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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 discharge
2、 adherent to vaginal walls no erythema/edema.pH akaline(over 4.5)Presence of“Clue cells”Cells studded with bacteriaCell wall indistinctFishy amine odor when 10%KOH added(TV,semen also causes odor releases.Relative absence of WBCs.,O&G Hospital of FuDan University*,Treatment,Oral metronidazole 400mg
3、BID for 7 daysOral clindamycin 300mg BID for 7 daysNo 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*,临床表现,分泌物增多 黄绿色、泡沐状外阴骚痒阴道粘
4、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 FuDan University*,注意事项,性伴侣治疗 随访
5、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 FuDan University*,临床分类,单纯性复杂性,O&G Ho
6、spital 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-Clinical Features,Lower abdominal pain allVaginal
7、 discharge 1/2Vaginal bleeding 1/2Dysuria 1/4Nausea,vomiting,anorexia 1/4,SYMPTOMS,O&G Hospital of FuDan University*,PID-Clinical Features,Abdominal or adnexal tenderness allCervical tenderness allAdnexal enlargement 1/3Fever 1/3RUQ tenderness up to 1/3,SIGNS,O&G Hospital of FuDan University*,Treatm
8、ent 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 casesWhere there is clear evidence of a pelvic abscess.Rupture of abscess,O&G Ho
9、spital 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 failsto respond to antimicrobial therapy within 72 hours.,O&G Hospital of FuDan University*,O&G Hospital of FuDan University*,
10、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 PID20-25%Infertility after 1 infection10-15%after 2 infections25-35%after 3 infections50-75%Ectopic pregnancy(with next pregnancy)7%*,CONSEQUENCES,FREQUENCY,*6-10 fold increase over normal incidence,
