GYNAECOLOGICAL

INFECTIONS
Presented by:
Reem Hawkash
Danah Almakayil
Mayada Alfadhil
Hamdah Alharthi

Supervisor Dr. Einas Mustafa Mudawi

 OBJECTIVES
Introduction

Presentation

Investigation

Diagnosis

Managment
 GYNECOLOGICAL INFECTIONS

Gynecological infections refer to infections affecting the female

reproductive system, including the vagina, cervix, uterus, fallopian tubes,
and ovaries.It is Common worldwide, with higher rates in low-resource
settings, and can Contributes to complications like infertility, ectopic
pregnancies, chronic pelvic pain, acute salpingo-oophoritis and TOA.

Risk Factors???
 GYNECOLOGICAL INFECTIONS

Risk Factors :
• Poor hygiene practices.
• Unprotected sexual intercourse.
• Hormonal imbalances.
• Compromised immunity (e.g., diabetes, HIV).
• High-risk behaviors: Multiple sexual partners, substance abuse.
 CLASSIFICATION

Bacterial infections: Fungal infection:

Syphilis Candidiasis
Bacterial vaginosis
Chlamydia
Neisseria gonorrhoea

Parasitic infections: Viral infections:

Pediculosis Pubis HIV
scabies HSV
Trichomoniasis HPV
 SYPHILIS

Treponema pallidum —spirochaete

Symptoms:
1. Primary syphilis
10–90 days postinfection.
Painless, genital ulcer (chancre)—may pass unnoticed on the cervix.
Inguinal lymphadenopathy.
2. Secondary syphilis 1. Sexual contact
Occurs within the first 2yrs of infection. 2. Vertical transmission
3. Blood transfusion or
Generalized polymorphic rash affecting palms and soles.
organ transplant (rare)
Generalized lymphadenopathy.
4. Close contact with
Genital condyloma lata.
infectious lesions
Anterior uveitis.
5. During birth
 SYPHILIS

3.Latent Syphilis :
Asymptomatic stage with positive serological tests.
Early Latent: Within 1 year of infection, infectious.
Late Latent: Beyond 1 year, typically non-infectious (Except Mother to fetus) but can
progress to tertiary syphilis.
Importance: Can reactivate if untreated, leading to tertiary syphilis.
Diagnosis: Positive treponemal and non-treponemal tests without clinical symptoms.
4.Tertiary syphilis
Presents in up to 40% of people infected for at least 2yrs, but may take 40+yrs to develop.
Neurosyphilis: tabes dorsalis and dementia.
Cardiovascular syphilis: commonly affecting the aortic root.
Gummas: inflammatory plaques or nodules.
 SYPHILIS
Diagnosis:
Labs:
▶︎Direct Detection: Use darkfield microscopy or PCR for lesion samples (best in early stages).
▶︎Serologic Testing:
1. Nontreponemal Tests: RPR or VDRL for screening and monitoring.
2. Treponemal Tests: FTA-ABS, TPPA, or EIA for confirmation.

Treatment
benzathine penicillin G 2.4 MU single dose IM (used in pregnancy)
Alternative for Penicillin Allergy: usually Doxycycline.
Penicillin desensitization is recommended for allergic pregnant women, as no effective
alternative is available for preventing congenital syphilis.

Fluorescent Treponemal Antibody-Absorption (FTA-ABS), T. pallidum Particle Agglutination (TPPA), Enzyme Immunoassay (EIA)
 BACTERIAL VIGINOSIS

BV is caused by an overgrowth of mixed anaerobes, including

Gardnerella and Mycoplasma hominis, which replace the
usually dominant vaginal lactobacilli.The commonest cause of
abnormal vaginal discharge in women of childbearing age.(Not
sexually transmitted)

Symptoms:
May be asymptomatic, but usually presents with a profuse,
whitish-grey, offensive-smelling vaginal discharge which a
characteristic ‘fishy’ smell.

if not treated can be associated with a number of pathologies

including (PID), and in pregnancy can lead to preterm birth and
rupture of membranes and miscarriage.
 BACTERIAL VIGINOSIS
Diagnosis: (Amsel criteria—3 out of 4 required for diagnosis.)
Homogeneous, thin, grayish-white vaginal discharge.
Positive “whiff test” (fishy odor when 10% KOH is added to a
sample).
Presence of clue cells on microscopy(Wet mount).
Elevated pH (>4.5).

