Infectious diseases of the genital organs treatment

Infection of the genital organs is the main feature

The number of patients with manifestations on the skin and mucous membranes of the genitals in the offices of dermatologists is growing, both in terms of older age and puberty (about 16 years). This happens because of fear of HIV infection and premalignant or malignant lesions, which are associated with genital infections in men and women. Any type of sexually transmitted infection refers to a broad range of diseases caused by bacteria, viruses, fungi and parasites. The differential diagnosis is extensive, due to the fact that many skin diseases appear only on the genitals (or in connection with the type of illness, or due to progression and the spread of the disease, or random). Problem identification is carried out based on the results that show clinical data and laboratory examination. Always necessary to exclude the infection with classical sexually transmitted diseases (syphilis, gonorrhea, venereal limfogranulema), treatment and monitoring of which is subject to legislative norms.

In this paper, we consider:

• the most common diseases,
• treatment of latent infections in women – drugs that it is advisable to take,
• what are the common medication involves the treatment of genital infections and urinary tract infections,
• is there a disease that are resistant to certain types of drugs, and how it can be cured,
• the most effective treatment – genital infections most effective drug.

Bacterial infectious diseases

Bacterial vaginosis

Bacterial vaginosis (BV) is a common vaginal infection that increases the risk of Contracting other sexually transmitted infections may occur along with them. First mentioned in 1955 as "nonspecific vaginitis" (Gardner and Dukes). The term "bacterial vaginosis" was introduced in 1984.

Etiology

Gardnerella vaginalis is reproduced, a facultative anaerobic bacterium with high concentrations of Mobiluncus SPP, Prevotella SPP, Peptostreptococci, Fusobacterium SPP, Bacteroides SPP, aerobic bacteria, alpha-hemolytic streptococci, etc. the Most common is the "combination" with Trichomonas.

Clinical picture

• The infection is asymptomatic in 50%.
• The disease is usually characterized by an abundant sticky discharge with fish odor.
• Involvement of the cervix leads to acute purulent cervicitis, which manifests as a discharge of grayish-white color, more dense consistency.
• Irritation of skin and mucous membranes of the genital organs, swelling, erosions, ulcers
• Non-specific urethritis.
• Possible complications: inflammation of the pelvis, complications after abortion or hysterectomy, and premature birth.

Diagnostics

• White-gray, homogeneous, sticky discharge.
• Microscopic examination of native preparation and the method of Gram (clue cells –epithelial cells with granular cytoplasm – the presence of bacteria).
• of the vaginal pH more than 4.5.
• positive amine test characteristic fishy smellupon alkalization of the fluorine of 10% KOH.

How to treat?

Metronidazole (nitroimidazole chemotherapeutic drugs – antibacterial effect on anaerobic bacteria and protozoa, e.g., Trichomonas):

• oral: 500 mg 2 times a day for 5-7 days, maybe 2 g disposable,
• vaginally: Klion D vaginal tablets 1-2/day for 10 days (combined product with fungistatic and fungicidal imidazole antifungal miconazole 150 mg + Metronidazole 100 mg),
• Clindamycin (lincosamides bacteriostatic antibiotic with an antibacterial spectrum),
• oral: 300 mg 2 times a day for 7 days,
• vaginally: 2% cream 5 g/day for 7 days.

Chlamydial infection of the reproductive system

Genital chlamydia is the most common sexually transmitted infection. It is, in total, 50-60% of all cases of nonspecific urethritis. The highest incidence is in women aged 16-19 years and men aged 20 to 24 years. Factors associated with a higher prevalence of chlamydial infection are rising at a time of heightened sexual activity and with the alternation of sexual partners, especially in the case of unprotected sex.

Etiology

Chlamydia have affinity with cylindrical epithelium (serotype D-K cause urogenital infections). The incubation period is 7-21 days.

