Genital infections, which is a combination of many germs, endangering reproductive function and causing tissue damage, is an issue that the physicians give significant importance in daily life. Anatomically, female genital system is a tract that combines intra-abdominal environment with the outside world. Thus, if a simple genital infection spreads into the abdominal cavity, it may cause serious conditions. The acidic environment of the vagina, intra-uterine layer which is discharged every month, secretions in cervix, making the transition difficult, the cell structure which covers the vagina and bacteria called lactobacilli in the natural flora are natural barrier mechanisms of the body against germs clinging to these regions and cause infection. In the presence of factors such as child birth, miscarriage, operations, pregnancy, use of antibiotics, synthetic underwear, hygiene problems, development of infection is easier despite these natural barriers.
The external genitalia is called as vulva. Usually they accompany vaginal infections. the reduction of estrogen, infections, tight clothing, detergents, synthetic underwear, depilatory creams, exposure to irritants such as vaginal sprays are among the factors that cause vulvitis. Diabetes, anemia, serious systemic diseases such as hepatic diseases and drugs can cause vulvitis. The most common complaints are itching, redness, swelling, painful sexual intercourse, stinging and burning. The treatment is regulated according to underlying factors and genital infections. Fungus infections are the most common factors and usually respond well to antimycotics applied in cream form.
Human papilloma virus (HPV) infection cause warts in penis of the men, and in the the vagina in vulva of women. In addition, some types of the virus may cause changes in cervical tissue and cervical cancer. Creams which can be used in the treatment are not as effective as incineration or surgical removal of warts. It may relapse In 30% of treated patients. Although transmission tracts other than sexual transmission are not clear, transmission of HPV virus is possible by skin contact. In order to be protected from External genital warts, contacting with infected material, the use of common epilation material should be avoided. The use of condoms, can protect the cervix, but cannot protect the external genitalia.
Genital infections-genital herpes - Herpes Simplex virus (HSV) infections can create painful ulcers in the genital organs. Fever, fatigue, muscle pain may be accompanied. There is no definitive treatment, but treatments reduce pain, help recovery of the infections in a shorter period of time, and prevent secondary infections on herpes. In order to avoid inflammation which may occur in infants, caesarean section is recommended for the patients having active Herpes lesion during pregnancy.
Bartholin gland located inside of the labia minora in either sides of the vagina contribute lubrication during sex. These glands extend in the vagina with thin channels. Previous vaginal infections and irritation may result in blockages in these channels causing incomplete secretion and storage within the gland leading swelling. As a result of this secretion’s combination with germs, the swelling is called as Bartholin's abscess if pus is accumulated within the cyst. Beside swelling, Bartholin's abscess is characterized by the serious pain, tenderness, redness. Surgical emptying of the abscess, marsupialisation of bartholin gland to the vaginal wall by a process called re-anastomosis and usage of antibiotics are required for the treatment. In the presence of recurrent infection, removal of the Bartholin's gland may be required.
Molluscum Contagiosum is a disease that manifests itself with skin rashes caused by a virus called poxvirus. Most frequent transmission is via the common towels and clothes. Molluscum Contagiosum is a disease which present dome-shaped, mid-bellied , meat colored lesions lining like pearls in dimensions of 1 to 5 mm in which white fat-like content may be observed when squeezed especially localized in genital region, in feet and hands. These rashes are mainly painless and sometimes may become itchy. Diagnosis can be made during gynecologic examination. Generally, it resolve spontaneously within 2 to 3 months without treatment. Burning or freezing therapy may be performed for the non-recovering lesions.
External genital contact allergens (pads, deodorant, depilatory creams), remaining moist for long time due to sweating, usage of synthetic panties, foreign bodies (keeping buffer, condoms and diaphragms inside for a long time )and infections cause vaginitis. Bacteries called lactobacilli living in acidic Ph, the vagina's natural flora element are available in the vagina preventing the growth of harmful microbes. Reduction in number of lactobacilli (antibiotic use, vaginal douching, Ph changes ) predisposes infection. In vaginal infections, the most common symptom is vaginal discharge. It is important to separate the physiologic discharge from the infectious one. Physiological discharge colorless, odorless and does not cause any symptoms. Discharges due to infection usually have dark yellow or green color and foul smelling, may be associated with itching burning, pain during sexual intercourse.
It is more common generally in pregnant women, patients using antibiotics, birth control pills, diabetic patients and in patients in long-staying with wet bathing suit after the pool. Most of the time, it is associated with a white discharge such as cheese or whey and itching. May be accompanied by vulvitis.It is treated with antimycotic pills, suppositories and creams. Co-treatment is not needed.
