INFLAMMATORY

DISEASES OF THE
FEMALE GENITAL
ORGANS
“KYIV MEDICAL UNIVERSITY”
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
DR. VIRA BOIKО
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VISION
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Taking urogenital swabs for microscopy
🞂 First – the discharge is taken with a sterile disposable
brush from the urethra
🞂 Second brush – from the cervical canal
🞂 Third one – from the posterior fornix of the vagina
Each time applying the discharge onto different
parts of the microscope slide.
4 degrees of vagina cleanness:
🞂 1st – solitary pavement epithelium cells, a large quantity
of the Doderlein’s vaginal bacilli, no other flora and
leucocytes.
🞂 2nd – solitary leucocytes, a small quantity saprophytes,
small bacilli.
🞂 3rd- a large quantity of pavement epithelium cells,
solitary or absent vaginal bacilli, a large quantity of
leucocytes and coccal flora.
🞂 4th – there are no vaginal bacilli, a large quantity of
leucocytes and cocci, there is a specific causative agent
 Normal vaginal microflora contains:
Lactobacillus (70-90%), Staphylococcus
epidermalis (30-60%>), diphteroids (30-60%>),
Hemolytic Streptococci (10-20%),
nonhaemolytic streptococci (5-30%>),
Escherichia coli (20-25%), Bacteroides (5-15%),
Peptococcus (10-60%), Peptostreptococcus (10-
40%), Clostridium (5-15%).
Presence of pathogenic flora without
inflammation isn't a sign of pathologic processes.
NONSPECIFIC INFLAMMATIONS OF THE
LOWER FEMALE GENITAL ORGANS

