盆腔感性疾病.pptVIP

女性生殖系统炎症Genital inflammatory diseases 朱芝玲 复旦大学附属妇产科医院 Female Reproductive Organs 阴道生态系统及影响因素 阴道正常菌群 维持阴道生态平衡 乳杆菌 阴道PH值 雌激素 细 菌 性 阴 道 病 阴道内正常菌群失调所致的一种混合感染 DIAGNOSIS Gray homogenous discharge adherent to vaginal walls – no erythema/edema. pH akaline (over 4.5) Presence of “Clue cells” Cells studded with bacteria Cell wall indistinct Fishy amine odor when 10% KOH added (TV, semen also causes odor releases. Relative absence of WBCs. Treatment Oral metronidazole 400mg BID for 7 days Oral clindamycin 300mg BID for 7 days No treatment for partner? (unrelated to recurrence) Recurrence not uncommon – 1) Repeat treatment – 2) Longer course 滴虫性阴道炎Trichomonal vaginitis 临床表现 分泌物增多 黄绿色、泡沐状 外阴骚痒 阴道粘膜充血 草莓样宫颈 诊 断 盆底主要支持结构 注意事项 外阴阴道假丝酵母菌病Vulvovaginal candidiasis 病因 条件致病菌 白假丝酵母菌（80－90％） 其它假丝酵母菌（10－20％） 诱发因素 妊娠、糖尿病、广谱抗生素等 PSEUDOHYPHAE 临床表现 临床分类 单纯性 复杂性 治疗 消除诱因 局部用药：栓剂 全身用药：氟康唑等 性伴侣治疗 盆腔炎性疾病Pelvic inflammatory disease PID - Clinical Features Lower abdominal pain all Vaginal discharge ~1/2 Vaginal bleeding ~1/2 Dysuria ~1/4 Nausea, vomiting, anorexia ~1/4 Treatment for acute PID Surgical treatment Severe cases Where there is clear evidence of a pelvic abscess. Rupture of abscess 盆腔炎性疾病后遗症sequelae of PID 盆腔炎性疾病后遗症PID - Prognosis Chronic pain 15% Subsequent PID 20-25% Infertility after 1 infection 10-15% after 2 infections 25-35% after 3 infections 50-75% Ectopic pregnancy (with next pregnancy) 7%* CONSEQUENCES FREQUENCY * 6-10 fold increase over normal incidence OG Hospital of FuDan University 病因： 传播方式 性生活直接传播 间接传播 分泌物生理盐水悬滴法 分泌物培养 注意事项 治 疗 全身用药 甲硝唑或替硝唑 2g 顿服 甲硝唑或替硝唑 400mg b.i.dΧ7天 局部用药 甲硝唑阴道泡腾片 200mg q.dΧ7天 疗效50％ 性伴侣治疗 随访 妊娠期治疗 Pathogenesis of PID Primary endocervicitis ? N. gonorrhoeae ??C. trachomatis ??other ? Factors influencing spread of bacteria ? cervical and endometrial infection ? state of cervical mucus ? retrograde me