ÜREME SİSTEMİ ENFEKSİYONLARI VE CİNSEL YOLLA BULAŞAN ENFEKSİYONLAR
Özet
Kadınların yaşam kalitesini doğrudan etkileyen üreme sistemi ve cinsel yolla bulaşan enfeksiyonlar (CYBE), jinekolojik sağlığın en önemli konuları arasında yer almaktadır. Vajinal floranın östrojen etkisiyle asidik bir dengede (pH 3.8-4.2) kalması koruyucu bir mekanizma oluştursa da; antibiyotik kullanımı, vajinal duş, yanlış hijyen ürünleri ve korunmasız ilişki gibi faktörler bu dengeyi bozarak vajinite yol açmaktadır. En yaygın türler bakteriyel vajinozis, vulvovajinal kandidiyazis ve trikomoniyazistir. Ayrıca östrojen azlığına bağlı atrofik vajinit, kronik deskuamatif vajinit ve kimyasallardan kaynaklanan nonenfeksiyöz vajinit gibi durumlar da gelişebilmektedir. Üreme sistemini etkileyen diğer tablolar ise vulvit, bartolinit, servisit ve kısırlığa yol açabilen pelvik inflamatuar hastalıktır (PID). Cinsel temasla bulaşan başlıca etkenler klamidya, gonore, sifiliz, genital herpes, HPV, HIV/AIDS ve viral hepatitlerdir. Çoğu enfeksiyon asemptomatik seyrettiği için düzenli taramalar ve erken tanı hayati önem taşır. Korunmada ve yönetimde hemşireler; perine hijyeni, vajinal duştan kaçınma, kondom kullanımı, eş tedavisi ve aşılama (HPV/HBV) konularında danışmanlık vererek bütüncül bakım sağlamaktadır.
Reproductive tract infections and sexually transmitted infections (STIs), which significantly impact women's quality of life, constitute a major domain in gynecological health. Although a healthy vaginal flora maintains an acidic pH (3.8-4.2) under estrogenic influence to prevent infections, factors such as antibiotic use, vaginal douching, incorrect hygiene products, and unprotected intercourse disrupt this balance and cause vaginitis. The most prevalent types are bacterial vaginosis, vulvovajinal candidiasis, and trichomoniasis. Estrogen deficiency leads to atrophic vaginitis, while chronic desquamative vaginitis and chemical-induced noninfectious vaginitis can also develop. Other conditions affecting the reproductive system include vulvitis, bartholinitis, cervicitis, and pelvic inflammatory disease (PID), which poses severe complications like infertility. Key pathogenetic agents transmitted sexually comprise chlamydia, gonorrhea, syphilis, genital herpes, HPV, HIV/AIDS, and viral hepatitises. Since many infections progress asymptomatically, regular screening and early diagnosis remain critical. In prevention and management, nurses provide holistic care and counseling regarding perineal hygiene, avoidance of vaginal douching, condom utilization, concurrent partner treatment, and vaccinations (HPV/HBV).
Referanslar
Hotun Şahin N, Bilgiç D. Üreme Sistemi Enfeksiyonları. İçinde: Kızılkaya Beji N. Hemşire ve Ebelere Yönelik Kadın Sağlığı ve Hastalıkları. Nobel Tıp Kitapevleri, İstanbul, 2019; 118-131.
Acarkan T. Vajinal Flora Bozukluğu ve Vajinit. Journal of Complementary Medicine, Regulation and Neural Therapy, 2016; 10(2): 8–12.
World Health Organization (WHO). Reproductive Health Indicators Reproductive Health and Research Guidelines for their generation, interpretation and analysis for global monitoring.2006.
Matthews N, Wong V, Brooks J, Kroumpouzos G. Genital diseases in the mature woman. Clin Dermatol, 2018; 36(2): 208-221. doi: 10.1016/j.clindermatol.2017.10.012.
