home Adviсe No infections. Infectious diseases. Types of viral diseases

No infections. Infectious diseases. Types of viral diseases

Sexually transmitted infectious diseases are a group of venereological pathologies, the main route of transmission of which is unprotected sexual contact. STDs are clinically heterogeneous nosological entities that are highly contagious, that is, infectious, and therefore pose a direct danger to human health.

What infections are sexually transmitted

The World Health Organization classifies STDs as follows::

Typical sexually transmitted infections

lymphogranulomatosis (inguinal form);
granuloma venereal type.

Other STDs:

which primarily affect the organs of the reproductive system:

urogenital shigellosis (occurs in persons with homosexual sexual intercourse);
trichomoniasis;
candidal lesions of the genital organs, manifested by balanoposthitis and vulvovaginitis;
gardnerellosis;
scabies;
flats ( lice pubis);
molluscum contagiosum.

which primarily affect other organs and systems:

neonatal sepsis;
Giardia;
AIDS;
amebiasis (typical for persons with homosexual contacts).

The main difference between any representative of an STD is its high susceptibility to changes in conditions in environment. For infection to occur, there must be direct contact between a sick person and a healthy person, and in some cases this is not necessarily sexual intercourse; household contact will be sufficient, as, for example, in the case of a viral disease. The danger increases in the presence of defects in the integrity of the mucous membranes and skin, which are the entrance gates for any infection. The risk of contracting an STD increases significantly during anal intercourse, using common funds personal hygiene and sexual toys. note: Almost all viral and bacterial sexually transmitted diseases penetrate the placental barrier, that is, they are transmitted to the fetus in utero and disrupt its physiological development. Sometimes the consequences of such infection appear only several years after the birth of the child in the form of dysfunction of the heart, liver, kidneys, and developmental disorders. Regarding the type of pathogen, sexually transmitted diseases are:

Highlight following reasons that contribute to the spread of STDs:

very close household contacts;
unprotected sex, which also includes anal and oral sex;
use of shared towels;
failure to comply with the necessary rules for sterilization of instruments (diseases are transmitted through contaminated instruments in medical, dental, cosmetology institutions, as well as in manicure and tattoo parlors);
procedure for transfusion of blood and its elements;
parenteral drug administration;
transplantation of organs and tissues.

STD: symptoms

The clinical picture of sexually transmitted diseases is slightly different, but, in general, there are a number of signs that are characteristic of almost each of them:

excessive weakness;
purulent or mucous discharge from the urethra;
cloudy urine;
burning and itching in the genital area;
enlarged lymph nodes in the groin;
discomfort during sexual intercourse and urination;
ulcers and ulcers in the groin, on the external genitalia;

For other organs, symptoms may appear depending on the type of infection that affects other systems. For example, the liver suffers from hepatitis, bones are affected in the last stages of syphilis, and chlamydia can affect joints.

Symptoms of sexually transmitted diseases in women

The presence of certain symptoms of STDs in women is explained by the characteristics of their physiology. The following signs should alert a woman and become a reason for an emergency visit to the gynecologist:

pain and feeling of dryness during sex;
single or group enlargement of lymph nodes;
dysmenorrhea (disturbances in the normal menstrual cycle);
pain and discharge from the anus;
itching in the perineal area;
anal irritation;
rash on the labia or around the anus, mouth, or body;
unusual vaginal discharge (green, foamy, smelly, bloody);
frequent painful urges to urination;
swelling of the vulva.

Sexually transmitted diseases in men: symptoms

You can suspect an STD in men based on the following signs::

blood in semen;
frequent and painful urge to urinate;
low-grade fever (not in all diseases);
problems with normal ejaculation;
pain in the scrotum;
discharge from the urethra (white, purulent, mucous, with an odor);
rash various kinds on the head of the penis, the penis itself, around it.

Important: most sexually transmitted pathologies have asymptomatic. It is very important to ask for medical assistance immediately after the first symptoms appear to prevent progression and complications.

Diagnostics

If there are any suspicious signs on the part of the genital organs, especially after unprotected sexual contact, you should consult a doctor as early as possible. Self-medication in this case is fraught with complications and serious consequences. Sometimes the symptoms of an STD disappear some time after their onset, and the patient thinks that he is healthy and everything went away on its own. But this only means that the disease has passed into a latent, that is, hidden form, and continues to circulate in the body. Important: If you detect suspicious symptoms, you must notify your sexual partner and undergo an examination with him andget tested for STDs. The diagnostic scheme includes the following points:

Survey. The doctor collects a detailed medical history from the patient, he asks about complaints, how long ago they appeared and their severity. Usually, a patient who has already consulted a doctor has various types of elements (ulcers, rashes, erosions) on the skin and mucous membranes of the genital organs, pain, burning, itching when urinating. It is also important to find out the number of sexual partners, previous sexually transmitted diseases, contraceptive methods used, and whether there were unprotected sexual contacts. A woman undergoes mandatory gynecological examination, and for a man urological, during which a specialist detects objective symptoms of STDs. If necessary, it is also possible to consult a dermatovenerologist.
Laboratory research. They are the basis for confirming the diagnosis. Testing for sexually transmitted infections involves examining the patient's blood and other biological fluids.

In particular, the following diagnostic methods are used:

Treatment of sexually transmitted infections

Appropriate therapy is always prescribed only by the attending physician based on test results. Depending on the identified pathogen, a treatment regimen is drawn up.
Most of diseases are successfully treated, but there are some that are considered incurable:

hepatitis C;
herpes types 1 and 2;

At the same time, maintenance therapy allows you to remove symptoms and alleviate the patient’s condition. Among the medications prescribed by a doctor, the following groups of drugs can be used:

to activate the body's immune response;
antiviral, allowing to accelerate remission when viral infection will go into the latent phase;
hepatoprotectors are used to support the liver in case of severe damage;
cardiac glycosides support the functioning of the heart muscle;
vitamin-mineral complexes are part of general strengthening therapy;

In the middle of the last century, humanity achieved certain successes in the fight against certain infections. But, as it turned out, it is too early to celebrate the final victory over such a scourge as infectious diseases. Their list contains more than 1,200 items, and is constantly updated with newly discovered diseases.

