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1、O&G Hospital of FuDan University,Female Reproductive Organs,O&G Hospital of FuDan University*,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,O&G Hospital of FuDan University*,细 菌 性 阴 道 病,O&G Hospital of FuDan University*,阴道内正常菌群失调所致的一种混合感染,O&G Hospital of FuDan University*,DIAGNOSIS,Gray homogenous disch
2、arge 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.,O&G Hospital of FuDan University*,Treatment,Oral metro
3、nidazole 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,O&G Hospital of FuDan University*,滴虫性阴道炎 Trichomonal vaginitis,病因： 传播方式 性生活直接传播 间接传播,O&G Hospital of FuDan University*,
4、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,O&G Hospital of FuDan University*,诊 断,分泌物生理盐水悬滴法 分泌物培养 注意事项,O&G Hospital of FuDan University*,O&G Hospital of FuDan University*,O&G Hospital of FuDan University*,盆底主要支持结构,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.d7天,局部用药 甲硝唑阴道泡腾片 200mg q.d7天 疗效50,O&G Hospital of
5、FuDan University*,注意事项,性伴侣治疗 随访 妊娠期治疗,O&G Hospital of FuDan University*,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（8090） 其它假丝酵母菌（1020） 诱发因素 妊娠、糖尿病、广谱抗生素等,O&G Hospital of FuDan University*,PSEUDOHYPHAE,O&G Hospital of FuDan University*,临床表现,O&G Hospital of FuDan University*,O&G Hospital of F
6、uDan University*,临床分类,单纯性 复杂性,O&G Hospital of FuDan University*,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,O&G Hospital of FuDan University*,O&G Hospital of FuDan University*,盆腔炎性疾病 Pelvic inflammatory disease,O&G Hospital of FuDan University*,Pathogenesis of PID,O&G Hospital of FuDan University*,PID - Clinica
7、l Features,Lower abdominal pain all Vaginal discharge 1/2 Vaginal bleeding 1/2 Dysuria 1/4 Nausea, vomiting, anorexia 1/4,SYMPTOMS,O&G Hospital of FuDan University*,PID - Clinical Features,Abdominal or adnexal tenderness all Cervical tenderness all Adnexal enlargement 1/3 Fever 1/3 RUQ tenderness up
8、 to 1/3,SIGNS,O&G Hospital of FuDan University*,Treatment for acute PID,Must include activity against: gonococcus streptococci community-acquired enteric Gram- negatives obligate anaerobes (e.g., Bacteroides) chlamydia,O&G Hospital of FuDan University*,Surgical treatment,Severe cases Where there is
9、clear evidence of a pelvic abscess. Rupture of abscess,O&G Hospital of FuDan University*,Trocar drainage, with or without placement of a drain, is successful in as many as 90% of patients with PID complicated by tubo-ovarian abscess that fails to respond to antimicrobial therapy within 72 hours.,O&G
10、 Hospital of FuDan University*,O&G Hospital of FuDan University*,盆腔炎性疾病后遗症sequelae of PID,O&G Hospital of FuDan University*,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,