,streptoc.,stapyloc.,coli,Tbc,gonorrhea(GO).Insanitaryconditioninpuerperium,sub-involutionuteri,placentalordeciduarest,incompleteabortion,curettage,HSG,tampo-nade,IUD,submucousmyoma,polyps,etc.[S]Metrorrhagia,menorrhagiaandhypermenorrhea.Paininlowerabdomen.[D]Cervicalsmearorbloodcultureforantibiogram.[T]Estrogen(Dienestrol?Premarine),antibioticsorcurettage.Senileendometritis

[E]Usuallyanerobes

Atrophicendometrium—(chronicprocess)

Stenosisofthecervicalcanal

Pyometra(DD:CA).[S]Bleedinginthepostmenopause(DD:CA),fever,generalconditions↓,purulentdischarge.[T]Estrogen,antibiotics,curettage,ifpyometraexistsdrainage.Salpingitis

[E]Intramenstrual,postpartalorintrauterineoperation

Ascendingprocess(Pathogens:GO,anaerobes,staphyloc,streptoc,coli,mycoplasma.chlamydia.Hematogen:Tbcetc.)Transmittingfromneighboringorgans.Infectedsalpinx

Closingthefimbrim

Dilatationofsalpinx

Saccosalpinx

Pyosalpinx

Hydrosalpixortubo-ovarianabscesso/aperitonitis.[S]

a.Acutephase:Fever↑,painandtensioninlowerabdomen,tenderness++oftendiarrheaorabstipation,dysuria,pollakisuria,nausea.b.Chronicphase:Painandtensioninlowerabdomen,infertility.c.Results:Wellbeing↓,recurrence↑,oftenprotractedtherapynecessary,retroflexiouterifixata,ileus,tubo-ovarianabscess,ectopicpregnancy,infertility.[DD]Appendicitis,ectopicpregnancy,endo-metriosis,urinarytractinfections,Dauglas’sabscess,torsionoftumorpedicle.[T]Antibiotics(Penicillinorcephalosporin,metronidazol),bedrest.Inchronicphase:Resorptiontherapy(notduringthemenstruation),OPifabscesspresent!.Genitaltuberculosis

[E]Prim.infectionwithmycobacteriumtuberculosisinlung~(Hematogenspreading)

GenitalTbc(Tube85-90%)+Endometriu