The most common factor is; Gardnerella vaginalis and the condition it creates is called as bacterial vaginosis. It is accompanied by yellow-green, malodorous (fishy odor discharge. The bad odor after intercourse is generally increased in vaginosis. in the presence of pregnancy it may increase the likelihood of abort. . Can be treated with pills or antibiotics in the form of suppositories. Co-treatment is not needed.
The most common factor is Trichomonas vaginalis which is transmitted by sexual intercourse. In addition to Green and smelly discharge it usually causes burning while urinating. In this infection, which is treated with anti-parasitic pills, the co-treatment is also required.
Cervix acts as a barrier between the upper genital organs and the lower genital organs.
Cervicitis, is an inflammation of the cervix with the general meaning. Is often related to an infection, but sometimes may occur due to trauma or irritation. It is difficult to suspect cervicitis since the symptoms are similar with many other diseases and it doesn’t create specific complaints. Generally it is realized with another reason in gynecological examination. The most frequent complaint is vaginal discharge starting after the menstrual period. Also, groin pain, lower back pain, spotting after intercourse and pain during sexual intercourse can also develop. Diagnosis is usually made during the examination, but culture test may also be required. 3 of the most common germs that cause cervicitis are gonorrhea, chlamydia and trichomonas. After identifying the underlying factors, healing can be achieved with appropriate antibiotic therapy. Co-treatment may be appropriate, otherwise the probability of recurrence of infection increases.
In some women, cervical canal epithelium covering the inside of the vagina may bulge towards vagina. Since this layer is a thinner layer than the epithelial layer in the cervix, blood vessels under this epithelium are closer to the surface. The condition which is resembled to “cervical wound” is actually not a real scar and is called as erosion. Since similar examination findings and similar complaints may be present In the early stages of cervical cancer, cervical cancer should be excluded in such cases. For this, smear or colposcopy can be done in cases where the physician finds it necessary. Treatment is not required for erosions which don’t cause serious complaints. Cervical burning, freezing or laser treatments can be applied for women having continuous complaints of discharge and spotting. In resistant cases, removal of a portion of the cervix (LEEP conization) may be required.
It is the most common and one of the most important diseases which is transmitted through sexual contact. Chlamydia infections in women not only cause odorless yellow discharge, bleeding in the middle of the menstrual period, pain during sexual intercourse, it may also cause problems in getting problem by forming obstructions and adhesions in tubes by progressing without presenting any symptom. In pregnant women, it is known to be associated with miscarriage and premature birth. When males are infected, White discharge in the penis can develop. The definitive diagnosis is made by vaginal culture. The use of antibiotics is required for the treatment.
It is known that these micro-organisms not leading any finding both in males and females increase the risk of abort.
Infections determined by necessary laboratory examinations can be treated with antibiotics.
Other important infections transmitted through sexual contact is gonorrhea. Whereas this infection can be asymptomatic in women, can also cause vaginal discharge, lower back pain and menstrual irregularities. It causes yellow urethral discharge, burning and pain while urinating in men. Infection can spread via blood and can create much more serious conditions. While it causes tubal blockage and adhesions in women, it can cause infertility in men by blocking the passage of sperm. After diagnosis, it is easy to treat the disease with antibiotics.
Inflammation of the inner layer of the uterus is not a common condition. Generally infection doesn’t occur Without an underlying factor because the inner layer of the uterus which is renewed every month is naturally resistant to infection with acidic pH of the vagina and the cervical secretions. If there is a problem with one of these natural barriers, then the infection develops. Endometritis may develop in cases of birth, miscarriage, premature rupture of membranes, uterus oriented operations, spiral, cancer, polyps.
Chronic endometritis: may occur during checkup examination by the gynecologist even if the patient's complaint is not noticeable. In addition, ongoing discomfort and mild pain in the groin can be found in the patient. Sometimes it manifests itself with interval bleeding after menstruation. Chronic endometritis rarely leads to infertility. Diagnosis is made by endometrial biopsies and treated with appropriate antibiotics.
Acute endometritis: Hypersensitivity is present in uterus. It may be associated with inflammation of the tubes. acute endometritis caused by Chlamydia and Gonorrhoea should not be forgotten and treatment should be made taking into account these two agents.
When pelvic infection or pelvic inflammatory disease is indicated, infections originating from ovaries, tubes, uterus and surrounding soft tissue are understood. Pelvic infections are usually polymicrobic (combination of many kinds of bacteria) infections. Germs which are normally present in lower genital system, go upwards and may cause infection. Rarely, the spread of infection via blood to the reproductive system can be seen; a typical example of this is tuberculosis in our country.
