Sexually transmitted diseases

Diagnosis of sexually transmitted diseases

Diagnosis of sexually transmitted diseases includes both express methods acquired in screening and classical (culture and virological) used for the final diagnosis.

Express methods include:

• Microscopy of smears (vaginal swabs) allows diagnosing diseases such as trichomoniasis, candidiasis, revealing leukocyte reaction, microscopic signs of bacterial vaginosis "key cells".
• Microscopy in the "dark field" allows you to see pale treponema from the primary focus (scraping of ulcerated papules), as well as from places of exanthemic rash.
• Microscopy of stained smears barks the ability to assess the condition of the vaginal biocenosis, diagnose gonorrhea, trichomoniasis, fungal lesions. Two coloring methods are used for the study: methylene blue and Gram in the Kopeloft modification. Coloring with methylene blue allows to determine morphology of microorganisms, their quantity, presence of mucus, leukocyte reaction, presence of "key cells". In Gram stain, differential diagnosis is carried out between gram-negative and gram-positive flora; according to the characteristic morphology, microorganisms can be indicated to the generic family (Streptococcus, Staphylococcus, Mobiluncus sp., Leptotrix, etc.).
• Immunoluminescent microscopy makes it possible to detect such difficult-to-diagnose infectious agents as chlamydia, mycoplasma, ureaplasma, herpesvirus type I and II, cytomegalovirus.
• Polymerase chain reaction (PCR) on the fragments of the genome catches the minimum number of microorganisms and viruses present in the material under study. At present, the spectrum of agents identified by this method is quite wide.
• The method of enzyme immunoassay makes it possible to assess the titre of immunoglobulins of class G and M and the change in their number in dynamics.

In recent years, gynecological practice is increasingly introducing microscopic studies of the material directly at a doctor's appointment.

Classical culture methods of research can take place in the diagnosis of gonorrhea infection, especially in women. Bacteriological diagnosis of nonspecific vaginitis is poorly informative, and more significant results can be obtained by using quantitative methods of studying the microflora of the vagina with the definition of antibiotic sensitivity. In the case of prolonged chronic course of trichomoniasis, the culture method may be the only one that allows one to identify the pathogen and determine the methods of its treatment.

The "gold standard" for the diagnosis of microorganisms throughout the world is the method of their isolation in the culture of cells. However, these studies require specially equipped laboratories, trained specialists and are quite expensive, which limits their application.

Treatment of sexually transmitted diseases

The main requirement for the treatment of sexually transmitted diseases is the compulsory simultaneous treatment of sexual partners. For the period of performing therapeutic measures, sexual intercourse should be completely ruled out.

Treatment of infectious diseases of the vulva, vagina and cervix presently presents known difficulties due, on the one hand, to a large number of microorganisms and their associations with a different spectrum of sensitivity to antibacterial agents. On the other hand, the numerous antibiotics of different pharmacological groups presently on the domestic market make it difficult to choose them in each specific case.

"Depending on the clinical manifestations, the duration of the disease and its connection with the sexual life, the suspected or detected types of pathogens, treatment should be etiotropic, pathogenetic and maximally individualized. An integrated approach to treatment presupposes an adequate combination of antibiotics, antiseptics, immunocorrectors, hormones, eubiotics, anti-inflammatory, desensitizing (antihistamines), antidepressant, restorative, vitamin complexes and drugs that affect tissue metabolism, as well as the use of physiotherapy and phytotherapy. 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 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 provides an impact on all potential pathogens.

Treatment of infectious diseases of the lower female genital area 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 maximally close to the normal microbiocenosis of the vagina.

The first stage of treatment should begin with instillation of the vagina 2-3% solution of lactic or boric acid daily for 100 ml with a 10-minute exposure once a day. Further it is expedient to appoint vaginal suppositories or ointment swabs with metronidazole, ornidazole or tinidazole; synestrol, follicle or ovestin. According to the indications (the presence of itching, burning, pain), menthol, anestezine, novocaine, and dicaine are included in the prescription. Suppositories or tampons should be applied 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. For this purpose, eubiotics are used: lactobacterin, acylact, bifidumbacterin, bifidin. All these drugs are administered intravaginally at 1-2.5 doses 2 times a day for 7-10 days.

Before use, dry porous mass of the preparation is diluted with boiled water (5 ml) with the addition of 5% lactose solution. The obtained solution is moistened with a cotton-gauze swab, which is introduced into the vagina for 2-3 hours; the interval between insertion of tampons is 10-12 hours.

In addition, local therapeutic measures include the use of antiseptics, powder antibiotics in the form of powder, vaginal tablets, suppositories, ointments, emulsions and creams containing antibacterial drugs. Used instillations antiseptic solutions (3% hydrogen peroxide, 5% dioxin, 1: 5000 furatsilina, 1% potassium permanganate, etc.), vaginal baths with the same solutions; powdering of the vaginal part of the cervix with tetracycline, erythromycin, levomycetin, etc .; vaginal pills and suppositories: "Clion D", metronidazole, etc .; synthomycin emulsion, water-soluble ointments "Levamikol", "Levasin", "Fibrolan-Salbe" on tampons, vaginal cream "Dalatsin C". Local treatment includes physical therapy procedures (helium-neon laser irradiation, vaginal ultrasound, ultrasound with antiseptic solutions).

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

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