Causes of Jock Itch in Women

Jock itch is mainly caused by a certain type of skin fungi known as dermatophytes. The two species that are most likely to be responsible for a groin skin fungus is Trichophyton rubrum and Epidermophyton floccosum. Less often, other Trichophyton species and Candidia (yeasts) may also cause a fungal infection of the skin. Although many people are exposed to these fungi, a skin infection only occurs in some. There are number of known risks but even in the face of these factors, it appears that individual susceptibility which may be genetic or some other as yet unidentified mechanism is a major component of developing fungal infections of the skin.

A fungal infection of the groin is more likely to arise with some underlying skin disease. A common predisposing factor in this regard is intertrigo – chaffing of the skin. This is more common in obese women where the skin folds provide two opposing surfaces for abrasion. Another factor in terms of chaffing is tight underwear which may irritate the skin in the area and make it prone to a fungal infection. Furthermore, the groin area is generally warm and moist as it is covered for most of the day and this provides the ideal conditions for fungi to thrive.

Although jock itch is more common in males, it is likely to arise in any person with one or more of these risk factors apart from those mentioned above :

• Living in a hot and humid climate
• Poorly fitting undergarments – too tight
• Using repeat courses of broad spectrum antibiotics
• Diabetes mellitus
• Immune deficiency
• Excessive sweating
• Poor personal hygiene
• Wearing wet clothes
• Not wiping dry properly after bathing
• Sharing personal items such as towels or underwear with an infected person

Signs and Symptoms of Jock Itch

The most common symptom is an itchy skin rash. It is usually a persistent itch which may ease with scratching but tends to return a short while later. The skin tends be scaling or peeling and while the area is initially red, it gradually becomes darker in color. A person often finds small specks of skin after scratching the area intensely. Sometimes there is musty odor with dampness in the area even without sweating. Burning, pain and heat in the area with a foul smelling discharge may indicate a superimposed bacterial infection.

Treatment of Jock Itch in Women

There are a number of topical and oral medication that can help to eradicate the fungus. Antifungal shampoo should be used in the area at least twice a week and antifungal cream should be applied to the area at least twice a day after bathing. Underwear needs to be changed twice daily and older underwear should be discarded at the start of treatment as it may contain fungal spores which can re-infect the area. The area must be kept dry with thorough wiping after bathing and using an antifungal drying powder if necessary. Oral antifungal drugs are only considered if the infection does not respond to topical applications. A low dose corticosteroid cream may help to relieve itching but long term use should be avoided as it can weaken the skin. Antibiotics are necessary when there is a secondary bacterial infection.

Causes of Urinary Tract Infections

Most urinary tract infections are due to bacteria invading the tract. These bacteria can adhere to the lining of the tract where it causes injury and leads to inflammation. It may enter the urethra through the external orifice and spread upwards into the bladder and less commonly even to the ureter or kidney. This is known as an ascending infection. Alternatively microorganisms may reach the kidney through the blood (hematogenous spread) or from neighboring sites of infection.

The most commonly involved bacteria is Escherichia coli (E.coli) from the rectum. Other species of bacteria are less commonly involved. Sometimes other microorganisms like viruses which may be transmitted through sexual contact can also cause urinary tract infections apart from infecting the genital tract. Women are at greater risk of urinary tract infections because of a shorter urethra. This allows the microorganisms to quickly reach the bladder where it can multiply further. Women who are sexually active are also at greater risk as well as those using diaphragms, with urethral abnormalities, undergoing menopause, having a suppressed immune system or with kidney stones.

Signs and Symptoms

The most common symptoms are burning upon urination, a constant urge to urinate and frequent urination. It is not uncommon for the urine to have a foul odor. There may be a persistent discomfort or dull pain at the lower abdominal region which may be worse with movement, when the bladder becomes distended with urine and just after urinating. The urine may also appear cloudy which is due to the presence of pus or pink or brown in color which may be due to blood.  It is not common for a fever to be present when the infection is isolated to the lower urinary tract but if the kidney is infected, a high fever may be present. Urethral discharge may also be present but not in every case.

