Obstetrics and gynecology. Inflammatory diseases of the female genital organs (bacterial vaginosis, chlamydial infection) (most important)

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Obstetrics and gynecology. Inflammatory diseases of the female genital organs (bacterial vaginosis, chlamydial infection) (most important)

Lecture notes, cheat sheets

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43. Inflammatory diseases of the female genital organs (bacterial vaginosis, chlamydial infection)

Factors contributing to the spread of infection are intrauterine interventions: abortion, diagnostic curettage, hysterosalpingography, probing of the uterine cavity, placement and removal of an intrauterine contraceptive.

Bacterial vaginosis. This disease is caused by a disruption of the biocenosis of the normal vaginal microflora. The main complaint of a woman is an increase in leucorrhoea; sometimes there may be itching (or burning) in the genital area. When examined in the speculum, there is no hyperemia or swelling of the vagina. The presence of bacterial vaginosis is confirmed by a positive amino test. The discharge does not smell of anything.

Treatment. Since anaerobic flora predominates in the vaginal biocenosis, trichopolum is used. Since the vaginal pH is alkaline, 1-2 douches are performed with solutions of boric acid, citric acid, and potassium permanganate. Clindomycin has a good positive effect. A prerequisite for the treatment of all colpitis is the restoration of normal vaginal microflora.

Chlamydia infection. Chlamydia are gram-negative rods. Currently, it is infection No. 1. Chlamydial infection contributes to the massive formation of adhesions in the abdominal cavity and, most importantly, in the ampullary section of the fallopian tubes. The main complaint among women will be infertility, often primary infertility. This infection does not have a clear clinical picture - it is mild and asymptomatic. For infection of chlamydial etiology, a characteristic symptom of perihepatitis is the formation of hepatic adhesions. This symptom was first noted in gonococcal pelvioperitonitis. Women with chlamydial infection complain of pain in the right hypochondrium, which must be differentiated from exacerbation of chronic cholecystitis, acute cholecystitis, various liver diseases, and in some cases with acute pneumonia. The real cause of these pains is perihepatitis, the formation of adhesions in the liver, where the pathogen enters through the lymphogenous route. Identification of chlamydia itself is difficult. If gonococcus can be seen in Gram smears, then the causative agent of chlamydial infection can only be determined using special studies - the method of immunofluorescence using immunoclonal antibodies. Due to the fact that chlamydia affects tissues that have columnar epithelium, it is necessary to take discharge from the cervical canal and urethra for analysis.

Treatment. Chlamydia is sensitive to tetracyclines. Doxycycline is prescribed. To treat infections caused by mycoplasma and ureoplasma, the same medications are used as for chlamydial therapy. The danger of these infections is that they cause infertility, premature termination of pregnancy, postpartum complications - chorioamnionitis, endometritis, metroendometritis. They have a negative effect on the fetus and placenta, causing chlamydial, mycoplasma, and viral pneumonia.

Author: Ivanov A.I.

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