How infectious diseases were studied

Mass diseases have been known to man since ancient times. There is evidence that back in the 5th century BC. philosophers and doctors guessed about the existence of certain tiny, invisible living organisms that could cause diseases characterized by rapid spread and high mortality rate. During the Middle Ages, however, these materialistic views were forgotten, and outbreaks of mass diseases were explained solely by God's punishment. But they knew already then that the sick had to be isolated, as well as the destruction of contaminated things, buildings and corpses.

Knowledge accumulated gradually, and the mid-19th century was marked by the emergence of such a science as microbiology. Then the causative agents of many diseases were discovered: cholera, plague, tuberculosis and others. since then they have been classified as a separate group.

Terminology

The word “infection” translated from Latin means “pollution”, “infection”. As a biological concept, this term denotes the penetration of a microscopic pathogen into a more highly organized organism. It can be a person or an animal, or a plant. Next, the interaction between the micro- and macroorganism systems begins, which, of course, does not occur in isolation, but under specific environmental conditions. This is a very complex biological process, and it is called infectious. As a result of such interaction, the macroorganism is either completely freed from the pathogen or dies. The form in which the infectious process manifests itself is a specific infectious disease.

Common characteristics of infectious diseases

We can talk about the onset of an infectious disease if, after the meeting of the pathogen and the macroorganism, in particular a person, the latter’s vital functions are disrupted, symptoms of the disease appear, and the antibody titer increases in the blood. There are also other forms of infectious processes: healthy carriage of the virus in the presence of immunity or natural immunity to this disease, chronic infections, slow infections.

In addition to the fact that all infectious diseases begin with pathogenic microorganisms, there are other characteristics common to them. Such diseases are contagious, that is, they can be transmitted from a sick person or animal to a healthy one. Under certain conditions, epidemics and pandemics may occur, that is, the massive spread of a disease, and this is already a very serious threat to society.

In addition, infectious diseases, a list of which can be found in any medical reference book, always occur cyclically. This means that during the course of the disease, certain time periods alternate with each other: the incubation period, the stage of precursors of the disease, the period of the height of the disease, the period of decline and, finally, the period of recovery.

The incubation period does not yet have any clinical manifestations. It is shorter, the higher the pathogenicity of the pathogen and the greater its dose, and can range from several hours to several months and even years. Precursors of the disease are the most common and fairly vague symptoms, on the basis of which it is difficult to suspect a specific infectious disease. Typical for her clinical manifestations are maximum at the height of the disease. Then the disease begins to fade, but for some infectious diseases relapses are typical.

Another specific characteristic of infectious diseases is the formation of immunity during the disease process.

Causative agents of infectious diseases

The causative agents of infectious diseases are fungi. For the introduction to be successful for a pathogenic microorganism, one meeting of the macro- and microorganism is not enough. Certain conditions must be met. Great importance has the actual state of the macroorganism and its protective systems.

Much depends on the pathogenicity of the pathogen itself. It is determined by the degree of virulence (toxicity) of the microorganism, its toxigenicity (in other words, the ability to produce toxins) and aggressiveness. Environmental conditions also play a big role.

Classification of infectious diseases

First of all, infectious diseases can be systematized depending on the pathogen. In general, viral, bacterial and fungal infections are isolated. Separately, chlamydia, mycoplasma, rickettsial, and spirochete infections are distinguished, although chlamydia, mycoplasma, rickettsia, and spirochetes belong to the kingdom of bacteria. Viruses are perhaps the most common pathogens. However, bacteria can also cause many ailments. Among the most famous are tonsillitis, meningitis, cholera, plague, bacterial pneumonia, tuberculosis, and tetanus. Fungal infectious diseases, or mycoses, include candidiasis, dermatophytosis, onychomycosis, and lichen.

Most often, infectious diseases are classified according to the location of the pathogens, taking into account the mechanism of their transmission, but this applies to those diseases that spread from person to person. Accordingly, intestinal infectious diseases transmitted by the fecal-oral route are distinguished (astrovirus infection, polio, cholera, typhoid fever). There are infectious diseases of the upper respiratory tract. The method of infection by them is called airborne (ARVI, diphtheria, scarlet fever, influenza). Infectious diseases They can also be localized in the blood and transmitted through insect bites and medical procedures. We are talking about injections and blood transfusions. These include hepatitis B, plague, and there are also external infections that affect skin and mucous membrane and transmitted by contact.

In the process of evolution, each type of pathogen of an infectious disease has its own entrance gates of infection. Thus, a number of microorganisms penetrate through the mucous membranes of the respiratory tract, others through digestive tract, genital tract. It happens, however, that the same pathogen can enter the human body simultaneously in different ways. For example, hepatitis B is transmitted through blood, from mother to child and by contact.

There are three main habitats for pathogens of infectious diseases. These are the human body, the animal body and the inanimate environment - soil and water bodies.

Symptoms of infectious diseases

Common symptoms of infectious diseases include malaise, headache, pallor, chills, muscle aches, fever, sometimes nausea and vomiting, diarrhea. In addition to the general ones, there are symptoms that are characteristic of only one disease. For example, the rash associated with meningococcal infection is very specific.

Diagnostics

As for diagnosis, it should be based on a comprehensive and comprehensive study of the patient. The study includes a detailed and thorough survey, examination of organs and systems, and necessarily an analysis of the results of laboratory tests. Early diagnosis infectious diseases presents certain difficulties, but is of great importance both for timely adequate treatment of the patient and for the organization of preventive measures.

