Servisitis SGD 16
Servisitis SGD 16
Servisitis SGD 16
PATHOPHYSIOLOGY
VAGINAL DISCHARGE
NURKHOLIS HARAHAP
2208260132
PELVIC
INFLAMMATORY DISEASE
PELVIC INFLAMMATORY DISEASE
Infection of the female upper genital organs
SUPPORTING INVESTIGATION
• Whole blood: Leukocytosis, increased ESR
• Increased C reactive protein
• Transvaginal ultrasound, MRI
• Endometrial biopsy
• Laparoscopy
• Microscopic vaginal discharge
TREATMENT
• Inpatient:
Cefotetan 2 gr IV/12 hours or cefoxitin 2 gr
IV/6 hours + Doxycycline 2x100 mg
Symptomatic
COMPLICATION PROGNOSIS
• Pelvic pain chronic Early Diagnosis and Treatment: Prompt
• Infertility recognition and treatment of PID are crucial in
• Ectopic Pragnancy preventing complications. Antibiotics are
• Abscess ovarian tubo usually prescribed to treat the infection, and
the sooner treatment begins, the better the
prognosis.
EDUCATION
• Explain that PID is caused by a bacterial infection, which often stems from sexually
transmitted infections such as chlamydia and gonorrhea
• Antibiotics are the primary treatment for PID and how important it is to follow the
instructions for using prescribed antibiotics.
• The importance of using condoms to prevent sexually transmitted infections that can
cause PID.
• Maintain genital hygiene, good nutrition, adequate hydration, avoid use vaginal
cleanser.
SERVICITIS
SERVICITIS
Inflammation of the uterine cervix
ETIOLOGY
a. Non-Infections b. Infections
• Local trauma (tampons, cervical cap, IUD thread,
• Neisseria gonorrhoeae
pessary ring, diaphragm)
• Chlamydia trachomatis
• Radiation
• Herpes simplex virus
• Irritation due to chemicals (vaginal cleanser,
• Trichomonas vaginalis
latex)
• Systemic inflammation (Bechet syndrome)
• Malignancy
RISK FACTOR CLINICAL MANIFESTATIONS
• Promiscuity • Asymptomatic
• Young age • Vaginal discharge
• Urban • Dysuria, dyspareunia
• Poor economic status • Abnormal vaginal bleeding
• Use of alcohol and drugs • Genital skin lesions (clustered vesicles, ulcer)
• Burning, itching sensation in the genitals
PATHOPHYSIOLOGY
PHYSICAL EXAMINATION
• External genitalia inspection : Skin lesions (clustered vesicles, ulcers)
• Inspection: vaginal discharge (N.Gonorrhoeae -> mucopurulent, Chlamydia
trachomatis-> mucoid, Trichomonas vaginalis-> foamy greenish yellow discharge,
foul odor), Strawberry cervix (Trichomonas vaginalis), vesicles/ulcers/erythema on
the portio (Herpes simplex)
• Bimanual examination: Cervical enlargement, cervical/portio swaying pain
SUPPORTING INVESTIGATION
• NAAT (Nucleic acid amplification testing)
• Microscopic -> NACL (Trichomonas vaginalis) wet preparation, Staining gram
(Bacteria), Tzank test (Herpes simplex)
N. Gonorrheae
NON PHARMACOLOGY
• Maintain genital hygiene
• Good nutrition
• Get enough hydration
• Avoid use vaginal cleanser
TREATMENT
HERPES SIMPLEX
Acyclovir, 5x200 mg/day, orally, for 7 days, OR
Acyclovir 3x400 mg/day for 7 days OR
Valacyclovir, 2x500 mg/day, orally, for 7 day,
TRIKOMONIASIS
• Metronidazole 2 gr SD 2
• Metronidazole 2 x 500 mg 7 days
COMPLICATION AND PROGNOSIS
• Infertility: If left untreated, cervicitis can cause inflammation that damages cervical tissue and
can even affect fertility in women.
