阴道局部免疫与阴道炎症 上海交通大学医学院精品课程课件_1.pptVIP

2006-11-27 Vulvovvaginal Infection Vulvovaginal Infections Definition inflammation of the vagina(阴道) and/or vulva (外阴) Defence Mechanisms Closure of the introitus（入口） Vaginal acidity (pH ? 4.5) Glandular secretions Defence mechanisms Closure of the introitus In children and virgin adults the vaginal canal is only a potential space kept closed by the surrounding muscles and provides another physical barrier Defence Mechanisms Vaginal acidity (pH ? 4.5) Glycogen(糖原) is produced by vaginal epithelium influenced by estrogens and is converted to lactic acid by Doderlein’s bacillus (德得来因杆菌). This maintains the vaginal pH between 3 and 4 which inhibits most other organisms Defence mechanisms Thick layer of vaginal squamous epithelium This is a considerable physical barrier to infection. Continual desquamation(脱落) of the superficial keratohyalin(角质透明蛋白) layer and glycogen production, both dependent upon ovarian estrogen action, combat bacteria. In children and post-menopausal patients the epithelium lacks oestrogen stimulation and is thin and easily traumatized or infected. Defence mechanisms Glandular secretions from the cervix and Bartholin’s glands(前庭大腺) maintain an outward fluid current helping to clear the canal of debris. In addition, cervical secretion contains immunoglobulins, especially IgA, and there are varying numbers of polymorphs, lymphocytes and macrophages Vaginal discharge-Composition Tissue fluid, cell debris, carbohydrate, lactobacilli(乳酸杆菌), lactic acid. The pH is about 4.5, a degree of acidity which inhibits the growth of organisms other than the lactobacills. Risk factors for Vulvovaginitis pregnant uncontrolled diabetes taking birth control pills taking antibiotics or corticosteroids previous candidal(念珠菌) infections Risk factors for Vulvovaginitis frequent sexual intercourse use douches(冲洗) use vaginal sponges or an IUD wear tight clothing (jeans, synthetic underwear, wet bat