Chlamydia is an obligate intracellular pathogen of the genus Chlamydia. Unlike bacteria, there are no mechanisms that provide energy for chemical processes, which affects their obligatory intracellular parasitism. The morphology depends on the stage of development of chlamydia. Form able to infect cells-the carriers – the elementary body (0.3 m) in cell medium gradually changed in the reticular body (0,6-01,0 m). Reticular body is taking energy from cell media, and microcolony chlamydia in microscopic studies appear in the form of inclusions. Differentiation of reticular bodies into infectious elementary body takes from 72 to 96 hours.

Clinical picture

• In men: urethritis (35-50% of cases of nonspecific urethritis), the spread of the infection leads to prostatitis, epididymitis and prolonged infection or in the absence of treatment can lead to infertility. The symptoms occur, approximately 60% of the people, manifested by burning and stinging in the urethra, may be present swelling, erythema.
• In women: cervicitis (75-85%), urethritis (50-60% together with the defeat of the cervix, independently 15-20%). In 70-80% of cases the infection is asymptomatic. Clinically manifests as Muco cervitech, increased sensitivity of the cervix with a tendency to bleeding. May be present swelling and redness. Observed discharge, tauricheskiy problems and pollakiuria. May be bleeding, discharge and bleeding after sexual intercourse, possible pain in the lower abdomen. Infection can progress to the mucous membrane of the uterus, fallopian tubes, and can lead to ectopic pregnancy or even infertility.
• Transfer to the child at birth, causing conjunctivitis (30-50%) and respiratory infections (60-70%), pneumonia (30%), otitis media as a complication may arise nasopharyngeal infection.
• Chlamydia is associated with inflammatory diseases of the pelvic region, perihepatitis syndrome (Fitz-Hugh-Curtis) and Reiter's syndrome.
• Extragenital may cause conjunctivitis, proctitis (8-10% are male homosexuals), arthritis (reactive arthritis of the large joints).

Diagnostics

Diagnosis of chlamydial infection is based on direct detection of anti-chlamydial genes, isolation of chlamydia in cell cultures, the presence of chlamydial DNA (methods of hybridization or legasova chain reaction, which are some of the most sensitive research methods. Is a swab from the affected mucous membrane, the urine sample (the first portion) of the ejaculate.

Treatment

• Antibiotics that inhibit protein synthesis of bacterial cells (tetracyclines, macrolides), act on the majority of clinical forms of the disease, and are among the drugs of first choice for treatment of chlamydial infection.
• Tetracycline antibiotics (have bacteriostatic activity and a broad antibacterial spectrum: aerobic and anaerobic bacteria, chlamydia, Mycoplasma, Rickettsia, spirochaetes and protozoa. The disadvantage is the development of resistance in some species of microorganisms). They penetrate well into tissues and secretion of the Central nervous system. Excreted in the bile and urine. To obtain the most effective pharmacokinetic properties, most commonly used Doxycycline.
• Macrolides (bacteriostatic against gram-positive bacteria, chlamydia, mycoplasmas, spirochaetes and other). Have a good penetration into tissues and secretions, do not penetrate into the CNS. Excreted in the urine and bile. Used mainly macrolides of the second generation because of their favorable pharmacokinetic properties, Azithromycin, Clarithromycin, Roxithromycin. Macrolides of the second generation have better tolerance on the part of the gastrointestinal tract and is characterized by smaller interaction with other drugs than the first generation macrolides, which include for example,Erythromycin, Spiramycin, Josamycin.
• Quinoline antibiotics (bactericidal active chinolone III generation have a broad spectrum of activity against gram-positive bacteria, act on Mycoplasma, chlamydia and Mycobacterium tuberculosis). Well penetrate the tissues and excreted in the bile and urine. For example, Ofloxacin to be used in the alternative treatment of chlamydial infection.

Mycoplasmosis infections of the genitourinary system

Mycoplasmas are gram-negative bacteria with no outer cell walls, the size of the corresponding large viruses (100-150 nm). They are often part of the normal microflora (present, approximately 70%of sexually active individuals), in patients with urogenital infection, their concentration in 2-4 times above, and may be a primary pathogen, especially in the case of immunodeficiency of the organism.

Etiology

Mycoplasma urogenital system include: Mycoplasma hominis, Mycoplasma genitalium, Mycoplasma fermentas, Mycoplasma incognitum, Ureaplasma urea lyticum.