Treatment

In the treatment of such ailments as infectious diseases, the list of which is so frighteningly extensive, there are several areas. First of all, these are measures aimed at reducing the activity of the pathogenic microorganism and neutralizing its toxins. For this purpose, antibacterial drugs, bacteriophages, interferons and other agents are used.

Secondly, it is necessary to activate the body’s defenses by using immunomodulatory drugs and vitamins. Treatment must be comprehensive. It is important to normalize the functions of organs and systems impaired by the disease. In any case, the treatment approach must take into account all the individual characteristics of the patient and the course of his disease.

Prevention

In order to protect yourself and your loved ones as much as possible from such a threat as infectious diseases, the list of which includes diseases of a viral, bacterial and fungal nature, you need to remember about quarantine measures, vaccination, and strengthening the immune system. And sometimes, to save yourself from infection, following basic rules of personal hygiene is enough.

MAKE AN APPOINTMENT WITH A UROLOGIST IN VOLGOGRAD

What are “hidden” infections, sexually transmitted infections (STIs)?

gonorrhea;
syphilis;
chancre;
venereal lymphogranulomatosis;
donovanosis;
HIV – infections;
viral hepatitis B, C, D;
chlamydia;
mycoplasmosis;
ureaplasmosis;
trichomoniasis;
Garnerellosis;
genital herpes;
genital warts;
cytomegalovirus infection;
sexually transmitted skin diseases (scabies, pubic lice, molluscum contaginosa).

The following reproductively significant genitourinary infections are distinguished:

Absolutely pathogenic.

Opportunistic.

Bacterii (enterobacteriaceae, enterocci, anaerobes, staphylococci, streptococci)
Mycoplasma hominis
Ureaplasma urealyticum T 960
Ureaplasma parvum
Candida albicans
Herpes simplex virus I-II
Cytomegalovirus

How does the process of contracting sexually transmitted infections occur?

For different infections The incubation period ranges from 2-3 days to several weeks and even months. Quite often, after contracting an STI, there are no symptoms at all, or they are mild, so it is very important after each casual relationship to be tested for the presence of sexually transmitted infections. Infection occurs through sexual contact, and not only through genital contact, but with the same probability through oral or anal contact. Several months may pass from the moment of infection to the development of the disease; this period is called the incubation period. As a rule, in the first three days after infection, chlamydia and other “hidden” STIs can be detected even by the most sensitive diagnostic methods impossible.

What to do if you suspect you have a sexually transmitted infection?

If you have had a new sexual relationship and find out that your sexual partner has an STI, feel characteristic symptoms, or simply doubt that you do not have an STI, you must undergo a special medical examination. Never attempt to self-medicate or take advice from a non-specialist. This can lead to chronicity inflammatory process and the development of complications. The saddest thing is that many infections can occur hidden. The person does not know and does not realize that he is sick. He remains unaware and can infect his partners. The following symptoms may indicate that you or your partner are sick:

inflammation in the genital area;
sores;
bubbles;
warts;
rash and plaque on the genitals;
discharge from the genitals; urethra;
rash on the surface of the body;
unreasonable temperature rises;
yellowness of the skin and whites of the eyes.

How reliable are the methods for diagnosing sexually transmitted infections?

Laboratory diagnosis is the main thing for prescribing adequate treatment. Modern methods for diagnosing STIs: polymerase chain reaction (PCR), immunofluorescence method (IFU), linked immunosorbent assay(ELISA), isolation of pathogens in cell cultures, etc. are extremely reliable (up to 90%). However, given the shortage of funds, not all laboratories in our country have sufficiently high-quality reagents and equipment. Another problem is that it is not always possible to accurately identify the infectious pathogen.

Who has the right to treat sexually transmitted infections?

According to the International Agreement adopted in Riga in 1990, the following doctors can treat sexually transmitted infections: dermatovenerologist, urologist, gynecologist. Only a qualified specialist can competently conduct an examination, make a diagnosis and prescribe systemic, targeted treatment.

What complications cause sexually transmitted infections?

The main danger lies in the consequences of STIs - their complications, which are dangerous both for women's health, and for men: prostatitis, inflammatory diseases of the uterus and appendages, often requiring surgical intervention, neoplasms of the genital organs, adhesions, cervical cancer (human papillomavirus) and liver cancer (hepatitis C), various pathologies fetus, birth of a non-viable or sick child. Chronic forms venereal diseases lead to defeat nervous system, bones, brain, intestines, of cardio-vascular system, are developing oncological diseases. STIs have a particularly significant impact on the reproductive function of men and women. According to some reports, up to 80% of the causes are male and female infertility caused by STIs. Possible acute conditions, requiring surgical intervention, intrauterine infection of the fetus, disruption of pregnancy and childbirth, the birth of a non-viable or sick child, or even the death of the infected person. Possible complications of STIs in men can be: infertility, epididymitis, narrowing (stricture) of the urethra, prostatitis, urethritis and others. Urogenital chlamydia accounts for up to 60% of all nongonorrheal urethritis in men. The most common complication of chlamydia in men is epididymitis (inflammation of the epididymis). In women, these are some diseases of the cervix, salpingitis (inflammation of the appendages) and tubal infertility. Chlamydia can cause serious pathology in the fetus and newborn, and can cause pelvioperitonitis and perihepatitis in women. Chlamydia also leads to Reiter's disease - severe damage to the joints and eyes. To detect the presence of an infection, you must undergo a thorough medical examination using modern methods laboratory research which will help identify the presence of infection at different stages of the disease. An important factor to prevent re-infection and effective treatment STIs are tested together with your sexual partner. Under no circumstances should you self-medicate or take “ magic pills“, this can lead to irreversible consequences and transfer the disease to a chronic stage, the treatment of which is extremely difficult.

How difficult is it to treat sexually transmitted infections?

