Obiettivi e finalità/Aims and scope

La Rivista Italiana di Ostetricia e Ginecologia pubblica contributi originali, review, case report e case series di elevato valore scientifico e mira a divenire un riferimento non solo per i Ginecologi, ma per tutti quei clinici che sono coinvolti nei percorsi di prevenzione, diagnosi e cura delle patologie femminili, in medicina della riproduzione, nella sorveglianza della gravidanza e nel percorso nascita. La peer review a cui sono sottoposti i contributi pubblicati garantisce il rigore metodologico e anche una fruibilità clinica immediata.


Vulviti da Staphylococcus aureus

Vulviti da Staphylococcus aureus: un’infezione insidiosa che sottolinea l’importanza di una appropriata igiene intima

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Fondazione Graziottin per la cura del dolore nella donna, Onlus

2 – Centro di Ginecologia e Sessuologia medica, H. San Raffaele Resnati Milano

Autore di riferimento: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog1202113

Abstract

Why do folliculitis and other bacterial vulvar infections represent disorders of interest in the gynecological practice? Which predisposing, precipitating, and maintaining factors should be considered by the gynecologist when recurrent bacterial infections of vulvar skin become a clinical challenge? When is it appropriate to think of Staphylococcus aureus as a principle etiological agent? Why do S. aureus vulvar infections represent an emerging threat for women’s health? New hygienic and cosmetic practices, including over-zealous cleansing and micro- and macro-traumatic hair removal techniques, lead to a significant increase of vulvar infections in the clinical practice. Factors predisposing to bacterial vulvar infections, such as personal and familial diabetes and obesity, indicate to the gynecologist an alteration of the vulvar ecosystem, which can predispose to more severe pathologies. S. aureus, the main infectious agent, causes increasing medical concerns because of its pathogenic and invasive capacity. Moreover, the rapid ability of S. aureus of developing antibiotic resistances is even more challenging in surgical specialties, especially in obstetrics and gynecology, for the reduced availability of effective antibiotics for treatment. The gynecologist has an important educational role on the appropriate hygiene principles, to reduce bacterial vulvar infections, more threatening for their increasing invasive potential, especially in more vulnerable subjects.

Keywords: intimate hygiene; cutaneous infections; staphylococcus aureus; vulva.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Sifilide: perché è una malattia più insidiosa nelle donne

Sifilide: perché è una malattia più insidiosa nelle donne

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Fondazione Graziottin per la cura del dolore nella donna, Onlus

2 – Centro di Ginecologia e Sessuologia medica, H. San Raffaele Resnati Milano

Autore di riferimento: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog1202112

Abstract

Why should syphilis be reconsidered in gynecological clinical practice? Why are women more vulnerable to late diagnosis? What are the key points for timely and effective diagnosis and treatment? What are the avoidable consequences of diagnostic and therapeutic delays? Syphilis is caused by the sexually and vertically transmitted bacterium Treponema pallidum. Syphilis, wrongly considered outdated, is making an aggressive comeback worldwide. From a medical point of view, diagnostic timeliness is hampered by: a lack of familiarity with this re-emerging disease and a consequent lack of consideration in the anamnestic picture and differential diagnosis; complex course, which alternates insidious and variable symptomatic phases, with periods of clinical latency, while the disease continues its pro-inflammatory and destructive action at the subclinical level. The late or missed diagnosis of syphilis leads to a prolonged infection, with permanent and at times fatal outcomes. The danger of a delay in diagnosis also results in persistent infectivity of the patients, who continue to infect their sexual partners, and the fetus, if pregnant. The aim of the work is: to identify the key points for timely and effective diagnosis and therapy of syphilis in gynecology, with a focus on vulvar and vaginal vulnerability; to analyze the reasons for its insidious hidden diffusibility; to discuss the diagnostic difficulties, the limited availability of the most effective drug, penicillin, the current lack of a vaccine and finally why it is difficult to follow the course of the disease and its therapy through laboratory diagnostics. The final goal is to enhance the diagnostic effectiveness of the gynecologist.

