Infektionen an Vulva, Vagina Und Zervix Literarische Übersichtsarbeit Und Internetkompendium

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Infektionen an Vulva, Vagina Und Zervix Literarische Übersichtsarbeit Und Internetkompendium Aus der Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Ludwig-Maximilians-Universität München Direktor: Prof. Dr. med. K. Friese Infektionen an Vulva, Vagina und Zervix Literarische Übersichtsarbeit und Internetkompendium Dissertation zum Erwerb des Doktorgrades der Medizin an der Medizinischen Fakultät der Ludwig-Maximilians-Universität München vorgelegt von Andrea Buchberger aus Dachau 2009 Abstract Die literarische Übersichtsarbeit und das Internetkompendium zur Thematik Infektionen an Vulva, Vagina und Zervix zeichnen sich durch große epidemiologische Bedeutung und fachliche Brisanz aus. Auf 265 Seiten werden 654 Fachartikel der vergangenen Dekade zitiert, 90 Abbildungen und Tabellen strukturieren die Flut an Daten. Die originäre Leistung liegt im Internetkompendium, das eine gute Übersicht über genitale Infektionen verschafft. Die wissenschaftlich fundierten Aussagen aus dem Grundlagenteil werden hier komprimiert auf einer Startseite zusammengefügt, in den tieferen Ebenen sind weiterführende Kommentare verlinkt. In einem diagnosebezogenen und in einem symptomorientierten Bereich sowie einen Abschnitt zur Prävention hat der Laie raschen Zugriff auf die für ihn relevanten Informationen. Genitalinfektionen sind häufig: Fast alle Frauen sind im Laufe ihres Lebens wenigstens einmal davon betroffen, viele leiden an rezidivierenden Verläufen. Auch die Inzidenz sexuell übertragbarer Krankheiten ist weltweit, in Europa und auch in Deutschland zunehmend. Doch die geschichtlichen Wurzeln reichen weit zurück: Seit alters her wurden zahlreiche Therapieoptionen ersonnen, in der Einleitung wird ein kurzer geschichtlicher Abriss gegeben. Im Anschluss daran folgt die Aufgabenstellung in der die Teile der Arbeit erläutert werden. Auch das System der Literaturrecherche wird beschrieben: Im Wesentlichen fand sie über das Internet statt, doch auch die Universitätsbibliothek in Großhadern, die medizinische Lesehalle und über Fernleihe die Bayerische Staatsbibliothek waren wichtige Literaturquellen. Dann kommt das allgemeine Infektiologiekapitel. Da eine einwandfreie Diagnostik notwendige Voraussetzung für eine wirksame Therapie ist, nimmt das Prozedere in der Diagnostik großen Raum ein. Es wird auch ein Überblick über die Erreger gegeben. Bakterien, Pilze, Viren und Parasiten werden systematisch besprochen. Schließlich wird ihre Bedeutung in den Organbereichen von außen nach innen angegeben: Zunächst werden die Entzündungen des äußeren Genitales, dann der Scheide und schließlich des Gebärmutterhalses beschrieben. Der Schwerpunkt liegt dabei auf den klinischen Erscheinungsformen. Die psychosomatische Bedeutung des Fluor genitalis wird auch berücksichtigt: Der Zusammenhang zwischen Genitalinfektionen und psychischen Phänomenen ist bidirektional: Zum einen verursacht erhöhter psychosozialer Stress Scheideninfektionen, zum anderen sind genitale Infektionen mit einer erheblichen Beeinträchtigung der Lebensqualität verbunden. Die Frauen werden sowohl körperlich als auch emotional in Mitleidenschaft gezogen. Selbstzweifel, sexuelle Funktionsstörungen sowie eine erhebliche Beeinträchtigung der Paarbeziehung können auftreten. Abstract Differentialdiagnostisch ist an Malignome, klassische sexuell übertragbare Erkrankungen sowie Krankheitsbilder nichtinfektiöser Genese zu denken. Bei den Infektionen der Zervix wird auf das zweithäufigste Malignom der Frau, das Zervixkarzinom, und seine Vorstufen sowie die Möglichkeit der Schutzimpfung eingegangen. Schließlich werden die erheblichen Auswirkungen von Genitalinfektionen auf die Geburtshilfe erläutert. Ungewollte Kinderlosigkeit durch Sterilität nach aszendierenden Infektionen geht häufig mit großem Kummer einher. Zudem stellt das durch Infektionen erhöhte Frühgeburtenrisiko sowohl menschlich als auch volkswirtschaftlich eine große Belastung dar. Kindliche Infektionen mit Herpes simplex Viren sind mit einer hohen Morbidität und Mortalität verbunden. Die wissenschaftlich fundierten Ausführungen über genitale Infektionen werden schließlich im Internetkompendium komprimiert zusammengefasst. Auf der Startseite erfolgt eine Synopsis der Thematik. Die diagnosebezogene Darstellung, richtet sich an Frauen, die mit einer Diagnose vom Arzt zurückkommen und sich über ihre Erkrankung informieren möchten. Als Gegenstück dazu steht die symptomorientierte Darstellung. Die Zielgruppe hierbei sind Frauen mit Beschwerden, die zunächst selbst recherchieren möchten, noch bevor sie sich vertrauensvoll an einen Arzt wenden. Die Fachbegriffe werden laienverständlich erklärt und in den tieferen Ebenen sind umfangreiche wissenschaftlich fundierte Informationen u. a. in Form von Tabellen und Abbildungen verlinkt. Selbstverständlich