Diagnosis and Treatment

 The most common tests are a urine dipstick and cytology and culture. A dipstick test can be done quickly in the doctor’s rooms and will be able to confirm an infection. A cytology and culture will be able to give a more detailed analysis and even identify the causative bacteria. Since most UTIs are bacterial infections, antibiotics are needed. It is important to consult with a doctor and commence with the correct type of antibiotic as certain types are more effective than others. Other measures may be needed for treating sexually transmitted diseases, correcting anatomical anomalies or removing bladder/kidney stones.

Causes of Bacterial Vaginosis

The exact reason why the bacterial population grows out of control is unclear. It is not associated with hygiene. Excessive washing and vaginal douching can in fact promote overgrowth of bacteria as it disturbs certain aspects of the micro-environment in the vagina like the pH. Multiple species of anerobic bacteria proliferate in the vagina with bacterial vaginosis but there is a decline in the lactobacilli. It may be some factor that disturbs the lactobacilli which allows for the other types of bacteria to grow out of control.

Apart from douching, cigarette smoking and multiple sex partners may be other risk factors for developing bacterial vaginosis. However, with the latter it must be noted that bacterial vaginosis can even occur in girls or women who are not sexually active. Furthermore bacterial vaginosis is not a sexually transmitted infection. Hormonal changes with the menstrual cycle, pregnancy and menopause and the use of an intra-uterine device (IUD) may also contribute to the development of bacterial vaginosis.

Signs and Symptoms

The signs and symptoms of bacterial vaginosis are not signficantly different from other types of genitourinary infections in women. Most women with bacterial vaginosis, however, have no symptoms (asymptomatic). An abnormal vaginal discharge with a fishy odor are the main symptoms. Usually there are no other symptoms as is seen with other infections. Pain, burning, itching of the vagina and so on should raise the awareness about some other infection as these are not typically seen with bacterial vaginosis.

Developing bacterial vaginosis will increase the susceptibility to contract other infections, including sexually transmitted infections. The signs and symptoms of these infections may then be superimposed over the underlying bacterial vaginosis.

Diagnosis

A medical history indicating the typical signs and symptoms and the absence of other infectious symptoms in conjunction with a pelvic examination may be sufficient for a diagnosis. However, it is advisable to follow up with further investigation like testing the pH of the vagina and examining the vaginal discharge under microscope.

Treatment

Many cases of bacterial vaginosis may resolve spontaneously meaning that it eases without any treatment. Identifying any risk factors and preventing or removing it will allow the bacterial populations to return to normal. Drugs may be taken orally and/or applied topically. This includes the drugs metronidazole, tinidazole and clindamycin. Although bacterial vaginosis can be successfully treated, it is not uncommon for it to recur usually within 3 to 6 months. Therefore women need to be aware of the risk factors and take the necessary measures to prevent  it.

Causes of Trichomoniasis

Trichomoniasis is caused by the single-celled parasite (protozoan) Trichomonas vaginalis. It is transmitted through sexual contact, particularly vaginal intercourse. It can also be transmitted among homosexual women bu vulva-to-vulva contact. Since the parasite cannot survive in the mouth or rectum it is not seen with oral or anal intercourse respectively. The parasite has a flagellum which is a tail-like protrusion that allows it to travel around the tissues of the vagina and urethra. It directly injures the tissue and causes the formation of tiny ulcers. As with most sexually transmitted infections, the risk of contracting trichomoniasis increases with having multiple sexual partners and unprotected sex. Those with a history of STDs including trichomoniasis are also at a greater risk. The infection is more commonly seen in females under the age of 35 years.

Signs and Symptoms

Trichomoniasis is similar in clinical presentation to other genitourinary infections. The signs and symptoms include :

• Abnormal vaginal discharge with a foul-smelling odor.
• Itchy and burning genitals
• Redness and swelling of the external genitalia.
• Pain during intercourse.
• Painful urination.

Some women are asymptomatic meaning that there are no signs and symptoms. The infection can extend all the way to the cervix where it causes inflammation (cervicitis) and may pass beyond the endocervical canal. In pregnant women this can lead to serious complication and cause preterm labor.

Diagnosis of Trichomoniasis

There are several methods to diagnose trichomoniasis. This includes a microscopic evaluation of a vaginal swab, pH testing, Pap smear and a culture. This allows for the Trichomonas vaginalis parasite to be identified and the infection differentiated from bacterial and fungal infections that may cause similar symptoms. Women with untreated Trichomonas vaginalis infection are at a greater risk of contracting viral infections like HIV. Therefore it is advisable to conduct HIV testing.

