"CERVICITIS" - A Disease Presentation , Slides of Pharmacology

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CERVICITIS

CASE PRESENTATION

SIBQATHULLAH K Pharm.D Intern Obstetrics & Gynecology

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**1. INTODUCTION 2. EPIDEMIOLOGY 3. PATHOPHYSIOLOGY

4. ETIOLOGY** 5. CLINICAL PRESENTATION **6. DIAGNOSIS
5. MANAGEMENT 8. SOAP NOTES** 9. PATIENT COUNSELLING 10. REFERENCE

CONTENTS

z The Exact prevalence of cervicitis is difficult to determine due to lack of standard definition and variation by population. Since Sexual activity is the main risk factor for the infectious causes, it may effect about 30% - 40% of the patients seen in Sexually Transmitted Infections (STI). The highest incidence is in sexually active women aged 15-24 , it is more common in HIV Positive women , with an estimate of 7400 per 1,00,000 women diagnosed with HIV across INDIA approx. EPIDEMIOLOGY

z PATHOPHYSIOLOGY Increased Vaso permeability (vascular permeability) Vasodilation of capillaries & arterioles (causing redness) Immune Response cause The inflamed cervix released cytokines to the immune system, increasing WBC counts in that region Cervicitis can be extended downward from the uterus (or) extended upward from the vagina

z It is broadly classified into ETIOLOGY

• (^) Neisseria Gonorrhea
• (^) Chlamydia Trachomatis
• (^) Herpes Simplex
• (^) Trichomonas Vaginalis
• (^) Mycoplasma Genitalium INFECTIOUS
• (^) Mechanical irritants
• (^) Chemical irritants NON INFECTIOUS

z Neisseria Gonorrhea Chlamydia Trachomatis Primarily infect the columnar Epithelium of endocervix. Herpes Simplex Trichomonas Vaginalis Mycoplasma Genitalium Affect the Squamous Epithelium of ectocervix. Mechanical irritants Surgical instruments or foreign objects like pessaries, condom, diaphragm, cervical caps, tampons can cause mechanical trauma. Chemical irritants Chemical irritants cause allergic reactions and include soap, laundry products, spermicides, latex, vaginal douches and contraceptive creams INFECTIOUS NON INFECTIOUS

z RISK FACTORS  (^) Risk of STD increase through sexually active with no use of protection.  (^) Menopause  (^) Multiple sexual partners  (^) Sex during early age

CLINICAL PRESENTATION

z SYMPTOMS

• (^) Yellowish or white discharge may occur with foul smell
• (^) Feverish states
• (^) Pain in lower abdomen and even during sexual intercourse
• (^) Stinging, burning or irritation in the affected area
• (^) Discomfort while urinating

z  (^) Eating yogurt or taking probiotic supplements: contains healthful bacteria called probiotics  (^) Eating garlic or taking a garlic supplement: Garlic has strong antibacterial properties  (^) Drinking green tea to reduce the risk of ovarian and endometrial cancers  (^) Avoiding irritants: Avoiding douches, tampons, diaphragms, and scented soaps reduces the risk of irritation NON PHARMACOLOGICAL MANAGEMENT

z  (^) Using condoms during sex: This reduces the risk of STIs, one of the leading causes of cervicitis  (^) If you get treatment for a sexually transmitted disease, ask your doctor if your partner should also be treated  (^) Wearing loose cotton underwear: Breathable underwear reduces the buildup of moisture and bacteria that can lead to infection

z TREATMENT ALGORITHM

z 17 SOME ANTIVIRAL ARE PRESCRIBED FOR VIRAL CERVICITIS o (^) ACYCLOVIR 400mg/800mg o (^) RITONAVIR 100mg o (^) VALACYCLOVIR 500mg/1gm o (^) FAMICICLOVIR 250mg/500mg TREATING NON INFECTIOUS CERVICITIS If The Non Infectious Cervicitis Persist Then It Needs To Be Addressed By The Removal Of Abnormal Tissues Surgically  (^) CRYOSURGERY – Freezing the tissue and destroying abnormal tissues  (^) CAUTERIZATION – Heating the tissue and destroying abnormal tissue  (^) LASER THERAPY – Laser removal of the tissue

z  PATIENT NAME : XXXX  (^) AGE : 30 Years  (^) SEX : FEMALE  (^) IP No : 140638  (^) WARD : OBG SUBJECTIVE EVIDENCE

z CHIEF COMPLAINTS  (^) C/O. Yellowish white Discharge per vagina since 1 year, foul smelling  (^) C/O. Itching  (^) C/O. Back pain since 1 year