Vulvitis: Difference between revisions

Revision as of 13:47, 2 February 2022

Vulvitis or inflammation of the external genital organs occurs more often in older women, in connection with damage to the superficial layers of the skin, or, on the contrary, in children with neglected hygiene. Normally the skin is very resistant to infection, but the problem arises when a woman is too obese or when the skin is repeatedly injured by scratching or macerated by urine, sweat, etc. Skin resistance also decreases in general metabolic disorders - diabetes mellitus, hepatopathy, anaemia, etc.

Clinical pattern

Itching of the external genitalia, burning during and after urination - i.e. pseudodysuria, difficulties during sexual intercourse.

Bacterial vulvitis

Folliculitis, furunculosis - circumscribed form;
phlegmon - unbounded.
On inspection we see reddened skin, which is further sensitive to touch, warm, swollen. When the hair sacs of the vulva are infected, the infection penetrates into the deeper layers, the so-called furuncles are formed. Furuncles often coalesce and form multiple purulent deposits, even phlegmon.
The solid infiltrate gradually coagulates to form an abscess. We rarely see this condition today, but if we diagnose it, we must think about possible immune system disorders - AIDS - and we must rule out diabetes mellitus.
With ulcerations we think of syphilitic ulcer (ulcus molle), tuberculous ulcer (ulcus vulvae chronicum), lymphogranuloma venereum. Also, we can sometimes see on the vulva swollen plaques - condylomata lata - representing the second stage of syphilis.

Inflammation of Bartholini's gland (Inflammatio glandulae vestibularis majoris seu Bartholini)

Inflammation of part or the whole gland;
begins with inflammation of the duct of the gland, swelling and obstruction of the duct, the contents stagnate, become infected and empyema develops; if left untreated, the inflammation spreads to the surrounding area and an abscess develops;
Anatomy of vulva
retention cyst - chronic form, the process is usually unilateral, the thickened duct of the gland is clogged with thick mucus.

Origins: E. coli, Chlamydia trachomatis, Neisseria gonorrhoeae, streptococci, staphylococci.
Clinical pattern: Pain, swelling of the area, difficulty walking, fever, reddened skin, elevated CRP and leukocytes.
Diagnostics: Culture is necessary.
Therapies: At the beginning conservative - rest, compresses, ATB, analgesics, in case of development of empyema and abscess surgical intervention is necessary - incision with drainage, chemical extirpation (we suction the contents of the cyst through the incision, then we insert 0.5 cm of AgNO3 (lapis) rods into the abscess cavity, we close the incision with a suture and within 48 h after removing the suture we pull out the wrinkled gland capsule).

Mycotic vulvitis

Whitish plaques on the vulva, small epithelial defects, itching.

Viral vulvitis

Condylomata accuminata

Warty growths caused by neoncogenic papillomaviruses;
the virus multiplies in the squamous epithelial cells, hence the growths are also found in the vagina and cervix.

Herpes simplex virus

The disease manifests itself after 3-6 days of incubation by small blisters on the labia and in the vagina;
possible bacterial superinfection;
highly infectious fluid oozes after blister rupture.

Diagnostics: Bacteriological examination, parasitological examination of stool, biochemical, haematological examination.
Therapy: is determined by the results of the examination - application of anti-inflammatory drugs, antifungal drugs, ointment with corticosteroids, in more severe forms of herpetic infections acyclovir (administration of the drug must be as soon as possible after seeding). In papillomavirus infections, a 20% solution of podophyllotoxin or trichloroacetic acid, newly - causes local immunoreaction.

Odkazy

Související články

Použitá literatura

Kategorie:Gynekologie Kategorie:Porodnictví Kategorie:Patologie Kategorie:Mikrobiologie