Treatment of Trichomoniasis

The antibiotic metronidazole and antiparasitic drug tinidazole are usually sufficient for successfully treating trichomoniasis. Systemic treatment through oral administration of these drugs is the most effective measure although there are topical applications for trichomoniasis. Alcohol should not be used when taking these drugs as it can cause severe adverse effects similar to those seen with certain drugs used for treating alcohol addiction. Patients need to be educated on effective measures to prevent infection or re-infection not only of trichomoniasis but also of other sexually transmitted infections. Sexual partners should also be treated to prevent re-infection.

Causes of Chlamydia in Women

Chlamydia is caused by the bacterium Chlamydia trachomatis which can be transmitted through vaginal, oral or anal intercourse. As is the case with other common sexually transmitted infections (STIs) like gonorrhea and syphilis, chlamydia can be passed from the mother to the infant during delivery (vaginal birth). The risk factors are also largely the same as other STIs – multiple sex partners, unprotected sex (without condoms) and having sex from an early age. If both partners are not treated, a person may be at risk of contracting the infection again despite receiving treatment. The risk factors should also raise the concern about HIV infection.

Signs and Symptoms in Women

Pain and discharge are the two main features of a chlamydia infection. The pain is typically located in the lower abdomen with painful urination and pain during intercourse. There may be itching and burning around the vagina.  There is an abnormal vaginal discharge that may have a foul odor. Fever may be present and women may report intermenstrual bleeding (bleed between periods). These symptoms if present tend to start a week or more after contracting the infection. The clinical presentation is not specific for chlamydia and it is important to exclude other conditions like a urinary tract infection, pelvic inflammatory disease and other sexually transmitted infections.In newborns who contract chlamydia from the mother during delivery, there may be eye and even lung infections.

Diagnosis of Chlamydia

A sample of the mucus on the cervix and urine can both be used for testing for chlamydia. Simultaneous HIV testing is always recommended for early diagnosis. Testing for chlamydia should be repeated after treatment. Partners should also be tested for chlamydia even if asymptomatic to curb the vicious cycle of re-infection.

Treatment of Chlamydia

Chlamydia is a bacterial infection and can therefore be treated with antibiotics. Some of these antibiotics like azithromycin can be used a single dose while other antibiotics for chlamydia like doxycycline need to be used daily for a week. The treatment could be continued for 10 to 14 days. In very rare cases the chlamydia infection may be so severe that hospitalization with the administration of IV antibiotics are necessary. Treatment for chlamydia is very effective but the infection can recur if exposed to an infected partner. It is therefore important for sexual partners to be treated as well even if asymptomatic.

]]> http://www.phaa.com/chlamydia-infection-in-women-causes-symptoms-diagnosis-and-treatment.htm/feed 0 http://www.phaa.com/cervicitis-cervix-inflammation-infection-injury.htm http://www.phaa.com/cervicitis-cervix-inflammation-infection-injury.htm#comments Wed, 14 Sep 2011 19:30:04 +0000 Dr. Chris http://www.phaa.com/?p=481 What is cervicitis?

Cervicitis is the term for inflammation of the cervix. Majority of the cases of cervicitis are due to infectious causes, particularly sexually transmitted infections. Cervicitis is a very common condition in women and the inflammation is more often related to sexual contact. The cervix is the lower part of the uterus which narrows and becomes continuous with the vagina. The part of the cervix that opens into the vagina is known as the external os while the portion that opens into the uterus is known as the internal os. It is lined with squamous epithelial cells and mucus-secreting cells. The cervix is the barrier part of the female genital tract that restricts the passage of microorganisms in the vagina from entering the uterus. However, it is also prone to any diseases that affect the vagina, particularly infections that gradually ascend up into the cervix and may eventually involve the uterus.

Causes of Cervicitis

Most cases of cervicitis are due to an infection. Of the various routes of transmission, it is more frequently seen with sexual contact. These sexually transmitted cases are due to bacteria, viruses or parasites that may cause gonorrhea, chlamydia, genital herpes and trichomoniasis. Although the human papilloma virus (HPV) is known to play a major role in the development of cervical cancer (cancer of the cervix), it is unlikely to cause cervicitis. Both HPV and HIV infection, however, may be possible risk factors for cervicitis.

