Genital infections are a group of infections caused by many types of microbes that can affect all organs of the genital system. The genital structures include vulva, vagina, cervix, uterus, tubes and ovaries. It is defined as a broad spectrum genital infection, ranging from a simple candida vaginitis to a tubaovarian abscess that leads to blockage of the tubes.
The genital structure creates a transition between the outer part of the body and the inside. For this reason, infections can sometimes become very extensive. Childbirths, abortions, surgical operations, improper hygienic practices are factors that increase the risk of infection.
Warts from HPV can occur in vulva and vagina in women. Detailed information is given under the heading Genital Warts.
Herpes simplex virus can cause painful ulcers called genital herpes. The first infection is called a primary infection and is more severe. Genital herpes is transmitted by direct contact. The individual with genital herpes should be screened for other sexually transmitted infections. In some people, it remains latent for years after catching the virus, and it does not manifest any findings. There is no definitive cure. Treatment aims at rapid improvement. Primary genital herpes can be especially important during pregnancy. Pregnant women with genital herpes should report this to their physician.
Bartolin gland is one of the genital glands that produce secretions to provide lubrication of the genital structure. It is located inside the inner lips. Swelling of the gland occurs when the duct is blocked due to infections, irritation or sometimes unknown cause. The swollen gland, which cannot drain its secretion, becomes susceptible to infection and abscess can develop. Bartholin’s abscess is a painful condition and requires urgent treatment with abscess drainage. In the treatment of bartholin cyst, silver nitrate application, marsupialization or complete removal of the cyst can be applied.
Vaginal Infections (Vaginitis)
Vaginal infections are encountered quite common because the vagina is an open environment, is open to irritation owing to sexual intercourse, allergens, pads, etc. It is mostly manifested by discharge. It is important to distinguish between infection related discharge from natural discharge of the vagina. The physiological discharge is clear, yellow-white, odorless, while the infective discharge can be green, dark yellow, itchy, foul-smelling and may be accompanied by pain and burning during the intercourse. Reducing lactobacilli, which are protective microbes of the vagina, with antibiotics and vaginal douching increases the chance of infection.
Candida Vaginitis (Vaginal yeast infection)
It is commonly seen with antibiotic use, in pregnant women, diabetic patients and people with vaginal douching habits. Causes itching and discharge that often resembles cottage cheese. Antifungal drugs, suppositories and creams are used in the treatment. Cotreatment of the male partner is not required.
It is a foul-smelling infection caused by a microbe called gadneralla vaginalis. The unpleasant odor increases especially after sexual intercourse. Antibiotics are used in the treatment. Cotreatment of the male partner is not required.
It is a form of parasitic vaginitis that is painful, foul-smelling, green discharge. Cotreatment of the male partner may be necessary. It is treated with antiparasitic drugs.
Cervical Infections (Cervicitis)
The cervix acts as a protector between the external genital organs and internal genital organs. Cervicitis is an inflammation of the cervical tissue. It is difficult for a woman to suspect cervicitis on her own because the symptoms are similar to many other diseases and do not cause special complaints. It is usually noticed by a physician during an examination for another reason. There may also be discharge, groin pain, low back pain, spotting after sexual intercourse and pain during intercourse. The diagnosis is usually made during the examination. Sometimes a culture test may be required.
Chlamydia, gonorrhea, trichomonas, mycoplasma and ureoplasm are microorganisms that cause cervicitis. Once the underlying factor is found, it is treated with an appropriate antibiotic. Cotreatment of the male partner may be necessary.
Chlamydia infection is one of the most common and most important sexually transmitted diseases. Chlamydia infections may cause odorless yellow discharge, vaginal spotting, painful sexual intercourse and may also lead to difficulties in conception by progressing without any symptoms, creating blockage and adhesions in the fallopian tubes. It may increase the risk of preterm birth in pregnant women. The diagnosis is made on the basis of clinical findings and microbiological tests. It is necessary to use antibiotics for treatment.
Another important infection that is transmitted through sexual contact is gonorrhea. This infection may not produce symptoms like other cervicitis, and may cause vaginal discharge, low back pain, and irregular spottings. With more severe symptoms in men, yellow discharge causes burning and pain when urinating. The infection can spread through the bloodstream, creating more serious conditions. It can cause blockage and adhesions in the fallopian tubes, leading to difficulty in conception. The diagnosis is made on the basis of clinical examination and microbiological tests. Antibiotics are used in the treatment.
Intrauterine Inflammation (Endometritis)
The intrauterine layer (endometrium) is naturally resistant to infections thanks to the acidic environment of the vagina, thick cervical secretions and the layer itself that is shed and renewed every month. The development of endometritis is extremely rare without an underlying cause such as childbirth, miscarriage, premature water breakage (premature rupture of membranes), intrauterine operations, intrauterine device (IUD), cancer, and the presence of polyps. Chronic endometritis: The patient may not have any complaints and the disease may come to during the physician’s examination, however it can also be manifested by restlessness and slight pain in the groin, and bleeding between periods. Chronic endometritis rarely leads to infertility. The diagnosis is made on the basis of endometrial biopsy. It is treated with the appropriate antibiotics. Acute endometritis is mostly manifested by tenderness, pain in the groin and fever after childbirth, miscarriage or intrauterine operation. It may be associated with inflammation of the fallopian tubes. The diagnosis is made on the basis of clinical examination. Treatment may require parenteral (intravenous or intramuscular) and multiple antibiotics.