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-'''Vulvitis''', ''vulvitida'' neboli ''zánět zevních pohlavních orgánů'' se vyskytuje spíše u starších žen, v souvislosti s poškozením povrchových vrstev kůže, nebo naopak u dětí se zanedbanou hygienou.
+Vulvitis or inflammation of the external genital organs occurs more often in older women, in connection with damage to the superficial layers of the skin, or, on the contrary, in children with neglected hygiene. Normally the skin is very resistant to infection, but the problem arises when a woman is too obese or when the skin is repeatedly injured by scratching or macerated by urine, sweat, etc. Skin resistance also decreases in general metabolic disorders - [[Diabetes Mellitus/type 2|diabetes mellitus]], [[hepatopathy]], [[anaemia]], etc.
-Za normálních okolností je kůže velmi odolná vůči infekci, problém nastává, když je žena příliš [[obezita|obézní]] nebo je kůže opakovaně zraňována při škrábání či macerována močí, potem… Odolnost kůže taktéž klesá při celkových poruchách metabolismu – [[diabetes mellitus]], hepatopatie, [[anémie]], apod.
+== Clinical pattern ==
-== Klinický obraz ==
+* Itching of the external genitalia, burning during and after urination - i.e. pseudodysuria, difficulties during sexual intercourse.
-* Svědění zevních rodidel, pálení při močení a po něm – t. j. pseudodysurie, potíže při sexuálním styku.
-== Bakteriální vulvitis ==
+== Bacterial vulvitis ==
-* '''[[Folikulitida]]''', '''furunkulóza''' – ohraničená forma;
+*[[Folliculitis]], furunculosis - circumscribed form;
-* '''[[flegmona]]''' – neohraničená.
+*[[phlegmon]] - unbounded.
-* Při pohledu vidíme '''zarudlou kůži''', která je dále citlivá na dotek, teplá, zduřelá. Při infekci vlasových váčků vulvy proniká infekce do hlubších vrstev, vznikají tzv. '''[[furunkl]]y'''. Furunkly často splývají a vytvářejí '''vícečetná hnisavá ložiska''', až '''flegmonu'''.
+*On inspection we see reddened skin, which is further sensitive to touch, warm, swollen. When the hair sacs of the vulva are infected, the infection penetrates into the deeper layers, the so-called furuncles are formed. Furuncles often coalesce and form multiple purulent deposits, even phlegmon.
-* Tuhý infiltrát postupně kolikvuje až vzniká '''[[absces]]'''. Tento stav dnes vidíme zřídka, ale pokud ho diagnostikujeme, musíme myslet na možné [[Imunodeficience|poruchy imunitního systému]] – [[AIDS]] a musíme vyloučit diabetes mellitus.
+*The solid infiltrate gradually coagulates to form an [[abscess]]. We rarely see this condition today, but if we diagnose it, we must think about possible immune system disorders - AIDS - and we must rule out diabetes mellitus.
-* Při ulceracích myslíme na [[Syfilis|syfilitický]] vřed (ulcus molle), [[Tuberkulóza|tuberkulóuzní]] vřed (ulcus vulvae chronicum), [[lymphogranuloma venereum]]. Také můžeme někdy vidět na vulvě mokvavé pláty – condylomata lata – představující [[Syfilis#Sekundární stadium|druhé stadium syfilis]].
+*With ulcerations we think of syphilitic ulcer (ulcus molle), tuberculous ulcer (ulcus vulvae chronicum), lymphogranuloma venereum. Also, we can sometimes see on the vulva swollen plaques - condylomata lata - representing the second stage of syphilis.
-=== Zánět [[Ženské pohlavní ústrojí#Vestibulární žlázy|Bartholiniho žlázy]] <small>(Inflammatio glandulae vestibularis majoris seu Bartholini)</small> ===
+=== Inflammation of [[Bartholini's gland]] <small>(Inflammatio glandulae vestibularis majoris seu Bartholini)</small> ===
-[[Soubor:Skenes gland CZ.jpg|250px|náhled|Anatomie vulvy]]
+* Inflammation of part or the whole gland;
-* Zánět části nebo žlázy celé;
+*begins with inflammation of the duct of the gland, swelling and obstruction of the duct, the contents stagnate, become infected and [[empyema]] develops; if left untreated, the inflammation spreads to the surrounding area and an abscess develops;
-* začíná zánětem vývodu žlázy, zduřením a ucpáním vývodu, obsah stagnuje, infikuje se a vzniká [[empyém]], při neléčení se zánět šíří i do okolí a vzniká absces;