After undergoing pelvic infection, it can leave extensive adhesions in the abdomen. These adhesions may cause problems in getting pregnant especially by involving the tubes and disrupting their movements and anatomy. This damage in the tubes, also increases the likelihood of ectopic pregnancy in the future. in cases where infection is not intervened, the inflammation enters the bloodstream and may cause life-threatening conditions.
Since pelvic infections are sexually transmitted diseases, they are more common in women who have polygamous sexual life or have a partner who has polygamous sexual life.
Spiral usage is a risk factor for pelvic infection. Microbes climbing upwards from the rope of the spiral which is inside spiral vagina and sources of infection reside upwards and may cause infection in here. Low socioeconomic status and untreated lower genital tract infection are also recognized as a risk factor.
Reason or complaint for admission may be general abdominal / pelvic pain, high fever, foul-smelling vaginal discharge and nausea, vomiting, inability to release gas in delayed cases. Tenderness is present in cervix and abdomen during physical examination and in some cases mass related to inflammation may be palpated.
In laboratory tests, there may be increase in inflammation cells (leucocyte) and parameters of infection (CRP, sedimentation). Since it may cause similar complaints, ectopic pregnancy should be examined, pregnancy test (βhCG) should be done.
Pelvic infection is a disease which should be treated immediately after being diagnosed. The cornerstone of treatment is antibiotic therapy. There is a large number of microorganisms which may cause the disease and the treatment should include All microbes which may cause the infection because there is no time to figure out which microorganism is the factor. In mild cases, oral antibiotic therapy is prescribed and the patient is sent home but serious cases, patients who don’t recover with oral treatment and have additional disease and the pregnant women should be hospitalized and intravenous antibiotic treatment should be administered. If presence of abscess around the ovary is suspected, the abscess can be drained by open or closed (laparoscopic) surgery.
The way to be protected against pelvic infections, is being protected from sexually transmitted diseases. Thus, avoiding from polygamy and partners who have polygamous sexual life and usage of condoms have protective effect.
Toxic shock syndrome, is seen in women who use vaginal tampons during their menstrual periods. When vaginal tampons are kept within the vagina for longer durations, accumulated blood provide proper feeding environment for bacteria (S. Aureus) and allow their rapid proliferation. Although they are present in normal flora, these bacteria release their toxins to the blood as a result of this proliferation and form a kind of intoxication. Toxic shock syndrome symptoms are sudden rising fever, nausea, vomiting, diarrhea, pain in the body and feeling of faintness. Treatment should be done under intensive care conditions. After cleaning the room initially, fluid treatment and intravenous antibiotic therapy should be started. To avoid toxic shock syndrome, tampons should be changed frequently during the day, same tampon should not be kept inside longer than 6 hours, hands should be washed with soap before placing and tampons should not be used as much as possible at night.
Other sexually transmitted infections
Disease caused by a bacterium can endanger life. The infection is transmitted through sexual contact. Complaints start to be seen between 10-90 days after sexual contact with an infected person, approximately on the 21st day. Mostly, the first sign of syphilis are painless soft swellings in the genital area. If left untreated, this condition will disappear by itself and bacteria will become permanent in the body. After a while (3 weeks to 6 months) redness spreading entire the body develops. Gray colored sores appear in the genital area and generally symptoms of fever, fatigue, sore throat and hair loss are seen. If the infection is not treated During this period, it affects vital organs such as heart, the brain and nervous system. At this stage, infection can create permanent damage in the body and may be life-threatening. Today, when diagnosed, the active treatment is possible for syphilis. Partners are required to be treated together.
Hepatitis B Infection is a condition starting due to infection in the liver caused by Hepatitis B virus. Whereas jaundice can develop after the infection, it can proceed without any symptoms, too. Hepatitis B infection can be cured without any sequel or form a condition which makes the infected a carriage, cause chronic infection, cirrhosis or even progresses until liver cancer. Hepatitis B virus is found in high concentrations in the blood, saliva, vaginal fluid and male sperm fluid (semen). Non-immune individuals become infected upon contact with these liquids. the primary form of protection from Hepatitis B is vaccination. Since the use of condoms during sexual intercourse reduces contact with the body fluids, it is helpful for protection.
Hepatitis C infection is the most common cause of chronic hepatitis and liver cancer. Although the most common infection is via blood circulation, it is also known to be transmitted sexually. Since The blood concentration of hepatitis C is less than hepatitis B, plural contacts are required within longer period of time for sexual transmission. People who have partners with hepatitis C are at risk. the use of condoms during sexual intercourse plays an important role for being protected against hepatitis C since an effective vaccine is not available yet.