🞂 Vulvitis
🞂 Bartholinitis
🞂 Colpitis
🞂 Cervicitis
Vulvitis
🞂 Is inflammation of the external genital organs (vulva).
🞂 More often it develops secondarily in inflammation of
the vagina, cervical canal and endometrium.
🞂 Primary vulvitis is observed in diabetes, not following
the rules of personal hygiene, thermal, mechanical, or
chemical action on genital skin.
🞂 There are differentiated acute and chronic vulvitis.
Clinical presentation:
🞂 Itch
🞂 Burning on the region of external genitals
🞂 Sometimes common ailment
🞂 Examination may show hyperemia, swollen vulva,
purulent or sero-purulent discharge, enlarged inguinal
lymph nodes
🞂 At the chronic stage the clinical signs decline, itch and
burning appear from time to time.
Diagnostics
🞂 Clinical presentation
🞂 Bacterioscopic examination
🞂 Bacteriological examination
Treatment
🞂 Herbal tinctures (camomile, marigold, sage)
🞂 Antiseptic solutions (dioxydin, miramistin,
chlorhexidine, potassium permanganate)
🞂 Complex antibacterial preparations
Bartholinitis
is an inflammation of Bartholin's gland (large gland
of vaginal vestibule).
Obstruction of the opening of the main duct into
the vestibule leads to abscess formation. Infection of
Bartholin's glands can lead to secondary infections,
abscess or cyst formation
Classification
🞂 According to the clinical course there are differentiated
acute and chronic bartholinitis , false and true abscess.
🞂 According to the etiology – primary and secondary
bartholinitis.
Clinical presentations
🞂 Painfulness in the region of the middle third of the
large lip of pudendum and body temperature rise.
🞂 Examination shows hyperemia, swollen large lips of
pudendum in the region of the gland.
🞂 In chronic bartholinitis clinical manifestation are often
absent
Complications
🞂 True abscess (acute period) is characterized by
inflammation of the Bartholin's glands tissue.
🞂 The course is acute, with fever and body temperature
rise, painfulness in the region of the large and small
lips of pudendum.
Diagnostics
🞂 Anamnesis
🞂 Speculum examination
🞂 Colposcopy
🞂 Bimanual gynecological investigation
🞂 Rectal examination
🞂 Profound palpation of the abdomen
🞂 bacteriological examination
Treatment
Conservative:
🞂 Bed rest;
🞂 Anesthetizing;
🞂 Anti-inflammatory;
🞂 Antibacterial therapy
If the patient’s condition worsens (abscess appears),
surgical treatment is indicated.
COLPITIS
is an inflammation of
vagina.
It is the most
frequent cause of visits
to gynecologists.
Clinical presentation
🞂 Profuse discharge, which may be liquid, watery,
purulent, and sometimes foamy;
🞂 Itch in the region of the vagina caused by the irritant
action of leukorrhea;
🞂 Sensation of burning, pressure, heat in the genital
organs and small pelvis, pains in the vagina during
coitus (dyspareunia)
Diagnostics
🞂 Speculum examination shows purulent deposition on
the surface of the vagina, thickening, swelling,
hyperemia of the mucous tunic, which bleeds easily
when touched
🞂 Colposcopy – sings of the inflammatory process
🞂 Bacterioscopic examination (Microscopy of the vaginal
contents in colpitis is characterized by an increased
number of leukocytes – more than 10
🞂 Bacteriological examination
Treatment
Treatment of nonspecific vaginitis is comlex:
🞂 using of antiinflammatory medicines
🞂 treatment of neuroendocrinologic and immunodificiency conditions
🞂 treating of male sexual partner; patients should avoid sexual contacts
while therapy
🞂 Local treatment includes using of syringing with antiseptic fluid
(KMn04, furacilin, chlorhexidin) no more than 3-4 days. In case of
acute or chronic vaginitis laser therapy may be used.
🞂 Metronidazol (vaginal suppositories), chlorhinaldin, terginan,
betadin, gynopaveril may be prescribed.
🞂 For normalization of vaginal ecosystem solkotrychovac, vagilak,
Lactobacterin and Bifidumbacterin are used.
Bacterial Vaginosis
🞂 is a result of an overgrowth of both anaerobic bacteria
and the aerobic bacteria Gardnerella vaginalis
🞂 Anaerobes and G. vaginalis are normal inhabitants of
vagina, but these bacteria overgrowth dominant of the
normal Lactobacillus flora results in the appearance of
a thin, fishy odor, gray vaginal discharge that adheres
to the vaginal walls.
Diagnosis
is based on the presence of the following characteristics of the
discharge:
• pH is higher than 4,5
• a homogeneous thin appearance
• a fishy amine odour produced by anaerobes when 10% KOH is
added
presence of clue cells (vaginal epithelial cells to which organisms
are attached).
Cultures aren't helpful because anaerobes and Gardnerella
vaginalis can be recovered from normal flora of healthy women, but the
concentration of both bacteria is higher in patients with bacterial
vaginosis (fig. 86). Factors that lead to overgrowth of G.vaginalis and
anaerobes have not been identified.
Treatmen
🞂 includes elimination of anaerobic agent of microflora,
inducement of local and general immunity and then the normal
microflora should be renewed.
🞂 Oral using of metronidazol (Flagyl) 500mg twice a day for 7
days or by intravaginal Metrogel 0,75% cream twice a day for 5
days, 2% Clindamycin cream (Cleocin) once daily for 7 days.
🞂 For normalization of vaginal microflora the local bifidumbacterin
insertion or 2-3%) solution of Lactic acid is used.
🞂 The treatment of the male parthner with Metronidazol can be
advocated only when bacterial vaginosis recurs, but effectiveness
is not proven.
Endocervicitis
is the inflammation of mucosa layer of the endocervix
Chlamidia trachomatis, Mycoplasma, Trichomonada
vaginalis, N. Gonorrhoeae, viruses, Candida, E.coli,
Staphylococci cause endocervicitis.
The inflammatory process is chiefly confined to the
endocervical glands. The squamous epithelium of the
exocervix may be involved into the process called acute
exocervicitis.
Chronic cervicitis manifestation is cervical erosion.
Erosion indicates the presence around the cervical os a zone
of infected tissue that has a granular appearance.
 The most important in the diagnosis of chronic cervitis is the
exclusion of the malignant process. Before the begining of treatment,
examination with colposcope should be carried out. The cervicitis may
appear as a reddish granulation raised above the surrounding surface,
giving the impression of being papillary.
A Papanicolaou smear should be obtained and suspicious areas should
undergo biopsy.
Treatment
Acute cervicitis is treated with appropriate antibiotics (it depends
on bacterial agent).
Local treatment of acute phase is a real danger of dissemination
of infection. Laser therapy is used in treatment of acute and chronic
cervicitis.
Electocautherization is the traditional treatment of chronic
cervicitis, especially with erosion, cervical ulcers or ectropion.
Nowadays cryosurgery or laser surgery has replaced
electrocautherization.
NONSPECIFIC INFLAMMATIONS OF
THE UPPER FEMALE GENITAL ORGANS
Endometritis
🞂 is an inflammation of endometrium (mucus layer of
uterine).
🞂 It may occur in such cases as: endometritis after uterine
curettage or suction and puerperal endometritis.
🞂 Endometritis is caused by bacterias, viruses,
mycoplasmas. The most frequent the associations of 3-
4 anaerobic bacteria and 1-2 aerobic are the main
reason of endometritis.
🞂 There are differentiated acute, subacute, and chronic
types of endometritis.
Acute endometritis
Clinical presentation:
🞂 Body temperature rises
🞂 Pulse becomes rapid
🞂 Painful sensation appears in the lower abdomen and
inguinal region
🞂 Mucopurulent and sanious-purulent discharge
In the peripheral blood:
🞂 Leukocitosis, roight leukogram shift, increased ESR
Vaginal examination shows somewhat enlarged
uterus, painful when palpated.
The acute phase of inflammation lasts for 5-10
days and stops in case of timely treatment or passes
into subacute or chronic form.

