FLUOR ALBUS

Soffin Arfian
SMF Obstetri & Ginekologi RS PKU Muhammadiyah
Surakarta / FK UMS
NORMAL VAGINA
The normal vaginal flora is predominantly aerobic,
with an average of six different species of bacteria,the
most common of which is hydrogen peroxide
producing lactobacilli
The microbiology of the vagina is determined by
factors that affect the ability of bacteria to survive.
These factors include vaginal pH and the avaibility
of glucose for bacterial metabolism. The normal
pH is lower than 4.5 which is maintained by the
production of lactid acid.
Esterogen-stimulated vaginal epithelial cells are rich
in glicogen. Vaginal epithelial cell breakdown glycogen
to monosaccharide ,which can then be converted by
lactobacilli to lactic acid
Clue cells are superficial vaginal epithelial cells
with adherent bacteria,usually G.vaginalis which
obliterates the crisp cell border and usually can be
visualized microscopically
VAGINAL INFECTION
1. Bacterial vaginosis

2. Trichomonas vaginitis

3. Vulvovaginal Candidiasis
BACTERIAL VAGINOSIS
Bacterial vaginosis has previously been referred to as
nonspesific vaginitis or Gardnerella vaginitis. It is an
alteration of normal vaginal bacterial flora that results
in the loss of hydrogen peroxide producing
lactbacilli and an overgrowth of predominantly
anaerobic bacteria.
Anaerobic bacteria can be found in less than 1% of the
flora of normal women.
A. Diagnosis
 A fishy vaginal odor
 Vaginal secretions are gray and thinly coat the
vaginal walls
 The pH of these secretions is higher than 4.5
(usually 4.7-5.7)
 Microscopy of the vaginal secretion reveals an
increased number of clue cells (more than 20%)
 The addition of KOH (whiff test) to the vaginal
secretions releases fishy ,amine like odor
B. Treatment
Ideally tretment of BV should inhibit anaerobes but
not vaginal lactobacilli:

 Metronidazole
 Clindamycin
TRICHOMONAS VAGINITIS
Trichomonas Vaginitis is caused by the sexually
transmitted , flagellated parasite , trichomonas
vaginalis. The transmission rate is high,70% of males
contract the disease after a single exposure to an
infected female, which suggest that the rate of male to
female transmission is even higher. Trichomonas
Vaginitis often accompanies bacterial vaginosis
A . Diagnosis

 Trichomonas Vaginitis is associated with

profuse,purulent,malodorous vaginal discharge that
may be accompanied by vulvar pruritus
 Vaginal secretions may exude from the vagina
 In patient with high concentrations of organism, a patchy
vaginal erythema and colpitis mascularis (strawberry Cx)
may be observed
 The pH of the vaginal secretion is usually higher than 5.0
 Microscopy of the secretions reveals motile
trichomonas and increased numbers of leucocytes
 Clue cells may be present because of the common
association with BV
 The whiff test may also be positive
B. Treatment

 Metronidazole

 The sexual partner should also be treated

VULVOVAGINAL CANDIDIASIS
It is estimated that as many as 75% of women
experience at least one episode of Vulvovaginal
Candidiasis during her lifetimes. Almost 45% of
women will experience two or more episodes per
year. Candidia albicans is responsible for 85-90%
of vaginal yeast infections. Other species of
Candida such as : C.glabarata,C.tropicalis can cause
vulvovaginal symptoms and tend to be resistant to
therapy
Factors that predispose women to the development of
symptomatic VVC include antibiotic use,pregnancy, and
diabetes. :
Through a mechanism referred to as ‘colonization resistance’ ,
lactobacilli prevent the overgrowth of the opportunistic
fungi; antibiotic use distrubs the normal vaginal flora,
decreasing the concentration of lactobacilli and other
normal flora, and thus allowing an overgrowth of fungi.
Pregnancy and diabetes are both associated with
qualitative decrease in cell mediated immunity , leading
to higher incidence of candidiasis.
A. Diagnosis
 The discharge can vary from watery to
homogenously thick. Vaginal
soreness,dyspareunia, vulvar burning, and
irritation may be present
 The pH of the vagina in patient with VVC is usually
normal (<4.5)
 Fungal elements either budding yeast forms or
mycelia will appear within as many as 80% of cases
 The whiff test is negative
B. Treatment
 Topically applied azole drugs are the most
commonly available treatment for VVC and are
more effective than nystatin
 An oral antifungal agent, fluconazole used in a single
150mg dose
- Adjunctive treatment with a weak topical steroid,such
as 1% hydrocortisone cream, may be helpful in
relieving some of the external irritative symptoms
PELVIC INFLAMATORY DISEASE
PID is caused by microorganisms colonizing the
endocervix ascending to the endometrium and
fallopian tubes.
PID is a clinical diagnosis implying that the patient
has upper genital tract infection and inflammation.
The inflammation may be present at any point
along a continuum that includes endometritis,
salpingitis, and peritonitis.
Most cases if PID are caused by sexually transmitted
microrganisms, Neisseria gonorrhoeae, and Chlamydia
trachomatis. Less frequently ,respiratory pathogens
such as Haemophilius influenzae,group A streptococci
and pneumococci can colonize the lower genital tract
and cause PID .Endogenous microorganisms found in
the vagina.particularly he BV microorganisms also are
often isolated from the upper genital tract of women
with PID
A. Diagnosis
- Traditionally, the diagnosis of PID has been based on a
triad of symptoms and signs including pelvic pain,
cervical motion & adnexal tenderness, and the
presence d fever. It is now recognized that there is
wide variation in many symptoms and signs among
women wih this condition,which makes the diagnosis of
acute PID difficult.
- The diagnosis of PID should be considered in women
with any genitourinary symptoms including, but not
limited to lower abdominal pain ,excessive vaginal
discharge ,menorrhagia,metorrhagia, fever ,chills ,and
urinary symptoms. Some women may develop PID
without having any symptoms
B. Treatment
 Must Provide Empiric, broad spectrum coverage of
likely pathogens including Neisseria gonorrhoeae,
Chlamydia trachomatis,gram negative facultative
bacteria ,anaerobes ,and streptococci.
 Hospialization is recommended especially when the
diagnosis is uncertain , pelvic abcess is suspected ,
clinical disease is severe or compliance with an
outpatient regimen is in question.
 Sexual partners of women with PID should be
evaluated, and Treated.
TUBO OVARIAN ABSCESS
TOA is an end stage process of acute PID. TOA Is
diagnosed when a patient with PID has a pelvic mass
that is palpable during bimanual examination. The
condition usually reflects an agglutination of pelvic
organs
Approximately 75% of women with TOA will
respond to antimicrobial therapy alone. Failure of
medical therapy suggest the need of surgical
exploration and drainage of the abscess
Terimakasih