If the doctor is well qualified, correct selection antibacterial drug, its dosage and duration of treatment, as well as the patient’s compliance with all doctor’s recommendations, success is guaranteed with a probability of 85-90%. In addition to antibiotic treatment, other drugs are prescribed: immunostimulants, enzymes, vitamins, and physical therapy. The duration of treatment for acute and subacute infections ranges from 1 to 7 days, for chronic infections it can last up to 14 days, and for complicated ones up to 1 month or more. We must remember that some infections are lifelong and cannot be completely cured. IN complex therapy infections require step-by-step treatment: “anti-film drugs”, anti-infective herbal and pharmacological preparations, immunomodulators, probiotics and prebiotics. Due to the increase in the number and prevalence of infections of the genitourinary system, the number of men with inflammatory diseases of the prostate gland (prostatitis), seminal vesicles (vesiculitis), and seminal tubercle (calliculitis) has also increased. Currently, 98% are hidden chronic forms of these diseases. Prostatitis, vesiculitis, calliculitis contribute to the development of congestion in the pelvic organs, form potential foci of infection, weaken testosterone metabolism (leading to androgen deficiency), contribute to vegetative-neurotic disorders in the pelvic organs, and weaken general and local immunological reactions. And the anatomical proximity of the prostate gland, seminal vesicles and seminal tubercle often leads to mutual infection of these glands, the emergence of premature ejaculation and decreased reproductive function. Quite often, treatment inflammatory diseases in men is based only on anti-infective therapy, which in turn can lead to relapse of the disease and chronicity of the process. The use of prostate massage in some situations is effective method, but this only produces a mechanical effect on the prostate, which is often painful for the patient.

Correctly selected pathogenetic treatment should be based on five basic rules:

Antibacterial/antiviral therapy (depending on the causative agent of the disease);
Improving arterial inflow and venous outflow of blood (this ensures complete delivery of antibacterial/antiviral agents to the site of inflammation, restoration of previous functions). Lack of arterial blood supply and venous stasis in the area of the prostate gland, negatively affect the course of the inflammatory process, reproductive and erectile functions in men;
Improving the outflow of secretions from the prostate gland and seminal vesicles (can be achieved by contracting the muscles of the pelvis, perineum and muscle fibers of the prostate gland);
General and local immunocorrection;
Comfort and minimal time costs, multiplied by high efficiency ongoing therapy.

The use of electromagnetic laser therapy devices makes it possible to achieve everything in a complex necessary effects impact on the diseased organ: restore physiological processes altered by the disease and activate natural protective functions body against pathology. Since the combination of laser, magnetic and electrotherapy simultaneously provides an anti-inflammatory effect, stimulation of various muscles, elimination of congestion, improvement of lymph and blood flow. The therapeutic effect is based on biostimulation and mobilization of the body's existing energy potential.

What physiotherapeutic techniques are used to treat sexually transmitted infections and complications?

Successfully used magnetic infrared laser therapy. The most commonly used method is urethral irradiation. Possible effects on the perineal area and the area above the pubis. Low-intensity laser radiation has a pronounced anti-inflammatory effect, stimulates local immunity, improves microcirculation in the area of inflammation, and affects permeability vascular wall, exhibits an analgesic effect. Intravenous laser blood irradiation (ILBI) is the most effective and universal laser therapy technique. Unlike local procedures laser therapy, the therapeutic effect is due to the activation of systemic therapeutic mechanisms the whole body, increasing the efficiency of the functioning of the blood supply, immune, other organs and systems, as well as the whole organism as a whole.

At chronic inflammation, apply electrophoresis of antibiotics, uroseptics. The current strength is adjusted to the appearance of a lung tingling. Intraorgan (urethral, rectal and urethrectal) electrophoresis is used with medicinal substances. In case of prolonged inflammation and increasing signs of sclerosis in the prostate, endourethral electrophores with collalizine may be performed.

Widely used transurethral or transrectal thermotherapy or hyperthermia. When treating sexually transmitted infections, superficial heating of the mucous membrane of the urethra and prostate gland to a depth of no more than 5 mm is required in order to sanitize the urogenital tract or provide better conditions for subsequent local drug therapy. The urethra and gland are heated using the transurethral or transrectal method evenly along the length of the urethra with a gradual rise in temperature from 39 to 45°C and automatic control directly in the urethra or rectum. Indications for the use of hyperthermia are: chronic urethritis, prostatitis, colpitis, cervicitis, ganglioneuritis.

Using Magnetherapy it becomes possible to simultaneously use urethral and rectal heating against the background of running magnetic field. This opportunity allows you to optimize the impact and reduce treatment time with a maximum percentage of favorable outcomes even in advanced cases. Magnetotherapy has an anti-inflammatory and analgesic effect, normalizes blood circulation, changes the course of redox and tissue enzymatic processes, creates conditions for more effective action antibiotics for the inflammatory process.

What are the most common reasons for treatment failure for sexually transmitted infections?

Most common cause is reinfection which occurs as a result of new sexual intercourse during treatment, lack of treatment of the sexual partner, or sexual intercourse without the use of a condom by a married couple undergoing treatment. Other reasons for unsuccessful treatment of STIs are incorrect diagnosis, incorrectly selected antibacterial drug, violation of treatment by the patient and resistance of the infection to the antibiotic.

What should you do after completing treatment for a sexually transmitted infection?

Monitoring the cure of infections is carried out no earlier than 2 weeks after finishing taking the antibiotic. The patient should be aware that some symptoms of the disease may remain for several weeks and even months after successful treatment. You can resume sexual activity without a condom with a regular sexual partner (partner) only after a follow-up examination that shows the absence of infections and inflammation.

What is the prevention of sexually transmitted infections?

A routine inspection must be carried out at least once every six months. Cannot be taken on your own medications. Uncontrolled use of antibiotics and anti-inflammatory drugs distorts the clinical picture, transforms the disease into an asymptomatic form, and leads to chronicity of the process and severe complications. Sexually transmitted infection is a problem that affects everyone. The optimal tactic is not to get sick at all. The best preventive measure for preventing STIs is a condom. It should be put on and taken off correctly and used for all types of sex, including oral. If unprotected contact does occur, there are methods of personal prevention, when the genital tract is washed with an antiseptic solution. This must be done in the first 2-4 hours after contact, not later. For some infections, special medications can be used for prevention. Their choice should be discussed with your doctor.