Keywords: syphilis; primary chancre; secondary syphilis; treponema pallidum; penicillin; vulva.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Herpes vulvari: inquadramento clinico e terapia

Herpes vulvari: inquadramento clinico e terapia

Stefano Astorino – Orcid

Unità operativa di dermatologia e m.s.t. del Policlinico Militare “Celio”, Roma

stefano.astorino.sa@gmail.com


DOI: 10.53146/lriog1202111

Abstract

Most young people with erosive-ulcerative-genital lesions (“Genital Ulcer Disease”) have genital herpes (prevalence 5-40%), sometimes associated with syphilis or other sexually transmitted diseases, with a significant risk of co-infection with HIV.
Also transmissible in asymptomatic (virus shedding) or “undiagnosed” due to mild, atypical symptoms (fissures, erythema, neuralgia), or hidden localizations, the primary infection of vulvar herpes (HSV2-1) has classic acute manifestations: pain, burning (sometimes sciatica, cruralgia, antalgic urinary retention), cluster vesicle- pustules on erythematous-edematous areas that evolve into confluent-polycyclic erosions, often ulcerative-aphthous-like; satellite lymphadenitis, fever sometimes high. In 1-3 weeks they heal (completely the erosions; ulcers with scars); after weeks or months of latency the secondary herpes relapses on average 5-6 times a year, with variable duration (on average 1 week). Relapsing symptoms and signs, similar to primary-Herpes, are more localized and attenuated, except in immunosuppressed, who manifest chronic, severe-ulcerative, disabling, hypertrophic-pseudo-tumor, generalized-varicelliform forms. Possible cause of fetal malformations, neonatal morbidity and lethality, herpes in pregnancy is effectively treated with systemic acyclovir. Sometimes it justifies caesarean-section. According to European-guidelines (2017), the diagnosis is clinical (when possible supported by PCR); topical antiviral-therapy offers few advantages (except foscarnet 1% in case of resistance and imiquimod 5% effective in HIV-associated pseudotumoral-forms) compared to local soothing-antiseptic and anti-inflammatory (including cortisone) therapy. Acyclovir (ACV), since its discovery (Elion_G.B.1978) the best systemic antiherpetic, is effective both with “episodic-therapy” (average adult dose: ACV tbl 200-800mg 3t./die for 7-10 days in primary-Herpes, for 2-5 days at each relapse) both with “continuous-suppressive-therapy” (if>6 relapses a year a.a.d.:ACV400mg 2t./die or similar: Famciclovir FCV 250mg 2t./die, Valaciclovir VLC 500mg 1t./die; replaceable in case of resistance with Foscarnet 40mg / kgI.V./8-12h.).

Keywords: vulvar herpes; HSV2-1; genital herpes; systemic antiviral therapy; topical therapy; guidelines.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Genital filler – le 5Ws – What, Who, Where, When, Why?

Genital filler – le 5Ws – What, Who, Where, When, Why?

Elena Fasola – Orcid

Gyplast Medical Institute, Milano

 

fasolaelena@yahoo.it


DOI: 10.53146/lriog1202110

Abstract

The recent introduction of injectable products in the market, hyaluronic acid based, indicated to counteract the signs and symptoms of tissue atrophy in vulvar area, inevitably generates the need to deepen the subject. The focus will be placed on the biochemical peculiarities and the ractional use of these products, to clarify how they are “processed” before being put on the market and therefore of what is infiltrated into the tissues at the end of the production process; what is the precise anatomical site in which they can be used, for what indications, with what techniques, contraindications and side effects. Among the products based on hyaluronic acid, first it is important to dwell on the big difference between non- cross-linked and cross-linked gels hyaluronic acid based, having themselves two different indications. The firsts are indicated for cutaneous and mucosal atrophy with eutrophication and biostimolating purposes, the seconds are used for iatrogenic scarring results, for example post-episioraffia or for reconstructive purposes in hypo / dystrophies of the fatty body of the Labia Majore and in macroscopic iatrogenic scarring with tissue loss. Also the technique by which they are injected is different (with needle or blunt tip cannula), with different contraindications and side effects. With a practical slant, the author intends to develop the topic with the aim of providing valid help to the doctor in his practical clinic.

Keywords: injectable hyaluronic acid; vulvar filler; atrophy; iatrogenic scarring; needle; cannula.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Covid: lesioni cutanee e mucose

Covid: lesioni cutanee e mucose: lesioni cutanee e mucose, con focus sulla regione vulvare e perineale

Gabriella Fabbrocini1 – Orcid, Lucia Gallo2 – Orcid

1 – Clinica Dermatologica, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II

Autore di riferimento: Gabriella Fabbrocini

gabriella.fabbrocini@unina.it


DOI: 10.53146/lriog120219

Abstract

The novel coronavirus disease (COVID-19) is associated with significant morbidity and mortality. While much of the focus has been on the cardiac and pulmonary complications, there are several important dermatologic components that clinicians must be aware of. There are several types of skin findings described in association with COVID-19. These include maculopapular rashes, urticaria, vesicles, petechiae, purpura, chilblains. While most of these dermatologic findings are self-resolving, they can help increase one’s suspicion for COVID-19. It is important to be aware of the dermatologic manifestations and complications of COVID-19. Knowledge of the components is important to help identify potential COVID-19 patients and properly treat complications.

Keywords: covid-19; coronavirus; dermatology; skin; mucoses.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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