7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 1/11

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 2/11

f.f. frecvente

dificultati terapeutice

frecvent forme cronice

Determinanti

*Germeni patogeni comuni –  bacterii: gonococ, stafilococ, colibacil, enterococ,

anaerobi, perfringens,Chlamidia trachomatis

- virusuri: herpetic, limfogranulomatos, condiloma ac.

- paraziti: Trichomonas vaginalis- fungi: Candida albicans

*Infectii specifice –  TBC, sifilis

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 3/11

Favorizanti

*de mediu extern: frig, umezeala (congestie), traumatism (sexual),

ef. fizice, ortostatism, oboseala, subnutritie (anergie

*de mediu intern: congestia pelvina (M), org. vecine (constipatie cr.,

inf. urinare, b. hepatice, compresiuni), b. infect. ac/c

 Sursele

a. Endogena: germeni saprofiti→patogeni  b. Exogena: ag. Patogeni inoculati

S,N,L: EVD repetate, travalii lungi, interventii obstetricale, traumatisme

Avorturile: ± resturi, chiuretaj

Raporturi sexuale: BTS

Explorari: histerometria, dilatatia colului, HSG, extragerea/montarea DIU, BE

Caile: canaliculara (mucoase), sanguina, limfatica, contiguitate ←dig. 

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 4/11

Clasificare *infectii joase: vulvo-vaginita, cervicita

*infectii inalte: metrita, anexita, pelviperitonita,

celulita pelvina, peritonita generalizata

nexista mec. biol. de aparare (integritatea epiteliului vaginal, pH acid ← flora fiziol.

= bacili Döderlein, cel. epiteliale bogate in glicogen ← E) 

epiteliu pluristratificat in continua descuamare superficiala (activitate sexuala)

Tulburarea echilibrului prin:

- traumatisme repetate (rap. sex, masturbare

- rupturi vulvoperineale, cervicale

- tumori

- corpuri straine

- disfunctii hormonale (pubertate,

menopauza)

- b. gen. (diabet)

- lipsa de igiena sau excesele

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 5/11

Vulvita acuta: usturime, prurit, congestie, edem, secretie

cronica: leucoree

Ex. bacteriologic al secretiei + antibiograma

Vulvita acuta catarala –  fetite

“ purulenta ← gonococ 

Bartholinita

Vulvita TBC

Sifilis vulvar

Herpes

Zona zoster

Limfogranulomatoza benigna

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 6/11

Frecvent asocieri vulva + vagin

Simptome.: leucoree, durere, arsura, prurit, dispareunie

FCB

Vaginita simpla eritematoasa

Vaginita granuloasa

Vaginita ulceroasa

Vaginita senila

Acuta

Cronica: papilomatoasa

*Trichomonas vaginalis ← Metronidazol (Flagyl) per os 1 g (4 cp) /zi,

10 zile, ambii parteneri, cp. vaginale 1/zi, 10 zilesau Fasigyn 2g doza unica ambii parteneri

*Candida albicans: favorizata de pH acid, Ab, CO, S,N, diabet, contact

sexual ← local irigatii Na2CO3, Stamicin, Canesten, Nistatin, Nizoral +

gen. Stamicin

*flora polimorfacreionase vaginale+ E in carente hormonale

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 7/11

  Clasificare

•Topografica: exo, endo, metrita

•Clinica: acuta, cronica

•Etiologica: nespecifica (bacterii, virusuri HPV, CMV)

specifica (TBC,sifilis,sancrul moale,limfogranulomatoza,actinomicoza,chist hidatic)

Etiopatogenie

Particularitati ale colului ← substratul histologic 

*exocolul: epiteliu pavimentos nekeratinizat

*endocolul: epiteliu cilindric unistratificat

*zona de tranzitie: mare instabilitate celulara, atipii

Factori determinanti = ag. patogeni

Factori favorizanti: sex, avort, N + ruptura colului, M, prolaps, carente hormonale,

agresiuni fizico-chimice, igiena precara, contraceptie chimica sau mecanica

Cai de propagare:descendenta

ascendenta

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 8/11

rara

eritematoasa

catarala

 purulenta

fibrinoasa

ulcero-necroticamembranoasa

gangrenoasa

Simptome: leucoreegonococica

difterica

trichomoniazica

 puerperala (streptococ, stafilococ)

foarte

frecventa

Simptome: leucoree

+ forme asimptomatice

eritematoasa

eroziva (ulcerata)

granulara (lenticulara)

ulcerovegetanta

chistica oua Naboth

scleroasa (atrofica)

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 9/11

FCBCitologia cervico vaginala (FCD, test Babes Papanicolaou, Pap-test)

Test Hinselmann (acid acetic 3%)

Test Lahm Schiller (sol. Iodo-iodurata 1%)

Colposcopia

BiopsiaAspecte colposcopice:

Eroziunea

Ectopia = proliferarea mucoasei

endocervicale → epiteliul

 pav. inlocuit cu cilindric

Zona de transformare

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 10/11

1. Infectii specifice cervicaleTBC colului, sifilis (primar –  sancrul dur, sec. - cel

mai contagios, tertiar –  goma), sancrul moale (b.

Ducrey), limfogranulomatoza inghinala virala,

actinomicoza (abcese cu granule de sulf), chist hidatic

2. Displazii (= modificarea arhitecturii, aspectului cel.,

rap. normale) simple sau agravate (atipii);

colposcopic: leucoplazia, baza de leucoplazie, mozaic,zona rosie

3. Cancerul de col uterin

4. Endometrioza colului

7/21/2019 Curs Amg 2013 Vaginite,Cervicite

http://slidepdf.com/reader/full/curs-amg-2013-vaginitecervicite 11/11

LentaPropagarea infectiei, sterilitate

Displazii, cancer

Profilactic

Curativ: gen.in inf. cu gonococ, trichomonas, candida;

local: ovule, DC

Formele rebele la trat.: conizatia, amputatia colului