L13B.

1 NUR2050 MEDICAL SURGICAL NURSING 4, LECTURE 13B: GENITAL TRACT INFECTIONS Key Terms: ectopic pregnancy placental abruption chancre abortion/stillbirth placenta praevia hyperemesis gravidarum preeclampsia condylomata salpingitis

O !e"#$%es: To review the effects of the sex hormones on the female genital system. To examine some pregnancy problems that become medical/surgical issues. To study the adverse effects of pathogens on the genital tracts and unborn babies. M&!'r T'($"s: Menstrual endocrinology regnancy pathophysiology !enital tract infections "nfections during pregnancy

Re)e%&*# #e+# '', -&.es: #melt$er and Bare% pages &&'(1&&)% 1&3*(1&31% 1&3+(1&3'% 13*3(13*+. MENSTRUAL ENDOCRINOLOG/ The e*e0$"$&) actions of 'es#r'.e* on the female body include increased formation of tissue (r'.es#er'*e re"e(#'rs ,important in pregnancy-. m&$*#e*&*"e of the reproductive structures% s/in and many other tissues. mild &*& ')$" &"#$'*s% including inhibition of bone mineral losses in older women. reduction in me*'(&1s&) sym(#'ms. elevation of serum 2DL levels and lowering of L0L levels. a greatly reduced ris/ of "'r'*&ry &r#ery 3$se&se.

The &3%erse effects of 'es#r'.e* on the female body include some degree of re&s# #e*3er*ess% nausea% anorexia% and 0)1$3 re#e*#$'*. an increased ris/ of endometrial and ,some- breast "&*"ers. a ,usually- small increase in the ris/ of #4r'm 'em ')$sm and pulmonary embolism.

The e*e0$"$&)51*3es$r& )e actions of (r'.es#er'*e on the female body include secretion of m1"1s in the genital tract. "&)m$*. of smooth muscles in the genital tract ,during conception and pregnancy-.

-REGNANC/ -AT2O-2/SIOLOG/ F'e#&) .es#&#$'*&) & *'rm&)$#$es that become medical(surgical problems rather than purely obstetric ones include 16 e"#'($" (re.*&*"y% in which an embryo implants in a 0&))'($&* #1 e or somewhere within the abdominal cavity. normal pregnancy manifestations may be experienced for &(3 months. the foetus and placenta '1#.r'7 the available space and blood supply. the woman usually complains of abdominal (&$* &*3 #e*3er*ess by &(3 months. "&#&s#r'(4$" r1(#1re and haemorrhage are inevitable without treatment. treatment involves surgical removal of the embryo% placenta and tube ,usually-.

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L13B.& s('*#&*e'1s)y #erm$*&#$*. pregnancies% which include spontaneous & 'r#$'*s, where the pregnancy fails in the first &* wee/s. s#$)) $r#4s, in which the foetus dies during delivery or shortly before gestation. death in utero due to ()&"e*#& (r&e%$&8 death of either/both mother and foetus due to ()&"e*#&) & r1(#$'*6

M&#er*&) .es#&#$'*&) & *'rm&)$#$es that become medical(surgical problems include 16 4y(eremes$s .r&%$3&r1m% a relatively uncommon disorder of pregnancy in which 26 high 12! and oestrogen levels cause severe vomiting. vomiting leads to significant dehydration% buffer disturbance and hypo/alemia. there is a need for correction of fluid deficits. anti(emetic therapy% though undesirable in pregnancy% may be unavoidable.

(ree")&m(s$&% is an abnormality of gestation in which there is pregnancy(induced hypertension% proteinuria and generalised oedema. the mechanisms causing the hypertension are poorly understood. treatment is re3uired urgently or the woman may suffer life(threatening convulsions.

-&r#1r$#$'* (r' )ems that become medical(surgical incidents include 16 "e(4&)'(e)%$" 3$s(r'('r#$'* 26 implies that the baby4s head is too large for passage through the pelvic birth canal. is much less common than abnormal presentation of the foetus to the birth canal. is one of the reasons why delivery may be delayed with possible damage to the foetus.

1#er$*e &#'*y is the failure of the postpartum uterus to clamp off the severed maternal blood vessels. may be lethal because the woman can easily lose 1(3 L of blood by this means. can be treated by manual manipulation or administration of an oxytocic substance.