Diagnostics is based on:

• Anamnestic data
• Clinical presentation
• Bacteriological study of uterine cavity aspirate
• US
• Hysteroscopy
Treatment
Large doses antibiotics lasts for 3-5-7 days
Chronic endometritis
Clinical presentation:
Mucopurulent leukorrhea, dull pain in the lower abdomen, sacrum, and
loin, menorrhagia.
Bimanual examination shows slight enlargement and hardening
of the uterus.
Diagnostics is based on:
🞂 Anamnestic data

🞂 Clinical presentation

🞂 Histological examination of the endometrium obtained after

separate diagnostic curettage (on the 5th – 8th of the menstrual cycle)
🞂 Hysteroscopy

🞂 US
Treatment
🞂 A complex treatment is used. It includes a medicines for curing of
accompaning deseases, desensibilisative medicines and additional
general health measures, vitamines.
🞂 Physiotherapy has an important role. It improves pelvic
hemodynamics. Diathermy on lower abdomen, electrophoresis with
copper, zinc, ultrasound, inductothermy, laser radiation are used. If
during physiotherapy the process becomes strained antibiotic therapy
is recomended. While remission antibiotic using is not proved.
🞂 Physiotherapy promotes to activation of hormonal ovarian function.
If effect is not enouph than a hormonal therapy is used (taking into
account the patient's age, term of deseases, degree of ovarian
hypofunction). Health resort treatment is effective (balneologic
therapy, mudcure resort).
Salpingoophoritis
is the inflammation of the uterine tubes and the ovaries.
Clinical presentation
🞂 pelvic pains of different intensity, mainly in the hypogastric
region, with a broad zone of irradiation
🞂 Febrile or subfebrile temperature, leukorrhea (more
frequently purulent)
🞂 Aggravation of general condition
🞂 Dyspepsia
🞂 Dysuria
The diagnosis of salpingoophoritis is
based on:
🞂 the history, physical examination and laboratory tests. Besides
that additional ultrasonography and laparoscopy can be used.
🞂 Laparoscopy provides the most accurate way to diagnose the
inflammatory process and its stage. It should be used in cases
when the diagnosis is unclear, especially in patients with severe
peritonitis, to exclude a ruptured abscess and appendicitis.
Besides diagnostic laparoscopy is used to provide treatment
procedures.
🞂 Ultrasound can be used to distinguish the presence of an abscess
from an inflammatory mass within the adnexal mass. It may also
be helpful in defining mass in the obuse patient or if the bimanual
examination is unsatisfactory because of the excessive tenderness.
Treatment
🞂 All patients with acute salpingoophoritis should be hospitalized. Adequate therapy of
salpingitis includes the assessment of severity, antibiotic treatment, additional general health
measures.
🞂 Before the culture test performing the antibiotic therapy is provide with broad spectrum
antibiotics. The most effective is the combination of Clindamicin with Chloramphenicol,
Gentamicin and Lincomicin, Doxycyclin, Clacid, Cefobid, Cyfran, Claforan, Dalacin С and
Unasyn.
🞂 When anaerobic agents are suspected metronidazol should be used, in severe cases
intravenously.
🞂 After temperature normalization and cessation of peritonitis signs antibacterial therapy is
continued for 5 days.
🞂 Detoxycation is indicated and is provided by using of 5% glucose solution, polyglucin,
reopolyglucin, solutions of proteins, correction of pH balance by using of 4% solution of
Sodium bicarbonates. Among physical methods of treatment cold on the lower part of the
abdomen is used.
🞂 Appropriate antibacterial treatment is combined with laparoscopy active drainage.
🞂 The tuboovarial abscess is drained of pus by puncture and rinsed with bacteriostatic solution
and local application of antibiotics. In subacute stage aloe, ultraviolet radiation,
authohaemotherapy is used. They prevent the chronic processes.
Pelviperitonitis. Peritonitis
Inflammation of pelvic peritoneum (pelviperitonitis) or
abdominal cavity (peritonitis) is accompanied by local and general
symptoms with dysfunction of the vital organs.
Most often this inflammation is secondary and completes such
destructive process in the internal genitals:
- Dissolution of a wall of pyosalpinx, puo-ovarium or purulent