How do genitourinary infections affect a man’s body?

The infectious process and its complications can affect isolated or sequentially various organs genitourinary tract: prostate gland, seminal vesicles, vas deferens, testicles and their appendages. With inflammation in the organs of the reproductive system, regardless of the infectious factor, damage may occur as a result of the action of reactive oxygen radicals and other inflammatory products. Subsequently, tissue sclerosis and the development of subtotal or total obstruction of the vas deferens may occur. Leukocytes during inflammatory processes lead to sperm agglutination. The emerging chronic inflammatory process in the gonads causes a toxic effect on the spermatogenic epithelium, disruption of the testicular barrier, rheological properties And chemical components seminal fluid, the appearance of ASAT. Violations of the physicochemical properties of seminal plasma, the habitat of sperm, naturally leads to pathozoospermia, most often in the form of asthenozoospermia or the induction of “false” antisperm antibodies associated with infections. Infectious disease agents can enter the genitals through the blood (for example, a virus mumps, Mycobacterium tuberculosis or Mycobacterium leprae) or ascending from the urethra.

Among the possible consequences infectious lesion genital tract in men:

Spread of a disease that leads to the development of disease or infertility in a woman, infection of eggs and embryo, miscarriage, abnormalities of the embryo and fetus;
Changes in germ cells, Sertoli cells, Leydig cells, which leads to male infertility (sterility);
Leukocyte infiltration of the genital tract is a T cell-mediated response to sperm and autoimmune infertility;
Decreased testosterone formation and, as a result, cachexia, male infertility;
Incorporation of the viral genome into the genome of the germ cell with a possible risk of transmission to subsequent generations.

The role of infections in disrupting the fertilizing ability of sperm is controversial. Despite many studies on the presence of pathogens in the genital tract, there are conflicting conclusions regarding the role they play in the occurrence of infertility. First of all, this is explained by the fact that these infections are often detected in both fertile and infertile couples.

The material was prepared by urologist-andrologist, physiotherapist, dermatovenerologist Oleg Viktorovich Akimov.

Video: Normal vaginal discharge. Inflammation of the vagina.

Treatment various infections in gynecology – this is the “bread” of modern commercial gynecology. In my practice, I simply use American and European standards treatment and diagnosis - and, oddly enough, there is an effect. In this publication I would like to simply and briefly talk about what is diagnosed and how it is treated in most cases.

Before clarifying this issue, I would like to dispel a few myths:

There is no diagnosis of “gardnerellosis” - now this condition is called “bacterial vaginosis”
there are no “treatment programs for chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis, gardnerellosis, etc.” 17-30 thousand per disease
human papillomavirus type 16.18 does not mean that you will definitely have cervical cancer
the treatment regimen for infections cannot include 5-7-10 drugs

Let's find out!

So, according to WHO (World Health Organization), there are only 5 sexually transmitted infections:

Syphilis
Gonorrhea
Chlamydia
Trichomoniasis

Other pathogens, such as herpes and human papillomavirus, are classified as diseases that are predominantly sexually transmitted.

For pathogens such as ureaplasma and mycoplasma, a place has not yet been found; we will talk about them below.

Infectious agents can be specific (all listed above) and nonspecific (intestinal flora, skin)

Vulvovaginitis (inflammation of the vagina and external genitalia)
Cervicitis (inflammation of the cervix)
Pelvic inflammatory diseases (PID) include: endometritis (inflammation of the uterine mucosa), salpingitis (inflammation of the tubes), salpingo-oophoritis (inflammation of the tubes and ovaries), endomyometritis (inflammation of the mucous and muscular lining of the uterus), panmetritis (inflammation of the entire uterus) and as a complication of pelvic peritonitis (inflammation of the pelvic peritoneum)

Now let's figure out what vaginitis is - that is, if you have bad vaginal discharge, then this (with the exception of rare cases) May be:

Trichomoniasis
Bacterial vaginosis (in other words, a violation of the flora)
Candidal vulvovaginitis (thrush)

Atrophic vaginitis (in older women due to hormone deficiency)
Chemical or allergic (irritation)

And that's it!!! World medicine does not classify anything else. Only these reasons (I repeat, except in rare cases) can lead to inflammation of the vagina.

However, discharge from the genital tract can be caused by inflammation of the cervix and pelvic organs.

Inflammation of the cervix is most often caused by:

Gonococci (causative agents of gonorrhea)
Chlamydia (the causative agent of chlamydia)

Human papillomaviruses and others can cause inflammation of the cervix, but with slightly different manifestations.

With pelvic inflammation, there may also be discharge from the genital tract, but there will also be other symptoms.

To summarize:
If you have unusual discharge from the genital tract, it could only be: bacterial vaginosis, trichomoniasis, vulvovaginal candidiasis (thrush), gonorrhea, chlamydia, or manifestations of pelvic inflammatory disease. We do not consider rare conditions.

Now about diagnostic methods... (most of the deceptions are here)

In normal gynecological practice Only 4 methods for diagnosing infections are needed.

Smear bacterioscopy (this is a regular smear for flora)
Bacteriological seeding (in this case, the resulting material is sown on special media and sensitivity to antibiotics is determined)
PCR - (polymerase chain reaction method) - allows you to determine the DNA of the pathogen
Serological methods allow specific reaction body for infection, confirm its presence, determine the stage (acute, chronic)

That's it, this arsenal is quite enough to diagnose all the necessary infections.

Now in more detail about each method.

