Infection of Female Reproductive System

Vaginitis

It is defined as a vaginal infection or inflammation. It is one of the most common reasons for gynecologist visits. Bacterial vaginosis, candidiasis, and trichomoniasis are the most common causes of symptomatic vaginal discharge.

Causes

• Infections caused by organisms such as bacteria, viruses, fungus, yeast, and so on.
• Chemical irritants in cream, spray, or certain garments
• Infection spread by a spouse.
• Inadequate perineal hygiene

Common types of Vaginitis

• Candida or yeast infection: Caused by fungus Candida albicans
• Bacterial vaginitis.
• Triochomoniasis vaginitis: Caused by the organism Trichomonas vaginalis.
• Chlamydia vaginitis: Caused by organism Chlamydia trachomatis.
• Viral vaginitis
• Atrophic Vaginitis (senile vaginitis): Caused by tissue thinning and shrinking, as well as decreased lubrication. It is associated with low estrogen levels and is common in postmenopausal women.

Signs and symptoms

• Vagina is red, bloated, and sensitive.
  Itching and irritation in the genital area.
  Micturation that is both painful and burning, accompanied with hematuria.
  Vaginal discharge of various severity and variety.

Diagnosis

• Detailed history.
• Vaginal examination.
• High vaginal swab for culture and sensitivity.

Prevention of Vaginitis

• After bathing, properly dry the perineal area.
• Always wear clean, soft cotton underwear.
• After a bowl movement, always clean the perineal area from front to back.
• Do not use douches or vaginal sprays.
• Consume a well-balanced diet and plenty of fluids.
• By using safer sex, you can avoid sexually transmitted diseases.

Vulvitis

Vulvitis is an inflammation of the vulva (visible external genitalia) that affects women of all ages. Vulvitis is not a sickness, but rather the inflammation of the vulva, or soft folds of skin on the exterior of the female genitalia. Infection, allergic reaction, or injury can all produce irritation. Because of its moistness and warmth, the vulva's skin is especially prone to irritation.

Cause

Germs such as bacteria, viruses, and fungus cause infections. The following infections can cause vulvitis:

• Thrush infection: It can cause a white discharge and frequently causes the vulval area to become red and irritated. Antifungal creams are typically used to treat this condition.
• Genital herpes infection: This is typically a sexually transmitted infection spread through skin-to-skin contact, which may not cause symptoms but can still spread the infection to others. If symptoms develop, they can range from mild soreness to painful blisters on the genitals and surrounding area, and are treatable with antiviral medication.
• Genital warts: A virus causes this through sexual contact, scabies, and pubic lice.
• Allergic or contact dermatitis:Any skin condition that affects the skin, such as psoriasis, lichen scleroses, or lichen planus, can also damage the skin of vulva.
• Irritation by chlorinated swimming pool or hot tub water, perfumed soap and cream: Some women develop vulvitis as a result of low oestrogen levels, which is usually associated with atrophic vaginitis, which causes the vagina to become extremely dry and sore. Wearing nylon pantyhose or synthetic underwear without a breathable cotton crotch
• Vulval cancer: It can start as a sore or lump in the vulva.
• Vulvodynia:It is a burning, stinging pain that affects the skin around the vagina or vulva and may cause swelling or inflammation.

Symptoms

• Redness and swelling on labia and other parts of vulva
• Intense itching
• Clear, fluid-filled blisters
• Sore, scaly, thick, or white patches on vulva
• A burning sensation in vulvar area

Diagnosis

• Blood tests
• Urine tests
• Tests for sexually transmitted diseases (STDs)
•  Pap smear

Management

• Avoid using irritant-causing items.
• To relieve irritation and itching, apply cortisone ointment to the affected region multiple times each day.
• Sitz baths with the application of topical estrogen cream

Prevention

• After showering, use gentle, unscented cleaning products on the genital area and carefully dry the genitals.
• Avoid using douches and other scented feminine products.
• Wearing breathable, loose-fitting cotton undergarments, as well as changing into dry clothing immediately after swimming and exercise, can also help avoid vulvitis.

Bartholine Cysts And Abscesses

Bartholin cysts form when the duct of the Bartholin gland, which typically secretes mucus near the hymenal ring, becomes obstructed by trauma or inflammation. Intermittent duct obstruction can cause the cyst to fluctuate in size, and if secondary infection occurs, the cyst can become an abscess. Bartholin's abscess is the accumulation of pus that forms a lump in the bartholin gland as a result of acute bartholinitis.

Epidemiology

The most common cystic growths in the vulva are Bartholin's duct cysts, which occur in the labia majora. 2% of women will develop a Bartholin's duct cyst or gland abscess at some point in their lives. Abscesses are around three times as prevalent as cysts.

