Vaginal infection

Most cases of infectious vaginitis are accounted for by nonspecific vaginitis (NSV), which causes 40-50%; candidiasis, which causes 20-30%; and trichomoniasis, which causes 20-30%. Common reasons for failure to relieve symptoms include diagnostic errors, and sexual reinfection, but nonsexual recurrence, drug resistance, or depressed host immunity may also be responsible. Most infections can be identifed and cured if the pathophysiology of a vaginal discharge is understood and the proper diagnostic steps taken. The components of a vaginal discharge include water, electrolytes, epithelial cells, microbial organisms, organic fatty acids, proteins, and carbohydrate compounds. In most women the overgrowth of potentially pathogenic organisms is prevented by a poorly understood interreaction between lactobacilli and other organisms in the normal vaginal flora. A specific diagnosis of cervicitis, trichomoniasis, NSV, candidiasis, or normal vaginal discharge can be made on the basis of physical examination of the vulva; the location, color, viscosity, consistency, and presence on the vaginal walls of vaginal discharge; the cervical discharge; elevated vaginal pH; and fishy amine odor. Based on these findings microscopic observation can be directed toward a specific diagnosis. The presence of lactobacilli, white blood cells, trichomonads, clue cells, and Candida organisms should be sought; the appropriate conditions for observation and interpretation of findings are discussed. Instructions are provided for the preparation of cervical cultures for N. gonorrhoeae and C. trachomatis, which should be obtained when purulent cervical exudate or purulent vaginal discharge is present. Further information on the etiology, diagnosis, and treatment of physiologic vaginal discharge and the specific infections including candidiasis, trichomoniasis, NSV, and cervicitis is provided.     

Puerperal infection

Puerperal infections are of great importance also under the conditions of modern obstetrics. There is a close connection with the problematic nature of hospitalism. The prospective study from 1,409 patients shows a puerperal fever at a percentage of 32.1%. Only 19.0% of the patients meet the criteria of a "standard puerperal morbidity". Within the complications occurring during the childbed period subinvolutio uteri holds the first place with 16.3%. The incidence of puerperal infections is influenced by predisposing factors dominated by the mode of accouchement. Ampicillin and chloramphenicol are the most used antibiotics. The preventive and therapeutic application of antibiotics is discussed. In the experimental part of the study the settlement of the vagina, the cervix, and the amniotic fluid is analysed. The evidence of causative organism for oxybiontic pathogenes partly also for anoxybiontic pathogenes and fungi is made. The fight against puerperal infections is particularly based on preventive measures. There must be mentioned a strict consideration of the antisepsis and asepsis as well as the restriction of predisposing factors. Under this precondition the wellaimed and indicated application of a therapy based on antibiotics will be successful.     

Urinary tract infection and Chlamydia infection in adolescent females

STUDY OBJECTIVE: To examine whether clinical or laboratory findings could distinguish Chlamydia trachomatis (CT) from urinary tract infection (UTI) among adolescent females in whom providers tested for both. DESIGN, SETTING, PARTICIPANTS: A laboratory database at an urban teen health center was reviewed to identify females who had both urine culture and ligase chain reaction (LCR) test for CT ordered at the same visit. History and physical findings were abstracted from the medical record. There were 81 visits with retrievable laboratory results and chart documentation. MAIN OUTCOME MEASURES: UTI was defined as >1000 colony-forming units on culture, and CT was defined as positive LCR test. Pearson's Chi-squared test was used to assess strength of the hypothesized associations. RESULTS: UTI was diagnosed in 20 (24%) and CT in 18 (22%) of 82 visits. Concurrent CT was diagnosed in 6 of 20 subjects with UTI. Symptoms and physical signs did not differentiate UTI from CT. Positive urinary nitrites were associated with UTI, but did not exclude CT. Similarly, wet prep evidence of trichomonas or white blood cells was associated with CT, but did not exclude UTI. Clinical diagnosis of CT or UTI was 50% sensitive and 70% specific. CONCLUSIONS: Adolescent females who are screened for both CT and UTI have high rates of concurrent disease. Urinary or vaginal symptoms do not differentiate well between these infections. Clinical diagnosis is imprecise, suggesting that adolescent females with vaginal or urinary symptoms should be tested for both CT and UTI.     

Congenital cytomegalovirus infection

Each year, thousands of children are born with or develop permanent disabilities such as hearing loss, vision loss, motor and cognitive deficits from congenital CMV infection (cCMV). However, awareness of cCMV and its associated sequelae is very low in pregnant women and healthcare providers. Both targeted and universal approaches to screen newborns for CMV infection are now achievable due to recent scientific advances including the development of a rapid, high-throughput method for detecting CMV in saliva, the efficacy of antiviral treatment in symptomatic infants, and the demonstration of cost effectiveness of CMV screening. Future studies are needed to address gaps in our understanding on the role of non-primary maternal CMV infections, the evaluation of antiviral treatment in asymptomatic infants, and the implementation of prevention strategies for cCMV.     

Genital Chlamydia infection

The aim of this overview is to show how a gynecology practice in one non university town diagnoses, treats and monitor the effect of treatment of genital Chlamydia infections (GCI). It goes into finance difficulties we meet diagnosing, identification and appropriate treatment due to the NHIF limitations. Our experience and conclusions over different social groups and patient's motivation for diagnosis and treatment.     

Disseminated gonococcal infection

N. gonorrhoeae is an infection found only in humans. In the United States, an estimated 600,000 new cases occur each year, with the peak incidence occurring in the summer months. Adolescents and young adults are at the highest risk of infection. N. gonorrhoeae affects both men and women. Infection in men typically produces symptoms that lead patients to seek treatment. On the other hand, N. gonorrhoeae infection in women often is asymptomatic and can lead to sterility or ectopic gestation. N. gonorrhoeae becomes disseminated in 1–3% of all gonococcal infections. Disseminated gonococcal infection (DGI) usually presents as an arthritis-dermatitis syndrome; patients experience migrating polyarthalgias usually affecting the knees, elbows, and distal joints. Approximately 75% of patients have a characteristic dermatitis consisting of discrete papules and pustules with a hemorrhagic component. If untreated, the arthritis tends to progress in one to two joints, usually the knee, ankle, elbow, or wrist. Treatment consists of hospitalization, evaluation for serious sequelae such as endocarditis and meningitis, and antibiotic therapy. Additionally, the patient's partner also should be treated. Disseminated gonococcal infection can cause serious complications during pregnancy such as septic abortion or chorioamnionitis, as well as preterm labor and preterm premature rupture of membranes.     

Nonpuerperal breast infection

Objective: We undertook a microbiological study of purulent specimens from women with symptomatic breast abscesses.Methods: Fifty-one purulent samples were collected in 2 periods (December 1991-April 1992 and January 1994-June 1994) from nonpuerperal breast abscesses in 44 patients attending our hospital.Results: One of the most frequently isolated microorganisms was Proteus mirabilis (9 patients, 20.4%), present as a pure culture in all but 1 specimen (isolated together with Peptostreptococcus spp.). Staphylococcus aureus was isolated in 10 specimens, 6 of which were post-tumorectomy abscesses. Polymicrobial anaerobic flora were isolated in 11 specimens (21.5%); Staphylococcus epidermidis in 4 (8%); and Streptococcus milleri,Alcaligenes sp., and mixed aerobic-anaerobic flora in 1 specimen each. The 7 remaining samples (13.7%) were negative bacteriological cultures.Conclusions: We draw attention to the frequent isolation of P. mirabilis in recurrent and torpid breast abscesses in 4 women in whom surgery was necessary in addition to antibiotic treatment.