+* [[File:Vulva Figure 28 02 02.jpg|thumb|Anatomy of vulva]][[retention cyst]] - chronic form, the process is usually unilateral, the thickened duct of the gland is clogged with thick mucus.
-* často vzniká [[retenční cysta]] – chronická forma, proces je vetšinou jednostranný, ztluštelý vývod žlázky je ucpán hustým hlenem.
+;Origins: ''[[Escherichia coli|E. coli]]'', ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', streptococci, staphylococci.
-;Původci: ''[[Escherichia coli|E. coli]]'', ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', [[Rod Streptococcus|streptokoky]], [[Rod Staphylococcus|stafylokoky]].
+;Clinical pattern: Pain, swelling of the area, difficulty walking, [[Fever (pediatrics)|fever,]] reddened skin, elevated [[CRP]] and leukocytes.
-;Klinický obraz: Bolest, otok oblasti, obtížná chůze, [[horečka]], zarudlá kůže, zvýšené [[CRP]] a leukocyty.
+;Diagnostics: Culture is necessary.
-;Diagnostika: Nutná kultivace.
+;Therapies: At the beginning conservative - rest, compresses, [[Antibiotics|ATB]], [[analgesics]], in case of development of empyema and abscess surgical intervention is necessary - incision with drainage, chemical extirpation (we suction the contents of the cyst through the incision, then we insert 0.5 cm of AgNO3 (lapis) rods into the abscess cavity, we close the incision with a suture and within 48 h after removing the suture we pull out the wrinkled gland capsule).
-;Terapie: Na začátku konzervativní – klid, obklady, [[Antibiotika|ATB]], [[analgetika]], při rozvoji empyému a abscesu je nutný chirurgický zákrok – incize s drenáží, chemická exstirpace (incizí odsajeme obsah cysty, poté do dutiny abscesu vložíme 0,5cm tyčinky AgNO<sub>3</sub> (''lapis''), incizi uzavřeme stehem a do 48 h po odstranění stehu vytáhneme svraštělé pouzdro žlázky).
+== Mycotic vulvitis ==
-== Mykotická vulvitis ==
+* Whitish plaques on the vulva, small epithelial defects, itching.
-* Bělavé povlaky na vulvě, drobné epitelové defekty, svědění.
-== Virová vulvitis ==
+== Viral vulvitis ==
 ==== Condylomata accuminata ====
-* Bradavičnaté výrůstky způsobeny neonkogenními [[Lidský papillomavirus|papillomaviry]];
+* Warty growths caused by neoncogenic [[papillomaviruses]];
-* virus se množí v buňkách dlaždicového epitelu, proto nacházíme výrůstky i v [[vagina|pochvě]] a na [[Cervix uteri|děložním hrdle]].
+*the virus multiplies in the squamous epithelial cells, hence the growths are also found in the [[vagina]] and [[cervix]].
-==== [[Virus herpes simplex]] ====
+==== [[Herpes simplex virus]] ====
-* Onemocnění se projevuje po 3–6 dnech inkubace drobnými puchýřky na stydkých pyscích a v pochvě;
+* The disease manifests itself after 3-6 days of incubation by small blisters on the labia and in the vagina;
-* možná bakteriální superinfekce;
+*possible bacterial superinfection;
-* po prasknutí puchýřku vytéká vysoce infekční tekutina.
+*highly infectious fluid oozes after blister rupture.
-;Diagnostika: bakteriologické vyšetření, parazitologické vyšetření stolice, biochemické, hematologické vyšetření.
+;Diagnostics: Bacteriological examination, parasitological examination of stool, biochemical, haematological examination.
-;Terapie: je dána výsledky vyšetření – aplikace protizánětlivých léků, '''[[antimykotika]]''', mast s '''[[kortikoidy]]''', u těžších forem herpetických infekcí '''[[aciklovir]]'''{{HVLP|vyhledej=aciklovir}} (podání léku musí byt co nejdříve od výsevu). U papilomavirových infekcí se užívá 20% roztok podofylotoxinu{{HVLP|vyhledej=podofylotoxin}} nebo kys. trichloroctová, nově {{HVLP|imichimod}} – působí lokální imunoreakci.
+;Therapy: is determined by the results of the examination - application of anti-inflammatory drugs, [[antifungal drugs]], ointment with [[Corticosteroids|corticosteroids,]] in more severe forms of herpetic infections [[acyclovir]] (administration of the drug must be as soon as possible after seeding). In papillomavirus infections, a 20% solution of podophyllotoxin or trichloroacetic acid, newly - causes local immunoreaction.
 <noinclude>
 == Odkazy ==
 === Související články ===