GENITAL TRACT INFECTIONS 2ommonly found '(('r#1*$s#$" microorganisms can cause male genital infections ,retrograde- such as epididymitis% orchitis% and prostatitis. patchy damage to the seminiferous tubules% with a subse3uent reduction in fertility. %&.$*$#$s involving superficial genital lesions% genital itch and urinary fre3uency. distinctive unpleasant '3'1rs associated with the female genitalia. #'+$" s4'", sy*3r'me ,notably due to S. aureus when tampons are used incorrectly-.

Se+1&))y #r&*sm$##e3 pathogens include the bacteria Treponema pallidum, Neisseria gonorrhoeae and Chlamydia. include the viruses HPV, HIV, and HSV and the yeast Candida albicans. mostly affect both males and females% though not necessarily to the same degree. produce lesions of the external genitalia% notably condylomata.

induce infertility% especially that secondary to pelvic inflammatory disease. can produce degenerative changes in the internal organs and in other organs as well. are an important cause of both penile and cervical cancers. L13B.3 often are damaging to the unborn embryo/foetus and even neonates.

Sy(4$)$s is caused by the highly infectious spirochete bacterium% Treponema pallidum. usually ac3uired by sexual intercourse but can cross the placenta ,"'*.e*$#&) sy(4$)$s-. readily "1re3 y &*#$ $'#$"s but not by the host5s immunological responses. /nown to primary% secondary and tertiary stages.

-r$m&ry sy(4$)$s develops about 3 wee/s after the sexual contact. involves formation of at least one red non(tender "4&*"re on the genitalia. typically appears to resolve spontaneously in a few wee/s without treatment.

Se"'*3&ry sy(4$)$s develops & months after the primary stage. manifests as a diffuse rash along with genital pla3ues ,condylomata lata-. causes oral lesions% lymphadenopathy% headache% arthritis% fever and malaise. also disappears spontaneously in a month or two.

Ter#$&ry sy(4$)$s re(develops 3(16 years after the initial infection. is characterised by the development of soft% rubbery tumours called gummas. damages many organs and tissues% notably including the heart% 27#% and liver. ultimately causes insanity and premature death.

G'*'rr4'e& is caused by Neisseria gonorrhoeae which causes genital tract lesions in both sexes and is a significant reason for infertility. in men causes infections of the internal genital organs and 1re#4r&) s#r$"#1re. in women causes s&)($*.$#$s and other forms of purulent or granulomatous lesion. fre3uently results in sterility a form of arthritis or other systemic disease in both sexes. can be controlled by penicillin therapy.

C4)&my3$&) $*0e"#$'*s produce initial small epidermal vesicles that ulcerate and become chronic lesions. occasionally cause maternal or foetal morbidity ,illness-. can be treated with erythromycin.

AIDS ,1"8 infection- is /nown to be lethal because of immunodeficiency and uncontrolled secondary disease states. ac3uired by babies in utero% at delivery% or during breast feeding.

Ge*$#&) 4er(es is characterised by

sexual transmission of 1#8(1 or 1#8(&% leading to oral or genital sores. initial mucous membrane vesicles which later become ulceration sites. an ability to $*0e"# 0'e#1ses 31r$*. (&r#1r$#$'* ,at least in the case of 1#8(&-. corneal /eratitis% encephalitis% and damage to the lungs and lymphoid organs. L13.+ a 50 (er"e*# 0e#&) m'r#&)$#y and severe 27# damage in those neonates that survive.

Candida albicans is important because it is present in most cases of vulvovaginal fungal infection. is present in &6 ( 6*9 of healthy women. is more aggressive in diabetics% pregnancy% and when antibiotics are being used.

INFECTIONS DURING -REGNANC/ "n regard to the development of infections in association with pregnancy it should be noted that a m1"'1s ()1. in the cervix ma/es transcervical infection of a foetus a rare event. some pathogens can "r'ss #4e ()&"e*#& to infect embryos and foetuses. infected mothers sometimes contaminate uninfected foetuses 31r$*. (&r#1r$#$'*. (1er(er&) se(s$s of the uterus after loss of the placenta can lead to septic shoc/

TORC2 $*0e"#$'*s% which typically are ac3uired transplacentally% include Toxoplasma% syphilis ,other-% rubella% cytomegalovirus and Herpes simplex. can cause ma:or developmental disturbances during embryonic development. also increase the ris/ of spontaneous & 'r#$'*, s#$)) $r#4% or premature delivery.