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Vulvovaginita sau scurgerile vaginale
publicat in data de 30-06-2009

Sub această denumire sunt reunite inflamaţiile mucoasei vaginale asociate cu cele vulvare. Inflamaţiile sunt produse cel mai adesea de agenţi infecţioşi, dar pot fi incriminaţi şi alţi factori :chimici, mecanici, alergici. Toate categoriile de agenţi patogeni(bacterii, virusuri, paraziţi) pot fi regăsite în etiologia vaginitelor. Gravitatea infecţiei variază cu vârsta bolnavei, cu starea ei de sănătate, cu virulenţa germenilor. Agenţii patogeni pot face parte din categoria „cu transmisiune sexuală sau  care aparţin florei oportuniste”. Bolile cu transmisiune sexuală pot fi minore (a căror transmitere sexuală este posibilă într-un procent variabil) şi cuprind infecţiile cu fungi(herpes genital, HPV), paraziţi(scabia, ftirizia pubiana). Boli cu transmitere sexuală majore sunt legalizate în majoritatea ţărilor şi declararea ei este obligatorie, incluzând clasicele boli venerice şi cuprind: sifilisul(produs de Treponema pallidium), gonoreea sau blenoragia (produsă de neisseria gonorheea), sancrul moale(produs de bacilul Ducrey), granulomul inghinal venerian(produs de Donovania granulomatis) şi SIDA (sindromul imuno deficienţei dobândite- produsă de HIV).


Bolile cu transmitere sexuală constituie o problemă de sănătate publică de interes naţional şi internaţional, datorită morbidităţii crescute, cu toate măsurile luate şi datorită leziunilor organice şi funcţionale grave pe care le determină. Este necesar să fie lămurită populaţia de atitudinea pe care trebuie să o adopte atunci când s-a îmbolnăvit. Mulţi bolnavi, în special tineri, dintr-un sentiment de ruşine sau teamă , în loc să se prezinte la medic, ascund boala şi o tratează empiric sau după indicaţiile unui prieten mai „experimentat”. Trebuie imprimat în mintea oamenilor şi mai ales a celor tineri, ca la cea mai mică leziune a organelor genitale să nu facă niciun tratament local sau general şi să se prezinte la cel mai apropiat serviciu medical  de specialitate pentru precizarea diagnosticului şi a tratamentului. Protecţia populaţiei sănătoase se reduce la profilaxia individuală şi la educaţia sexuală şi antiveneriană (folosirea prezervativului, spălarea cu apă şi săpun a organelor genitale imediat după contactul sexual).


Principalul simptom pe care îl sesizează pacienta este LEUCOREEA, definită ca o scurgere albicioasă sau gălbuie, exteriorizată la nivelul vaginului. Există leucoreea fiziologică, normală, care poate deveni mai abundentă în anumite perioade ale menstruaţiei şi leucoreea patologică (scurgere vaginală abundentă ce se datorează unor inflamaţii ale vaginului, colului, uterului, trompelor dar şi a altor patologii genitale(tumori, infecţii, etc.). Leucoreea fiziologică nu este însoţită de dureri, prurit, iritaţie locală şi nu necesită tratament. Uneori poate fi foarte abundentă, deranjantă şi trădează o impregnare estrogenică excesivă. Dar, foarte important, nu vă autodiagnosticaţi ci mergeţi la medic şi efectuaţi un consult şi un examen al secreţiei vaginale. Leucoreea patologică este datorată în cea mai mare parte infecţiilor genitale joase. Flora banală existentă în vagin, în mod normal(stafilococi, streptococi, ecoli) se poate exarceba în anumite situaţii sau apar alţi germeni din vecinătate, care duc la infecţii locale cu scurgeri abundente , urât mirositoare, pruriginoase. Leucoreea are aspecte diferite în funcţie de germenii incriminaţi.


În VULVOVAGINITA CU TRICHOMONAS, scurgerea are culoarea verzuie, este fluidă, spumoasă, cu miros fad. În mod obişnuit, dar nu exclusiv, transmisia are loc pe cale sexuală. Prezenţa parazitului poate rămâne asimptomatică la bărbat, eventualitate ce reprezintă aproape o regulă. Leucoreea se însoţeşte de prurit(mâncărime), usturimi, dispareurie superficială(disconfort la contact sexual).
Tratarea partenerului este obligatorie în trichomoniază, iar eficacitatea tratamentului este estimată la 90% din cazurile tratate.
În VULVOVAGINITA MICOTICĂ (candida albicans), leucoreea este de culoare albă, grunjoasă, abundentă, pruriginoasă. Cel mai adesea este comensală şi doar facultativ patogenă. Candidozele vaginale se întâlnesc cu incidenţă crescută într-o serie de circumstanţe în care este modificat echilibrul biotipului vaginal: administrare de antibiotice, de corticosteroizi sau de citostatice, contracepţie orală cu estroprogestative în sarcină sau diabet. Candidoza este diagnosticată la 6 % până la 28% din numărul total al femeilor. Candidoza vaginală poate fi asimptomatică. Semnele subiective sunt în general reprezentate de prurit uneori intens şi rebel, usturimi şi dispaneunie. La gravide poate fi deosebit de abundentă, formată din grunji albi, într-o secreţie apoasă cu aspect de „lapte brânzit”. Tratamentul local este obligatoriu în candidoze. Leziunea micotică vulvo-vaginală poate evolua în acelaşi timp cu micoza localizată la nivelul faringelui stomacului, sau există chiar o septicemie cu candida. De aceea, pe lângă tratamentul local în cazul candidozelor cu recidive repetate, este necesar tratamentul oral al ambilor parteneri pentru sterilizarea rezervorului intestinal, pe o perioadă mai lungă de 15 zile.
 
