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INFLAMMATORY DISEASES OF THE UPPER DEPARTMENT OF FEMALE GENITAL ORGANS.

Acute salpingo-oophoritis (in first place in frequency). The infectious process passes to the ovary during ovulation, when after the release of the egg the wound surface is exposed, that is, the entrance gate to the infection.

Clinic: pains of various nature and severity of the lower abdomen, the process is usually bilateral. Symptoms of intoxication (fever, chills, weakness, malaise, etc.).

Inspection in the mirrors: purulent discharge, inflammatory changes in the vagina. In a bimanual study, dense edematous painful appendages (normally they are not determined). If pelvoperitonitis develops, symptoms of peritoneal irritation are noted and with a bimanual examination, it is not possible to clearly contour either the uterus or the appendages. The inflammatory process begins with the vaginal mucosa, then the transition to the muscle and serous layers. Due to the adhesion of the fallopian tubes, the ampulla of the fallopian tubes is sealed - or hydrosalpinx. If the infection got into the ovary, purulent fusion occurs. With a bimanual study, a painful motionless formation is determined, since an adhesion process develops. The diagnosis is also based on bacteriological and bacterioscopic examination. Ultrasound laparoscopy is informative only in the case of pyosalpinx. Treatment: surgical (tubectomy with pyosalpinx, with combined damage - adnexectomy, drainage of the abdominal cavity). Emergency indications for surgery occur in the presence of purulent tubo-ovarian formations:

1. perforation of the abscess;

2. the threat of perforation;

3. pelvioperitonitis;

4. peritonitis.

Endometritis - damage to the endometrium. With damage to the endometrium and muscle layer - metroendometritis.

Metrothrombophlebitis - damage to the endometrium, myometrium and blood vessels (with infected abortions). These diseases occur after any interventions, operations.

Clinic: symptoms of intoxication, pain, purulent-bloody discharge.

Bimanual examination: the uterus is swollen, enlarged, soft, painful. Quite sluggish endometritis leads to cicatricial changes in the endometrium and subsequently to menstrual irregularities up to infertility.

Endometriosis is a pathological process characterized by the growth of the uterine mucosa (endometrium) inside and outside it. In this regard, two types of endometriosis are distinguished: genital (developing inside the reproductive system), including adenomyosis, and extragenital (in other organs). The first type is most common, but the second is also found. In some cases, a combination of both forms is possible.

The causes of the disease are not fully understood, but there is a connection with abortion, hormonal abnormalities, and stress. Also a large role is played by a genetic predisposition. Among the main symptoms, there are:

• pain during menstruation, during intercourse;

• dark blood discharge before and after menstruation;

• pain in the lower abdomen, radiating to the anus;

• discharge from the mammary glands, etc.

Depending on the stage of the disease and the localization of the nodes, the individual characteristics of the patient and other factors, conservative therapy or surgical intervention, as well as their combination, is indicated. With minor complaints, small single formations, further regular monitoring by a specialist is possible without treatment. However, if the pathological process is progressing, the use of medications will most likely be required. To eliminate symptoms, such as lower abdominal pain, painkillers are prescribed, and hormonal drugs are used to combat the disease itself.

Trichomoniasis It is one of the most common inflammatory diseases of the lower

genitals, caused by vaginal trichomonads - the simplest of the class of flagella.

Infection occurs, as a rule, through sexual contact. Non-sexual infection is possible through the hands of medical personnel in case of non-compliance with aseptic rules, as well as through personal toilet items (sponges, washcloths, night pots, bedding, etc.).

The household way of infection is more often observed in girls; they can become infected during childbirth by mothers.

Trichomoniasis is diagnosed in 40-80% of patients suffering from gynecological diseases - especially often (90%) in patients with gonorrhea, due to the common pathways of infection. In addition, phagocytosis of gonococcus trichomonads is noted. In 86% of women, the lesion is localized in the lower part of the genitourinary organs (of which 98.9% develop vulvovaginitis), an ascending process is present in 14%.