Sometimes the naturally-occurring bacteria in the vagina may multiply excessively and affect the micro-environment within the vagina. This can subsequently lead to irritation of the vagina (bacterial vaginosis) and cervix. It is more likely to arise in women who use vaginal douches on a regular basis thereby affecting the population control within the micro-environment and introduces other microorganisms into the vagina.

Injury is largely due to chemical irritation caused by douches, lubricants and tampons. Mechanical injury with sexual activity is not a common cause of cervicitis but should not be ruled out entirely. Allergies may be another possible causes of cervicitis when a women is hypersensitive to the latex of condoms, lubricants and certain tampons. High quality products are less likely to cause these allergic reactions as it has been produced with hypoallergenic material and tested thoroughly prior to commercial availability.

Risk factors largely relates to sexual behavior and includes having sex from an early age and intercourse with multiple partners, particularly unprotected sex. Women who douche on a frequent basis are also at a greater risk of developing cervicitis.

Signs and Symptoms of Cervicitis

The clinical presentation is not significantly different from inflammation/infection of other organs of the female reproductive system. Often the neighboring structures are involved as well and the term pelvic inflammatory disease (PID) is used as an umbrella term for the condition. Signs and symptoms of cervicitis may include :

• Abnormal vaginal discharge often with a foul odor
• Intermenstrual bleeding – bleeding/spotting between periods
• Lower abdominal pain and/or lower back pain
• Itching and/or burning of the vagina
• Pain during intercourse often with bleeding afterwards
• Urinary frequency and pain upon urination (dysuria)

Diagnosis and Treatment of Cervicitis

The medical history along with the findings of a clinical examination may be sufficient for diagnosis. A swab may be used to collect samples of vaginal and cervical fluid and discharge for further laboratory testing.

The treatment depends on the cause and in the case of infections, the causative organism. Medication may therefore include antibiotics and antiviral agents. Supportive treatment and discontinuation of the causative action may sometimes be all that is necessary to allow the inflammation to subside and for the cervix to heal. Surgery is very rarely indicated and only in severe cases. This may include procedures such as cauterization to destroy the affected tissue.

Salpingitis is the term for inflammation of the fallopian tubes. Most cases are due to an infection. The fallopian tubes are located on either side of the uterus. The hollow cavity of the fallopian tubes allow for an egg cell (ovum) that is released from the ovary to pass into the uterus. Although salpingitis is not often discussed on its own as it is part of the umbrella term pelvic  inflammatory disease (PID), it is an important cause of infertility in women.

Sometimes the term salpingitis and pelvic inflammatory disease are used interchangeably but PID can include the inflammation of any part of the female reproductive system including the ovaries, uterus and cervix as well as other structures. It is, however, uncommon for the fallopian tubes to be inflamed on its own without any of the surrounding organs to be affected. This is largely due to the fact that most cases are due to infections that travel up the vaginal tract and it is unlikely that the cervix and uterus are not also infected.

Causes of Salpingitis

Almost all cases of salpingitis are due to an infection. Of the various pathogens, most are due to a bacterial infection. The pathogen typically enters through the vagina and gradually travels upwards towards the fallopian tubes (ascending infection). The pathogens may include those that are transmitted sexually (sexually transmitted infections). The most common bacteria include streptococci, staphylococci, mycoplasma and the bacteria that causes commonly STD’s like gonorrhea and chlamydia. These bacteria cause suppurative salpingitis.

Salpingitis is almost always seen in sexually active women. If it occurs in children, sexual abuse needs to be excluded as a possible cause. However, the pathogens can reach the fallopian tubes through the lymph vessels (lymphatic spread) or even through the bloodstream (hematogenous) from distant sites. Women who recently underwent surgery, including a D&C and those who use vaginal douches are at a greater risk of salpingitis. Another type of fallopian tube infection known as tuberculous salpingitis is rare in developed nations and occurs as a consequence of tuberculosis. However, it is fairly common in countries where tuberculosis is prevalent.