Clinical picture

Mycoplasma are part of a mixed flora nonspecific urethritis, where Mycolasma Hominis is more than 20%, and Ureaplasma urealyticum – more than 52%.

• Bacteria are directly involved in the development of non-specific urethritis (18-45%). Clinically manifested as pollakiuria. Typical are creamy discharge, erythema and swelling of the orifice of the urethra. In the case of the development of the disease the bacteria can cause prostatitis and epididymitis.
• In women can occur Muco-purulent cervicitis or pyelonephritis.
• Bacteria can promote the formation of Reiter's syndrome.
• The disease may be asymptomatic.

Diagnostics

Diagnosis is quite complicated, being used liquid and solid media (soil PPLO), enzyme-linked immunosorbent assay ELISA, identifies the nucleic acid by PCR (polymerase chain reaction). We investigate the discharge from the affected mucous membranes, semen, urine.

Treatment

Mycoplasma has no cell wall, its surface formed a three-layered membrane rich in lipids (bacteria resistant to penicillin and other antibacterial substances which destroy peptidoglycan or inhibit its synthesis as an essential component of the cell wall). The treatment of the disease is identical with the treatment of chlamydia.

Mycoplasma common resistance to Macrolides, the drug of choice is Doxycycline (100 mg 2 times/day for 7 days), another possibility is presented by the drug Clindamycin (300 mg 2 times/day for 7 days).

Viral infection

Genital warts (condyloma acuminate, venereal warts)
Genital warts occur in 10-20% of the population aged 16-49 years. The maximum prevalence was among women in the period of sexual activity at the age of 20-24 and men aged 25-34 years.

Etiology

The human papillomavirus (HPV). Approximately 25 genotypes of HPV have a "preference" in the anogenital region. Types of HPV are divided into low or high oncogenic potential. The incubation period of the disease ranges from 2 weeks to 9 months.

Clinical picture

The infection affects the skin and mucous membranes. Men, in most cases, is localized at the opening of the urethra on the glans penis and the scrotum. Women most often affects the labia.

Extragenital localization is very common, especially among homosexual couples, represented most often perianal. Not uncommon, for example, localization in the corners of the mouth, legs and other less obvious places, often associated with a variety of sexual activity.

Clinical form: small whitish or pink, very fragile portavoce papules, slightly krovotechenie trauma. Can occur either single or (in most cases) focal way.

Warts can grow and merge with each other. Pressure, friction, perspiration leads to the destruction of their surface, infiltration and secondary infection with a strong smell. In the case of neglect, perhaps with immunodeficiency (for example, in the presence of HIV and cancer), warts are becoming more common and grow to larger sizes – giant warts (associated with HPV types 16 and 18 precancerous and malignant lesions).

Subclinical form: flat damage can be visualized 3-5% acetic acid (white region).

Latent type: diagnostic cytological, hybridization. As complications may occur balanitis, balanoposthitis, phimosis and paraphimosis.

Diagnostics

Clinical examination and anamnesis. In case of doubt can be conducted histological examination or hybridization methods. The doctor always performs a full examination focusing on the exception matches with other sexually transmitted diseases, including serology.

Treatment

• Surgical: wear (more suitable for single lesions), a total excision of large deposits. The disadvantage is a possible recurrence in the scar, and further, is difficult, treatment.
• Physical: cryo-destruction with liquid nitrogen (a very effective, often long, painful, destructive method, requiring regular retreatment), electrosurgical ablation, electronictechnology.
• Chemical: 10-25% solution Podofillina, Podophyllotoxin (0.15 percent), bi - and trichloroacetic acid.
• Immunomodulatory, antiviral, cytotoxic: aldara (Imiquimod 5%), alpha-interferon, 5-fluorouracil.
• Laser.

Conclusion

Treatment of any disease transmitted sexually, belongs to the hands of a specialist! Inadequate therapy, as well as self-treatment can lead to serious complications requiring lengthy and costly treatment!

It is advisable to prevent is always to give preference to safe sex. Important proper personal hygiene.