Pelvic Inflammatory Disease
Pelvic inflammatory disease refers to infections arising from the ovaries, fallopian tubes, uterus and soft tissues around them. Pelvic infections often involve many types of microbes at the same time. Infection occurs by the upward spread of microbes normally found in the lower genital system. Very rarely, the spread of infection, such as tuberculosis, to the reproductive system takes place through the bloodstream. Since microorganisms that cause pelvic infection are often sexually transmitted, they are more common in women who have multiple sexual partners. The use of intrauterine device (IUD) is also a risk factor for pelvic infection as it enables the microbes to reach up into the uterus from the string which stays in the vagina.
Low socio-economic status and untreated lower genital system infections are also considered as risk factors. The reason for seeking medical help is often severe groin pain, high fever, foul-smelling vaginal discharge. In delayed cases, additional complaints of nausea, vomiting, and absence of gas passage can be seen.
Diagnosis is made on the basis of detecting cervical and abdominal tenderness during pelvic examination and even in some patients, the inflammatory mass can be palpated (felt by the examiners hand), and this mass is called tuboovarian abscess. In laboratory tests, an increase in inflammatory cells (leukocyte), an increase in infection parameters (CRP, sedimentation) can be found. Ectopic pregnancy, ovarian cyst rupture and ovarian cyst torsion (cyst twisting around itself and leading to gangrene) should be excluded, as these conditions may cause similar complaints. Pelvic infection is an urgent condition that should be treated immediately when diagnosed.
Antibiotic therapy is given for treatment. Since there are various microorganisms involved, broad-spectrum antibiotic therapy is applied to target all the microbes that may cause. In mild cases, outpatient oral antibiotics can be given. Severe cases, patients who do not improve with oral treatment, those with additional diseases such as diabetes and pregnant women should be hospitalized and antibiotic therapy should be given intravenously. If a tubaovarian abscess is detected, it may be necessary to drain the abscess by keyhole (laparoscopic) surgery or interventional radiological procedure.
In cases where the infection is not treated in pelvic inflammatory disease, microorganisms may enter the blood and cause life-threatening conditions. Previous pelvic inflammatory disease may cause widespread adhesions inside the abdomen. These adhesions can cause problems in getting pregnant especially by occluding the tubes and disrupting their movements and anatomy. This damage in the tubes also increases the likelihood of an ectopic pregnancy in the future.
Today, increasing infertility rates are attributed to late marriage and recurrent pelvic inflammatory diseases during this period.
The way to protect from pelvic infections is by protecting from sexually transmitted diseases. Therefore, avoiding sexual activity with multiple partners or with people who may have sex with multiple partners, and using condoms have a protective effect.
Toxic Shock Syndrome
Toxic shock syndrome is a very rare but serious condition seen in women who use vaginal tampons during their menstrual periods. When the vaginal tampon is kept in the vagina for a long time, the accumulated blood provides a suitable medium for bacteria (S. Aureus) and allows them to multiply rapidly. Although they are found in normal flora, as a result of this overgrowth, these bacteria secrete their toxins into the blood and form a kind of poisoning and shock.
Suddenly rising fever, nausea, vomiting, diarrhea, widespread pain in the body and fainting are possible symptoms.
Treatment should be done in intensive care conditions. Firstly, after clearing the focus, fluid therapy and intravenous antibiotic treatment should be started. To prevent toxic shock syndrome, vaginal tampons should be preferred as little as possible, they should be changed frequently during the day, the same tampon should not be kept longer than 6 hours, hands should be washed with soap before placing, and night tampons should not be used as much as possible.
Other Sexually Transmitted Infections
Hepatitis B: Hepatitis B infection is a common and serious public health problem faced by 30 percent of the society and 10 percent remain as a carrier for the infection. Hepatitis B infection is a a disease that starts with the infection of the liver after hepatitis B virus has entered the body through blood or sexual contact. It may cause jaundice after transmission or progresses without any signs, symptoms or laboratory evidence.
Hepatitis B infection can heal without any sequelae and provide immunity to the person, as well as a clinical picture that can progresses to carrier state, chronic infection, cirrhosis and even liver cancer. Hepatitis B virus is found in high concentrations in blood, saliva, vaginal fluids and semen. People without immunity become infected through contact with these fluids. It is possible to be protected from hepatitis B. Vaccination provides primary protection.
Hepatitis C: Hepatitis C infection is one of the most common causes of chronic hepatitis and liver cancer. Although the most common transmission is through blood, it is also known to be sexually transmitted. Since hepatitis C has a lower blood concentration than Hepatitis B, multiple sexual contact is required over time for sexual transmission. People who have a partner infected with hepatitis C are in the risk group. No vaccine is currently available. It is important to use condoms in sexual intercourse for protection from hepatitis C.
AIDS: AIDS (Acquired Immune Deficiency Syndrome) is a disease caused by the HIV virus, leading to collapse of the immune system, making it unable to cope even with a simple infection. The most common route HIV transmission is via unprotected sexual intercourse. The risk of male-to-female transmission is 10 times higher than female-to-male transmission risk. Antivirals are used in the treatment. Avoiding multiple sex partners and using condoms during sex can be protective.