tuboovarian mass;
- Various gynecological surgeries;
- Illegal abortions, including the ones complicated with uterine

wall perforation
- Ovarian tumor necrosis due to tumor pedicle torsion or tumor

capsular breaking
Depending on the spread of the inflammatory
process such forms of the process are
differentiated:
1. Local.
1.1 Limited – inflammatory infiltrate or abscess in an
abdominal organ.
1.2 Unlimited – the process is localized in a peritoneal recess.
2. Widespread.
2.1 Diffuse – the process covers 2-5 anatomical region of the
abdominal cavity.
2.2 Generalized – from 5 to 9 regions.
2.3 General – overall affection of the serous coat of the
abdominal organs and walls.
The clinical presentation
🞂 High body temperature (especially in the purulent process)
🞂 Rupid pulse
🞂 Feeling unwell
🞂 Severe pain in the lower abdomen
🞂 Fever
🞂 Abdominal swelling
🞂 Tension of the anterior abdominal wall muscles
🞂 Positive Shchotkin-Blumberg’s symptom in the lower abdomen
🞂 Sharp ESR increase, leukocytosis, left leukogram shift
🞂 During the first day of the disease gynecological examination shows only
rigidity and painfulness of the posterior vaginal vault, later on there is detected
exudate, protrusion of the cupola of the posterior vault
🞂 Local manifestation include such symptoms: abdominal pain, protective tension
of the abdominal wall muscles and other signs of peritoneum irritation,
enteroparesis.
Diagnostics is based on:
🞂 Anamnestic data;
🞂 Clinical presentation;
🞂 Bacteriological examination of the punctate obtained
by means of exudate aspiration (if it possible),
laboratory blood analyses;
🞂 US;
🞂 Laparoscopy.
Treatment
🞂 For pelviperitonitis is based on principles of complex therapy for
acute endometritis
🞂 In case peritonitis the treatment is provided in three stages:
preoperative preparation, operative intervention, intensive therapy in
the postoperative period
🞂 Antibiotic therapy
🞂 Detoxication therapy: infusion of colloid and crystalloid media in
the ratio 2:1, the total volume of infusion makes 3-5 L/day.
🞂 Microcirculation normalization: heparin, fraxiparin, nicotinic acid,
aminophyline, contrical
🞂 Stimulating therapy: gama-globulin, serum imunoglobulin, immune-
active plasma
🞂 Fight against enteroparesis – proserin, umbretid
 SEXUALLY
TRANSMITTED
DISEASES
(the WHO’s
classification)
Classic venereal diseases
Nosology Microorganism
1. Syphilis Treponema pallidum
2. Gonorrhea Neisseria gonorrhoeae
3. Chancroid Hemophilus ducrei
4. Lymphogranuloma
venereum Chlamydia trachomatis
5. Donovanosis, Callimmantobacterium
or granuloma inguinale granulomatis
3,4,5 are mostly in tropic countries
Other sexually transmitted infections
Nosology
A — that affect mostly genital tract
1. Syphilis
1. Urogenital chlamydiasis
2. Urogenital trichomoniasis
3. Urogenital mycoplasmosis
4. Candidosis vulvovaginitis
5. Genital herpes
6. Genital warts
7. Molluscum contagiosum
Microorganism
Treponema pallidum
Chlamydia trachomatis
Trichomonas vaginalis
Mykoplasma hominis
Candida albicans
Herpes simplex virus
Papillomavirus hominis
Molluscovirus hominis
8. Bacterial vaginosis Gardnerella vaginalis
9. Urogenital shigellosis of homosexualists Shigella species
10. Pediculosis pubis Phthyrus pubis
11. Scabies Sarcoptes scabiei
B — With mostly affection of other organs
1. Infection, caused by HIV Human immunodeficiency virus
2. Hepatitis B Hepatitis B virus
3. Cytomegalovirus infection Cytomegalovirus hominis
4. Amebiasis Entamoeba hystolytica
5. Lambliosis Giardia lamblia
Gonorrhea
Gonorrhea is a contagious disease caused by
Neisseria gonorrhoeae (is a Gram-negative diplococcus).
Ways of infecting:
🞂 the disease is sexually transmitted
🞂 homosexual contacts, urogenital contacts
🞂 very rarely through sponges, towels, underwear
🞂 during labour from mother (infected eyes, vagina in
girls)
Incubational period lasts for 3-7 days, sometimes for
2-3 weeks.
