Gynecological inflammations

Inflammation of a woman's genitals is the most common reason for visiting a gynecological office. In most cases, it is an infectious disease, often sexually transmitted. Anatomically, according to localization, it is divided into :
 * Inflammation of external organs:
 * vulvititis,
 * bartholinitis.
 * Inflammation of internal organs:


 * colpitis ( vaginitis ),
 * cervicitis ,
 * inflammations of the uterus: endometritis, myometritis , perimetritis ,
 * adnexitis ,
 * deep pelvic inflammation ( pelvic inflammatory disease, PID), i.e. inflammation of the uterine appendages, ligaments and pelvic peritoneum.

Several floors can be affected at the same time, e.g. simultaneously the vagina and external genitalia irritated by vaginal discharge, such as vulvovaginitis.

Etiological agent
Bacteria (e.g. bacterial vaginosis, chlamydial infections , etc.), viruses (e.g. HPV - condylomata accuminata , herpes genitalis, etc.), fungi (e.g. vulvovaginal candidiasis ) and parasites (e.g. trichomoniasis ) apply.

The spread of infection can take place per continuitatem, hematogenous or lymphogenous , ascending or descending. The most common spread is the intracanalicular rise of microorganisms through the genitals.

Symptoms
Symptoms include: fluor (discharge), dyspareunia (painful intercourse), dysmenorrhoea (painful menses), pelvalgia (pain in the lower abdomen), sacralgia (pain in the lower back). As a complication of these infections, adhesions in the abdominal cavity, infertility causing even ectopic pregnancy or sterility can occur.

Diagnostics
The basis is anamnesis, a physical examination, including a vaginal examination with a smear of vaginal secretions for microscopic examination , an amine test and pH determination. Microbiological culture is only an additional examination, it is burdened by time latency, and the vast majority of inflammations can be diagnosed even without it. In the case of inflammation of the pelvic organs, in addition to the physical examination, ultrasonography is also an important modality.

Microscopic examination
The basic and most telling microscopic examination is native microscopy at 400x magnification, possibly supplemented by microscopy with a few drops of 10% potassium hydroxide ( amine test - see below, but also better visibility of yeast). Six classes of microbial vaginal image (MOP I–VI) stained according to Gram are already considered obsolete. On the other hand, native microscopy is very time-consuming and requires a great deal of experience with interpretation, so it is usually performed less often than the examination of stained preparations according to Gram or Giemsa.

In the native preparation, the presence and amount of leukocytes, epithelia and clue cells, microorganisms are evaluated. The movement of some microorganisms (e.g. trichomonads) can be evaluated in phase contrast.

Amine test
In the alkaline enviroment created by the pottasium hydroxide solution, biogenic amines (putrescine, cadeverine and tyramine ). are released during bacterial vaginosis. These are manifested by an unmistakable fishy smell.

Treatment
Therapy is causal according to the identified etiopathogenetic agent. Probiotic cultures of lactobacilli are not very important, as they contain other strains of lactobacilli than are natural for the vaginal environment.

There are over-the-counter antifungal preparations for the treatment of vaginal candidiasis. Manufacturers sometimes add lactic acid to them, which acidifies vaginal secretions and creates an unsuitable environment for the development of bacterial vaginosis.

Related Articles

 * Vulvitis
 * Vulvovaginitis
 * Trichomonad vulvovaginitis
 * Bacterial vaginosis
 * Vulvovaginitis candidomyceta
 * Deeo pelvic inflammatory disease
 * Sexually transmitted diseases