Smear bacterioscopy

This method only shows:

Presence or absence of inflammation (based on the number of leukocytes) - ATTENTION! a lot of leukocytes in the absence of inflammation may be a consequence of getting into the blood smear.
Diagnose the following diseases (gonorrhea, trichomoniasis, thrush, bacterial vaginosis)
Detect nonspecific flora (in case of inflammation caused by nonspecific microorganisms)
Describe the state of normal vaginal flora

Thus, with the help of a regular smear, you should be diagnosed or excluded the following diagnoses:

Gonorrhea
Bacterial vaginosis (although there are 4 criteria for making this diagnosis in clinical practice sufficiently characteristic color of discharge, fishy smell and the presence of key cells in the smear)
Vulvovaginal candidiasis (thrush)
Suspect the presence of an inflammatory process in the pelvic organs (leukocytosis, nonspecific flora)
Trichomoniasis (a difficult diagnosis: in a dried smear, the flagella of trichomonas disappear and they become indistinguishable from macrophages (ordinary blood cells), so the diagnosis can not be made, about trichomoniasis, see below)

Bacteriological culture

This method allows you to determine the composition of the flora and the amount of the pathogen (that is, there is a lot of it or a little), and in addition, determine which antibiotics it is most sensitive to.

Cultures are most often taken from the vagina, cervical canal and uterine cavity.

When is it advisable to take tank sowing:

If a smear contains many leukocytes and nonspecific flora
In a fertility treatment program or before planned pregnancy(cultures are taken from the cervical canal and uterine cavity)
If ureaplasma is detected by PCR (seeding is carried out on a special medium)
In the treatment of all types of PID

In general, this is all, there are no more common indications. It is not advisable to prescribe tank sowing in other cases, or just like that.

PCR

This is the most common diagnostic method at the moment and it is with it that most confusion is associated.

This diagnostic method allows you to determine the DNA of the pathogen, that is, when using this method, we answer only one question - if the material contains at least several specific fragments of the microorganism.

What this means is that a positive result can occur even if there are very few microorganisms and if the microorganism has already died (but the DNA remains).

When this matters - if control after treatment is carried out too early (dead microorganisms remain) - it can be decided that the treatment was not effective. In another case, make a diagnosis, despite the fact that the causative agent of the disease is extremely small (this is important when questioning the need for treatment of ureaplasmosis).

What infections can be diagnosed using PCR:

Chlamydia (they are not detected in a smear)
Human papillomavirus
Herpes simplex virus
Cytomegalovirus (of importance mainly before or during planned pregnancy)
Ureaplasma (Parva only, T960 - no)
Mycoplasma?

All other pathogens are diagnosed in a regular smear or are of no importance at all. And there is no point in determining by PCR method (gonorrhea, bacterial vaginosis or thrush). It is extremely rare, in controversial cases it is possible, but for everyone it is extremely inappropriate. Therefore, when you are offered to take a PCR test for 10-15, then 20 pathogens - remember - this is not advisable!!!

Serological methods

When using this method, it is determined whether the body has ever had or is currently in contact with a specific pathogen. In this case, the amount of special blood proteins (immunoglobulins), which come in several classes, is assessed. Typically there are three class M,G and A. What does the presence of each of these classes of immunoglobulins indicate?

Immunoglobulins class M (IgM) are the first to appear in the blood, immediately after contact of the body with the causative agent of the disease, they gradually increase and then disappear. That is, the presence of IgM indicates that the disease is in acute stage and is happening in your body at the moment.
Class G immunoglobulins (IgG) - essentially reflect the immune system's memory of contact with a pathogen - this means that their presence indicates that you once had this disease, the disease has passed acute phase(IgM has already disappeared) that you have been vaccinated or are immune to this pathogen. The concentration (titer) of this immunoglobulin upon contact with the pathogen increases together with IgM, then IgM disappears, and IgG titer saved on high level and gradually decreases.
Immunoglobulin class A (IgA) – this immunoglobulin is primarily responsible for providing local immunity mucous membranes, but its soluble form is important when its titer in the blood increases when diagnosing chlamydia.

The titers (concentrations) of the immunoglobulins described above are different and these indicators can be interpreted in different ways. It happens that the immunoglobulin titer is doubtful and it is difficult to draw a conclusion from such an analysis.

So, using the serological method you can determine:

presence of an acute stage of the disease (presence of IgM)
presence of immunity to a specific pathogen (presence of Ig G; for example, rubella, hepatitis, etc.)
establish a fact recently past illness(high IgG levels)
fact of carriage (for example, for herpes - the presence of IgG)

Now let's figure out how this works in practice - the most common cases.

Vulvovaginal candidiasis (thrush)

Simitoma: itching, white curdled discharge
Analyzes: an examination and a general smear are enough
Treatment: Usually 1-2 doses of fluconazole (150 mg each - Diflucan, Diflanzon, etc.) or suppositories are enough - the range is wide. Nothing additional is required.

Bacterial vaginosis
Symptoms: white creamy discharge, fishy smell
Analyzes: An examination and a general smear are sufficient (in smears there are gardnerella and key cells), PCR and other studies are redundant.
Treatment: 2 options: trichopolum (metronidazole) or ornidazole (ornidazole) 500 mg 2 times a day after meals or dalacin (clindamycin) suppositories - 3-5 days. All.

Trichomoniasis

Symptoms: watery, foamy discharge from the genital tract
Analyzes: examination, smear (often not detected in a smear), PCR (may not show it), there is a reliable method - to look at the smear immediately after taking a drop, but almost no one does it.
Treatment: only two drugs: metronidazole (Trichopol) and ornidazole (Tiberal) - taken equally at 500 mg twice a day after meals - 5 days. In 90% of cases this is enough.

Trichomoniasis – video version:

Gonorrhea

Symptoms: greenish-yellowish discharge, maybe just cloudy
Analyzes: examination, smear, can be supplemented with PCR
Treatment: usually 1-2 injections are enough (for example, Rocephin 1 g intramuscularly 1 time per day for 2 days)
Usually, gonorrhea is combined with chlamydia and/or trichomoniasis, so Trichopolum or Tiberal is added to the treatment for 5 days and a PCR test for chlamydia is taken - if chlamydia is detected, the treatment is supplemented.