Pathology

Distal artery occlusion The retention of secretions in Bartholin's duct may result in duct dilatation and cyst development. The cyst may become infected, resulting in an abscess in the gland. A Bartholin's duct cyst is not always present before a gland abscess develops. Polymicrobial abscesses of the Bartholin's gland Despite the fact that Neisseria gonorrhea is the most prevalent aerobic isolate, anaerobes are the most common pathogens. Chlamydia trachomatis could possibly be the culprit. However, sexually transmitted infections are no longer thought to be the exclusive cause of Bartholin's duct cysts and gland abscesses.

Treatment

• Treatment for a Bartholin's duct cyst is determined by the patient's symptoms. Asymptomatic cysts may not require treatment, but symptomatic Bartholin's duct cysts and gland abscesses do. An abscess rarely heals on its own unless it ruptures spontaneously.
• Although incision and drainage is a reasonably quick and straightforward treatment that provides virtually instant comfort to the patient, it should be avoided because the cyst or abscess has a proclivity to return. In most cases, abscess cultures are taken, as well as screening for and treating sexually transmitted illnesses. The cavity drains spontaneously after the cyst is vertically removed. The cavity can also be sutured and irrigated with saline solution.
• Because vulvar masses in postmenopausal women can be cancerous, an excision biopsy may be necessary.
• Sitz baths, administered two to three times per day, may help with patient comfort and recovery in the initial postoperative period. Coitus can be continued following catheter implantation.

Endometritis

Endometritis is an inflammatory disorder of the uterine lining that is usually caused by an infection.

Causes

• Chlamydia and gonorrhea are examples of sexually transmitted diseases (STIs).
• Tuberculosis.
• Infections caused by the 2-3 vaginal bacteria.

Risk factors

• Endometritis can be caused by infection after a miscarriage or childbirth, particularly after a protracted labor or a cesarean delivery.
• The following medical treatments can raise your risk of getting endometritis:
  • Hysteroscopy
  • Placement of an intrauterine device (IUD)
  • Dilation and curettage (uterine scraping)

Diagnosis

• STI infection causing bacteria of gonorrhea and vaginal swab culture
• Urine and blood cultures
• The total blood count (WBC) and the erythrocyte sedimentation rate (ESR). Endometritis will produce an increase in your WBC count and ESR.
• Biopsy of the endometrium
• A CT scan of the abdomen is performed to detect any suspicious tumors or thrombus.

Signs and Symptoms

• Depending on the severity of the virus, persistently high temperature to 104°F (40°C).
• Pachycardia
• Chills caused by a serious illness
• Tenderness reaching laterally from the uterus
• Bimanual examination for pelvic discomfort
• Subsequent evolution
• Scanty, odorless lochia or foul-smelling, seropurulent lochia
• The onset varies depending on the pathogen, with Group B streptococcus showing first.
• White blood cell count may be raised above the normal puerperium leukocytosis. 

Treatment

• Broad-spectrum antibiotics, such as cephalosporins (e.g., cefoxitin, cefotetan) and extended-spectrum penicillin, or a penicillin/betalactamase inhibitor combination (Augmentin, Unasyn).
• Clindamycin and gentamicin can also be given together, as can metronidazole if the mother is not breastfeeding.
• Mild endometritis can be treated with oral medication, but more severe infections necessitate hospitalization for intravenous therapy.

Complication

• Salpingitis
• Thrombophlebitis septica
• Peritonitis
• Fasciitis necrotizing
• Infertility
• Septicemia (bacteria in the blood) Septic shock (an overwhelming blood infection that causes very low blood pressure)
• Septicemia can lead to sepsis, a severe infection that can worsen quickly.

It can lead to septic shock, which is a life-threatening emergency.

Endometriosis

The presence of endometrial tissue outside of the uterine cavity is known as endometriosis. Endometriosis is thought to affect 5 to 20% of women, with symptoms ranging from none to severe pelvic pain or infertility. Anatomical locations Endometriosis can appear anywhere in the pelvis as well as on other extrapelvic peritoneal surfaces. Endometriosis is most typically encountered in the pelvic dependent areas. Frequently implicated are the ovary, pelvic peritoneum, anterior and posterior culdesacs, and uterosacral ligaments. Furthermore, the rectovaginal septum, ureter, and, on rare occasions, the ureter.

Cause

Endometriosis has no known cause; however, it is uncommon before menarche and after menopause, and is most commonly diagnosed between the ages of 20 and 30.