Signs and Symptoms of Salpingitis

Salpingitis may be acute or chronic. Acute salpingitis typically presents with intense symptoms whereas the signs and symptoms may be mild or even barely noticeable in chronic salpingitis. The common clinical features include :

• Abnormal vaginal discharge with foul odor
• Vaginal odor
• Lower back pain
• Lower abdominal pain
• Pain that is periodic and arises more often with ovulation and sexual intercourse
• Fever
• Frequent urination
• Nausea and vomiting
• Intermenstrual spotting – bleeding between periods

Diagnosis and Treatment

Salpingitis closely resembles urinary tract infections (UTIs) which are common in women. Further tests may therefore be required although the presentation and findings upon clinical examination by a doctor may be sufficient. Women should not assume the symptoms are due to a UTI and therefore attempt to self-medicate. Blood tests, microscopic examination and culture of discharge and the vaginal mucus and sometimes even a laparoscopy may therefore be necessary. If left untreated, the fallopian tubes can be severely damaged and this can lead to abscess formation, increase the chances of ectopic pregnancy or contribute to infertility.

Oral antibiotics are effective most of the time, however, IV administration of antibiotics may be necessary in more severe infections. Surgery is rarely necessary but could be required in untreated and chronic infections. Salpingitis cannot and should not be treated with vaginal douches or topical applications inserted into the vagina.

Causes of Syphilis

Syphilis is caused by the Treponema pallidum bacterium. The infection can be acquired through any break in the skin and mucous membranes. The most common route of transmission is through sexual contact, however, it is possible to contract syphilis through kissing and blood transfusions. Between mother and child, the infection can be transmitted across the placenta. Syphilis leads to the formation of sores, which may be found on the lips, in the mouth, on the genitals and the rectum. Direct contact with these sores, known as chancres, can lead to the transmission of syphilis. Therefore risk factors for contracting syphilis includes unprotected sex, intercourse with multiple partners and even intravenous drug use. Health care workers may also be at risk.

Stages of Syphilis

There are different stages of syphilis – primary, secondary, latent and late. The incubation period is between 10 to 90 days with a mean time of 14 to 28 days. This means that there are no signs or symptoms for this period of time.

Signs and Symptoms

In primary syphilis, there is usually the single sore (chancre) although there can be multiple chancres. These small, round sores are painless and arises at the site where the bacteria entered. It lasts for up to 6 weeks before resolving spontaneously. In the secondary stage, there is a skin rash which is not itchy. It often, but not always, arises as the chancre is disappearing. The rash is red to reddish brown spots on the palms of the hand and soles of the soles of the feet. It can also occur at other sites, particularly the trunk and limbs but a rash on the palms and soles following a chancre is a good indication of syphilis. At this point other symptoms are also present including fever,  swollen lymph nodes and fatigue. Some patients may also experience a sore throat, patches of hair loss, muscle aches and headaches. Sometimes the symptoms of the secondary stage resolve only to return a short while later. Eventually, however, the disease will progress to the latent stage if is not treated. This may occur within 3 to 4 months of the onset of secondary symptoms.

The latent stage follows when the symptoms of the primary and secondary stages disappear. It is referred to as latent because there are no signs and symptoms during this period but the infection is still present. In the first 2 years or so, a period known as early latency, a person can still transmit syphilis to a partner during sexual intercourse. However, in late latency, the person is not sexually infectious. Women with syphilis can still transmit the infection to their unborn child for up to several years after infection. The late stage does not occur in every person with syphilis. In fact it only arises in a minority of syphilis patients who do are left untreated. When it does occur, however, it is very severe and sometimes even fatal. Many different organs and systems in the body are affected and some of the symptoms may include blindness, muscle weakness or paralysis, numbness and difficulty in coordinating muscle movements.

 Tests and Treatment of Syphilis

A thorough medical history and the findings of a clinical examination may prompt the need for further tests to confirm syphilis. Blood, cerebrospinal fluid (lumbar puncture) and fluid from the sores may all be utilized to confirm the diagnosis. Syphilis patients should also be tested for HIV as unprotected sex, risky sexual behavior and/or exposure of the sores are also risk factors for HIV. Treatment for syphilis is quick, inexpensive and very effective. It can be cured although it is a possible for a person to be reinfected at a later stage. Just a single dose of penicillin is sufficient in most cases, although additional doses may be necessary for those patients who had the infection for long periods. A person who is sensitive to penicillin first has to undergo desensitization and then the penicillin is administered.

What causes gonorhhea?