Donders GGG. Definition and classification of abnormal vaginal flora. Best Practice & Research Clinical Obstetrics and Gynaecology,2007; 21(3): 355–373. https://doi.org/10.1016/j.bpobgyn.2007.01.002
Granato PA. Vaginitis: Clinical and Laboratory Aspects for Diagnosis Paul. Clinical Microbiology Newsletter, 2010; 32(15): 111–116. https://doi.org/10.1016/j.clinmicnews.2010.07.001
The American College of Obstetricians and Gynecologists (ACOG). Vaginitis. Erişim Adresi: https://www.acog.org/womens-health/faqs/vaginitis. 2017. Erişim Tarihi:13.04.2021.
Yazıcı S, Çuvadar A. Genital Sistem Enfeksiyonlarının Önlenmesi ve Ebelik Yaklaşımları. Journal of Health Professions Research, 2019; 1(1): 33–37.
Okumuş F. Vaginal Douche and Professional Approach: Review. Turkiye Klinikleri J Nurs Sci, 2015; 7(2): 112–120. https://doi.org/10.5336/nurses.2013-33747
Paladine LH, Desai UA. Vaginitis: Diagnosis and Treatment. American Family Physician, 2018; 97(5): 321-329.
Raphaelidis L. Uncommon Vaginitis Cases : Expect the Unexpected. TJNP: The Journal for Nurse Practitioners, 2015; 11(1): 135–138. https://doi.org/10.1016/j.nurpra.2014.07.037
Demir CS, Küçükgöz Güleç Ü. Obstetrik ve Jinekoloji. Akademisyen Tıp Kitabevi, Ankara, 2015; 265-275.
Erenus M, Yoldemir T. Netter Obstetri, Jinekoloji ve Kadın Sağlığı. Güneş Tıp Kitapevleri, Ankara, 2008; 504-536.
Özkan S, Sevil Ü. Kadınlarda sık görülen vulvovajinal enfeksiyonlar (Ebe/Hemşireler için). İzmir: Pakman Matbaacılık. 2004.
Sherrard J,Wilson J, Donders G, Mendling W, & Jensen JS. European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge, International Journal of STD & AIDS 2018; 29(13): 1258–1272.
Bleibel B, Nguyen H. Vaginal Atrophy. 2021 Feb 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32644723.
The America Colloge of Obstetricians Gynecologists (ACOG). Chlamydia, Gonorrhea, and Syphilis. https://www.acog.org/womens-health/faqs/chlamydia-gonorrhea-and-syphilis.2021
Wiers SG. Improving the Care of Women with Vulvovaginal Atrophy in Primary Care. Advances In Family Practice Nursing, 2019; 1: 75-86
Uzsezer Güler B. Vajinal Enfeksiyonlar ve Cinsel Yolla Bulaşan Hastalıklar. İçinde: Dinçgez Çakmak B. Jinekolojide Pratik Bilgiler. Livre de Lyon, Lyon, 2020; 161-172.
Hainer BL, Gibson MV. Vaginitis. Am Fam Physician. 2011; 83(7): 807-15. PMID: 21524046.
T.C. Sağlık Bakanlığı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü (AÇSAP). Cinsel Yolla Bulaşan Enfeksiyonlar Katılımcı Kitabı, Ankara. 2009.
