reproductive tract infection

1. Shri Vinoba Bhave College of Nursing
Seminar Presentation on
Pregnancy with Reproductive Tract infection
Prepared by: Khan Najbun
MSc (N) II yr

2. Introduction
• Sexually transmitted disease (STDs) in pregnancy may result
in adverse pregnancy outcomes, fetal infection, neonatal
infection, and a broad range of social consequences.

3. • Definition of STI:
Sexually transmitted infections (STIs) are groups of
infections that are predominantly transmitted through unprotected
sexual contact with an infected person.
• Definition of RTIs :
Reproductive Tract Infections (RTIs) are infections of the
genital tract. They refer to the site where the infection develops.
They may or not be transmitted through sexual contact.

4. Reproductive Tract Infection / Sexually
Transmitted Diseases.
• Vaginal Infections
 Candida vaginitis
Trichomonas vaginitis
Bacterial vaginosis
• HPV infections
• Chlamydia infections
• Gonorrhea
• Pelvic Inflammatory Diseases (PID)

5. • Urinary Tract Infection
Asymptomatic bacteriuria
Cystitis and urethritis
Chronic pyelonephritis
Chronic renal diseases
• Hepatitis
• Human immune deficiency Virus (HIV)

6. • TORCH infection
Toxoplasmosis
Syphillis
Rubella
Cytomegalovirus
Herpes simples

7. • Other infections
Influenza
Measles
Chicken pox
Mumps
Poliomyelitis
Tuberculosis
• Streptococcal infections
• Toxic shock syndrome

8. Causative organism
STD Bacteria
Gonorrhea Neisseria gonorrhoea
Syphillis Treponema pallidum
Chancroid Hemophillus ducryi
Non specific urethritis Chlamydia trachomatis
Lymphogranuloma
venerium
Chlamydia trachomatis

9. STD Virus
AIDS HIV 1 & HIV 2
Genital Herpes Herpes Simplex Virus
Genital Warts Human Papilloma Virus
Hepatitis HBV , HCV
STD Causative organism
-Vaginal thrush
-Balanoposthitis
Fungal : Candida albicans
-Vaginitis , Urethritis ,
-Balanoposthitis
Protozoal : Trichomonas vaginalis
Genital Scabies Arthropods : Sarcoptes scabei

10. Gonorrhea

11. Gonorrhea
• Caused by – Neisseria gonorrheae
• Most commonly infects the mucosa of the lower genital tract.
• The endocervical glands, urethra, anus and oropharynx may
be sites of infection.
• Incidence : 12-40%
• Incubation period : 2-5 days

12. Symptoms
Dysuria
 Frequency & purulent vaginal discharge appear 3-5 days
after exposure.
 Infection spreads to the fallopian tubes and ovaries.
 lower abdominal pain
 Fever
 leukocytosis
 Tubal infection may result in scarring and subsequent
infertility.

13. Gonorrhea during Pregnancy
• Although gonorrhea usually causes few symptoms during
pregnancy, it can result in serious postpartum and neonatal
infections.
• Routine gonorrhea testing it recommended in early pregnancy
and should be repeated at 28 weeks gestation in high- risk
populations.

14. Risk during Pregnancy
• Septic abortion
• Chorioamnionitis
• Premature delivery
• Premature rupture of membrane
• Intrauterine growth retardation

15. Effect on Newborn
• Ophthalmic infections
• Infections of nasopharyngeal passages , vagina , anus , ear
canals and scalp abscesses.

16. Diagnosis
• Nucleic Acid Amplication Testing (NAAT) of urine or
endocervical discharge is done.
• First void morning urine sample or at least one hour since the
last void sample should be tested.
• NAAT is very sensitive and specific

17. • In the acute phase, secretions from the urethra, Bartholin’s
gland, and endocervix are collected for gram stain and
culture.
• Diagnosis is by culture on a Thayer – Martin medium or
gram stained cervical smear with intracellular gram –
negative diplocooci
• An immunoassay test for antibodies.

