Seminar presentation

1. Reproductive tract
infections
BSC(H) NURSING
RAKCON

2. Reproductive tract

3. Reproductive tract infections
Reproductive tract infection are recognized as a public health
problem and ranking second after maternal morbidity and
mortality as the cause of loss of healthy life among women of
reproductive age in developing countries
They can have serious consequences including infertility ,ectopic
pregnancy, chronic pelvic pain, abortion ,cervical cancer,
menstrual disorder, pregnancy loss,

4. Defenses of genital tract
Cervical defense
• Mucus plug
• effects of mucus
Uterine defense
• Cystic shedding of endometrium
• Tubal defense
• Integrated mucus and epithelial cilia
• Peristalsis of tube and also the movement of the cilia are
towards the uterus

5. Defense of genital tract
Vulval defense
• Apposition of cleft by labia
• Bartholin gland
• Fungicidal apocrine gland secretion
• Resistance of Vulval and perineal skin
 Vaginal defense
• Apposition of the anterior and posterior wall with its
transverse rugae
• Estrogen
• Doderlin’s bacilli

6. REPRODUCTIVE TRACT INFECTIONS
The vaginal area of the female reproductive system is
protected against infection by its normally low PH
(3.5-4.5), which is maintained by the actions of
doderlein’s bacilli (a part of normal flora) and hormone
estrogen.

7. RTI
 RTI refers to three different types of infections affecting the
reproductive tract;
1. endogenous infection are probably the most common
infections includes candidiasis and bacterial vaginosis .
2. Iatrogenic infections occur when the cause of
infection(bacteria or other microorganism)is introduced into
the reproductive tract via a medical instrument.
3. Sexually transmitted disease are caused by viruses ,bacteria
or parasites that are transmitted through sexual activity

8. REPRODUCTIVE TRACT INFECTIONS
Lower reproductive tract infection- it affects the outer
genitals and reproductive organs . Infections in the area of
the vulva , vagina , cervix, e.g. vaginitis, cervicitis,
Upper reproductive tract infection-infections in uterus,
fallopian tube, and ovaries

9. Vulvovaginal infections
These are the common problems. The epithelium of the vagina
is highly responsive to estrogen ,which includes glycogen
formation. The subsequent breakdown of glycogen into lactic
acid produces a low vaginal PH when estrogen decreases
during lactation and menopause glycogen also decreases and
infection may occur. when patients are treated with
antibiotics the normal vaginal flora are reduced this result in
altered in PH and a growth of organisms. other potential
factors that may initiate infection include sexual intercourse
with an infected partner and wearing tight, non absorbent and
heat retaining clothing.

10. Vulvovaginal infections
Causative agent- candida albicans(fungus)
Manifestations- pruritis, thick white curd like discharge.
management
Medical management- antifungal agents like miconazole,
clotrimazole, fluconazole.
Clean undergarments .
Maintain hydration .

11. Reproductive tract infections
Vulvitis- inflammation of the vulva ,may occur with
other disorders ,such as diabetes , dermatologic
problems, poor hygiene or STDs
Vulvodynia-it is an intense burning and inflammation of
the vulva may be relation to high level of calcium
oxalate crystals in the urine

12. vaginitis
Vaginitis is inflammation of vagina occurs when candida or
trichomonas species or other bacteria invade the vagina .
Normal white discharge becomes more profuse in vaginitis.
Urethritis may accompany vaginitis because of proximity
Clinical manifestations are itching , bad odor , redness ,
burning sensations or edema which may aggravate by voiding
or defecation.
Drug of choice hydrocortisone ointment

13. INFECTION OF CERVIX
Infection of cervix can be caused by a variety of pathogens
,particularly sexually transmitted infections, such as
gonorrhea, chlamydia, and human pappilloma virus
Infections of the cervix are considered more serious than
vaginitis they are often asymptomatic

14. candidiasis
Candidiasis is a fungal or yeast infection caused by strains of
candida . Like C albicans or C glabrate
Clinical manifestation – vaginal discharge that causes pruritis
and possible irritation . The discharge may be watery thick and
tenacious white . A burning sensation which may follow
urination
Diagnosis is made by microscopic identification of spores and
hyphae on a glass slide prepared from a discharge specimen

