yeast infection ppt

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Yeast infections are generally caused by an organism called Candida albicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.


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Yeast Infection Treatment : 

Supervised by: DR.Na’el obeidat Presented by: Mohammad Jabari Yeast Infection Treatment Yeast infections are generally caused by an organism called Candida barbicans. Natural cures are simple, less expensive, and by far the most important point, they actually work. Get few tips for avoiding this disease with ease.

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Seminar objects: Normal & Abnormal vaginal discharge Candidal Vaginitis Trichomonas virginal's Prevention Bacterial vaginosis

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# Discharge is common to all women and helps vaginas stay healthy by regularly flushing them out and maintaining their pH. #A normal vaginal discharge consists of about a teaspoon (4 milliliters) a day that is white or transparent, thick to thin, and odorless. #This is formed by the normal bacteria and fluids the vaginal cells put off. The discharge can be more noticeable at different times of the month depending on ovulation, menstrual flow, sexual activity and birth control.

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#It is not uncommon for the normal discharge to be dark, brown or discolored a day or two following the menstrual period. #The following situations can increase the amount of normal vaginal discharge: 1-Emotional stress 2-Ovulation (the production and release of an egg from your ovary in the middle of your menstrual cycle) 3-Pregnancy 4-Sexual excitement

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#Candida vaginitis (candidiasis or moniliasis) is the second most common vaginal infection in the United States. Etiology: #The etiologic agent is a yeast (fungi) organism, usually Candida albicans. #The organism is a common inhabitant of the bowel and perianal region #Thirty percent of women may have vaginal colonization and have no symptoms of infection.

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Risk Factors: Several factors may lead to symptomatic infection instead of colonization. Contraceptive practices (e.g., birth control pills and vaginal spermicides, which influence vaginal pH) Use of systemic steroids, which influence the immune system Use of antibiotics, which alters the microbiology of the vagina; 25% to 70% of women report yeast infections after antibiotic use. Any antibiotic, particularly a broad-spectrum agent, may play a causative role. Tight clothing, panty hose, and bathing suits (yeast thrives in a dark, warm, moist environment) Undiagnosed or uncontrolled diabetes mellitus

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#Another reason for a refractory monilial infection may be compromised immune status; with recurrent monilial vaginitis, an HIV test is indicated, along with a fasting serum glucose level. #There has been a recent increase in the number of infections caused by non-albicans species. Up to 20% of infections maybe caused by organisms such as Candida tropicalis and Torulopsis glabrata. These organisms may be resistant to standard treatment regimens.

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Clinical Presentation: #Patients with monilial vaginitis characteristically complain of a thick, white discharge and extreme vulvar pruritus. The vulva may be red and swollen, fissures may occur. #Symptoms may recur and be most prominent just before menses or in association with intercourse. #Yeast infections may occur more frequently during pregnancy. #Patients with infections caused by C. tropicalis and T glabrata may have an atypical presentation. Irritation may be paramount, with little discharge or pruritus.

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Diagnosis: #Diagnosis is made by history, physical examination, and microscopic examination of the vaginal discharge in saline and 10% KOH. #On examination, excoriations of the vulva may be noticeable; the vulva and vagina may be erythematous, with patches of adherent cottage cheese-like discharge. Candidal infections of the vulva are characterized by classic satellite lesions. #Infection with C. tropicalis and T glabrata may not be associated with the classic discharge; discharge may be white-gray and thin.

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#Vaginal pH may be normal or slightly more basic than normal (4.0 to 4.7). #Wet mount microscopic examination reveals hyphae or pseudohyphae with budding yeast in 50% to 70% of women with yeast infections. #Cultures are not necessary to make the diagnosis except in some cases of recurrent infections.

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Treatment: #Many agents are available for the treatment of vulvovaginal candidiasis. These include topical agents, which may be available over the counter (OTC) or by prescription, and oral agents, which are available by prescription only. #Antifungal intravaginal agents are administered as suppositories or creams. These drugs are available in three regimens: a single dose, 3-day course, or 7-day course. Agents include butoconazole, clotrimazole, miconazole, tioconazole, and terconazole. OTC regimens should be used only by women who have been diagnosed with a yeast infection in the past and are experiencing identical symptoms.

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#Oral agents: include fluconazole and ketoconazole. -Fluconazole is available as a single-dose (150 mg) treatment for uncomplicated vaginal candidiasis. -Ketoconazole is used effectively for the treatment of chronic and recurrent candidiasis; a 5% incidence of hepatotoxicity limits more widespread use. The dosing schedule is 200 mg twice a day for 5 days, then 100 to 200 mg daily for 6 months. #Boric acid capsules intravaginally, 600 mg for 14 days, may be effective.

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Chronic recurrent yeast infections: #(5% of women). In most cases, no exacerbating factor can be found; however, the following possibilities should be considered: 1-Failure to complete a full course of therapy. 2-HIV infection. Recalcitrant candidiasis may be a presenting symptom in women with HIV infection. HIV testing should be considered and offered to the patient. 3-Chronic antibiotic therapy. 4-Infection with a resistant organism such as C. tropicalis or T glabrata. 5-Sexual transmission from the male partner. 6-Allergic reaction to partner's semen or a vaginal spermicide. 7-Diabetes. Patients should have a fasting serum glucose level if they have recurrent infections.