În VULVOVAGINITA GONOCOCICA, leucoreea este galben purulentă, contagiunea se face prin contact sexual iar fenomenele clinice apar la 3-5 zile de la infecţie şi se asociază cu prurit şi disurie. De multe ori debutul şi simptomele sunt discrete şi trec neobservate. Infecţia se manifestă actualmente de o manieră foarte variabilă: fie ca o uretrită cu disurie, o bartholinită şi excepţional cu debut brutal cu febră, dureri intense, leucoree abundentă. Dacă boala nu este descoperită şi tratată corect, în timp poate prinde căile genitale superioare, poate da manifestări articulare, cutanate, oculare, faringiene sau se cronicizează. Poate da pelviperitonite, peritonite, septicemii. Este responsabilă de obstrucţia tubară, generatoare de sterilitate. Tratamentul se aplică obligatoriu şi partenerului. Iniţial, tratamentul este „a la minut” şi se completează printr-un tratament „a la long”, pe durata de 4-10 zile. La sfârşitul tratamentului trebuie făcută o nouă prelevare bacteriologică. Vindecările se afirmă după două prelevări negative.


În VULVOVAGINITA CU CHLAMYDII, leucoreea este galben purulentă şi este însoţită frecvent de cistită amicrobiană, metroragii, disurie, dureri pelvine. Netratată se poate complica ducând la infertilitate , endometrite, ocluzie tubară, aderenţe abdominale, boala inflamatorie pelvină. Formele asimptomatice sunt frecvente la 1/3 din cazuri sunt descoperite de un consult sau când partenerul are uretrită. Infecţiile genito-urinare cu chlamydia înregistrează în prezent în SUA aproximativ 3 milione de cazuri noi anual, mai mult decât gonoreea, sifilisul şi herpesul genital la un loc. Femeile par să joace rolul central în transmisia chlamydia-transmisie orizontală la bărbat şi transmisie verticale la nou-născut. Dacă mama prezintă infecţie genitală, afectarea nou-născutului atinge 66-70 %. Doar 10-20% din nou-născuţi prezintă pneumonii, iar 25-55% conjuctivite. Tratamentul este general, local şi igieno-dietetic şi este necesar simultan pentru ambii parteneri.


În VULVOVAGINITELE NESPECIFICE, denumite vaginoze, leucoreea, este de culoare gri cenuşie, cu miros fetid, în general datorându-se unor asocieri de germeni şi însoţindu-se de prurit frecvent şi supărător. Cea mai frecvent întâlnită este vulvovaginita cu Gardnorella vaginali`s , o bacterie anaerobă care se găseşte în mod normal (saprofit) în vagin şi constituie „o rezervă potenţial patogenă”. Euflora vaginală care este într-un echilibru labil şi dinamic, în anumite condiţii, poate deveni patogenă şi declanşează o vulvovaginită. În aceste cazuri tratamentul partenerului nu este necesar.
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69 comentarii

o femeie a scris la 2009-07-06 22:06:13:
interesant articolul
diana a scris la 2009-07-07 09:56:53:
cele mai multe boli ale femeilor survin din cauza barbatilor care umbla pe la toate mizerabilele. ei nu simt nimic cand le contacteaza dar femeiele da.
ella a scris la 2009-07-08 12:34:34:
asa este, pt k ei sunt doar purtatori, la ei nu se manifesta in nici un fel , in schimb la noi da.
cosmina a scris la 2009-07-08 20:37:43:
asa este . barbatii au raspandit bolile astea, nu femeile dar femeile sufera acum ptr asta. Toti barbatii sint niste porci ordinari. nu exista barbat sa nu se duca macar o data la o tarfa si sa se umple de tot felul de boli
un doctor a scris la 2009-07-11 21:31:19:
anumite scurgeri vaginale provin si de la antibioticele administrate haotic, dupa ureche.
voda anamaria a scris la 2011-04-30 16:29:29:
Am facut tratament cu:Nizoral,Flucoric,Tantum Rosa,Septovag,Feueigiu,Feunisa B,Ceai pelin si galbenele.OVULE Polygynax,Macmiror complex,Betadine,Flumizin,Viuiflor Am mai luat si Ruwatinax.Am mai luat si 15 pastile de zanocin.As dori sa stiu daca raman insarcinata afecteaza cu ceva fatul???? va rog sa imi raspundeti
cristina a scris la 2011-11-04 15:35:01:
nu am niciun comentariu
dana a scris la 2011-12-18 13:00:15:
Si eu sufar de vulvovaginita de mai multi ani si nu-mi trece.Sunt infectata cu candida albicans.Am fost la 3 doctori si am luat si ogroaza de medicamente care nu m-au ajutat cu nimic.Ce m-a ajutat insa a fost ceaiul de menta,care m-a scapat de arsuri ptr aproape 1 an de zile.Nu m-a scapat si de scurgeri,dar cel putin m-am simtit mai bine.Nu stiu dca functioneaza ptr toata lumea dar merge incercat ptr ca pe mine una m-a ajutat mult.Chiar am citit ca ceaiul verde are propietatea de a slabi virusurile,deci probabil asta e explicatia.Insa la mine arsurile au disparut dupa o sapt-doua.
Lucian a scris la 2013-11-27 11:54:19:
cosmina a scris la 2009-07-08 20:37:43: asa este . barbatii au raspandit bolile astea, nu femeile dar femeile sufera acum ptr asta. Toti barbatii sint niste porci ordinari. nu exista barbat sa nu se duca macar o data la o tarfa si sa se umple de tot felul de boli Imi pare rau ca ai parerea asta despre barbati:).Dar sa stii ca gresesti.Uite eu nu am fost niciodata la o tarfa sau cum ii zici tu:) si niciodata nu am sa ma duc.Ca nu am nevoie.Fete sunt destule....
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