15. Management of candidiasis
Goal of treatment is to eliminate symptoms treatment
include antifungal agents such as miconazole , nystatin ,
clotrimazole and terconazole.
These agents are inserted into the vagina with an applicator
at bed time . There are one night , three night , or seven
night treatment course available.
 oral medication is also available (fluconazole)

16. BACTERIAL VAGINOSIS
It is caused by an overgrowth of bacteria normally found in
vagina . Characterized by an odor that patient describe as
flesh like and particularly noticeable after sexual intercourse
or during menstruation
Under the microscope the vaginal cells are coated with
bacteria and are described as ‘clue cells’
Vaginal PH is above 4.7
 drug of choice is metronidazole orally twice a day for one
week and clindamycin vaginal cream

17. Trichomoniasis
Trichomoniasis is caused by a one-celled protozoan
organism called Trichomonas vaginalis. It travels from
person to person through genital contact during sex.
In women, the organism causes an infection in the vagina,
urethra, or both. In men, the infection only happens in the
urethra. Once the infection begins, it can easily be spread
through unprotected genital contact.
Trichomoniasis is not spread through normal physical
contact such as hugging, kissing, sharing dishes, or sitting
on a toilet seat. In addition, it can’t be spread through
sexual contact that doesn’t involve the genitals.

18. trichomanias

19. TRICHOMONIASIS
 Trichomoniasis often has no symptoms. The CDC reports that only 30 percent of
people with trichomoniasis Trusted Source report any symptoms at all. In one
study, 85 percent of affected women Trusted Source did not have any
symptoms.
 When symptoms do occur, they often begin five to 28 days after a person is
infected. Although for some people it can take much longer.
 The most common symptoms among women are:
• vaginal discharge, which can be white, gray, yellow, or green, and usually
frothy with an unpleasant smell
• vaginal spotting or bleeding
• genital burning or itching
• genital redness or swelling

20. trichomoniasis
• frequent urge to urinate
• pain during urination or sexual intercourse
 the most common symptoms in men are:
• discharge from the urethra
• burning during urination or after ejaculation
• an urge to urinate frequently

21. Treatment of trichomoniasis
Trichomoniasis can be cured with antibiotics. metronidazole
(Flagyl) or tinidazole (Tindamax). Do not drink any alcohol for
the first 24 hours after taking metronidazole or the first 72 hours
after taking tinidazole. It can cause severe nausea and vomiting.
 Sexual partners are properly tested and take the medication,
too. Not having any symptoms doesn’t mean they don’t have
the infection.
 Avoid sexual contact for a week after both the partners have
been treated.

22. HUMAN PAPPILOMA VIRUS
 Human papillomavirus (HPV) is a viral infection that’s passed between
people through skin-to-skin contact. There are over 100 varieties of
HPV, more than 40 of which are passed through sexual contact and can
affect your genitals, mouth, or throat.
 According to the Centers for Disease Control and Prevention (CDC),
HPV is the most common sexually transmitted infection (STI).
 It’s so common that most sexually active people will get some variety of
it at some point, even if they have few sexual partners.
 Some cases of genital HPV infection may not cause any health
problems. However, some types of HPV can lead to the development
of genital warts and even cancers of the cervix, anus, and throat.

24. Clinical manifestation of HPV
 Common symptoms of some types of HPV are warts, especially genital
warts. Genital warts may appear as a small bump, cluster of bumps, or
stem-like protrusions. They commonly affect the vulva in women, or
possibly the cervix, and the penis or scrotum in men. They may also
appear around the anus and in the groin.
Treatment
Warts often go away without treatment, particularly in children. However, there's no
cure for the virus, so they can reappear in the same place or other places.
•Salicylic acid. salicylic acid work by removing layers of a wart a little at a time. .
•Imiquimod. This prescription cream might enhance immune system's ability to fight
HPV.
•Podofilox. topical prescription, podofilox works by destroying genital wart tissue..
•Trichloroacetic acid. This chemical treatment burns off warts on the palms, soles
and genitals.