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#Trichomonas vaginalis vaginitis (trichomoniasis) is the third most common vaginitis, accounting for 25% of cases. Etiology: #The motile protozoan T vaginalis is the etiologic agent. The trichomonad can be recovered from 70% to 80% of the male partners of the infected patient; therefore, Trichomonas vaginitis is an STD. #This infection is the most prevalent nonviral STD in the United States (Van der Pol, 2005, 2007). Unlike other STDs, its incidence appears to increase with age in some studies. Trichomoniasis is more commonly diagnosed in women because most men are asymptomatic. However, up to 70 percent of male partners of women with vaginal trichomoniasis will have trichomonads in their urinary tract.

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#This parasite is usually a marker of high-risk sexual behavior, and co-infection with other sexually transmitted pathogens is common, especially Neisseria gonorrhoeae. Trichomonas vaginalis has predilection for squamous epithelium, and lesions may increase accessibility to other sexually transmitted species. Vertical transmission during birth is possible and may persist for a year. Clinical presentation: #Trichomonas vaginitis is a multifocal infection involving the vaginal epithelium, Skene glands, Bartholin glands, and urethra. #No symptoms may be noted in up to one-half of women with trichomoniasis. However, in those with complaints, vaginal discharge is typically described as foul, thin, and yellow or green. Additionally, dysuria, dyspareunia, vulvar pruritus, and pain may be noted. At times, symptomatology and physical findings are identical to those of acute pelvic inflammatory disease.

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Diagnosis: #Incubation with T vaginalis requires 3 days to 4 weeks, and the vagina, urethra, endocervix, and bladder can be infected, such colonization may persist for months or years in some women. #With trichomoniasis, the vulva may be erythematous, edematous, and excoriated. The vagina contains the above-described discharge, and subepithelial hemorrhages or "strawberry spots" may be seen on the vagina and cervix. Trichomoniasis is typically diagnosed by microscopic identification of parasites in a saline preparation of the discharge. #Trichomonads are anteriorly flagellated, and therefore mobile, anaerobic protozoa. They are oval and slightly larger than a white blood cell (WBC). Trichomonads become less motile with cooling, and slides should be read within 20 minutes. Inspection of a saline preparation is highly specific, yet sensitivity is not as high as hoped (60 to 70 percent). In addition to microscopy, vaginal pH is often elevated.

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#The most sensitive diagnostic technique is culture, which is impractical because special media (Diamond media) is required and few laboratories are equipped. Moreover, nucleic acid amplification tests (NAAT) for trichomonal DNA are sensitive and specific, but not widely available. Alternatively, the OSOM Trichomonas Rapid Test (Genzyme, Cambridge, MA) is an immunochromatographic assay, which has 88 percent sensitivity and 99 percent specificity. It is available for office use, and results are available in 10 minutes (Huppert, 2005). Trichomonads may also be noted on Pap smear screening and sensitivity approximates 60 percent. #Women with trichomonal infection should be tested for other sexually transmitted infections. Additionally, sexual contact(s) should be evaluated or referred for evaluation.

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Laboratory tests: 1-The vaginal pH is usually between 5.0 and 7.0. 2-Saline wet mount of the vaginal discharge reveals numerous leukocytes and the highly motile, flagellated trichomonads (as many as 75% of cases). 3-Cultures are not usually necessary to make the diagnosis. They should be obtained when the diagnosis is suspected but cannot be confirmed by wet mount examination. 4-Pap smears may be positive in as many as 65% of cases. Positive Pap smears should be confirmed by wet mount examination because of the high false-positive rate.

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Treatment: #Because Trichomonas is sexually transmitted, both partners require therapy; 25% of women will be reinfected if their partner does not receive treatment. A-Vaginal therapy alone is ineffective because of the multiple sites of infection, and systemic agents are necessary. B-If both partners are treated simultaneously, cure rates of 90% are achieved with treatment with metronidazole. Patients should be warned that a disulfiram-like reaction may occur and that they should abstain from alcohol use during treatment. 1-The preferred regimen is 2 gin one dose because of ease of compliance. As many as 10% of patients may experience vomiting. 2-An alternative regimen is 500 mg twice daily for 7 days.

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C-Resistant cases may require treatment with intravenous metronidazole. Because resistance is rare, other causes, such as noncompliance of the patient or partner, should be considered. D-Metronidazole is contraindicated for use during the first trimester of pregnancy. After this time, it can be used to treat Trichomonas infections. E-Infected patients should be screened for other STDs.

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Photomicrograph of a vaginal smear saline preparation containing trichomonads (arrows). Drawing depicts anatomic features of trichomonads. Flagella allow this parasite to be motile.

