GENITAL TRACT

INFECTIONS
Khushboo
M.SC. Nursing 2nd year
M.S.K.C.O.N

OBJECTIVES
At the end of the class the students will be able to
Define torch

List down the cause of the torch

Enlist the sign & symptoms of torch

Enumerates the sign ,symptoms, causes, prevention & treatment of
toxoplasmosis
Explain the symptoms, causes, diagnosis, prevention &treatment of
rubella
Outline symptoms, causes & treatment of cytomegalovirus
Explicate the herpes simplex virus, HIV, varicella zoster virus

INTRODUCTION

Genital tract infections (RTIs) are caused by organisms normally present in the
reproductive tract, or introduced from the outside during sexual contact or
medical procedures. These different but overlapping categories of RTI are called
endogenous, sexually transmitted infections (STIs) and iatrogenic, reflecting how
they are acquired and spread.

Sexually transmitted diseases (STD), such as chlamydia, gonorrhea, chancroid,

and human immunodeficiency virus (HIV)

Endogenous infections, which are caused by overgrowth of organisms normally

present in the genital tract of healthy women, such as bacterial vaginosis or
vulvovaginal candidiasis and

Iatrogenic infections, which are associated with improperly performed medical

procedures such as unsafe abortion or poor delivery practices.

TORCH INFECTIONS

Introduction: This infection is dangerous for pregnant woman, especially

because it could effect to the unborn child.
The TORCH infections can lead to severe fetal anomalies or even fetal loss.
They are a group of viral, bacterial, and protozoan infections that gain
access to the fetal bloodstream transplacentally via the chorionic villi.
Hematogenous transmission may occur at any time during gestation or
occasionally at the time of delivery via maternal-to-fetal transfusion.

Definition: TORCH are groups of infection, consist of Toxoplasmosis,

Rubella, Cytomegalovirus and Herpes simplex virus.
The "other agents" included under O are Syphilis, Varicella-Zoster Virus,
HIV, and Parvovirus.

T Toxoplasmosis
O Other infections
R Rubella
C
Cytomegalovirus
H Herpes
simplex
virus

TOXOPLASMOSIS
Toxoplasmosis is an infection caused by a single-celled parasite called
Toxoplasma gondii. The parasite infects most genera of warm-blooded
animals, including humans, but the primary host is the felid (cat)
family
RISK OF FETAL INFECTION

15 % in First Trimester

25 % in Second Trimester

65 % in Third Trimester - ( but almost 90% of newborns are without clinical

signs of disease ).

40% of fetuses are affected if the mother has the illness.

CAUSE OF TOXOPLASMOSIS

Contact with cats or cat

feces
Eating raw or undercooked
meat
Drinking raw milk from an
infected goat
Organ transplantation or
blood transfusion from an
infected person

TRANSMISSION MAY OCCUR THROUGH

Ingestion of raw or partly cooked meat, especially pork, lamb, or venison

containing Toxoplasma cysts:

Ingestion of contaminated cat feces This can occur through hand-tomouth contact following gardening, cleaning a cat's litter box, contact
with children's sandpits, or touching a leech; the parasite can survive in
the environment for over a year.

SIGNS AND SYMPTOMS

Swollen lymph nodes,
Encephalitis
Nasal malformations
Necrotizing retinochoroiditis
Muscle aches and pains that last for a month or more.
Forming cysts in nervous and muscle tissue
Depression

Treatment: Piramycin(25-50 mg/ day + clindamycin

300mg four times a day) in infected mothers to reduce
transmission to the fetus.

Prevention: wash hands before eating, after handling

raw meat , after contact with cat feces, & soil & cook
their meat adequately.

INFECTION IN THE PREGNANCY MAY RESULT IN

CHARACTERISTIC TRIAD OF FETAL
ANOMALIES

Chorioretinitis

Spontaneous
abortion.

Hydrocephaly or
microcephaly

Perinatal death.

Cerebral
calcification

Abnormal growth.

HEALTH EDUCATION

-Women planning a pregnancy may be tested before pregnancy. If the test is

positive there is no need to worry about passing a new infection to the baby.
Women who test negative can take precautions.
-Wear gloves and wash hands carefully after handling soil.
- Cook meat thoroughly (until no longer pink inside and juices run clear)
- Wash hands and any equipment or surfaces that raw meat contacts
thoroughly with warm water and soap.
-Keep the cat inside and do not feed raw meat. Avoid handling stray cats or
new kittens that may have eaten raw meat. Have someone else change the
litter box.