Gonorrhea is a sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium. It is more commonly transmitted through sexual intercourse – vaginal, oral or anal – but may also be passed from mother to baby during childbirth. Gonorrhoea affects the epithelial lining of the lower genital tract. but may also infect the rectum (anal intercourse or urogenital contamination in women), throat (oral intercourse) or the eyes of adults by making contact with contaminated fingers. With regards to the genital tract in women, gonorrhea affects the urethra, paraurethral glands, Bartholin’s glands, vagina and may even extend to  the cervix. Transmission to the newborns is by direct contact with the vaginal epithelium when passing down the birth canal.

Signs and Symptoms in Women

The incubation period is between 2 to 10 days with a mean of 3 to 6 days. This means that for this period of time from exposure, there are no symptoms. However, symptoms may still not arise afterwards as between 50% to 80% of women with gonorrhea remain asymptomatic. Nevertheless the person is still a carrier and can infect others.

The common symptoms in women with gonorrhea infection of the lower genital tract includes :

• Painful urination (dysuria)
• Excessive vaginal discharge
• Lower abdominal pain
• Pelvic pain
• Intermenstrual bleeding or spotting, particularly after intercourse

Other clinical features may depend on the site that is affected :

• Rectum – rectal bleeding, itchy anus, discharge
• Eyes – pain, sensitivity to light, discharge from eyes
• Throat – sore throat, painful swallowing, swollen neck lymph nodes

Diagnosis of Gonorrhea

A urine sample may be sufficient to detect the bacteria but only if it is present in the urine. A vaginal swab is often preferable. Due to the prevalence  and risk of other sexually transmitted infections, it may be advisable for women with gonorrhea to consider additional tests like for HIV.

Treatment of Gonorrhea

Gonorrhea requires antibiotics for effective treatment. Vaginal douches are not effective and gonorrhea should not be treated without the supervision of a medical professional. Failure to treat gonorrhea promptly may lead to Bartholin’s gland abscess, pelvic inflammatory disease (PID) which can lead to infertility or ectopic pregnancy, and disseminated gonococcal infection. These conditions can then complicate treatment. Antibiotics used for treating gonorrhea include   ceftriaxone an spectinomycin. Pregnant women may also be prescribed cefixime and amoxicillin plus probenecid.

Mastitis is the term for infection of the breasts and while acute cases are more common in breastfeeding women, it can also arise in non-lactating women particularly when there is a structural defect of the breast or chronic systemic disease. The possibility of developing an infection should not detract mothers from breastfeeding but immediate medical attention should be sought once the symptoms start to develop. Breastfeeding mothers will not definitely develop mastitis and a little caution may help in preventing an infection.

Causes of Mastitis in Women

Breast infections in lactating women (lactational mastitis) typically arises in the first 6 weeks of breastfeeding. The nipple is generally sore and develops small cracks and fissures which allow bacteria to invade the underlying tissue.  These infections are more central (from the nipple), superficial and may lead to the formation of abscesses. This may be just a single abscess or multiple abscesses. The bacteria involves in these infections are typically found on the skin of humans. It includes Staphylococcus aureus, Streptococcus epidermidis and other streptococci. Although the infection is superficially initially, it may spread to deeper layers without appropriate treatment as early as possible. An entire lactiferous duct and its ductules as well as the lobules may be involved. Frequent drainage of milk may play an integral role in ‘washing’ away the bacteria and preventing deeper infection.

Non-lactational infections may be associated with other causes like injury to the breasts, postoperative infection and in immunocompromised patients like those with HIV or uncontrolled diabetes mellitus. The infection is more likely to affect the periphery of the breast and is usually chronic in nature. Another types of chronic mastitis is perilobular mastitis where keratin plugs arise within the ducts and block it. A secondary infection then sets in. It is more often associated with nipple deformities.

Signs and Symptoms of Mastitis

Mastitis, as with any inflammation, presents with tenderness or pain of the breasts, swelling and redness. The skin over the infected area may feel warmer than normal. An abscess may be seen as obvious bump on the breast surface with redness of the skin over the abscess and warmth. Initially an infection may present as just mild discomfort but quickly progresses to more acute symptoms if there is no intervention. A discharge from the breast may be present and this is often yellow to green with a foul odor. Other features may include a fever, fatigue and headaches.

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