Coudray MS, Madhivanan P. Bacterial Vaginosis - A Brief Synopsis of the Literature. Eur J Obstet Gynecol Reprod Biol., 2021; 245: 143–148. https://doi.org/10.1016/j.ejogrb.2019.12.035.Bacterial
Karaer A, Boylu M, Avsar AF. Vaginitis in Turkish women : symptoms , epidemiologic – microbiologic association. 2005; 121: 211–215. https://doi.org/10.1016/j.ejogrb.2004.11.030
Li M, Li L, Wang R, Yan S, Ma X, Jiang S, Gao T, Yao Y, Li B. Taiwanese Journal of Obstetrics & Gynecology Prevalence and risk factors for bacterial vaginosis and cervicitis among 511 female workers attending gynecological examination in. 58. 2019. https://doi.org/10.1016
Rice A, ElWandy M, Hadoura E, Mahmood T. Vaginal discharge. Obstetrics, Gynaecology & Reproductive Medicine, 2016; 26(11): 317–323. https://doi.org/10.1016/j.ogrm.2016.08.002
Haggerty CL, Totten PA, Tang G, Astete SG, Ferris MJ, Norori J, Bass DC, Martin DH, Taylor BD, Ness RB. Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sex Transm Infect, 2016; 92(6): 441-446. doi: 10.1136
Biswal B, Singh K, Ismail M, Jalal M, Safruddin E. Rahim Ağzı Kanserinde Bakteriyel Vajinozun Güncel Kavramı. Klinik Jinekoloji ve Obstetrik Dergisi, 2014; 3(1): 1-7.
Drugbo II, Nyengidiki TK, Bassey G, Wariso KT. Bacterial vaginosis among women with tubal factor infertility in Nigeria. Int J Gynaecol Obstet, 2015; 131(2):133-6. doi: 10.1016/j.ijgo.2015.05.031.
Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol, 2021; 224(3): 251-257. doi: 10.1016/j.ajog.2020.10.019.
Neal CM, Kus LH, Eckert LO, Peipert JF. Noncandidal vaginitis: a comprehensive approach to diagnosis and management. The American Journal of Obstetrics & Gynecology, 2020; 222(2): 114–122. https://doi.org/10.1016/j.ajog.2019.09.001
Nugent RP, Krohn MA, Hillier SL. Reliability of Diagnosing Bacterial Vaginosis Is Improved by Standardized Method of Gram Stain Interpretation a. Journal Of Clinical Microbiology, 1991; 29(2): 297–301.
Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med, 1983; 74(1):14-22. doi: 10.1016/0002-9343(83)91112-9.
Rao V.L, Mahmood T. Vaginal discharge. Obstetrics, Gynaecology & Reproductive Medicine, 2019; 30(1): 11–18. https://doi.org/10.1016/j.ogrm.2019.10.004
Yurttaş Akar Ç. Bir Aile Sağlığı Merkezi'ne Kayıtlı 15-49 Yaş Kadınlar Arasında Vajinit Prevelansı Ve Etkileyen Faktörlerin Belirlenmesi. J Midwifery and Health Sc, 2020; 3(2): 100–114.
Kahyaoğlu Süt H. 18-49 Yaş Arası Kadınlarda Genital Hijyen Davranışları İle Genital Enfeksiyon Arasındaki İlişkinin İncelenmesi. Journal of Duzce University Health Sciences Institute, 2016; 6(1): 8–13.
Rahman S, Ozan AT. Vajinal Akıntı Şikayeti Olan Kadınlarda Sık Görülen Genital Yol Enfeksiyonlarının İncelenmesi Investigation of Common Genital Tract Infections in Women with Vaginal Discharge, 2020; 7(4): 469–475. https://doi.org/10.34087/cbusbed/742223
T.C. Sağlık Bakanlığı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü (AÇSAP). Aile Planlaması Danışmalığı İçin Resimli Rehber, Ankara. 2010.
Kaplan S. Bakteriyel Vajinozis Riski ve Kontrasepsiyon. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 2020; 17(3): 407-411.
Woelber L, Prieske K, Mendling W, Schmalfeldt B, Tietz H, Jaeger A. Vulvar Pruritus — Causes , Diagnosis and Therapeutic Approach, Deutsches Ärzteblatt International, 2020; 117: 126-133. https://doi.org/10.3238/arztebl.2020.0126
Dündar T, Özsoy S. Bakteriyel Vajinozisin Preterm Eylem Üzerindeki Etkisi. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 2018; 5(2): 152-159.