RUBELLA
Introduction : Rubella, also known as German measles or
three-day measles, disease caused by the rubella virus. The name
"rubella" is derived from Latin, meaning little red. Infection of the
mother by Rubella virus during pregnancy can be serious; if the
mother is infected within the first 20 weeks of pregnancy, the child
may be born with congenital rubella syndrome. Spontaneous abortion
occurs in up to 20% of cases.

DEFINITION- A mild contagious eruptive

disease caused by a virus and capable of
producing congenital defects in infants born to
mothers infected during the first three months
of pregnancy.

SIGNS AND SYMPTOMS

Appearance of a
rash on the face
which spreads to
the trunk and limbs

Occasionally
vomiting

Low grade
fever 100.4
oo
F

Swollen
glands or
lymph nodes

Headache and
conjunctivitis

Red papules
on the area of
the soft palate

Joint pains,

CONGENITAL RUBELLA SYNDROME

Rubella can cause congenital rubella syndrome in the newly born. The syndrome
(CRS) follows intrauterine infection by the Rubella virus and comprises cardiac,
cerebral, ophthalmic and auditory defects. It may also cause prematurity, low
birth weight, and neonatal thrombocytopenia, anemia and hepatitis

CAUSE
The virus is transmitted by the respiratory route and
replicates in the nasopharynx and lymph nodes. The
virus is found in the blood 5 to 7 days after infection
and spreads throughout the body. The virus has
teratogenic properties and is capable of crossing the
placenta and infecting the fetus where it stops cells
from developing or destroys them.

DIAGNOSIS
Rubella virus specific IgM antibodies are present
in people recently infected by Rubella virus but
these antibodies can persist for over a year and
a positive test result needs to be interpreted
with caution. The presence of these antibodies
with a short time after, the characteristic rash
confirms the diagnosis.

PREVENTION
Rubella infections are prevented by active immunization programs
using live, disabled virus vaccines. The vaccine is now usually given as
part of the MMR vaccine. The WHO recommends the first dose is given
at 12 to 18 months of age with a second dose at 36 months.
Screening for rubella susceptibility by history of vaccination
First preconception counseling visit to reduce incidence of congenital
rubella syndrome
susceptible pregnant women should be vaccinated as soon as possible.

TREATMENT
There is no specific treatment for Rubella

However, diminish discomfort.

Treatment of newly born babies is focused on

management of the complications.
Congenital heart defects and cataracts can be
corrected by direct surgery.

HEALTH EDUCATION

Vaccination of non-immune women before pregnancy is the best

prevention.

The rubella and MMR (measles, mumps, rubella) vaccines are not
recommended during pregnancy.

A woman should wait 28 days after vaccination to attempt

conception.

Breastfeeding women may be vaccinated.

Pregnant women who are non-immune for rubella should avoid

anyone with rubella or the symptoms of rubella.

CYTOMEGALOVIRUS
Meaning -Cytomegalovirus
(from the Greek cyto-, "cell",
and
-megalo-, "large")
is a viral genus of the viral family known as
Herpesviridae or herpesviruses.

Definition
This is a viral genus of Herpes Viruses transmitted
through bodily fluids such as saliva, urine. Rarely
transmitted
transplant

by

blood

transfusion

and

organ

TRANSMISSION
Incubation :
unknown

Transplacental
transmission

Transmission can occur

through contact with saliva,
urine, feces, blood, and
mucous. It can also be
transmitted sexually and
through transfusion and
organ donation.

Infants who are infected

during birth rarely have
serious problems from
the infection.

CMV is very common

in young children

SYMPTOMS
Infants who are infected before birth
usually show no symptoms of a CMV
infection after they are born.
They may develop severe symptoms
including:
.
Sore throat
Fatigue
Blindness

Neurological and
Developmental
problems
over
time

Hearing loss
Body aches
Fever

Some infants may have other

symptoms at birth including:

Seizures

Jaundice
Premature
delivery

Enlarged
liver and
spleen

Small
head or
microceph
aly

Being
small for
gestationa
l age

Rashes on
body

Feeding
difficulties
.

TRANSMISSION OF INFECTION
Transmission requires close contact.
Body fluids like saliva, breast milk, vaginal fluids, semen,
urine, and stool.
Blood products and Donated organs
Infection may be transmitted to the new born baby from the
passage through infected mothers birth canal,
Breast milk from infected mother or contact with another
infected person

DIAGNOSTIC FINDINGS
Maternal - ELISA, fluorescent antibody (FA), complement fixation (CF), seroconversion to +IgM, and
isolation of the virus by culture.