Classification
According to the stage of spreading the process
🞂 the gonorrhea of lower part of genital organs
(gonorrheal urethritis, endocervicitis, Bartholinitis,
vulvovagi¬nitis)
🞂 gonorrhea of upper parts — gonorrhea ascendens
(endometritis, salpingitis, pelvioperitonitis)
Classification
According to duration there are such forms of
gonorrhea:
🞂 fresh gonorrheal infection with acute, subacute, torpid
passing, which lasts less than two months
🞂 chronic gonorrheal infection, lasting more than two
months
🞂 latent gonorrheal infection
Gonococcal urethritis.
Clinical manifestation appears within 3-5 days after
infection and is characterized by dysuria. Variable degrees
of edema and erythema of the urethral meatus, purulent or
mucopurulent discharge are present.
Gonococcal Bartholinitis.
It may occur when N. gonorrhea with vaginal
discharge infects the Bartholin’s gland. It is manifested by
edema, erythema around the duct’s. When the occlusion
occurs, pseudoabscess or Bartholin’s abscess which are
accompanied by purulent process symptoms can develop.
Gonococcal endocervicitis.
Inflammatory process develops in mucosal layer of
the cervical canal. Examination reveals edema and
erythema of vagina and part of the cervix. There is a red
crown around the cervical os and a mucopurulent cervical
discharge.
Gonococcal proctitis
occurs very rarely. Rectum is involved into the
process in the result of contamination with the infected
genital discharge. Clinic includes tenesmus and rectal
pain.
Gonococcal endometritis
is the first stage of the ascendant gonorrhea with
infection of basal and functional layer of endometrium. It
is manifested by lower abdominal pain, high body
temperature, sometimes nausea, vomiting. Pain often has
spasmodic character. Discharge is sanguine-purulent or
mucopurulent. Uterus is painful at palpation. Chronic
endometritis is characterized by menstrual disorders.
Gonococcal salpingitis
is the infection of the fallopian tubes, mostly
bilateral. In acute stage the pain in lower part of abdomen
is common. It becomes stronger, motion, nausea,
vomiting. Menstrual disorders can occur.
Gonococcal pelvioperitonitis
a specific inflammation of pelvic perito-neum and
is a sequel of salpongoophoritis. The onset is acute.
Severe lower abdominal pain, peritoneal irritation
symptoms, vomiting, meteorism, constipation, high body
temperature can be found. Gonococcal inflammation is
cha-racterized by the tendency to adhesion process, that
leads to localization of inflammation in pelvis.
Gonorrhea during pregnancy
is often asymptomatic. It can lead to complication
of pregnancy, labor and is a risk factor both for the fetus
and for the newborn. Possible complications for mother
(chorioamnionitis, subevolution of uterus, endometritis)
and fetus (premature delivery, unophthalmia, intrauterine
sepsis, death) can occur. Artificial abortion is dangerous
because of possibility of the uterus, ovaries, tubes
infection and other complications.
Gonorrhea in children.
🞂 Mechanism of infection: during delivery when a child
passes through infected birth canal, or intrauterine
through amniotic fluid, and from ill mother to child
while looking after it. Elder children may be infected
while using common toilet, sponge, bath.
🞂 Gonorrhea in girls is acute with the expressed edema
and erythema of mucosal membrane, mucopurulent
discharge, frequent and painful urination, itching.
There can be high body temperature. In girls gonorrhea
causes the same complications as in women.
Diagnosis
of gonorrhea is confirmed by positive results of
bacterioscopic and bacteriologic tests of cervical, vaginal,
urethral discharge. To acuten the chronic process the so-
called “provocation” is conducted:
🞂 1) 0,25% solution of argentum nitrici on mucosal
membrane of the cervix, vagina and urethra is applied
🞂 2) introducing of gonovaccine, pyrogenal, prodigiozan