darf im Internetkompendium auch der äußerst wichtige Teil der Prävention nicht fehlen. Hierbei ist insbesondere auf den konsequenten Kondomgebrauch sowie die Möglichkeit der HPV-Schutzimpfung hinzuweisen. Die Krebsvorsorgeuntersuchung behält weiterhin uneingeschränkt ihren Stellenwert. Diskussion, Zusammenfassung, Literaturverzeichnis, Danksagung und Lebenslauf runden die Dissertation ab. Aus der Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Ludwig-Maximilians-Universität München Direktor: Prof. Dr. med. K. Friese Infektionen an Vulva, Vagina und Zervix Literarische Übersichtsarbeit und Internetkompendium Dissertation zum Erwerb des Doktorgrades der Medizin an der Medizinischen Fakultät der Ludwig-Maximilians-Universität München vorgelegt von Andrea Buchberger aus Dachau 2009 Mit Genehmigung der Medizinischen Fakultät der Universität München Berichterstatter: Prof. Dr. Dr. E.R. Weissenbacher Mitberichterstatter: Priv. Doz. Dr. Rainer Steldinger Mitbetreuung durch den promovierten Mitarbeiter: Prof. Dr. H. Spitzbart Dekan: Prof. Dr. med. Dr. h.c. M. Reiser FACR, FRCR Tag der mündlichen Prüfung: 19. 02. 2009 Für Puck Inhaltsverzeichnis Abbildungsverzeichnis ...................................................................................................... 10 Tabellenverzeichnis ........................................................................................................... 11 Abkürzungsverzeichnis ..................................................................................................... 14 Einleitung ........................................................................................................................... 17 Aufgabenstellung .............................................................................................................. 20 1 ALLGEMEINE INFEKTIOLOGIE........................................................................ 21 1.1 Prozedere in der Diagnostik bei Infektionen an Vulva, Vagina und Zervix ..................... 22 1.2 Bakterien....................................................................................................................... 30 1.2.1 Grampositive Bakterien........................................................................................... 33 1.2.1.1 Laktobazillen .................................................................................................... 33 1.2.1.2 Atopobium vaginae........................................................................................... 36 1.2.1.3 Enterokokken ................................................................................................... 37 1.2.1.4 Streptokokken .................................................................................................. 37 1.2.1.5 Staphylokokken ................................................................................................ 38 1.2.1.6 Bifidusbakterien................................................................................................ 39 1.2.1.7 Gardnerella vaginalis........................................................................................ 39 1.2.1.8 Clostridien ........................................................................................................ 40 1.2.1.9 Mykoplasmen ................................................................................................... 41 1.2.2 Gramnegative Bakterien ......................................................................................... 42 1.2.2.1 Chlamydien ...................................................................................................... 42 1.2.2.2 Neisseria gonorrhoeae ..................................................................................... 44 1.2.2.3 Sonstige gramnegative Kokken ........................................................................ 46 1.2.2.4 Pseudomonaden .............................................................................................. 46 1.2.2.5 Treponema pallidum......................................................................................... 47 1.2.2.6 Bacteroidaceae ................................................................................................ 50 1.2.2.7 Mobiluncus Spezies.......................................................................................... 52 1.3 Pilze .............................................................................................................................. 53 1.3.1 Candida .................................................................................................................. 53 1.3.2 Dermatophyten ....................................................................................................... 57 Inhaltsverzeichnis 1.4 Viren.............................................................................................................................
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