Treatment:
-Metronidazole orally or vaginally.
-Clindamycin orally or vaginally.
Lifestyle factors—avoidance of vaginal douching/overwashing which
can destroy natural vaginal flora.
 CHLAMYDIA

Chlamydia is a common sexually transmitted

infection (STI) caused by Chlamydia trachomatis.

It primarily affects the female reproductive

system, causing cervicitis and pelvic inflammatory
disease (PID).

Mode of transmission:
It is transmitted through sexual contact
(vaginal, anal, or oral).
It can also be passed from mother to baby
during childbirth, leading to neonatal
infections.
 CHLAMYDIA
Clinical Features
~70–80% of cases are asymptomatic .
Symptoms
Dysuria
Abnormal vaginal discharge
Intermenstrual or postcoital bleeding
Lower abdominal pain

Diagnosis
Diagnosed by Nucleic Acid Amplification Test (NAAT).
Samples are collected via vulvovaginal swab (self-taken) or endocervical swab.

Treatment
Azithromycin 1g single dose or doxycycline 100mg bd for 7 days.
Contact tracing and treatment of partners.
 GONORRHEA

Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium

Neisseria gonorrhoeae.

Symptoms
Often asymptomatic, especially in women, and frequently
diagnosed during screening or contact tracing.
When symptoms are present, they may include:
• Vaginal discharge.
• Lower abdominal pain.
• Intermenstrual bleeding (IMB).
• Postcoital bleeding (PCB).
 GONORRHEA

Diagnosis
Endocervical or vulvovaginal swabs are tested
using NAAT (Nucleic Acid Amplification Test).
If NAAT confirms the diagnosis, cultures should
be taken from all infected sites before starting
antibiotics to assess antibiotic sensitivity.
Screening for co-infections (e.g., Chlamydia
trachomatis) is crucial, as dual infections are
common.
 GONORRHEA
Treatment
Dual therapy:
Parenteral third-generation cephalosporin (e.g., ceftriaxone).
Azithromycin: added to delay further antimicrobial resistance.

Alternative for severe penicillin allergy:

Spectinomycin, plus azithromycin.

Treatment includes contact tracing and managing sexual partners to

prevent reinfection.
 Questions
A 22-year-old sexually active woman presents with abnormal vaginal discharge and mild pelvic pain. She denies
fever or chills. On examination, cervical motion tenderness is noted. A cervical swab is sent for testing. What is the
most likely causative organism?

A) Neisseria gonorrhoeae
B) Mycoplasma genitalium
C) Chlamydia trachomatis
D) Trichomonas vaginalis

A 28-year-old woman presents with intermenstrual bleeding and lower abdominal pain. On examination, cervical
motion tenderness is noted. NAAT confirms Neisseria gonorrhoeae. What is the next step in management?

A) Observation and follow-up in 1 week

B) Treat with ceftriaxone and azithromycin
C) Start fluoroquinolones for 7 days
D) Perform pelvic ultrasound
 PARASITIC INFECTION (PEDICULOSIS PUBIS)

Pediculosis pubis is one of the most contagious STDs caused by crab louse or Phthirus pubis. It is also transmitted
through intimate contact and shared towels or sheets. The parasites deposit their eggs at the base of hair follicles.
The louse feeds on human blood.

CLINICAL FEATURES
● Intense itching in the pubic area.
● There may be the presence of a vulvar rash.
● The intense itching can cause insomnia, irritation and social embarrassment.
 PARASITIC INFECTION (PEDICULOSIS PUBIS)

Diagnosis

● Diagnosis is established on inspection - finding of eggs/ lice in the pubic hair. The louse can be identified
under the microscope.