Şen S, Başar F. Kütahya Bölgesinde Yaşayan Kadınların Pap Smear Testi Konusundaki Farkındalıkları. Sürekli Tıp Eğitimi Dergisi, 2019; 28(1): 28-36. Doi:10.17942/sted.336703
Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis, 2018; 18(11): e339-e347. doi: 10.1016/S1473-3099(18)30103-8.
Sasani E, Rafat Z, Ashrafi K, Salimi Y, Zandi M, Soltani S, Hashemi F, Hashemi SJ. Vulvovaginal candidiasis in Iran: A systematic review and meta-analysis on the epidemiology, clinical manifestations, demographic characteristics, risk factors, etiologic agents and laboratory diagnosis. Microb Pathog, 2021; 16: 154:104802. doi: 10.1016/j.micpath.2021.104802.
Felix TC, Röder DV, Pedroso RD. ‘‘Alternative and complementary therapies for vulvovaginal candidiasis.’’ Folia Microbiologica, 2019; 64 (2): 133-141.
Shenoy A, Gottlieb A. Probiotics for oral and vulvovaginal candidiasis: A review. Dermatol Ther, 2019; 32(4): e12970. doi: 10.1111/dth.12970.
Kim JM, Park YJ. Probiotics in the Prevention and Treatment of Postmenopausal Vaginal İnfections: Review Article. Journal of Menopausal Medicine, 2017; 23: 139-145.
Leitsch D. Recent Advances in the Trichomonas vaginalis Field [ version 1 ; referees : 2 approved ] Referee Status. 2016; 5: 1–7. https://doi.org/10.12688/f1000research.7594.1
Bulletin of the World Health Organization. 2019; 97: 548-562P. doi: http://dx.doi.org/10.2471/BLT.18.228486
Centers for Disease Control and Prevention (CDC). Trichomoniasis Statistic. 2021. Erişim Adresi: https://www.cdc.gov/std/trichomonas/stats.htm Erişim Tarihi: 15.04.2021.
Yang S, Zhao W, Wang H, Wang Y, Li J, Wu X. European Journal of Obstetrics & Gynecology and Reproductive Biology Trichomonas vaginalis infection-associated risk of cervical cancer : A. European Journal of Obstetrics and Gynecology, 2018; 228: 166–173. https://doi.org/10.1016/j.ejogrb.2018.06.031
Zhang ZF, Graham S, Yu SZ, Marshall J, Zielezny M, Chen YX, Sun M, Tang SL, Liao CS, Xu JL, et al. Trichomonas vaginalis and cervical cancer. A prospective study in China. Ann Epidemiol, 1995; 5(4): 325-32. doi: 10.1016/1047-2797(94)00101-x. PMID: 8520717.
Hezarjaribi HZ, Fakhar M, Shokri A, Teshnizi SH, Sadough A, Taghavi M. Trichomonas vaginalis infection among Iranian general population of women: a systematic review and meta-analysis. Parasitol Res, 2015; 114(4): 1291-300. doi: 10.1007/s00436-015-4393-3.
Snell M, Barron LM, Koetting C. Detecting Trichomonas vaginalis in High-Risk Women: A Tricky Situation. The Journal for Nurse Practioners, 2016; 12(4): 271-276.
Chen Y, Bruning E, Rubino J, Eder SE. Role of female intimate hygiene in vulvovaginal health : Global hygiene practices and product usage. 2017. https://doi.org/10.1177/1745505717731011
Bouchemal K, Bories C, Loiseau PM. Strategies for Prevention and Treatment of Trichomonas vaginalis Infections. Clin Microbiol Rev, 2017; 30(3): 811-825.