• Risk of Chronic Pelvic Disease: Chronic or frequently recurring cervicitis can increase the
risk of inflammation of other pelvic organs, such as the uterus, fallopian tubes, or ovaries
EDUCATION
• Avoid making cervicitis worse or triggering, such as chemicals in soap or detergent,
certain condoms, or other allergens.
• keep the genital area clean in a gentle and non-irritating way, such as using warm
water and neutral soap, without fragrances or harsh chemicals.
• Recommend wearing underwear made from sweat-wicking and loose-fitting
materials, which can help retain moisture and reduce irritation
• the importance of using condoms in every sexual intercourse to prevent transmission
of sexually transmitted infections that can cause or worsen cervicitis.
Prevention
Prevention efforts are divided into several levels according to travel
disease. It is known that there are 3 main levels of disease prevention, namely:
• prevention first level (primary prevention),
• secondary level prevention (secondary prevention),
• and third level prevention (tertiary prevention).
VULVOVAGINALIS
CANDIDIASIS
VULVOVAGINALIS CANDIDIASIS
Mucosal infections vagina and/or vulva (non-keratinized epithelium) caused by the
fungus Candida species
the presence of cells yeast or budding yeast cells), blastospores, and pseudohyphae
(pseudohyphae)a lot.
TREATMENT
Spuculum :
• vaginal discharge increased, homogeneous gray color, low or normal viscosity, odor,
and rarely foams.
• vaginal discharge adheres tothe vaginal walls appear as a thin layer or diffuse sheen,
pH of vaginal secretions ranges between 4.5-5.5. Symptoms of inflammation
generally there are none. There is erythema on vagina or vulva or petechiae on
vaginal wall.
SUPPORTING INVESTIGATION
With a microscope, on preparation Wet vaginal secretions with saline solution physiology shows few
or no leukocytes, numerous epithelial cells and the presence of coccobacill group. There is a clue cell
(cell vaginal epithelium covered with coccobacilli so the cell boundaries are not clear) is
pathognomonic
SUPPORTING INVESTIGATION
• To establish a diagnosis, 3 of the 4 AMSEL criteria are required:
(1) Homogeneous, white, noninflammatory secretions
that lines the walls of vaina;
(2) Wet preparation examination with saline
shows the presence of clue cells;
(3) pH vaginal discharge above 4.5;
(4) “whiff test” (vaginal fluid smells like fish after
addition of potassium hydroxide solution KOH] 10%) positive
TREATMENT
• vaginal discharge of yellowish hijua color, foamy like soapy water, and itching in the
genitalia organs
• Disuria
• Dyspareunia
• strawberry servic
PATHOPHYSIOLOGY
SUPPORTING INVESTIGATION
In this microscopic examination, we will find a picture of the morphology of Trichomonas vaginalis
and also the movement of the trophozoid Trichomonas vaginalis that stomps.
SUPPORTING INVESTIGATION
• To establish a diagnosis, 3 of the 4 AMSEL criteria are required:
(1) yellow-green, foamy, sticky and abundant
(2) Microskopis, Tricomonas, Leukocytes>10 Wide Field of View
(3) pH vaginal discharge > 4.5;
(4) “whiff test” positive
TREATMENT
increase in vaginal pH
VAGINAL
DISCHARGE
increased growth of candida albicans
increase in vaginal pH
VAGINAL
DISCHARGE
REFERENCE
• Tay F. Local Recurrence of Primary Cardiac Leiomyosarcoma After Resection : A Rare Case. Indones J
cancer. 2021;15:223–5.
• Mestiri S, Elghali MA, Bourigua R, Abdessayed N, Nasri S, Amine BA, et al. rare tumors Soft tissue le
iomyosarcoma — diagnostics , management , and prognosis : Data of the registry cancer of the center
of Tunisia. J sage pub. 2019;11:1–7.
• Mangla A, Yadav U, Health CC. Cancer , Leiomyosarcoma Cancer , Leiomyosarcoma. NCBI J. 2019;(
November).