Treatment

● Local application of permethrin cream 5% - two applications 10 days apart - to kill newly hatched eggs or
local application of gamma-benzene hexachloride 1% as lotion / cream or shampoo after showering so that the
drug effects last for 12 hours on 2 successive days. This treatment is contraindicated in pregnant and nursing
mothers. All clothes should be properly laundered.
 PARASITIC INFECTION (SCABIES)
It is transmitted through close contact/fomites and caused by itch mite.

CLINICAL FEATURES
● Intense burning along with intermittent episodes of intense itching/burning.
● Itching is more severe at night.
● It may present as papules, vesicles or burrows.

DIAGNOSIS
● It is established on microscopic examination of skin scrapings under oil.

TREATMENT
● lt consists of local application of permethrin cream 5% twice a day for 2 successive days or application of
30 ml of lotion over the entire skin surface, leaving it on for 12 hours. Pruritus may persist for a while; this should be
controlled with antihistamines. Treatment should be withhold during pregnancy and lactation. Clothes should be
properly laundered.
 PARASITIC INFECTION (TRICHOMONIASIS)
Trichomoniasis is a common sexually transmitted infection (STI) caused by a protozoan parasite called Trichomonas
vaginalis. It primarily affects the urogenital tract, particularly the vagina in women and the urethra in men.

Cause:
• The infection is caused by Trichomonas vaginalis, a single-celled, flagellated protozoan parasite.

Mode of Transmission:
• Spread primarily through sexual contact (vaginal, anal, or oral).
• Can also be transmitted through sharing sex toys.
 PARASITIC INFECTION (TRICHOMONIASIS)
Symptoms
• Ranges from asymptomatic to severe, acute inflammatory disease.
• Purulent, malodorous, thin, frothy discharge.
• Dysuria (external), dyspareunia and pruritis are common.
• strawberry cervix

Diagnosis
The gold standard is a nucleic acid amplification test (NAAT) preferably on a vaginal
or endocervical swab or on urine, with sensitivities and specificities reaching over 95%.
Microscopy and culture of a sample of the vaginal discharge are also used.

Treatment
Metronidazole 2g orally in a single dose.
Metronidazole 400–500mg bd for 5–7 days.
Contact tracing and treatment of partners.
FUNGAL INFECTION (CANDIDAL (MONILIAL) VAGINITIS)

● lt is a fungal infection caused by yeast-like microorganisms called Candida or Monilia.

● The commonest species causing human disease is Candida albicans, which is Gram positive and grows in
acidic medium.
● Almost 25% of women harbour Candida in the vagina.

RISK FACTORS:
These include promiscuity, immunosuppression, HIV infection. pregnancy, steroid therapy, following long-term broad
spectrum antibiotic therapy. use of oral contraceptive pills, diabetes mellitus, poor personal hygiene and obesity

CLINICAL FEATURES:
• Vulvar/vaginal pruritis.
• Burning , Irritation
• White, clumpy discharge.
• Normal vaginal PH.
FUNGAL INFECTION (CANDIDAL (MONILIAL) VAGINITIS)

DIAGNOSIS:
❖ Microscopic examination of a smear of the vaginal discharge treated with 10% KOH solution, which
dissolves all other cellular debris, leaving the mycelia and spores of the Candida.
❖ Gram staining of the discharge or Pap smears.
❖ Culture on Sabouraud's agar or Nickerson's medium.

TREATMENT:
• Topical intravaginal pessaries or oral imidazoles are effective
• Oral Imidazoles such as:
fluconazole , single dose 150 mg
 HERPES SIMPLEX VIRUS

Herpes simplex virus (HSV) is a double-stranded DNA virus.

There are two viral types, HSV-1 and HSV-2.

Transmission :
Direct contact with herpes sores, fluids, or skin: The virus spreads through skin-to-skin contact,
especially during sexual activity.

Asymptomatic shedding: Even without visible sores, the virus can still spread.