Meites E, Gaydos CA, Hobbs MM, Kissinger P, Nyirjesy P, Schwebke JR, et al. A Review of Evidence-Based Care of Symptomatic Trichomoniasis and Asymptomatic Trichomonas vaginalis Infections. Clin Infect Dis, 2015; 15: 837- 48. https://doi.org/10.1093/cid/civ738
Reichman O, Sobel J. Best Practice & Research Clinical Obstetrics and Gynaecology Desquamative in fl ammatory vaginitis. 2014; 28: 1042–1050. https://doi.org/10.1016/j.bpobgyn.2014.07.003
Ledger WJ, Monif GRG. A Growing Concern : Inability to Diagnose Vulvovaginal Infections Correctly, 2004; 103(4): 782–784. https://doi.org/10.1097/01.AOG.0000114988.61223.22
Martin CD, Holland AC. The Journal for Nurse Practitioners Desquamative In flammatory Vaginitis : A Closer Look. 2020; 16: 732–734. https://doi.org/10.1016/j.nurpra.2020.08.010
Balcı O, Çapar M. Vajinal Enfeksiyonlar. Turk J Obstet Gynecol, 2005; 2 (5): 14-20.
Çimşit G. Genital Akıntılarda Ayırıcı Tanı. Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi, 2005; 1(48): 31-35.
Paradise JE, Willis ED. Probability of vaginal foreign body in girls with genital complaints. Am J Dis Child. 1985; 139(5): 472-6. doi: 10.1001/archpedi.1985.02140070046031. PMID: 3984971.
Kurdoğlu Z. Geleneksel Yöntemlerle Tedavi Edilen İnfertil Bir Kadında Vajende Saptanan Yabancı Cisim: Olgu Sunumu. Van Tıp Dergisi, 2011; 18(4): 217–219.
Anderson J, Paterek E. Vaginal Foreign Body Evaluation and Treatment. 2020. May 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31747201.
National Library of Medicine, Sexually Transmitted Diseases, 2019. Available from: https://medlineplus.gov/sexuallytransmitteddiseases.html.
Sünter AT, Terzi Ö. Bulaşıcı Hastalıklar. İçinde: Çvr. Edt. Acar Vaizoğlu S. Yeni Halk Sağlığı. Palme Yayın Evi, Ankara, 2019; 218-222.
Hughes, G., & Field, N. (2015). The epidemiology of sexually transmitted infections in the UK: impact of behavior, services and interventions. Future microbiology, 10(1), 35-51.
Kimberly AK, Gail AB. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep. 2015; 64(3): 34-52.
Akdolun Balkaya N. Üreme Sistemi Enfeksiyonları ve Cinsel Yolla Bulaşan Enfeksiyonlar. İçinde: Şirin A, Kavlak O. Kadın Sağlığı. Nobel Tıp Kitapevleri, İstanbul, 2015; 217-255.
Report on global sexually transmitted infection surveillance, Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. ISBN 978-92-4-156569-1, https://apps.who.int/iris/bitstream/handle/10665/277258/9789241565691-eng.pdf?ua=1
Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Global and regional estimates of the prevalence and incidence of four curable sexually transmitted infections in 2016. Bull World Health Organ 2019; 97:548–562P | doi: http://dx.doi.org/10.2471/BLT.18.228486
The America Colloge of Obstetricians Gynecologists (ACOG), Chlamydia, Gonorrhea, and Syphilis. 2021. https://www.acog.org/womens-health/faqs/chlamydia-gonorrhea-and-syphilis.
National Institute for Health and Care Excellence (NICE). NICE impact sexual health.2019. file:///C:/Users/Pau/Desktop/Kitap/NICEimpact-sexual-health.pdf.
Report on global sexually transmitted infection surveillance, Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. ISBN 978-92-4-156569-1, https://apps.who.int/iris/bitstream/handle/10665/277258/9789241565691-eng.pdf?ua=1
Centers for Disease Control and Prevention (CDC). U.S. Department of Health and Human Services. Sexually Transmitted Disease Surveillance 2018, https://www.cdc.gov/std/stats18/toc.htm.