Chlamydia

Symptoms: as a rule, there are no symptoms, or there is simply more abundant discharge of a changed color
Analyzes: PCR can be supplemented with a blood test for IgG and Ig A for chlamydia
Treatment: several options: azithromycin (Sumamed) 1 g. on the 1st-3rd-7th and 14th day of treatment once; vilprofen (jozomycin) 1 t 2 times a day for 10-14 days (or 1 tablet 3 times a day for 10 days) - many different regimens. There are other regimens with other antibiotics, but they are used less frequently. Important - no immunomodulators, enzymes, etc.

Herpes

Symptoms: painful blisters that burst and erosions form in their place.
Analyzes: examination, PCR, blood for IgG and Ig M for herpes.
Treatment: acyclovir, valtrex - different regimens and doses
Important: a few days before the blisters appear and after complete healing, you can infect your partner with herpes.

A few words about ureaplasma and mycoplasma. First a short review.

Ureaplasma and mycoplasma

Video: Ureaplasma

The role of these pathogens in gynecological and urological practice is quite ambiguous. It so happened that in our country, with the advent of PCR diagnostics, these pathogens became on a par with sexually transmitted infections, and a wide variety of treatment regimens for them began to be developed.

At the same time, the West’s attitude towards these pathogens remained calm.

Until now, in America and European countries, routine screening of patients for the analysis of these pathogens is not carried out. Detection of ureaplasmas and mycoplasmas is recognized as labor-intensive, and is mainly carried out in scientifically oriented laboratories. Still, there is attention to these pathogens in the West.

Ureplasma and mycoplasma are considered commensals (live normally) in the genital tract of both men and women. According to various sources, more than 60% have sexual active women ureaplasma is detected.

Much attention is paid to ureaplasma infection regarding its role in obstetric pathology. Some studies show the importance of this pathogen in the formation of such conditions as: chorioamnionitis, premature rupture of membranes, premature birth, fetal malnutrition. It is important to note that ureplama in all these cases was detected in the amniotic fluid, and not in the cervical canal.

The role of ureplasma infection has been identified in the formation of pneumonia in newborns and chronic diseases lungs, regardless of the type of delivery. This pathogen is detected in the trachea of newborns, mostly in those born before 34 weeks. So in newborns weighing less than 2500 grams. ureplasma is released in 34% of cases.

At the same time, ureaplasma lung infection is rare in full-term children. In particular, this is explained by the fact that the frequency of ureplasmic chorioamnianitis (inflammation of the amniotic membranes) is higher up to 32 weeks. The presence of chorioamnionitis affects the transplacental passage of immunoglobulins, which leads to higher infection of newborns born prematurely.

You have noticed that I do not use immunomodulators or other drugs in any treatment regimen.

It is no secret that Western medicine does not use immunomodulators in treatment regimens for inflammatory diseases. All immunomodulating and immunostimulating drugs presented on our market are exclusively domestically produced. None of these drugs have undergone clinical trials according to the GCP format, and it is this research format, accepted throughout the world, that involves proof of the effectiveness of drugs and determines the full range of possible side effects. The design of such studies is very complex and the requirements for drugs are increased. Such studies are typically international, multicenter, and placebo-controlled.

The idea of an immunomodulator itself is not bad, however, it is implemented too primitively. “Stimulating” the immune system in order to activate natural mechanisms to fight infection - this is how the main task of these drugs is regulated. However, the immune system is much more complex than it appears at first glance.

When an irritant is introduced into the body, no one knows what state the immune system is in. Activation of a nonspecific response to an irritant should theoretically help improve the therapeutic effect of antibacterial drugs, by transferring the entire immune system to an activated state.

But the problem is that it is not possible to study to what extent the immune system is activated in each individual patient, how long this response lasts, what mechanisms are activated in parallel, how quickly this system is depleted and what kind of reverse effect this “emergency boost” will have.

It can easily be assumed that the rapid clinical effect of such doping can be reversed by a higher frequency of relapses of the disease due to depletion of the immune system. In addition, activation of autoimmune processes is possible, and the most unpleasant thing is delayed effects - the risk of developing malignant diseases immune system.

Let all of the above possible consequences treatment will never happen, but the peculiarity of introducing a drug to the market requires its long-term study and proof of its safety. This has not been done for immunomodulators. Drugs rushed to the market too quickly, and our system for recording side effects of drugs practically does not work. That is why we still do not know what percentage of complications that have already occurred.

Thus, I would like to once again turn to common sense and ordinary logic. In our country we have all the drugs that the Western public uses to treat their patients, without the use of immunomodulators and others aids, and their patients are cured. So why take the risk and test drugs that do not have reliable safety certificates recognized throughout the world.

Necessary and not necessary tests (video)

Sexually transmitted diseases (STDs) and sexually transmitted infections (STIs) refer to conditions associated with infectious agents that are transmitted primarily through sexual contact (including those that can be contracted through oral sex). These terms are used more often than the term “sexually transmitted diseases.” A more correct name is “sexually transmitted infections,” since the presence of an infection does not always lead to illness, but a person can spread the pathogen.

Get tested in the CIR laboratories!

Sexual infections using PCR method (smear of discharge, smear from the urethra):

Look

According to the international classification of diseases, 10th revision (ICD-10), the group of infections transmitted mainly sexually, enter various shapes the following diseases:

In other groups of ICD-10, other infections are identified, including sexually transmitted ones:

Conditions caused by HIV (human immunodeficiency virus)
Viral hepatitis B and C
Candidiasis ( fungal infection)
Molluscum contagiosum
Phthiriasis (pediculosis pubis, pubic lice)
Scabies

There are also infectious agents - causative agents of urogenital infections, which under certain conditions can cause inflammatory diseases of the genitourinary system in men and women or be dangerous during pregnancy and childbirth:

Preferred routes of transmission of STDs. Unprotected sex. What can you get infected from oral sex?