Symptoms of Endometriosis

• Pelvic pain

Endometriosis-associated pelvic or lower abdominal pain may be tied to the menstrual cycle and manifest as discomfort during or after ovulation. The pain may be present intermittently from ovulation until menstruation or may last throughout the menstruation as dysmenorrhea. This discomfort can occur in patterns other than the menstrual cycle. Pain from sexual activity can occur during or after sex and might be severe enough to prevent sexual activity.

• Painful defecation occurs less frequently than other types of pelvic pain and is usually caused by recto sigmoid involvement with endometriotic implants.
• Infertility

Women with endometriosis may present for an infertility evaluation with any of the symptoms listed above or simply with infertility. A diagnosis of appendicitis or ectopic pregnancy may be confused because each of these conditions can present with an acute onset of severe, unilateral pelvic pain.

Diagnosis

• Physical examination findings may be normal, with no considerable discomfort associated with organ palpation or movement. However, there may be substantial cervical motion soreness, bilateral or unilateral adnexal tenderness, ovarian hypertrophy, or a fixed, retroverted uterus.
• Only visualization via laparoscopy allows for a definitive diagnosis.
• Biopsies to confirm the diagnosis and aid in future treatment.
• Imaging, such as that available with MRI, may provide further information, although ultrasound is not particularly beneficial.
• It is worth noting that the CA-125 marker test, which is often used in the treatment of ovarian cancer, may be positive in women who have endometriosis. The CA 125, like its usage in ovarian cancer, is not a definite diagnostic tool because it can be raised in women with PID, who are pregnant, or who have fibroids, but it can be used to evaluate ongoing treatment.

Treatment

• Treatment is determined by the client's wishes, her age, the degree of pain and its influence on her quality of life, her desire for future childbearing, and the extent to which her fertility is impeded.
• Endometriosis medical treatment is based on the assumption that changing the ovulatory cycle and establishing a hypo estrogenic state will reduce discomfort, lesion growth, and stimulation. The most commonly used method is to utilize danocrine to induce ovulation (Danazol). Danazol suppresses the LH and FSH surges that occur during ovulation and, at most doses, causes amenorrhea. Danazol has significant androgenic side effects, which may include a deepening of the voice, weight gain, and a decrease in HDL.
• Depot medroxyprogesterone acetate and mifepristone (Mifeprex, RU-486) were also used as progestins and antiprogestins. These drugs frequently cause irregular vaginal bleeding as a side effect. Combination oral contraceptives (both high- and low-dose formulations) are another popular alternative. If routine OC use does not provide adequate relief, a continuous regimen (i.e., omitting the inert pills in the OC pack and taking the hormone-containing pills constantly) may be used to induce amenorrhea.
• Gonadotropin-releasing hormone (GnRH) agonists can be administered to diminish ovarian stimulation and induce pseudomenopause. As expected, GnRH agonists may cause a variety of side effects similar to menopause, such as hot flashes, irregular vaginal bleeding, vaginal dryness, decreased libido, breast tenderness, depression, insomnia, and an effect on bone mineral density.
• NSAIDs, for example, are used to relieve pain.
• Medications that suppress endometrial hormonal stimulation, such as combination or progestin-only hormonal contraceptives.
• Surgical removal of the lesions, a mix of medical and surgical methods, or complete surgical removal with hysterectomy and oophorectomy, depending on the woman's age, ovaries, and desire to have a future child.
• The removal of the lesions may result in the restoration of normal reproductive function and a reduction in discomfort as the goals of surgical treatment for endometriosis.
• A combination of medical and surgical treatment is a common approach for infertile women.

Salphingitis

In teenage and adult women, salpingitis is an acute inflammation of the fallopian tubes caused by sexually transmitted microorganisms such as Chlamydia and gonorrhea.

It is uncommon in sexually inactive girls and is usually the outcome of a blood-borne or infectious disease. Sexual abuse should be considered in young females who have no history of consensual sexual intercourse.

Types of Salpingitis

Salpingitis is classified as either acute or chronic.

The fallopian tubes grow red and bloated in acute salpingitis, and they exude excess fluid, causing the inner walls of the tubes to cling together. The tubes may also become entangled with neighboring structures, such as the intestines. A fallopian tube may occasionally swell and inflate with pus. In rare circumstances, the tube ruptures, resulting in a potentially fatal infection of the abdominal cavity (peritonitis).

Acute salpingitis is generally followed by chronic salpingitis. The illness is milder, lasts longer, and may not cause many obvious symptoms.