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#Bacterial vaginosis is the most common vaginal infection in the United States today. In the past, bacterial vaginitis was known as nonspecific vaginitis and Gardnerella vaginitis. Etiology: #Bacterial vaginosis is a polymicrobial clinical syndrome caused by an overgrowth of a variety of bacterial species, particularly anaerobes, often found normally in the vagina. Organisms most often involved include Bacteroides, Peptostreptococcus, Gardnerella vaginalis, and Mycoplasma hominis. #The anaerobic bacteria produce enzymes that break down peptides to amino acids and amines, resulting in compounds associated with the discharge and odor characteristic of this infection.

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Risk Factors: #This condition is not considered by the Centers for Disease Control and Prevention (CDC) consensus group to be a sexually transmitted disease (STD), and it is seen in women without previous sexual experience. Many risk factors, however, are associated with sexual activity, and an increased risk of acquiring STDs has been reported in affected women 1-Oral sex 2-Douching 3-Black race 4-Cigarette smoking 5-Sex during menses 6-Intrauterine device 7-Early age of sexual intercourse 8-New or multiple sexual partners 9-Sexual activity with other women

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Clinical Presentation: #Fifty percent of women with bacterial vaginosis are asymptomatic. In symptomatic patients, the most common presentation is a malodorous, gray discharge. Diagnosis: #Three of the following four criteria must be present: A-The vaginal pH is generally between 5.0 and 5.5. B-Wet mount preparations with saline reveal a CLUE CELL background with minimal or no leukocytes, an abundance of bacteria, and the characteristic clue cells. The clue cells are squamous cells in which coccobacillary bacteria have obscured the sharp borders and cytoplasm. C-Application of 10% KOH to the wet mount specimen produces a fishy odor, indicating a positive WHIFF test. D-A gray, homogenous, malodorous discharge is present.

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Treatment: #Therapy is based on the use of agents with anaerobic activity and involves both topical and systemic agents. The combination appears to be 90% effective. A-Vaginal preparations: 1-Intravaginal 2% clindamycin cream is used at bedtime for 7 days. 2-Intravaginal metronidazole is applied once a day for 5 days. B-Oral regimens: 1-Metronidazole may be administered two ways: 500 mg twice daily for 7 days or a single, 2-g dose. 2-Clindamycin, 300 mg twice daily for 7 days (may be associated with diarrhea, especially Clostridium difficile)

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C-Sexual partners should be treated in cases of repeated episodes of bacterial vaginosis. Routine treatment of partners has not been shown to improve cure rates or lower reinfection rates. D-Treatment during pregnancy is critical; data suggest an association of adverse maternal and fetal outcomes with bacterial vaginosis. 1-Clindamycin may be used throughout pregnancy. 2-Metronidazole may be used after the first trimester. E-Patients with recurrences should be screened for STDs.

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Photograph of saline wet preparation reveals clue cells. Squamous cells are covered with bacteria to the extent that cell borders are blurred and nuclei are not visible. A saline preparation, also termed a wet prep, is made by mixing a sample of vaginal discharge obtained with a cotton swab and a few drops of saline on a microscope slide

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#To help prevent and treat vaginal discharge: 1-Keep your genital area clean and dry. 2-Do not douche. While many women feel cleaner if they douche after menstruation or intercourse, it may actually worsen vaginal discharge because it removes healthy bacteria lining the vagina that are there to protect you from infection. It can also lead to infection in the uterus and fallopian tubes, and is never recommended. 3-Use an over-the-counter yeast infection treatment cream or vaginal suppository, if you know that you have a yeast infection. 4-Eat yogurt with live cultures or take Lactobacillus acidophilus tablets when you are on antibiotics to avoid a yeast infection.

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5-Use condoms to avoid catching or spreading sexually transmitted diseases. 6-Avoid using feminine hygiene sprays, fragrances, or powders in the genital area. 7-Avoid wearing extremely tight-fitting pants or shorts, which may cause irritation. 8-Wear cotton underwear or cotton-crotch pantyhose. Avoid underwear made of silk or nylon, because these materials are not very absorbent and restrict air flow. This can increase sweating in the genital area, which can cause irritation. 9-Use pads and not tampons. 10-Keep your blood sugar levels under good control if you have diabetes.

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#If the discharge is caused by a sexually transmitted disease, your sexual partner (or partners) must be treated as well, even if they have no symptoms. Failure of partners to accept treatment can cause the infection to keep coming back and may lead to pelvic inflammatory disease or infertility. Call your doctor right away if: #Your discharge is associated with fever or pain in your pelvis or abdomen. #You have been exposed to a sexual partner with gonorrhea, chlamydia, or other sexually transmitted disease. #You have increased thirst or appetite, unexplained weight loss, increased urinary frequency, or fatigue -- these may be signs of diabetes.

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Also call if: #A child who has not reached puberty has vaginal discharge. #You think that your discharge may be related to a medication. #You are concerned that you may have a sexually transmitted disease or you are unsure of possible exposure. #Your symptoms worsen or last longer than 1 week despite home care measures. #You have blisters or other lesions on your vagina or vulva (exterior genitalia). #You have burning with urination or other urinary symptoms -- you may have a urinary tract infection.

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