18. Treatment
• Preventive
Adequate therapy for gonococcal infection
Meticulous follow up till patient declared cured.
Treat adequately male sexual partner simultaneously
Avoid multiple sex partners
Use condom till both sexual partners are free from disease.

19. • Curative
 Ceftriaxone sodium 125 mg IM single dose
 Cefixime (suprax) 400 mg orally single dose
Ciprofloxacine 500 mg orally single dose
Ofloxacine 400 mg orally single dose
Spectinomycine HLL (Trobicin) 2g IM single dose
combined with doxycycline 100 mg orally BD for 7 Days.
Gonorrehea infection during pregnancy are treated with
ceftriaxone 125 mg IM or other Cephalosporine, plus
erythromycin base 500 mg orally qid for 7 days.

20. • In neonate prophylaxis : topical application of 1% Silver
nitrate.
Follow up
• Culture: 7 days after the therapy
• Repeat culture at monthly interval following menses for 3
months
• Report persistently negative patient is declared cured.

21. Syphilis

22. Syphilis
• Causative agent : Treponema Pallidum
• Transmission through abraded skin or mucosal surface
• Incubation period : 9 -90 days
• Incidence : < 10%

23. Primary syphilis
Secondary syphilis
Latent syphilis
Tertiary syphilis
Congenital syphilis
Classification

24. Primary syphilis
• Single or multiple lesion located in labia
• Fourchette , anus, cervix, and nipple are the other sites of lesion
• Small papule formed, quickly erode to form an ulcer
• Ulcer painless without any inflammatory reaction
• Inguinal gland enlarged , discrete, and painless
• Primary chancre heals spontaneously in 1-8 weeks.

26. Secondary syphilis
• 6 weeks to 6 months from onset of primary chancre
• These are coarse, flat- topped, moist, necrotic lesions and teeming with
treponemes
• Systemic symptoms like fever, headache and sore throat
• Macullopapular skin rashes
• Generalized lymphadenopathy
• Mucosal ulcer
• Alopecia

28. Latent syphilis
• Quiescence phase after the stage of secondary syphilis has resolved.
• Duration : 2 to 20 years.
Tertiary syphilis
• Damages central nervous , cardiovascular, musculoskeletal system
• Cranial nerve palsies
• Hemiplagia
• Aortic aneurysm
• Gummas of skin & bones.

29. Congenital Syphilis
• Congenital syphilis usually occurs following vertical
transmission of T. pallidum from the infected mother to the
fetus in utero, but neonates may also be infected during
passage through the infected birth canal at delivery.

31. Early sign Late sign
Maculopapular rash Hutchinson teeth
Rhinitis Deafness
Hepatospleenomegaly Saddle nose
Jaundice Hydrocephalus
Lymphadenopathy Mental retardation
Pneumonia Optic nerve atrophy

32. Effect on pregnancy
• Mother
- Accelerate course of HIV infection in pregnant women
• Baby
- Abortion
- Preterm birth
- Intrauterine death
- Non- immune fetal hydrops
- Delivery of highly infected baby

33. Diagnosis
• Obstetric history in multigravida
• Clinical findings
• Investigaions
Serology test:
- VDRL
- Fluroscent Treponemal Antibody Absorption Test ( FTA-ABS)
- Treponema pellidum Micro Hemagglutination Test (MHA-TP)

34. Fetal infection diagnosed by
- Polymerase chain reaction (PCR) of T. Pallidum in amniotic
fluid , fetal serum or spinal fluid.

