Sexually transmitted diseases

Diagnosis of sexually transmitted diseases

Diagnosis of sexually transmitted diseases includes both rapid methods acquired during screening and classical methods (cultural and virological) used for the final diagnosis.

Express methods include:

• Microscopy of vaginal smears (vaginal washes) allows diagnosing diseases such as trichomoniasis, candidiasis, identifying leukocyte reaction, microscopic signs of bacterial vaginosis "key cells".
• Dark field microscopy allows one to see pale treponemas from the primary lesion (scraping of ulcerated papules), as well as from sites of exanthematous rash.
• Microscopy of stained smears allows to assess the state of vaginal biocenosis, diagnose gonorrhea, trichomoniasis, fungal infections. Two staining methods are used for the study: methylene blue and Gram's method in the Kopeloft modification. Methylene blue staining allows to determine the morphology of microorganisms, their quantity, the presence of mucus, leukocyte reaction, the presence of "key cells". When staining according to Gram, differential diagnostics is carried out between gram-negative and gram-positive flora, according to the characteristic morphology, it is possible to indicate microorganisms to their generic affiliation (streptococci, staphylococci, Mobiluncus sp., Leptotrix, etc.).
• Immunoluminescent microscopy allows detection of difficult to diagnose infectious agents such as: chlamydia, mycoplasma, ureaplasma, herpes virus types I and II, cytomegalovirus.
• Polymerase chain reaction (PCR) on genome fragments captures a minimal amount of microorganisms and viruses present in the material being studied. Currently, the spectrum of agents identified by this method is quite wide.
• The enzyme immunoassay method makes it possible to evaluate the titer of immunoglobulins of class G and M and the change in their quantity over time.

In recent years, microscopic examination of material directly during a doctor's appointment has been increasingly introduced into gynecological practice.

Classical cultural methods of research can be used in diagnostics of gonorrheal infection, especially in women. Bacteriological diagnostics of non-specific vaginitis is uninformative, and more significant results can be obtained using quantitative methods of studying the vaginal microflora with determination of antibiotic sensitivity. In case of protracted chronic trichomoniasis, the cultural method may be the only one that allows identifying the pathogen and determining methods of its treatment.

The "gold standard" of microorganism diagnostics worldwide is considered to be the method of their isolation in cell culture. However, these studies require specially equipped laboratories, trained specialists and are quite expensive, which limits their use.

Treatment of sexually transmitted diseases

The main requirement for the treatment of sexually transmitted diseases is mandatory simultaneous treatment of sexual partners. Sexual contacts should be completely excluded during the period of therapeutic measures.

Treatment of infectious diseases of the vulva, vagina and cervix at the present stage presents certain difficulties, caused, on the one hand, by a large number of microorganisms and their associations, having a different spectrum of sensitivity to antibacterial agents. On the other hand, numerous antibiotics of different pharmacological groups, currently presented on the domestic market, make it difficult to choose them in each specific case.

'Depending on the clinical manifestations, duration of the disease and its connection with sexual life, suspected or detected types of pathogens, treatment should be etiotropic, pathogenetic and maximally individualized. A comprehensive approach to treatment involves an adequate combination of antibiotics, antiseptics, immunocorrectors, hormones, eubiotics, anti-inflammatory, desensitizing (antihistamine), antidepressant, restorative, vitamin complexes and drugs that affect tissue metabolism, as well as the use of physiotherapeutic methods and herbal medicine. At the same time, there should be a reasonable combination of systemic and local methods of therapy.

The main point of therapy of infectious processes of the genital organs is the correct choice of antibacterial drugs or their combinations, dosages, methods of administration, duration of the course. The choice of antibiotics is based on the spectrum of their antimicrobial action. Rational antibiotic therapy involves the impact on all potential pathogens.

Treatment of infectious diseases of the lower female genital organs consists of two consecutive stages, which include:

1. creation of optimal physiological conditions of the vaginal environment, correction of local and general immunity, endocrine status;
2. restoration of normal or as close to normal vaginal microbiocenosis as possible.

The first stage of treatment should begin with vaginal instillation of 2-3% lactic or boric acid solution daily, 100 ml with a 10-minute exposure once a day. Then it is advisable to prescribe vaginal suppositories or ointment tampons with metronidazole, ornidazole or tinidazole; sinestrol, folliculin or ovestin. According to indications (itching, burning, pain), menthol, anesthesin, novocaine, dicaine are included in the prescription. Suppositories or tampons should be used 2 times a day: in the morning and in the evening for 2-3 hours. The duration of the first course of treatment is 7-10 days.

The second stage of treatment involves the restoration of the vaginal biocenosis. Eubiotics are used for this purpose: lactobacterin, acylact, bifidumbacterin, bifidin. All of the above drugs are used intravaginally, 1-2.5 doses 2 times a day for 7-10 days.

Before use, the dry porous mass of the preparation is diluted with boiled water (5 ml) with the addition of a 5% lactose solution. The resulting solution is used to moisten a cotton-gauze tampon, which is inserted into the vagina for 2-3 hours; the interval between inserting tampons is 10-12 hours.

In addition to the above, local therapeutic measures include the use of antiseptics, antibiotic powders, vaginal tablets, suppositories, ointments, emulsions and creams containing antibacterial drugs. Instillations of antiseptic solutions (3% hydrogen peroxide, 5% dioxidine, 1:5000 furacilin, 1% potassium permanganate, etc.), vaginal baths with the same solutions are used; powders of the vaginal part of the cervix with tetracycline, erythromycin, chloramphenicol, etc.; vaginal tablets and suppositories: "Klion D", metronidazole, etc.; syntomycin emulsion, water-soluble ointments "Levamikol", "Levasin", "Fibrolan-Salbe" on tampons, vaginal cream "Dalacin C". Local treatment includes physiotherapy procedures (irradiation with a helium-neon laser, UV irradiation of the vagina, ultrasound with antiseptic solutions).

An important place is given to anti-inflammatory therapy. For this purpose, non-steroidal anti-inflammatory drugs are used - indomethacin, brufen, flugalin, piroxicam and antihistamines - suprastin, tavegil, pipolfen, etc. It is advisable to conduct psychotherapy with the prescription of antidepressants and tranquilizers in patients with sexually transmitted diseases.

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