Affected infants may demonstrate the following ultrasound findings: microcephaly,

hydrocephalus, necrotic cystic or calcified lesions in the brain, liver or placenta, IUGR,
oligohydramnios, ascites, pleural or pericardial effusion, hypoechogenic bowel and hydrops.

Amniocentisis with culture or DNA identification.

Cordocentesis can be used to document presence and severity of disease.

Newborn virus isolation is the optimal method of documenting CMV infection. Specimens can be
taken from urine, nasopharnyx, conjunctiva and spinal fluid.

POTENTIAL MATERNAL AND NEONATAL EFFECTS

Maternal Most infections are asymptomatic
Neonatal Approximate congenital infection rate of 1%. Of
these, 10 % will be symptomatic, of which 25 % will have fatal
disease and 90% of the survivors will have serious sequelae
IUGR,

microcephaly,

CNS

abnormalities,

hydrocephaly,

periventricular calcification, deafness, blindness, and mental

retardation.

INTERVENTIONS
Maternal treat symptoms
Neonatal - no satisfactory treatment available. Infant is contagious
and should be isolated
HEALTH EDUCATION

Universal precautions and careful hand washing, especially after

any contact with saliva, urine, feces, blood and mucous.

Avoid sharing glasses or eating utensils.

Medical or day care workers may consider being tested prior to
pregnancy to determine if they have had CMV, as they would then
have little cause for concern

HERPES SIMPLEX VIRUS

Herpes simplex virus : Herpes is caused by the herpes simplex viruses,
which are similar to the viruses that cause chickenpox and shingles.
After the initial infection,
the herpes simplex
viruses can hide within
nerve cells and later
launch new attacks.

TRANSMISSION
Incubation 2 to 10 days
Intimate

mucocutaneous

exposure,

intercourse,

mouth

to

genital contact or kissing in the presence of a cold sore.

Passage through an infected birth canal.
Transplacental infection happens rarely with an initial maternal
infection during pregnancy.

SYMPTOMS
Cervical
inflammation

Pelvic
pain

Hematuria

Dysuria

THE NEW BORN WITH HERPES SYMPTOMS

CNS infection
Local infection in skin, eye or mouth

DIAGNOSTIC FINDINGS
tissue culture
swab specimen from vesicles
pap smear of lesion
visualization of a blister or ulcer-like, painful
lesion

INTERVENTIONS

Women with prodromal symptoms or an active lesion will be

counseled to have cesarean delivery. The greatest protection to the
fetus is if this is accomplished before ROM greater than 4 hours.
Anti-viral drugs, Oral acyclovir is sometimes used in late pregnancy to
decrease the need for cesarean birth.
Acyclovir and vidarabine are used to treat neonatal HSV.

HEALTH EDUCATION

Encourage women to avoid triggers (heat, friction, intercourse, peanuts,

chocolate, fever or stress), especially during the later part of pregnancy.

Recommend condoms or abstinence in pregnant women without HSV who

have partners with HSV.

Encourage careful hand washing to prevent spread of HSV to others or to

other parts of the body

People with active cold sore lesions should avoid kissing others, especially
newborns.

Educate women of the importance of reporting symptoms or lesions to their

care providers with suspected labor or ruptured membranes

SYPHILIS

Syphilis is a sexually transmitted infection caused by

the spirochete bacterium
Treponema pallidum
subspecies pallidum.

ROUTE OF TRANSMISSION-:
through sexual contact;
from mother to fetus during
pregnancy or at birth.

SYMPTOMS
Jaundice, Skin lesion, deformed nails, psedoparalysis, can also involve
central nervous system, teeth and skin.

PREVENTION
Cesarean birth is recommended in infected persons.

TREATMENT
Intravenous and intramuscular antibiotic treatment is recommended
within 24 hours of birth to newborn.

VARICELLA ZOSTER VIRUS

Varicella is a common, highly contagious, self-limited disease of childhood that is

transmitted by respiratory droplets or close contact

ROUTE OF TRANSMISSION- through placenta

SYMPTOMS
Fatigue
Headache

Fever,
usually low
grade

Flu like
symptoms

TREATMENT
Symptomatic treatment - eg,
analgesia and antipyretics
such as paracetamol

Antihistamines

Calamine lotion

Acyclovir

HIV

HIV
stands
for
human
immunodeficiency virus. It breaks down
the immune system
It is the most advanced stage of HIV
disease

SYMPTOMS OF HIV
Swollen glands in the throat, armpit, or
groin.
Slight

fever,

muscle aches.