There is a fresh disease with acute, subacute and torpid (low-symptom) course, chronic trichomoniasis (disease duration more than 2 years) and asymptomatic trichomoniasis (persistent and transient trichomonas carriage). The incubation period ranges from 3 days to 3-4 weeks, averaging 10-14 days.

Clinical forms of trichomoniasis:

1. Trichomonas vulvitis and vestibulitis. Complaints of a burning sensation in the external genital area, profuse purulent foamy discharge, itching, and sometimes frequent urges to urinate. On examination, the mucous membrane of the vulva and vagina is swollen, hyperemic, covered with liquid purulent secretions with small-pointed hemorrhages (erosion).

2. Trichomonas urethritis.

3. Trichomonas colpitis.

4. Trichomonas endocervicitis.

The diagnosis is made on the basis of complaints, anamnesis, clinic and detection of trichomonads with microscopy of pathological material, less often crops on artificial nutrient media.

Treatment. An indispensable condition is the simultaneous treatment of both spouses (or sexual partners). During treatment and subsequent monitoring, sexual activity is prohibited. Local treatment of trichomoniasis has lost its significance and is carried out only with intolerance to metronidazole or with a stubborn course of mixed infection. The main anti-trichomonas drug is metronidazole (Trichopolum). 5 grams are used per course (sometimes up to 7.5 - 10 grams).
4 days at 0.25 3 times a day and the next 4 days at 0.25 2 times a day - the first day at 0.5 g. 2 times, in the second 0.25 gr. 3 times, in the following days, 0.25 g. 2 times. This technique is considered the most effective. Pregnant treatment with metronidazole should be carried out only in the last trimester.

Cure criteria: absence of Trichomonas in smears during 3 menstrual cycles.

Gonorrhea. Called by gonococcus. The incubation period for gonorrhea is from 3-5 to 14-15 days.

The transmission path is often sexual, household way (through linen, washcloths, towels). It is observed very rarely (more often in girls). Gonococci affect parts of the reproductive system lined with single-row epithelium: cylindrical (urethra, paraurethral passages, excretory ducts of the large glands of the vestibule, cervical canal, uterine body, fallopian tubes), and endothelium (synovial membranes, peritoneum, germinal endothelium, ovaries), as well as bladder and rectum.

The vaginal mucosa, covered with stratified squamous epithelium, is resistant to gonococci. Gonococcus spreads more often along the mucous membrane by a direct transition along the “channels” (the canaliculary pathway of distribution is along the length). Gonococci can enter the bloodstream, which is facilitated by an abundant network of blood vessels in the genitourinary organs. There is no acquired immunity in gonorrhea. Reinfection is as acute as the primary infection. Congenital immunity also does not exist.

Classification.

• acute

• subacute

• torpid (low symptom)

By localization

a. Lower genital area

b. Upper genital area

Gonorrhea of ​​the lower genital organs:

• Gonorrheal urethritis;

• Gonorrheal endocervicitis;

• Gonorrheal bartholinitis;

• Gonorrheal colpitis and vulvovaginitis;

• Gonorrheal proctitis.

Gonorrhea of ​​the upper genital area:

• Gonorrheal endometritis;

• Gonorrheal salpingoophoritis;

• Gonorrheal pelvioperitonitis.

Diagnostics.

Bacterioscopy (material from the cervical canal, urethra, vagina, and, if necessary, the rectum).

Bacteriological methods - sowing of these secretions on a medium with the addition of native protein and vitamins.

In chronic and torpid gonorrhea, these studies are carried out during the first 3 days after provocation.

Provocation methods:

• chemical - lubrication of the urethra with a solution of silver nitrate;

• biological - intramuscular administration of gonovaccine (500 million microbial bodies);

• physiological - menstruation, when smears are taken on the days of greatest bleeding;

• physiotherapeutic procedures - inductothermy, ultrasound.

Treatment:

Antibacterial therapy:

The criterion for the cure of gonorrhea is the absence of gonococci in smears after a complex provocation for 3 days of menstrual cycles.

