If you want to give your Obstetrics and Gynaecology preparation a quick boost, then read this blog post on Genital Tract Infections!
The burden of untreated infections is especially high for women because sometimes these infections are asymptomatic or in other cases the symptoms are not recognizable. But not anymore because we have outlined everything you need to know in the paragraphs below!
Let’s learn more about Genital Tract Infections, a critical topic for your OBGYN preparation.
Asherman Syndrome
Etiology
Overzealous Curettage done For
AUB (Abnormal Uterine bleeding),
MTP
Secondary PPH
Such curettage injures basal lamina causing scarring & Fibrosis of endometrium . This then leads to secondary amenorrhea.
Endometrial TB also causes Asherman Syndrome
Important information Max chances of occurrence of Asherman’s syndrome is when curettage was done for: Secondary PPH
Treatment
Hysteroscopic Adhesiolysis
Followed with High dose Estrogens & Progesterone: for cyclical withdrawal
Important information MC cause if PID in India is Chlamydia, and not TB
Clinical Features
Symptoms
Pain abdomen
Congestive dysmenorrhea
Dysparunia
Fever
Signs
Fever
Admit IF
Temp > 38°C/ 100.4°F
Severe Symptoms
Suspicious Pelvic Abscess
Unreliable/ Non Compliant Patient
Uncertain Diagnosis
↑ CRP
Leucocytosis
On P/v
cervical motion tenderness
Uterine tenderness
Adnexal tenderness
Important information Cervical motion Tenderness is seen In Ruptured Ectopic Pregnancy as well as PID
Additional Criteria
Culture & Sensitivity Of
Endometrial Biopsy
Vaginal swab
Cervical Swab
Culture Medias For
Gonorrhea: Thayer martin media
Chlamydia: Mc coy cell lines [PCR Preferred]
↑ ESR/ CRP
↑ TLC
Fever > 100.4°F [38°C]
Elaborate Criteria
Diagnostic Laparoscopy
Gives direct evidence
Laparoscopy “IF DONE” is the best way to diagnose PID
USG: Documents pelvic/tuboovarian abscess
Discharge Criteria: Temperature < 99.5°F
Treatment
Centre for disease control of atlanta In patient regimes
Out patient regimes
Broad Spectrum Antibiotics
OPD Regime
Cefoxitine 2gm iv or Cefotaxime 1gm iv
Doxycycline 100 gm BD x 14 Days: For chlamydia
Metronidazole 500 mg BD x 14 Days
For anaerobes
For bacterial vaginosis
Azithromycin can be given instead of Doxycycline
Clindamycin can be given instead of Metronidazole
Important information It is very important to treat Bacterial Vaginosis - metro is always given in all regimes. Untreated BV is important cause of relapse
Vaginitis
Ph of Vagina
Candidiasis → can occur in acidic ph of 4.5
Bacterial vaginosis can occur in Alkaline PH
Trichomoniasis Alkalinity Shift also predisposes [5.5 or 6...]
Amsel’s Criteria
Useful in Dx of Bacterial vaginosis
≥ 3 out of 4 are required
Creamy discharge
Whiff Test ⊕
Fishy odour
Clue Cells
Acidic ph
Alkaline ph > 7
Candidiasis
Bacterial vaginosis
Trichomoniasis
Dimorphic Fungi
Blastospores [Spreads]
Mycelia [Invasion & adherence]
Curdy white discharge plaque on vaginal wall on removal causes Petechiae
Out of proportion Pruritus
Complicated / uncomplicated
Uncomplicated
Seen in Ⓝ women
Good prognosis
a/w albicans
Complicated
In immunocompromised [in DM, TB, pregnancy etc]
Recurrent, Severe
a/w non-albicans
Hemphilus vaginalis aka Gardenella vaginalis
AMSEL’S >/= 3 out of 4
Creamy discharge
Whift Test: +ve
Secretion + 10% KOH → amines
Fishy odour
Clue Cells: vaginal epithelium with embeded bacteria
No Pruritis
by Trichomonas vaginalis Flagellate protozoan
Motile organism cause severe irritation & severe pruritis
Colpitis Macularis [Strawberry Vagina]
Greenish yellow, Frothy discharge
Treatment
Azoles
Oral
Fluconazole
Rx both male & female
Treatment
METRONIDAZOLE
Rx the Women [no sexual transmission]
Treatment
METRONIDAZOLE
Rx both man & women
Important informationMC Vaginitis: Bacterial Vaginosis
Bacterial Vaginosis can cause
PID
Relapse of PID
Chorioamnionitis [PID in pregnancy]
Abortion
IU Death
Puerperal sepsis
Vault cellulitis
Whiff test can also be positive in trichomoniasis
As both Bacterial vaginosis & Trichomoniasis CO-Exists
Classical For Bacterial vaginosis
Rx the male partner also in Trichomoniasis
Rx the male partner also in candidiasis
Rx only women in B Vaginosis (as not STTD)
Q. Which of the following is the drug of choice for bacterial vaginosis in pregnancy?
Metronidazole
Clindamycin
Erythromycin
Rovamycin
Q. A sexually active lady came with profuse yellowish frothy discharge with intense itching. On local examination of the vagina a ‘strawberry’ like cervix is revealed. What condition she is likely suffering from?
Candidiasis
Trichomonas vaginitis
Bacterial vaginosis
Gonorrhea
Q. Green frothy discharge is seen in?
Herpes simplex
Candida albicans
Trichomonas vaginalis
Normal vaginal flora
Q. A HSG is suggestive of Asherman syndrome. The woman suffering from this syndrome is likely to have which of the following presentations?
Amenorrhea
Oligomenorrhea
Menorrhagia
Dysmenorrhea
Q. A woman presents with secondary amenorrhoea since 3 months since she had a curettage for missed abortion. FSH is 7 IU/L. A UPT is negative. What is the most likely diagnosis?
Pituitary failure
Ovarian failure
Uterine synechiae
Pregnancy
Q. A 28 year old woman was suspected to have genital tuberculosis. What is the percentage that fallopian tube would be involved in this case?
100
80
60
50
Q. 18 year old girl comes to gynae OPD presenting with 6 months of amenorrhea, with h/o low grade fever, weight loss, pain abdomen, generalized weakness. On examination pelvic mass felt on left side with features of ascites. Diagnosis?
TB pelvis with tubo ovarian mass
Ectopic pregnancy
Granulosa cell tumour
Fibroid degeneration
And that is everything you need to know about Genital Tract Infections for your Obstetrics and Gynecology preparation! For more informative posts like this, keep following PrepLadder’s blog.
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