1. Genital Infection
Khalid Sait FRCSC
Professor
Faculty of Medicine
King Abdulaziz University

2. VAGINAL ECOSYSTEM
n NORMAL FLORA:
LACTOBACILLUS
STREPTOCCOCCUS STAPH,
GARDNERELLA
PEPTOSTREPTOCOCCUS
BACTERODIDES
CANDIDA
n NORMAL pH 3.8 – 4.2

3. DISTURBANCE OF THE
ECHOSYSTEM
n ANTIBIOTICS
n HORMONES
n CONTRACEPTIVES
n DOUCHES
n SEXUAL INTERCOURSE
n STD’S
n STRESS

5. WET PREPARATION
SLIDE TEST

8. CANDIDAL VAGINITIS
n Main Complaint: Pruritus
n Thick white cottage cheese discharge
n No odor
n Adherent discharge , hyperemic vagina
n Ph less than 4.5
n KOH- Hyphae and pseudohyphae
n Treatment : Anti Fungal

11. ANTIFUNGAL CREAMS
n CLOTRIMAZOLE (CANESTEN)
n BUTOCONAZOLE (FEMSTAT)
n MICONAZOLE (MONISTAT)
n TICONAZOLE (GYNECURE)
n TERCONAZOLE (TERAZOL)

12. CANDIDA RESISTANT STRAINS
n ORAL KETOCONAZOLE (NIZORAL)
200 mg po bid x 5 days
n ORAL FLUCONAZOLE (DIFLUCAN)
n 150 MG PO X 1 DOSE

13. CANDIDA RESISTANT
STRAINS
n 1% GENTIAN VIOLET
n 3% POTASSIUM SORBATE
n BORIC ACID
600 MG GELATIN CAPSULE
INTRAVAGINALLY OD X 2 WEEKS

14. CANDIDA VAGINITIS
RECURRENCE
n Different species of Candida
n Insufficient duration of treatment
n Re-infection VS Recurrence
n HIV + Patients
n Post menopausal women

16. TRICHOMONAS VAGINALIS
n Main complaint: copious D/C
n Yellow, grey, green, frothy D/C
n +Odor
n Pseudomembrane, strawberry cervix
n pH>6
n Wet mount : flagellated organisms
n Rx: PO Flagyl+ partners

23. TRICHOMONAS
TREATMENT
n METRONIDAZOLE
n 500 mg PO BID X 7 DAYS OR
n 2 gm. single dose
n TREAT PARTNERS SIMULTANEOUSLY
n RESISTANT STRAINS- HIGH DOSE 2.5 G/
DAY X 10 DAYS OR IV
n CLOTRIMAZOLE CRAM

24. TRICHOMONAS TREATMENT
(CONT’D)
n HYPERTONIC SALINE
PROPYLENE GLYCOL
n TREAT IN PREGNANCY:
CLOTRIMAZOLE
METRONIDAZOLE

26. BACTERIAL VAGINOSIS
n MAIN COMPLAIN: MALODOROS D/C
n HOMOGENEDUS, THIN-GRAY WHITE D/C
n +++ODOR
n Ph 5-6
n WET MOUNT CLUE CELLS
n KOH ++ WHIFF TEST( AMINE)
n Rx: FLAGYL / CLINDAMYCIN + PARTNER

27. BACTERIAL VAGINOSIS
n 50% OF VAGINITIS
n GARDNERELLA VAGINALIS,
MOBILUNCUS,BACTEROIDES,
PEPTOSTREPTOCCOCCUS
n INCREASED INCIDENCE OF PRETERM
LABOR PROM, CHORIOAMNONITIS

28. BACTERIAL VAGINOSIS
n 3 OF 4 CRITERIA TO MAKE DIAGNOSIS:
pH>4.5 (USUALLY 5-6)
CLUE CELLS
POSITIVE KOH TEST
HOMOGENOUS DISCHARGE

29. BACTERIAL VAGINOSIS HISTORY
OF NOMENCLATURE
1. Nonspecific vaginitis (1892)
2. Haemophilus vaginitis (1955)
3. Corynebacterium vaginitis (1963)
4. Gardnerella vaginitis (1980)
5. Anaerobic vaginosis( 1982)
6. Nonspecific vaginosis (1984)
7. Bacterial vaginosis (1984)