Syphilis causes a spiral-shaped microorganism, pale treponema. The incubation period: from 10 to 50 days, can increase to 190 days if infection occurred at the time of taking antibiotics.

Routes of transmission of the pathogen: Infection with syphilis most often occurs through sexual contact. It is also possible domestic infection, when using objects contaminated with the patient’s secretions (saliva, seed, blood, vaginal and other secretions). During pregnancy, the fetus may become infected by an infected mother.

The clinical picture:

Stage I - Primary syphilis: at the site of treponema penetration, a painless ulcer (hard chancre, 0.7 - 1.5 cm in size) appears on the genitals, less often in other places (vagina, cervix, anus, oral mucosa). The ulcer disappears after 4-8 weeks, even without treatment.

Stage II - Without treatment, after 2 - 2.5 months, secondary syphilis develops, which is characterized by damage to the skin and mucous membranes in the form of various rashes (spots, tubercles, nodules that are sharply delimited from healthy skin, do not merge, do not peel, do not itch, located on the skin of the trunk and limbs, are on the skin of the head and face). This rash is contagious! In addition, lymph nodes increase, possibly an increase in body temperature, weakness, malaise. Without treatment, this rash spontaneously disappears after 2-3 months, relapses can be repeated several times within 1 to 3 years.

Stage III - In a small number of untreated or improperly treated patients, the disease passes into tertiary syphilis in 4 to 10 years, involving various internal organs (cerebral vessels, aorta, damage to the nervous system, bone damage, etc.)

Laboratory diagnostics:

• microscopy of fresh smears in a dark field reveals spirochetes in primary and sometimes secondary syphilis;

• express method for determination of serum reagents in the blood (RPR-test, VDRL-test), with primary syphilis can be negative;

• a test for specific antibodies to spirochete in blood serum (ELISA, FTA-FDS test, MHA-TP test), with primary syphilis may be negative

• Wasserman RW reaction, becomes positive at 6-7 weeks after infection

• during pregnancy, the reactions of RIBT, RIF, RW Wasserman reaction can be false positive and this means that the pregnant woman may not be sick with syphilis !!!

Treatment: Antibacterial therapy is carried out in specialized institutions (ARC), after the end of treatment, long-term monitoring for the presence of antibodies in the blood serum is carried out, only after their complete disappearance the patient is considered recovered. Detection of syphilis in a pregnant woman is NOT an indication for abortion. There are treatments during pregnancy. After birth, the child is subject to special observation, if necessary, he is treated.
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INFLAMMATORY DISEASES OF THE UPPER DEPARTMENT OF FEMALE GENITAL ORGANS.