headaches,

fatigue,

and

SYMPTOMS OF AIDS
Thrush

Severe or recurring vaginal yeast infections

Chronic pelvic inflammatory disease

Severe and frequent infections

Periods of extreme and unexplained tiredness that may be combined with
headaches, lightheadedness, and/or dizziness
Quick loss of more than 10 pounds of weight that is not due to increased
physical exercise or dieting
Bruising more easily than normal

long periods of frequent diarrhea

frequent fevers and/or night sweats

swelling or hardening of glands located in the throat, armpit, or groin

periods of persistent, deep, dry coughing

increasing shortness of breath

the appearance of discolored or purplish growths on the skin or inside the mouth
unexplained bleeding from growths on the skin, from the mouth, nose, anus, or vagina, or
from any opening in the body

frequent or unusual skin rashes

severe numbness or pain in the hands or feet, the

loss of muscle control and reflex, paralysis, or loss
of muscular strength

confusion, personality change, or decreased

mental

MODE OF TRANSMISSION
Sexual contact with HIV infected person

Infected blood transfusion

Getting HIV-infected blood, semen, or vaginal
secretions into open wounds or sores.

Sharing needle contaminated with HIV

Mother to child transmission in pregnancy, labor,
delivery and breast feeding

TREATMENT
Although there is no cure for acquired immunodeficiency
syndrome (AIDS), medications have been highly effective in
fighting HIV and its complications. Drug treatments help
reduce the HIV virus in your body, keep your immune
system as healthy as possible and decrease the
complications you may develop.

Abacavir (Ziagen, )

Didanosine (Videx,
dideoxyinosine, )

Zidovudine (Retrovir,
ZDV )

Emtricitabine
(Emtriva )

Zalcitabine (Hivid, )

Tenofovir (Viread )

Lamivudine (Epivir)

Stavudine (Zerit)

PARVOVIRUS
Parvovirus infection is a common and highly contagious childhood ailment sometimes
called slapped-cheek disease because of the distinctive face rash that develops

SYMPTOMS

Sore
throat

Headache

Upset
stomach

Slight fever

Fatigue

Itching

CAUSE
The human parvovirus B19 causes parvovirus infection.

COMPLICATION
Parvovirus can also cause anemia and related complications in:
The unborn children of women infected with parvovirus during
pregnancy
People who have weakened immune systems

PREVENTION
There's no vaccine to prevent parvovirus infection.
Washing hands and child's hands frequently may help
diminish the chances of getting an infection.
TREATMENT
Severe anemia may need to be hospitalized and receive
blood transfusions
May receive antibodies, via immune globulin injections, to
treat the infection

TORCH SYMPTOMS

Fever and poor feeding

The newborn is often small for gestational age

Rash on the skin may be present, with small reddish or purplish spots due to
bleeding from capillaries under the skin.

An enlarged liver and spleen (hepatosplenomegaly)

Hearing impairment,

Eye problems,

Mental retardation,

Autism, and
Death can be caused by TORCH infections

DIAGNOSIS
Physical examination of the newborn
Blood test
Urine test,
Spinal fluid for test
TORCH SCREEN TEST
The TORCH screen is a test that screens for:
toxoplasmosis
rubella
cytomegalovirus
herpes simplex

TREATMENT AND PREVENTION

Antibiotics if the mother is diagnosed early in her
pregnancy.
Vaccinating the mother prior to pregnancy.

REFERENCES

Jacob Annamma , A Comprehensive textbook of Midwifery & Gynecological Nursing 3 rd Edition, Publisher
Jaypee, Page no-546-547.

Kumari Neelem,Sharma Shivani, Gupta Preeti, Midwifery & gynecological Nursing Edition 2011,Publisher
Pee Vee. Page No-357-358.

Dutta D.C, Text book of Obstetrics 6th Edition ,Publisher new central agency .Page no 296-297.

http://www.mayoclinic.com/health/parvovirusinfection/DS00437/DSECTION=treatments-and-drugs

http://www.thefreedictionary.com/rubella

http://www.news-medical.net/health/What-is-Cytomegalovirus.aspx

http://obgyn.med.umich.edu/sites/obgyn.med.umich.edu/files/internal_resources_clinical/torch-tr.pdf

http://www.accesspediatrics.com/abstract/6693046

http://friskakrismariani.blog

http://www.healthline.com/health/torch-screenspot.in/2008/05/torch-toxoplasma-rubella.html

http://en.wikipedia.org/wiki/TORCH_infections

http://en.wikipedia.org/wiki/Toxoplasmosis

http://en.wikipedia.org/wiki/Rubella

http://en.wikipedia.org/wiki/Herpes_simplex_virus

http://en.wikipedia.org/wiki/Cytomegalovirus

http://www.onhealth.com/toxoplasmosis/article.htm