25. Treatment of HPV
Surgical and other procedures
•Freezing with liquid nitrogen (cryotherapy)
•Burning with an electrical current (electrocautery)
•Surgical removal
•Laser surgery

26. HERPESVIRUS TYPE 2 INFECTION (HSV)
 Herpes simplex virus type 2 (HSV-2)
 HSV-2 infection is widespread throughout the world and is almost exclusively
sexually transmitted, causing genital herpes. HSV-2 is the main cause of
genital herpes, which can also be caused by herpes simplex virus type 1 (HSV-
1). Infection with HSV-2 is lifelong and incurable.
 SIGNS AND SYMPTOMS
genital herpes is characterized by one or more genital or anal blisters or open
sores called ulcers. In addition to genital ulcers, symptoms of new genital
herpes infections often include fever, body aches, and swollen lymph nodes.
After an initial genital herpes infection with HSV-2, recurrent symptoms are
common but often less severe than the first outbreak. The frequency of
outbreaks tends to decrease over time but can occur for many years. People
infected with HSV-2 may experience sensations of mild tingling or shooting
pain in the legs, hips, and buttocks before the appearance of genital ulcers.

27. TREATMENT
 Antivirals, such as acyclovir, famciclovir, and valacyclovir are the most
effective medications available for people infected with HSV. These can
help to reduce the severity and frequency of symptoms, but cannot cure
the infection.

28. CHLAMYDIA AND GONORRHEA
 Chlamydia and gonorrhea are sexually transmitted bacterial infections. A
person can contract one of these infections if they have unprotected
sexual contact with someone who has it. It can be hard to tell the
difference between the two, as the symptoms can be similar.
 According to the CDC, some males, and most females, with gonorrhea
may not experience any symptoms at all.

29. Signs and symptoms
 person does experience symptoms , or they might not appear for several
weeks.
 As the symptoms can be similar and may overlap, it is important for a doctor to
test for the infections before prescribing any treatment.
 females may experience a burning sensation during urination and abnormal or
increased discharge from the vagina.

30. Signs and symptoms
Males may experience:
•a burning sensation during urination
•discharge from the penis
•painful swelling of the testicles and penis, though this is less common
A person may also experience symptoms in the rectum. Symptoms in
the rectum may include:
•pain or soreness ,discharge, bleeding
A person can also experience chlamydia and gonorrhea in the
throat. Most oral infections of this nature will have no symptoms, but a
person may experience a sore throat.

31.  Treatment for chlamydia
 In 2006, the American Academy of Family Physicians recommended
the antibiotics azithromycin or doxycycline to treat chlamydia.
 A person may only require one dose, or they may have to take the
antibiotic every day for 7 days.
 Treatment for gonorrhea
 The CDC recommend a single injection of ceftriaxone and an oral
azithromycin.
 Antibiotic resistant gonorrhea has become more common, so it is
important that people take the entire treatment course.

32. PELVIC INFLAMMATORY DISEASE
 Pelvic inflammatory disease (PID) is an infection of the female reproductive
organs. PID usually is contracted through sexual contact. PID can damage the
uterus, ovaries, fallopian tubes or other parts of the female reproductive system. It
also can cause severe pain and make it difficult to become pregnant.
•Women with sexually transmitted diseases — especially gonorrhea and chlamydia
— are at greater risk for developing PID.
•Women with many sexual partners are at greater risk for sexually transmitted
diseases and PID.
•Women who have already had PID are at higher risk for another episode.
•Sexually active teenagers are more likely to develop PID than are older women

33. PELVIC INFLAMMATORY DISEASE
Normally, the cervix prevents bacteria that enter the vagina from
spreading to the internal reproductive organs. If the cervix is
exposed to a sexually transmitted disease — such
as gonorrhea and chlamydia — the cervix itself becomes infected
and is less able to prevent the spread of organisms to the internal
organs. PID occurs when the disease-causing organisms travel from
the cervix to the upper genital tract. Untreated gonorrhea and
chlamydia cause about 90% of all cases of PID. Other causes include
abortion, childbirth, and pelvic procedures.

34. PID
 The symptoms of PID can vary, but may include the following:
• Dull pain or tenderness in the stomach or lower abdominal area, or pain in
the right upper abdomen(though this is much less common).
• Abnormal vaginal discharge that is yellow or green in color and has an
unusual odor.
• Irregular periods.
• Spotting or cramping throughout the month.
• Chills or high fever.
• Nausea and vomiting.
• Pain during sex.