35. Treatment
Mother
• For primary , secondary or latent syphilis :
- Benzathine penicillin 2.4 million units IM single dose
• Duration >1 year :
- Benzathine penicillin 2.4 million units IM weekly for 3 doses
- Patient allergic to penicillin : oral azithromycin 2 g single dose

36. • Tertiary disease :
- Neurosyphilis : Aqueous crystalline penicillin G 18 -24
million units I daily for 10 -14 days
• Treatment given in early pregnancy should be repeated in
late pregnancy
• Treatment repeated in subsequent pregnancy

37. Baby
• Positive serological reaction without clinical evidence of the
disease: single dose of penicillin G 50000 units per kg body
weight IM.
• Infected baby with positive serological reaction:
- Isolation with mother
- IM administration of aqueous procaine penicillin g 50,000
units/ kg body weight for 10 days
• An apparently healthy child of a known syphilitic mother :
serological reaction tested weekly for the first month & then,
monthly for 6 months.

38. Genital Herpes

39. Genital Herpes simplex
• Incidence : 1%
• Two types of Herpes Simplex Viruses (HSV)
• HSV- 1 is mainly seen as “cold sores” of the lips
• HSV -2 causes 85% of genital herpes lesions
• Incubation period : 2-14 days

40. Symptoms
• Red painful inflammatory area on the clitoris , labia,
vestibule, vagina, perineum and cervix.
• Flue like symptoms with achiness, fever, headache, and
inguinal adenopathy
• Multiple vesicles appear which progress into multiple
shallow ulcers.
• Inguinal lymphadenopathy
• Vulvar burning, pruritus, dysuria, or retention of urine
• Frequency of recurrent infection is high with HSV 2.

41. Diagnosis
• Virus tissue culture and isolation
• Detection of virus antigen by ELISA or immunoflurescent
method
• PCR test to identify the HSV DNA is the rapid, specific and
most accurate test.

42. Herpes infection during pregnancy
• 1- 2% pregnancies are complicated by HSV infection.
• Genital infection in pregnancy is caused by HSV 2
• Maternal infection rarely transmitted to transplacental to the fetus :
in first trimester causes spontaneous abortion or severe fetal
abnormalities.
• After 20th weeks of gestation increase risk of premature birth
• Fetus is infected after rupture of the membrane

43. Treatment
• In non pregnant women , acyclovir 200 mg orally five times daily
or 400 mg 3 times daily for 10 days.
• For recurrent infection , acyclovir 200 mg five times daily for 5
days or 500 mg twice daily for 5 days
• Chronic suppressive therapy with 400 mg acyclovir twice daily
• Perineal comfort promoted

44. Cytomegalovirus infection
• It is a DNA virus.
• Incidence : 0.3-2.4%
• Transmission may be sexual, respiratory droplet or
transplacental, close contact & breast feeding

45. • 60% general population has antibodies to CMV by age 35-40
years
• It is found universally throughout all geographic locations
• 75 % of pregnant women in developed countries are immune
& about 1-4 % women acquire a primary infection in
pregnancy.
• Most cytomegalovirus infection are asymptomatic.

46. • Women younger than 25 years have great risk of acquiring
CMV infection.
• 4-8 weeks after infection: fever, fatigue, malaise with
splenomegly & atypical lymphocytes
• There is no effective treatment
• Congenital infection occur in 0.5% - 2% of all neonates,
only 5-10 % manifest evidence of disease.

47. Cytomegalovirus infection in pregnancy
• Rate of seroconversion during pregnancy 1%-2%
• Primary infection in pregnancy increases risk of congenital
CMV
• 30 -50% fetus infected with CMV during the first trimester
• Only 10-15% exhibits clinical manifestation

48. Clinical manifestation
• CNS abnormality
• Microcephaly
• Hydrocephaly
• Cerebral calcification
• Deafness
• Chorioretinits

49. Cont…
• Hepatosplenomegaly
• Jaundice
• Hemolytic anemia
• Covulsion
• Mental retardation
• Spastic diplegia

50. Diagnosis
• Urine culture
• Urine analysis showing cells with intranueclear inclusion
bodies
• Viral culture or DNA analysis of amniotic fluid by PCR or
HCMV IgM antibody activity in cord blood.
• Indirect hemagglutination and ELISA test

51. Treatment
• Maintain hygiene
• Antenatal screening
• No vaccine available or prophylactic therapies to prevent the
transmission of HCMV

52. SUMMARY