With unprotected sexual intercourse, there is a high risk of infection with trichomoniasis, hepatitis B and C, HIV, herpes, human papillomavirus, and scabies. Infections can be transmitted through any type of sexual contact, not just vaginal sex. Yes, when oral sex there is a possibility of infection with gonococci, which can cause specific pharyngitis (inflammation of the larynx) or stomatitis (inflammation of the oral mucosa), herpes virus, papillomavirus infection, syphilis, hepatitis B and C, HIV infection.

Preventing contracting STDs

Prevention of contracting STIs is extremely important, especially in the case of incurable diseases(HIV infection). It is possible to significantly prevent infection with sexually transmitted infections by using barrier contraceptives (condoms, both male and female).
It is important to avoid contact with the biological fluids of a partner (sperm, vaginal discharge, saliva), which may be a carrier of infectious agents.
Ideally both partners before starting sexual relations must undergo an infection carrier examination, which includes blood tests and smears of genital discharge. It is important to know that many infections cannot be detected immediately after infection.
Vaccination is used to prevent certain diseases (eg, hepatitis B, some types of human papillomavirus).

Emergency prevention after unprotected sex

You should immediately toilet the external genitalia using antiseptics. As prescribed by a doctor, it is necessary to take medications (antibiotics) to prevent the development of certain diseases (it should be borne in mind that such tactics do not help in the case of hepatitis, HIV infection, papillomavirus infection).
After 14 days, you should take smears to detect infections (), after 1.5-2 months - tests to diagnose hepatitis B and C, syphilis, and HIV infection. If you are at high risk of contracting HIV and receive a first negative test, you should repeat the HIV blood test at a later date, as early testing may not detect infection.

Diagnosis of STDs. What tests for STIs should be taken and in what cases. Tests after unprotected sex.

Testing for STDs is carried out in the following cases:

Presence of symptoms of sexually transmitted diseases
Screening tests to detect hidden infections (blood tests and smears of genital discharge)
Examination during pregnancy (blood tests and smears of genital discharge)
Screening of blood donors (tests for HIV, hepatitis B and C, syphilis)
Tests after unprotected sex(blood tests and smears of genital discharge)

To diagnose STDs and inflammatory diseases of the genital organs, the following tests and procedures are performed:

Examination by a specialist (gynecologist or urologist-andrologist)
Tests to detect infections:

Blood tests for the diagnosis of hepatitis B, hepatitis C, syphilis, HIV infection.
Analysis of genital discharge by bacteriological method (culture), as well as microscopic examination material of the vagina, cervical canal, urethra.
Tests to determine antibodies to urogenital infections (for example, antibodies to chlamydia, gardnerella, mycoplasma).

Tests to detect inflammatory changes in genitourinary organs:

Spermogram
Microscopic examination of a smear from the urethra/vagina
General analysis urine
Urinalysis according to Nechiporenko

Colposcopy (examination of the cervix using special device- colposcope)
Ultrasound examination of the genitourinary system

Briefly about some infections (including sexually transmitted diseases):

I would like to know what tests need to be taken to be sure that all STIs are absent? Is there one test that can check for all of these diseases? What is the most reliable material for research?

In order to exclude the presence of sexually transmitted infections, it is advisable to donate blood from a vein for syphilis (antibodies to Treponema pallidum), antibodies to HIV, hepatitis B (HBsAg) and C (antibodies to HCV) and a smear of genital discharge to identify pathogens urogenital infections (such a smear can show from one to an unlimited number of infections). Our laboratory offers a study of a block of urogenital infections using the PCR method, which can be taken in one go, simultaneously with a blood test from a vein.

Please tell me, do the ideal results of a gynecological smear (according to the doctor) exclude the presence of any infections or is it still necessary to be tested for STIs?

The fact is that, according to the results of a microscopic examination of a gynecological smear, if it is found in it increased number leukocytes, a more in-depth examination is indicated, and therefore it is recommended to be tested for. However, if the number of leukocytes in the smear is not increased, this can not serve as a criterion for the absence of sexually transmitted infections, since many of them can occur hidden, including human papillomavirus infection, dangerous by development cervical cancer. To be excluded or confirmed, you must take the .

Please tell me how long after casual sex you need to take tests, and what kind.

To obtain reliable results, a test for STIs of the cervical canal and vaginal discharge (smear for STIs and gynecological smear) is recommended to be performed 10-14 days after unprotected sexual intercourse. Blood test for syphilis, HIV, hepatitis B and C - after 1.5-2 months.

Please tell me, is it possible that my husband was found to have a Gardnerella vaginalis infection (PCR), it was not found in me, and the number of leukocytes in all my husband’s tests was 1 (sperm, smears, prostate juice). When treating this infection, do both partners need to be treated?

There is no single point of view when detecting only Gardnerella, since their detection is one of the indicators of such a clinical symptom complex as dysbiosis of the genital tract.
The question of the advisability of treating one or both spouses is decided by the doctor, taking into account all clinical data. If an andrologist insists on treating her husband, the wife is advised to contact a gynecologist and decide at the appointment whether it is worth treating both of them.

So where should we get tests for these infections? Where do they get it from in your laboratory? And if they took it, for example, from the vagina, but didn’t find it there, is it possible that the infection could be somewhere else?

As a rule, a smear for STIs is taken simultaneously from two or three points: the vagina, the cervical canal of the cervix and sometimes from the urethra. In men, the test is not taken from the urethra. To exclude damage to the internal genital organs, a spermogram is analyzed, as well as a study of prostate juice (microscopic examination, PCR, bacteriological examination).

I had unprotected sexual intercourse.... tell me what infections should be tested for and what else (hepatitis, AIDS)?