35. PID treatment
 Antibiotic treatment
 The first kind of treatment is with antibiotic. It is important to follow the doctor’s
instructions and complete all of the prescription. A course usually lasts 14
days.
 PID often involves more than one type of bacteria, so the patient may take two
antibiotics together.
 If tests show which bacteria are causing the disease, more targeted therapy is
possible.
 Antibiotics for PID include:
• cefoxitin
• metronidazole
• ceftriaxone
• doxycycline
 If the antibiotics do not make a difference within 3 days, the patient should
seek further help. She may receive intravenous antibiotic therapy or a change
of medication.

36. Prevention of PID
PID can become a serious condition, but there are some
ways to minimize the risk:
• having regular screening, especially for those who have
multiple sex partners
• ensuring sexual partners are tested for infections and STIs
• not douching, because this increases the risk
• using a condom or cervical cap and practicing safe sex
• not having sex too soon after childbirth or a termination or
loss of pregnancy

37. TOXIC SHOCK SYNDROME
 Toxic shock syndrome is a rare but serious medical condition caused by
a bacterial infection. It is caused when the bacterium Staphylococcus
aureus gets into the bloodstream and produces toxins.
 Although toxic shock syndrome has been linked to superabsorbent
tampon use in menstruating women, this condition can affect men,
children, and people of all ages
 Infection usually occurs when bacteria enter your body through an
opening in your skin, such as a cut, sore, or other wound. Experts are
not sure why tampon use sometimes leads to the condition. Some
believe that a tampon left in place for a long period of time attracts
bacteria. Another possibility is that tampon fibers scratch the vagina,
creating an opening for bacteria to enter your bloodstream.

38. Symptoms of toxic shock syndrome
 Symptoms of toxic shock syndrome can vary from person to person. In most
cases, symptoms appear suddenly. Common signs of this condition include:
• sudden fever , early septic shock
• low blood pressure
• headache
• muscle aches
• confusion
• Elevated BUN level
• nausea
• Vomiting and diarrhea
• rash
• redness of eyes, mouth, and throat
• Seizures

39. TREATMENT OF TOXIC SHOCK SYNDROME
Toxic shock syndrome is a medical emergency. Some people
with the condition have to stay in the intensive care unit for
several days so that medical staff can closely monitor them. An
intravenous (IV) antibiotic therapy is given to help you fight the
bacterial infection. Patient will receive 6–8 weeks of antibiotics
based on result of blood , urine and other culture
Respiratory distress – oxygen therapy
• medication to stabilize blood pressure
• IV fluids to fight dehydration
• gamma globulin injections to suppress inflammation and boost
your body’s immune system
• If acidosis appear sodium bicarbonate is administered

40. treatment
Other treatment methods for toxic shock syndrome vary
depending on the underlying cause. For example, if a vaginal
sponge or tampon triggered toxic shock, Remove this foreign
object from your body. If an open wound or surgical wound
caused your toxic shock syndrome, drain the pus or blood
from the wound to help clear up any infection
I/V dopamine to treat shock

41. MALE REPRODUCTIVE TRACT INFECTIONS
EPIDIDYMITIS
 Epididymitis is an inflammation of the epididymis. The epididymis is a tube
located at the back of the testicles that stores and carries sperm. When this tube
becomes swollen, it can cause pain and swelling in the testicles.
 Epididymitis can affect men of all ages, but it’s most common in men between
ages 14 and 35. It’s usually caused by a bacterial infection or a sexually
transmitted disease (STD). The condition usually improves with antibiotics.
 Acute epididymitis lasts six weeks or less. In most cases of acute epididymitis,
the testes are also inflamed. This condition is called epididymo-orchitis.
According to the Centers for Disease Control and Prevention (CDC), gonorrhea
and chlamydia are the most common causes in men 35 years old or younger.
 Chronic epididymitis, on the other hand, lasts six weeks or more. Symptoms
include discomfort or pain in the scrotum, epididymis, or the testicles. This may
be caused by granulomatous reactions, which can result in cysts or calcifications.

