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.
Overzealous Curettage done For
AUB (Abnormal Uterine bleeding),
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
Followed with High dose Estrogens & Progesterone: for cyclical withdrawal
Important information MC cause if PID in India is Chlamydia, and not TB
Temp > 38°C/ 100.4°F
Suspicious Pelvic Abscess
Unreliable/ Non Compliant Patient
cervical motion tenderness
Important information Cervical motion Tenderness is seen In Ruptured Ectopic Pregnancy as well as PID
Culture & Sensitivity Of
Culture Medias For
Gonorrhea: Thayer martin media
Chlamydia: Mc coy cell lines [PCR Preferred]
↑ ESR/ CRP
Fever > 100.4°F [38°C]
Gives direct evidence
Laparoscopy “IF DONE” is the best way to diagnose PID
USG: Documents pelvic/tuboovarian abscess
Discharge Criteria: Temperature < 99.5°F
Centre for disease control of atlanta In patient regimes
Out patient regimes
Broad Spectrum Antibiotics
Cefoxitine 2gm iv or Cefotaxime 1gm iv
Doxycycline 100 gm BD x 14 Days: For chlamydia
Metronidazole 500 mg BD x 14 Days
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
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...]
Useful in Dx of Bacterial vaginosis
≥ 3 out of 4 are required
Whiff Test ⊕
Alkaline ph > 7
Mycelia [Invasion & adherence]
Curdy white discharge plaque on vaginal wall on removal causes Petechiae
Out of proportion Pruritus
Complicated / uncomplicated
Seen in Ⓝ women
In immunocompromised [in DM, TB, pregnancy etc]
Hemphilus vaginalis aka Gardenella vaginalis
AMSEL’S >/= 3 out of 4
Whift Test: +ve
Secretion + 10% KOH → amines
Clue Cells: vaginal epithelium with embeded bacteria
by Trichomonas vaginalis Flagellate protozoan
Motile organism cause severe irritation & severe pruritis
Colpitis Macularis [Strawberry Vagina]
Greenish yellow, Frothy discharge
Rx both male & female
Rx the Women [no sexual transmission]
Rx both man & women
Important informationMC Vaginitis: Bacterial Vaginosis
Bacterial Vaginosis can cause
Relapse of PID
Chorioamnionitis [PID in pregnancy]
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?
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?
Q. Green frothy discharge is seen in?
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?
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?
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?
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
Granulosa cell tumour
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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