Etiology

• Bacteria most commonly associated with salpingitis include actinomyces, Chlamydia trachomatis, enteric gram-negative rods (e.g., E.coli), Gardnerellavaginalis, Haemophilus influenza, mycoplasma Neisseria gonorrhoeae, and, in rare cases, staphylococcus streptococcus, Trichomonosvaginalis, and Urea plasma
• Herpes and CMV are also present, as well as fungus and parasites.
• Polymicrobial content ranges from 30-40%.
• N gonorrhoeae is the most commonly reported sexually transmitted illness linked with PID.
• Untreated chlamydial or gonorrheal infections lead to PID in 10-20% of cases.

Ascending infection may occur through

• Sexual intercourse
• Miscarriage
• Childbirth
• Insertion of an IUD (intra-uterine device)
• Abortion
• Appendicitis

Sign and Symptoms

• Abnormal vaginal discharge, such as spotting of an unusual hue or odor between periods
• Dysmenorrhoea (painful periods) (painful periods)
• Ovulation discomfort
• Sexual encounters that are uncomfortable or painful
• A fever of more than 101°F
• Both sides of the lower abdomen are in agony. Rebound tenderness is possible at times.
• Lower back ache and incessant urination
• Vomiting and nausea
• Symptoms typically appear after the menstrual cycle.

Diagnosis

• General examination: In order to check for localized tenderness and enlarged lymph glands
• Pelvic examination: For tenderness and discharge.
• Blood tests: White blood cell count and other factors that indicate infection.
• Vaginal or cervical swab: In order to detect the STI bacteria identification.
• Blood and urine culture
• Laparoscopy

Treatment

The treatment of acute salpingitis depends upon:

• Early detection.
• Bed rest and hospitalization
• Antibiotic therapy that considers the polymicrobial etiology of acute salpingitis.
• Recurrent occurrences of salpingitis can be avoided by educating patients and identifying and treating sexual partners.

Oophoritis

Oophoritis is an inflammatory disorder involving one or both ovaries.

Sexually transmitted illnesses such as gonorrhea and chlamydia typically transfer bacteria into the reproductive organs. Bacteria can also be introduced through childbirth, abortion, the insertion of an intrauterine device, or douching. In some cases, oophoritis is associated with inflammation of the fallopian tubes (salpingo-oophoritis), and it is classified as a Pelvic Inflammatory Disease. The term oophoritis is commonly used to describe the inflammatory condition known as pelvic inflammatory disease.

Etiology

Gonococcus, chlamydia, streptococcus, and anaerobes have been implicated as causative organisms in cases of recent sexual intercourse, IUD insertion, or recent childbirth or abortion.

Symptoms

Depending on whether oophoritis is acute or chronic, may experience different symptoms.

• Acute oophoritis symptoms
• High fever and chills
• Vomiting
• Severe lower abdominal pain

Chronic oophoritis symptoms:

• Fever
• Lower back pain
• Abdominal pain
• Malaise

Diagnosis

• Physical examination and history
• Examining the Pelvis
• Vaginal discharge culture test
• Ultrasound of the cervix: Magnetic resonance imaging may provide extra information in circumstances when anatomy is uncertain.
• Colpocentesis is a test in which a needle is inserted into the highest section of the vagina. This needle pressures the tube and ovaries, causing the collected fluid to be secreted. The fluid is then collected and sent to a laboratory for testing to identify the pathogenic microorganisms.
• Laparoscopic examinations: To enter the laproscope, a tiny abdominal insertion is required. This is a medical examination gadget with a light at the tip that provides a clear image of the pelvic organs after being inserted into the abdominal cavity.
• To begin, the patient is given antibiotics to prevent bacteria development. Application of a heating pad to the lower abdomen for symptomatic alleviation. This may aid with pain relief.
• Warm baths are also recommended 2-3 times per day for 10-15 minutes to reduce discomfort. Treat sexually transmitted infections such as gonorrhea and chlamydia.
• Pain alleviation without the use of nonsteroidal anti-inflammatory medications (NSAIDs)
• Douching should be avoided.
• Sexual activity should be avoided until the infection has subsided.
• Laparoscopy with abscess drainage, adnexa removal, and total abdominal hysterectomy-bilateral sagittal oophorectomy (TAH/BSO) are surgical possibilities.
• Oophorectomy, Laparoscopy is more usually used to remove an ovary. However, laparotomy is usually recommended if there is a high risk of malignancy, the ovary is larger than 8 to 10 cm, or extensive adhesions are expected. A salpingo oophorectomy is often performed in these cases. Oophorectomy is usually performed to eliminate ovarian disease discovered via transvaginal or transabdominal sonography.
• The depth of the abscess, the patient's immunological impairment, and the preservation of fertility for future child bearing potential are all factors that impact the sort of surgery employed. In individuals who are not surgical candidates, interventional radiology can be utilized to drain abscesses.

Complication

• Ectopic Pregnancy