Mother-to-child transmission: A pregnant woman with an active HSV infection can pass the
virus to her baby during childbirth (neonatal herpes).
 HERPES SIMPLEX VIRUS

Symptoms:

• Blisters and sores

• Itching and burning
• Flu-like symptoms:

Diagnosis:

• clinical examination: we can often diagnose herpes based on the appearance of sores.
• Laboratory tests:
Swabs from the sores can be tested for the virus.
Look for Viral DNA with PCR.
Blood tests can detect antibodies to the virus.
Growing virus in cultur.
 HERPES SIMPLEX VIRUS

Treatment:

There is no cure for herpes, but antiviral medications can manage the symptoms:

• Acyclovir, Valacyclovir , and Famciclovir: These antiviral drugs reduce the frequency and
severity of outbreaks and help prevent transmission.

• Suppressive therapy: Daily antiviral medication can help

reduce the likelihood of outbreaks.
 HUMAN PAPILLOMA VIRUS

Human Papillomavirus (HPV) is a group of more than 200 related viruses, some of which can cause
genital warts and are associated with certain types of cancer. HPV is one of the most common sexually
transmitted infections.

Transmission :

Sexual contact: HPV is spread through vaginal, anal, or oral sex with an infected person. It
can also spread through close skin-to-skin contact.
Asymptomatic transmission: Even without visible warts or symptoms, the virus can still be
transmitted.
HPV can be passed from mother to baby during childbirth.
 HUMAN PAPILLOMA VIRUS

symptoms :
Asymptomatic: Most HPV infections do not cause symptoms and go away on their own without causing
health problems.
Genital warts: Small, flesh-colored or gray swellings that may be raised or flat and appear in the
genital area.
Pre-cancerous changes: In high-risk HPV types, there are usually no symptoms until the virus causes
abnormal cell changes, which can be detected through screening.

Associated Cancers:

Cervical cancer: Almost all cervical cancers are caused by high-risk HPV types.
Regular Pap smears or HPV tests are essential for early detection.
 HUMAN PAPILLOMA VIRUS

Diagnosis :
• Pap smear (Pap test): This test detects abnormal cervical cells that may develop into cancer.
• HPV DNA test: This can be used to detect the presence of high-risk HPV types in cervical cells.
• Visual diagnosis: Genital warts can often be diagnosed through a physical examination.

Treatment :
• Genital warts: These can be treated with prescription creams, cryotherapy (freezing), or surgical
removal.
• Abnormal cells: Pre-cancerous changes in cervical cells can be managed with procedures like
LEEP (Loop Electrosurgical Excision Procedure) or conization to remove affected tissue.
• Cancer treatment: Cancers caused by HPV are treated with surgery, radiation, or chemotherapy
depending on the type and stage.
 HUMAN IMMUNODEFICINCY VIRUS

HIV is a (RNA) retrovirus transmit-ted through

sexual contact, blood shared needles usually among intravenous drug users,
or vertical (mother-to-child) transmis- sion, which mainly occurs in the late third trimester or during
labour, delivery or breastfeeding.
The principal risks of mother-to-child (vertical) transmission are related to maternal plasma
viral load, obstetric factors and infant feeding

CLINICAL FEATURES :
Untreated, infection with HIV begins with an asymptomatic stage with gradual compromise of
immune function eventually leading to acquired immunodeficiency syndrome (AIDS).
The time between HIV infection and the development of AIDS ranges from a few months to as long
as 17 years in untreated patients.
 HUMAN IMMUNODEFICINCY VIRUS

Prevention :
pre-exposure prophylaxis
post-exposure prophylaxis
Use of condoms
Regular testing and early diagnosis
Harm reduction for drug use

Treatment :
Antiretroviral Therapy (ART) is the standard treatment for HIV.
ART involves taking a combination of HIV medications (often in a single daily pill) that reduce the viral load to
undetectable levels, allowing the immune system to recover and preventing the progression to AIDS. ART also
helps prevent the transmission of the virus to others.
OUR REFERENCES
 THANK YOU

December 2024