🞂 3) diathermy

🞂 Smears must be taken on the 2-4th day of the menstrual

cycle and after provocation in 24, 48, 72 hours, that
allows to reveal N. gonorrhea.
Treatment
🞂 The main medicines in gonorrhea treatment are
antibiotics. Gonococcal infection very often is
accompanied with trichomoniasis, chlamidiasis,
candidiasis, mycoplasmosis.
🞂 Antibiotics that have influence on the following agents
such as: Ciprofloxacin, Doxycyclin, Trobicyn,
Sumamed, Cephtriaxon, Afloxacin in combination with
Metronidazol, Tiberal, Naxogyn should be prescribed.
Treatment
🞂 Gonovaccine is used after ineffective antibiotic
treatment and relapse in the latent fresh torpid and
chronic form of the disease (200-300 mln. of microbe
bodies, in 2-3 days intramuscularly). During pregnancy
immunotherapy and antibiotics with negative influence
on a fetus are not used.
🞂 For toilet of external genital organs 0,002% solution of
Chlorhexidine, Re-cutan, Baliz-2 are prescribed.
Urogenital trichomoniasis
🞂 Urogenital trichomoniasis
is caused by Trichomonas
vaginalis and is a result of
their invasion into the
lower part of genital tract
and urethra.
🞂 Trichomonas vaginalis is a
flagellate protozoan and it
is transmitted by sexual
intercourse.
🞂 Incubation period lasts for
5-15 days.
Clinical manifestations