33. DISEASES EPIDEMIOLOGICALLY
LINKED TO BACTERIAL VAGINOSIS
n GYNECOLOGIC
n Abnormal vaginal discharge
n Mucoprulent cervicitis
n Urinary tract infection
n Postoperative infection
n Cervical dysplasia
n Nonpuerperal endometritis
n Pelvic inflammatory disease
n OBSTETRIC
n Chorioamnionitis
n Premature labor
n Premature rupture of
membrane
n Postpartum endometritis

34. BACTERIAL VAGINOSIS
TREATMENT
n ONLY IF SYMPTOMATIC
n TREAT PARTNER?
n RECURRENCES
n TREAT IN PREGNANCY:
n 1ST TRIMESTER :-AMOXIL
n -CLINDAMYCIN

35. BACTERIAL VAGINOSIS
TREAMENT
n METRONIDAZOLE
n INTRAVAGINAL GEL 0.75% BID X 5 DAYS
n 500 MG PO BID X 7 DAYS
n 2 GRAM SINGLE DOSE
n CLINDAMYCIN
n 2% CREAM OB X 7 DAYS
n 300 MG BID X 7 DAYS
n HYDROGEN PEROXIDE

38. ACTINOMYCES
n ACTINOMYCES ISRAELI
n WOMEN WITH IUD’S

40. HERPES SIMPLEX
n PAINFUL ULCER
n TENDER NODE
n SWAB FOR CULTUR FROM THE ULCER
IS IMPORTANT
n TREATMENT: ACYCLOVIR
FAMCICLOVIR
n TREATMENT OF PARTNER

45. MOLLUSCUM CONTIOSUM
n Umbilicated papule
n DNA pox virus
n Spont. resoluation may up to 2 years
n Cryo. or laser or excision

50. CHANCER
n PAINLESS ULCER
n NON TENDER LYMPH NODE
n VDRL
n TPHAT
n EXUDATE FOR DARK FIELD MIC
n PENICILLIN G 2.4- 7.2 U IM
n TREAT PARTNER

53. Chancroid
n Haemophilis ducreyi
n PAINFUL ULCER
n Treatment
Cotrimoxazol or erythromycin

64. Manifestation of HPV
genotypes
Genotype Lesions
HPV 6 &11 Genital warts
HPV 16, 18, 31 Vulval intraepithelial neoplasia
squamous cell carcinoma

65. n 1% of the adult population have symptomatic
External Genital Warts.
n Infection occur during the first few years after
onset of sexual activity so infection among
older women is more likely to reflect persistent
infection.

66. n Genital human papillomavirus (HPV) infection
is the most common sexual transmitted
disease.
n 10-30% of the population in Canada are
infected.
n The prevalence of HPV is highest among
sexually active adolescents and young adults.

67. n Clinical manifestation of HPV infection
include asymptomatic infection and dysplastic
cellular changes that range from Koiliocytosis
to precancerous and malignant cellular
changes.
n Spontaneous clearance of the virus occur in
40-60% because of acquired cellular immune
response.

68. HPV - Treatment
n Observation
n Podophyllin
n Trichloroacetic acid
n Interferon
n Imiquimod ( Aldara)
n Excision /Laser

69. Treatment
n First line treatment will achieve clearance within 1-6
months, although disease persist in up to one third of
patients.
n Home therapy can be proposed in most cases as first
line therapy. Acuminate warts respond in 90% but
macular and papular lesions in only 50% of cases.
n Lesions occurring in new sites during treatment or
after clearance do not necessitate a change of
treatment modality
n Other concern.

71. PID
n NISSERIA GONORRHEAE
n CHLAMYDIA TRACHOMATIS
n G – VE AND ANAEROBIC

72. PID
n SYMPTOMS AND SIGNS
n CULTURE
n CERVICAL PCR
n TREATMENT
CEFXITIN 2 G IV 8 H + DOXYCYCLIN 100
MG IV BID FOR 2-5 DAYS
n TREAT PARTNER WITH CEFIXIME 400 MG +
AZITHROMYCIN 1 GM PO SINGLE DOZE

73. Genital Infection
Khalid Sait FRCSC
Professor of
Gynecological Oncologist
Faclty of Medicine
King Abdulaziz University Q&A