  1. INFLAMMATORY DISEASES OF THE UPPER DEPARTMENT OF FEMALE GENITAL ORGANS.
    Acute salpingo-oophoritis (in first place in frequency). The infectious process passes to the ovary during ovulation, when after the release of the egg the wound surface is exposed, that is, the entrance gate to the infection. Clinic: pains of various nature and severity of the lower abdomen, the process is usually bilateral. Symptoms of intoxication (fever, chills, weakness, malaise, etc.).
  2. INFLAMMATORY DISEASES OF THE LOWER DEPARTMENT OF FEMALE GENITAL ORGANS
    Chlamydial infection - up to 60-70% of patients with VZNE are infected with chlamydia. It is transmitted only sexually. Has a lot to do with gonococci. Chlamydia - Gr (-) intracellular bacteria tropic to the cylindrical epithelium (cervical canal, fallopian tubes, bartholin gland ducts, urethra and paraurethral passages). The incubation period is 20-30 days. There is no bright clinic, initially there is a tendency to
  3. INFLAMMATORY DISEASES OF THE LOWER DEPARTMENT OF FEMALE GENITAL ORGANS
    Chlamydial infection - up to 60-70% of patients with VZNE are infected with chlamydia. It is transmitted only sexually. Has a lot to do with gonococci. Chlamydia - Gr (-) intracellular bacteria tropic to the cylindrical epithelium (cervical canal, fallopian tubes, bartholin gland ducts, urethra and paraurethral passages). The incubation period is 20-30 days. There is no bright clinic, initially there is a tendency to
  4. Female genital inflammatory diseases
    Inflammatory diseases of the female genital organs (VZPO) occupy the first place in the structure of gynecological diseases. About 40% of gynecological patients in the hospital have VZPO. The cause of all inflammatory diseases of the genitals are microbes, which most often enter the body of a woman through sexual contact. Pathogens can also spread by the lymphogenous, hematogenous route,
  5. INFLAMMATORY DISEASES OF FEMALE GENITAL ORGANS
    The problem of inflammatory processes of the genitals has always been the focus of attention of obstetrician-gynecologists for the following reasons: • in frequency they occupy the first place in gynecology; • their consequences are very diverse and include various violations of the menstrual and reproductive functions (infertility, miscarriage, ectopic pregnancy), as well as general organ damage involving
  6. Inflammatory diseases of the female genital organs (bacterial vaginosis, chlamydial infection)
    Factors contributing to the spread of infection are intrauterine interventions: abortion, diagnostic curettage, hysterosal pingography, probing of the uterine cavity, placement and removal of an intrauterine contraceptive. Bacterial vaginosis. This disease is caused by a violation of the biocenosis of the normal microflora of the vagina. The main complaint of a woman is to increase the allocation
  7. Inflammatory diseases of the female genital organs (viral infections, candidal colpitis)
    Viral infections. Herpes virus of the second serotype and human papillomavirus cause inflammation of the cervix. Cytomegalovirus infection proceeds in the form of carriage, but has a damaging effect on the fetus, causing, in addition to miscarriages, malformation of the fetus. All viral infections are latent, difficult to treat, prone to relapses and exacerbations. With herpetic infection during
  8. Purulent-inflammatory diseases of the upper genitalia
    Purulent-inflammatory diseases of the upper sections
  9. Sexually transmitted diseases of the female genital organs
    One of the negative phenomena of our modernity is the rapid increase in the frequency and number of sexually transmitted diseases. This is facilitated by changes in the orientation of sexual behavior of young people, the widespread use of contraceptives, the expansion of international tourism, prostitution, the resistance of pathogens to antibacterial agents and the absence of etiopathogenetic
  10. 2. General information about inflammatory diseases of the female reproductive system.
    Infectious damage, depending on the localization, causes inflammation: • of the vagina (colpitis); • external genitalia (vulvitis); • large gland of the vestibule (bartholinitis); • cervix (cervicitis); • inner lining of the cervical canal (endocervicitis); • the inner lining of the uterus (endometritis); • fallopian tubes (salpingitis); • ovaries (oophoritis);
  11. Genital inflammatory diseases
    Inflammatory diseases of the female genital organs are the most common gynecological pathology. They most often become the main cause of infertility in women. These diseases, caused by various microorganisms, arise as a result of infectious processes in the urethra, vulva (external genitalia of a woman), vagina, uterus, fallopian tubes and ovaries. Usually,
  12. Inflammatory diseases of the internal genital organs in girls and girls
    Definition of a concept. Inflammatory diseases of the internal genitalia in girls and girls include endocervicitis, endometritis, salpingoophoritis, perimetritis, pelvioperitonitis. As with vulvovaginitis, inflammatory processes of the internal genital organs are divided into non-specific (more often) and specific (rarely). According to localization, salpingoophoritis is most often found. Frequency. For the last
  13. Inflammatory diseases of the external genitalia in girls and girls
    Definition of a concept. Inflammatory diseases of the genitals in girls and girls are inflammation of the external genitalia and vagina, uterine appendages and, less commonly, the uterus of various etiologies. At the same time, age-specificity of forms of inflammatory diseases takes place: during childhood, it is most often vulvovaginitis, and during puberty, inflammation of the uterus and sometimes the uterus. 3.4.1.
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