🞂 Vaginitis, urethritis, endocervicitis, proctitis are the

most common manifestations, ascendant infection
meets rarely.
Forms of genital trichomoniasis:
🞂 fresh (acute, subacute and torpid forms)
🞂 chronic trichomoniasis (with torpid form and duration
of more than 2 months)
🞂 trichomonas carriage (is characterized by the absence
of symptoms, while Trichomonas vaginalis are present)
Objective data:
🞂 erythema, maceration, vulva, perineum scratching,
cervical erosion, erythema and edema of vaginal
mucosa, foamy purulent discharge. At torpid forms
clinical manifestations are mild or absent.
🞂 Chronic trichomoniasis is characterized by vaginal
discharge, itching, but there are no inflammatory
manifestations, there can be frequent relapsing.
Diagnosis.
- Anamnestic data;
- Objective examination;
- Vaginal smears;
- Polymerase chain reaction (PCR)
Treatment.
The main principles are:
🞂 treatment of the woman and her sexual partner
🞂 avoiding of intercourse until the patient and her
partners are cured
🞂 using of antitrichomonades treatment with local
treatment, and hygienic procedures: shaving hair on
pubis, everyday changing of underwear
🞂 treatment of accompanying diseases of genital organs
Antitrichomonade remedies are metronidazole (Trichopol, Clion,
Metragil, Flagil), Fasigyn (Tinidazol), Atrican, Naxogyn, Tiberal,
Solkotrichovak, Tergynan.
Recently for treatment of trichomoniasis Metronidazole should be
prescribed. On the first day they use 0,25g 4 times a day, on the
next days — 0,25g 3 times a day. All dosage on treatment course is
5-6 g. Tinidazole is used in such regimen after meals:
- once 2 g (4 tablets each 0,5 g)
- 0,5g every 15 minutes 4 times
- 0,15g twice a day during 7 days
Naxogyn is used in dose of 500 mg twice a day 6 days. During
pregnancy and breast-feeding all these medicines are
contraindicated.
Clion-D is used in the form of vaginal tablets 1 tabl. for night
during 10 days. Locally antiseptic solution can be used: Baliz-2,
0,002% solution of Chlorhexidin, Tricho¬monacid.
Urogenital chlamidiasis
🞂 is a rather spread infectional disease, which is
transmitted mostly sexually.
🞂 Infective agent of urogenital chlamidiasis is gram-
negative bacteria - Chlamydia trachomatis
🞂 There are two main forms of chlamidia — elementary
body and reticular body.
Ways of transmission:

🞂 sexual
🞂 intrapartum (passing through the infected birth canal)
🞂 nonsexual way (polluted hands, instruments,
underwear, toilet, etc.)
🞂 Besides infection of urogenital organs,
Chlamidia trachomatis can cause pharyngitis,
conjunctivitis, perihepatitis, otitis, pneumonia, other
diseases (Reiter’s syndrome).
Clinical manifestations
🞂 Incubational period lasts from 5 to 30 days. The main primary
form of chlamidial infection is endocervicitis with mild
symptoms or without any. In acute stage purulent or
mucopurulent discharge from the cervix, edema and erythema of
the vaginal part of the cervix are observed. In chronic stage there
is the mucopurulent discharge and pseudoerosion of the cervix.
🞂 Chlamidial urethritis can be asymptomatic or it manifests itself
by dysuria. There are no specific symptoms for clinical
diagnostics of chlamidiasis.
🞂 Salpingitis, caused by Chlamidia trachomatis, is characterized by
the same symptoms like the process caused by other bacteria.
🞂 The sequale of chlamidial salpingitis is infertility.
Diagnosis
🞂 is based on the history (both partners are ill, there is the
infertility). Residual diagnosis is established after
revealing chlamidias in the scrap from the cervix and
vagina.
🞂 The most exact are immuno-enzyme and immuno-
fluorescent methods.
Treatment
🞂 It is necessary to cure the woman and her sexual
partner. The woman should avoid sexual intercourses,
alcohol, psychical and physical overload.
🞂 Medicines from the tetracyclin group are prescribed
(Doxycyclin, Rondo-micyn, Morphocyclin), Sumamed,
Tarivid, Macrolids (Clacid, Erythromycin).
Treatment
🞂 To prevent candidosis Diflucanum in dose 150 mg is used, Nistatin or
Levorin (2.000.000 IU per day during treatment) are prescribed.
🞂 Fromilid (Clarythromycin), an acid-resistant antibiotic from macrolid group
is recommended. An important property of this drug is its possibility to cell
penetration, that’s why Fromilid is 8 times more active, than Erythromycin.
It doesn’t suppress immune system, activates phagocyto-macrophagal
system and some enzymes, that take part in destroying of pathogenic
bacterias. The dose of fromilid is 500 mg twice a day during 7-14 days in
case of fresh incomplicated chlamidiosis. In chronic forms the treatment
course must be elongated till 3-4 weeks.
🞂 At urogenital chlamidial infection medicines from ftorchinolon group,
Ciprofloxacin (Ciprinol) are used. Ciprinol is prescribed in the dose of 0,5g
orally or 0,2g intravenously each 12 hours during 10-14 days.
🞂 During treatment the ultraviolet irradiation including sun radiation are
contraindicated.
Urogenital mycoplasmosis
🞂 Microbal agents are Mycoplasma
hominis, Mycoplasma
genitalium, Ureaplasma
urealiticum.
🞂 In the etiology of the
inflammatory diseases of female
genital organs the associaton of
mycoplasmosis with
trichomoniasis, N. gonorrhea,
Chlamidia trachomatis,
anaerobes is of great importance.
🞂 Mycoplasmas are transmitted
sexually and they are highly
spread among the population.
Clinic.
Mycoplasmas infection can occur in acute and chronic
form, and has no symptoms, which are specific for this
agent. It is often found in healthy women. Mycoplasmosis is
characterized by torpid course, sometimes the latent forms of
the reproductive system inflammation are observed. The
agents may be activated under the influence of menstruation,
oral contraceptives, pregnancy, delivery. Ureaplasma is
identified in the patients with vaginitis, cervicitis, urethritis,
in association with other bacteria the symptoms are typically
and described in the part “Nonspecific inflammatory
diseases of the female genital organs”.
Diagnosis.
To reveal ureaplasmas the bacteriological method is
used. Material is taken from the purulent discharge of
Bartholin’s glands, from uterine tubes at salpingitis,
tuboovatian tumors at pelvic inflammatory disease. Test on the
urease is done (colour index). It is based on the property of
ureaplasms to product urease, that changes the pH and the
colour of indicator.
Serological diagnosis is also used. Immunogram in
diagnosis of mycoplasmosis and other infection (Chlamidia,
gonorrhea, trochomoniases, herpes simplex virus) is indicated.
Polymerase chain reaction (PCR)
Treatment
🞂 Using of antimicrobal medicines from macrolid group
(Erythromycin, Sumamed, Roxitromycin), Tetracyclin
group (Tetracyclin, Doxycyclin), Fluorochinolones
(Ciprofloxacin) is etiotropic treatment. They are
prescribed for not less than 10-14 days with the
following laboratory control. Another course of
treatment is immunity stimulation (Immunoglobulin,
Levamizol, T-activin, Ginseng Tincture).
Candidiasis vulvovaginitis
🞂 is a polyorganic disease,
caused by yeast fungi
(Candida albicans, C.
glabrata, C. tropicalis).
🞂 It can be transmitted
sexually.
🞂 The most frequent
localization is in vagina,
vulva, but there can be
candidiasis endocervicitis,
endometritis, salpingitis.
Predisposing factors:
• endogenous long lasting diseases, such as diabetes
mellitus, avitaminosis
• exogenous factors, that predispose fungal
colonization and decrease the general reactivity of
the organism (long treatment with antibiotics) and
local im¬munity in vaginal mucosa
• high virulency of Candidas
There are such kinds of candididas vulvovaginitis:
• primary
• antibiotics-induced (as a result of antibiotic
treatment)
• as a sequale of changes in different systems of the
organism (diabetes, pregnancy, using of estrogens)
Clinical manifestations:
🞂 Candidiasis vulvovaginitis is characterized by vulvar
itching, pruritus, cottage-cheese-like discharge.
🞂 Examination reveals edema and erythema of genital
mucos with whitish adherent discharge, that include
pseudomicelium of fungi, exfoliated epithelial cells and
leukocytes.
Diagnosis.
🞂 clinical manifestations,
🞂 vaginal examination,
🞂 colposcopy,
🞂 bacterioscopic and bacteriological methods.
Treatment.
Acute form is treated by Orungal 200 mg twice a day
during 3 days; at chronic form they use 100 mg twice a day
during 6-7 days, then during 3-6 menstrual cycles 1 capsule
on the first day of menstrual cycle is taken.
High effectiveness is observed while using Diflucan
in dose 150 mg per 1 reception, and Gynopevaril — one
suppository (150 mg) during 3 days. In case of relapse one
suppository (50 mg) twice a day for 7 days and application
of Gyno-pevaril creme during 10 days is recommended.
The next step of treatment is normalization of vaginal
ecosystem.
Thank you for your
attention!