WHO GUIDELINES FOR THE Treatment of Chlamydia trachomatis, 2016a https://apps.who.int/iris/bitstream/handle/10665/246165/9789241549714-eng.pdf?sequence=1
WHO GUIDELINES FOR THE Treatment of Neisseria gonorrhoeae, 2016b, https://apps.who.int/iris/bitstream/handle/10665/246114/9789241549691-eng.pdf?sequence=1
Department of Health and Human Services (CDC). Sexually Transmitted Disease Treatment Guidelines 2015; 64 (3) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf
Workowski KA, Bolan GD. Centers for Disease Control and Prevention. U.S. 2015.
Patel R et al. European guidelines for the management of genital herpes. International journal of STD & AIDS, 2017; 28(14): 1366-1379.
Manini I, Montomoli E. Epidemiology and prevention of Human Papillomavirus. Ann Ig, 2018; 30(4): 28-32.
Markowitz LE, Dunne EF, Saraiya M, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2014; 63(No. RR-05). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm
Adegoke O, Kulasingam S, Virnig B. Cervical cancer trends in the United States: a 35-year population-based analysis. Journal of women's health, 2012; 21(10): 1031-1037.
Bruni L, Diaz M, Castellsagué M, Ferrer E, Bosch FX, de Sanjosé S. Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. Journal of Infectious Diseases, 2010; 202(12): 1789-1799.
Zur Hausen, H. Papillomaviruses in the causation of human cancers—A brief historical account. Virology 2009; 384: 260–265. [CrossRef] [PubMed]
Taşkın L, Işık Koç. Üreme Organ Enfeksiyonları. İçinde: Çoşkun AM. Kadın Sağlığı ve Hastalıkları El Kitabı. Koç Üniversitesi Yayınları, İstanbul, 2016; 463-497.
Taşkın L. Doğum ve Kadın Sağlığı Hemşireliği. Akademisyen Tıp Kitabevi, Ankara, 2016.
Arslan U, Fındık D. Cinsel Yolla Bulaşan Hastalıklar. İçinde: Çiçek MN, Mungan MT. Klinikte Obstetrik ve Jinekoloji. Güneş Tıp Kitapevleri, Ankara, 2007; 577-586.
Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. 2019.
Committee On Practice Bulletins. Cervical cancer screening and prevention. The American College of Obstetricians and Gynecologists, Practice Bulletin; 2017.
Avcı GA, Bozdayı G. İnsan Papilloma Virüsü Human Papillomavirus. Kafkas Tıp Bilimleri Dergisi. 2013; 3(3): 36-144.
Şahiner F, Şener K. Human Papilloma Virüs Enfeksiyonları, Risk Faktörleri ve Koruyucu Önlemler. TAF Preventive Medicine Bulletin. 2013; 12(6): 715-722.
Merck Vaccines Gardasil 9. Prescribing Information. Erişim Adresi: http://www.merck.com/product/usa/pi_circulars/g/gardasil_9/gardasil_9_pi.pdf. 2014. Erişim Tarihi: 18 Mart 2021.
UNAIDS Fact Sheet, 2020. World AIDS Day 2020. Global HIV Statıstıcs https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf. Ulaşım Tarihi. 16.03.2021.
Eisinger RW, Fauci AS. Ending the HIV/AIDS pandemic. Emerging infectious diseases, 2018; 24(3): 413.
Razavi H. Global epidemiology of viral hepatitis. Gastroenterology Clinics, 2020; 49(2): 179-189.
Morrone, Aldo. Donovanosis, Chancroid, and Endemic Treponematoses: Clinical Features and Control. In: Sexually Transmitted Infections. Springer, Cham, 2020; 319-335.
Barrow RY, Ahmed F, Bolan GA, Workowski KA. Recommendations for providing quality sexually transmitted diseases clinical services, 2020. MMWR Recommendations and Reports, 2020; 68(5), 1.