42. Sign and symptoms - EPIDIDYMITIS
Epididymitis may begin with only a few mild symptoms. When
it’s left untreated, however, the symptoms tend to get worse.
People with epididymitis may experience:
• low-grade fever
• chills
• pain in the pelvic area
• pressure in the testicles
• pain and tenderness in the testicles

43. Sign and symptoms - EPIDIDYMITIS
• redness and warmth in the scrotum
• enlarged lymph nodes in the groin
• pain during sexual intercourse and ejaculation
• pain during urination or bowel movements
• urgent and frequent urination
• abnormal penile discharge
• blood in the semen

44. TREATMENT
Treatment for epididymitis involves treating the
underlying infection and easing symptoms.
Common treatments include:
• antibiotics, which are administered for 4 to 6 weeks in
chronic epididymitis, and can include doxycycline and
ciprofloxacin
• pain medication, which can be available over-the-counter
(ibuprofen) or can require a prescription (codeine or
morphine)
• anti-inflammatory medication like piroxicam (Feldene) or
ketorolac (Toradol)
• bed rest

45. Treatment
Additional treatments may include:
• elevating the scrotum, for at least two days if possible
• applying cold packs to the scrotum
• wearing an athletic cup for support
• avoiding lifting heavy objects
In cases of an STI, abstain from sexual intercourse until
completed course of antibiotics .

46. Treatment …
These methods are usually successful. It can sometimes take
several weeks for the soreness or discomfort to go away
completely. Most epididymitis cases clear up within 3 months.
However, more invasive treatment may be needed in some
cases.
If an abscess has formed on the testicles, your doctor can drain
the pus using a needle or with surgery.
Surgery is another option if no other treatments have been
successful. This involves removing all or part of the epididymis.
Surgery may also be necessary to correct any physical defects
that may be causing epididymitis.

47. PROSTATITIS
 Prostatitis is swelling and inflammation of the prostate gland, a walnut-
sized gland situated directly below the bladder in men. The prostate
gland produces fluid (semen) that nourishes and transports sperm..
 Prostatitis affects men of all ages but tends to be more common in men
50 or younger. The condition has a number of causes. Sometimes the
cause isn't identified. If prostatitis is caused by a bacterial infection, it
can usually be treated with antibiotics.
 Depending on the cause, prostatitis can come on gradually or suddenly.
It might improve quickly, either on its own or with treatment.
 Some types of prostatitis last for months or
keep recurring (chronic prostatitis).

48. Signs and symptoms
 Prostatitis signs and symptoms depend on the cause. They can
include:
• Pain or burning sensation when urinating (dysuria)
• Difficulty urinating, such as dribbling or hesitant urination
• Frequent urination, particularly at night (nocturia)
• Urgent need to urinate
• Cloudy urine
• Blood in the urine
• Pain in the abdomen, groin or lower back
• Pain in the area between the scrotum and rectum (perineum)
• Pain or discomfort of the penis or testicles
• Painful ejaculation
• Flu-like signs and symptoms (with bacterial prostatitis

49. Treatment
• Antibiotics. Taking antibiotics is the most commonly prescribed
treatment for prostatitis based on the type of bacteria that might be
causing your infection.(trimethoprim sulfamethoxazole)
• In severe symptoms, intravenous (IV) antibiotics administered. take
oral antibiotics for four to six weeks but might need longer treatment
for chronic or recurring prostatitis.
• Alpha blockers. These medications help relax the bladder neck and the
muscle fibers where your prostate joins your bladder. This treatment
might ease symptoms, such as painful urination.
• Anti-inflammatory agents. Nonsteroidal anti-inflammatory drugs
(NSAIDs) might make you more comfortable.

50. Prevention of RTI
 A comprehensive approach to RTIs includes prevention of
sexually transmitted, iatrogenic and endogenous infections.
RTI prevention means reducing exposure—by using
condoms
 reducing numbers of sex partners.
 Condoms must be used correctly and consistently to prevent
STI.

51. Nursing diagnosis
 Pain , discomfort and distress r/t burning , odor or itching from
the infectious process.
 Anxiety r/t severity and suddenness of symptoms and to concern
about recovery
 Risk for reoccurrence of infection or spread of infection
 Fluid volume deficit r/t vomiting and diarrhea
 Fatigue r/t severity of illness and of shock
 Knowledge deficit about risk factor and behaviour