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Sexually transmitted diseases and their prevention

Happiness is like health:

when you do not notice it, then it is.

Ivan Turgenev

Sexually transmitted diseases. Urogenital infections. Venereology. Syphilis. Gonorrhea. Chlamydia Trichomoniasis

Sexually transmitted infections have long been referred to as sexually transmitted diseases or, as they are now called, sexually transmitted diseases (STDs). Since the perestroika and the beginning of the sexual revolution, the incidence of syphilis has increased tenfold in our country. In 1998, the incidence of syphilis for the first time more than 2 times higher than the incidence of gonorrhea (119.9 cases in 1998), although earlier gonorrhea significantly prevailed over syphilis.

The incidence of other forms of STDs has increased several times. From 1985 to 1999 - trichomoniasis 2.5 times, chlamydia 2 times, ureplasmosis 3 times, urogenital candidiasis 10 times. Such a high prevalence of these diseases indicates sharp negative changes in the way and conditions of life, especially of the younger generation. Irregular sexual relations, violations of the hygienic regimen, non-observance of healthy lifestyle, drug addiction, alcoholism are favorable soil for their spread.

Sexually transmitted diseases (from Lat. Veneris - Venus, among the ancient Romans the goddess of love) - diseases, united by the principle of transmission through sexual contact. A more correct term is: sexually transmitted diseases (or infections, diseases) (STDs, STIs, STDs). Some experts classify STDs as “old” and “new.”

Venereal diseases, known since ancient times, are referred to the old, and urogenital infections detected using modern methods of examination are referred to new ones. The “old” STIs include gonorrhea, syphilis, soft chancre, venereal lymphogranulomatosis, donovanosis. The last three are practically not found in Russia, therefore only gonorrhea and syphilis are considered to be “classical” sexually transmitted diseases.

“New” STIs include HIV infection, viral hepatitis B, C and D, chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis, gardnerellosis, genital herpes, genital warts, cytomegalovirus and vaginal dysbiosis, as well as sexually transmitted diseases of the skin (scabies) pubic lice, molluscum contagiosum).

Venereology is a branch of clinical medicine that studies the causes (including social), developmental mechanisms, manifestations, methods of diagnosis, treatment and prevention of sexually transmitted diseases. Despite the significant achievements of venereology and the fight against sexually transmitted diseases carried out in all countries, they are still widespread and continue to be a serious social and moral problem. The social significance of sexually transmitted diseases is determined by their prevalence, danger and severity of consequences for the sick person's health, as well as the impact on the reproduction of healthy offspring.

Many gynecological diseases, infertility of men and women are often the result of sexually transmitted diseases, their complications.

STIs are transmitted through homosexual and heterosexual intercourse: vaginal, anal and oral. The more sexual partners a person has, the higher the risk of infection.

A serious rise in sexually transmitted diseases was observed in Belarus at the turn of the century. For example, during 2000, 2660 patients with syphilis and 1922 gonorrhea were registered in Buryatia.

Syphilis is an infectious disease caused by a spirochete, a bacterium in the form of a curl, called pale treponema (Treponema pallidum), transmitted mainly through sexual contact and characterized by the periodicity of the course. In 1905, F. Shaudin and E. Hoffmann discovered pale treponema.

Opinions about the origin of syphilis are controversial. The syphilis epidemic devastated Europe in the last decade of the 15th century, when it was nicknamed "bigpox," as opposed to "smallpox." Since the epidemic coincided with the return of Columbus from America (1493), many reputable scientists believe that syphilis was imported from the West Indies. It is noteworthy that, apparently, Columbus himself died of syphilitic aortitis.

According to another theory, syphilis already existed in the Old World, however, it spread more widely during the wars that began shortly after Columbus returned to Europe. When in 1495, soldiers of the French army hibernated in Naples, syphilitic ulcers appeared in their genital area, and then their bodies began to become covered with a rash. The Italians found this a “French disease,” and the French blamed Italians for everything.

The incidence of syphilis in Buryatia is almost two times higher than in the whole of the Russian Federation, and is 121.7 per 100,000 population.

Syphilis infection occurs from a sick person through sexual contact. It can also be transmitted in utero from a mother with a syphilis patient to a child.

After infection, an incubation period lasting an average of 3-4 weeks follows. In the "classical" course of syphilitic infection, 3 clinical periods are distinguished: primary, secondary and tertiary, which successively replace each other after the incubation period.

The primary period of syphilis is characterized by the appearance of erosive and ulcerative lesions in the genital area and an increase in inguinal lymph nodes. Its duration is 6-7 weeks.

Further, 2-3 months after infection or 6-7 weeks after the onset of primary affect (ulcers), a secondary period of syphilis occurs, in which there are a variety of rashes on the skin and mucous membranes, hair loss, sometimes hoarse voice; the duration of this period without treatment (or if it is not enough) on average is 3-5 years.

Further, the tertiary period of syphilis develops, in which a few nodes and ulcers appear on the body, healing with the formation of scars. With a long duration of the disease and the lack of proper treatment, lesions of the internal organs and central nervous system can be observed, which can lead to death.

Syphilis is an acutely infectious disease that poses a danger to others and is harmful to health, and therefore requires immediate examination and treatment in a specialized institution.

Gonorrhea (from the Greek. Gonos + rhoia - seed + expiration) or gonorrhea (from the German tripper - drip) is a common infectious disease with pronounced manifestations in the genitourinary tract caused by gonococcus. This is a sexually transmitted disease of a person, the causative agent of which is gonococcus (from the Greek gonos + kokkos - seed + grain), resembling a coffee bean under a microscope. It was discovered in 1879 by the German scientist Albert Nayser.

Gonorrhea is one of the most common sexually transmitted infections. It accounts for a quarter of all STIs.

Manifestations of gonococcal infection can be very different - from an asymptomatic course to inflammation of the pelvic organs, general infection of the blood and even meningitis - inflammation of the membranes of the brain caused by this microbe.

However, most often gonorrhea occurs in the form of inflammation of the mucous membranes of the genitourinary organs and is accompanied by purulent discharge from the urethra in men and the cervix in women.

Diseases with a similar clinical picture have been known since ancient times. The modern name of the disease "gonorrhea" was first used by Galen, who in the 2nd century AD mistakenly interpreted male discharge from the urethra as ovulation.

In men, the detectability of gonorrhea is 2 times higher than in women. This is because gonorrhea urethritis causes severe burning sensation and pain during urination, and men are forced to consult a doctor. Women usually do not experience unpleasant sensations, and only those who are attentive to themselves show an increase and purulent nature of the discharge from the vagina.

Gonorrhea can be infected with any type of sexual contact (vaginal, oral, anal sex).

Young children can become infected when they pass through the birth canal of a mother with a patient with gonorrhea. To prevent this, in the first minutes after birth, all babies are buried in the eyes, and for girls also in the sexual gap 1% silver nitrate solution or 30% albucide solution.

Chlamydial infection has always existed, however, they learned to detect it only two decades ago. In 1990, data were published that 2/3 of couples undergoing treatment for infertility, found chlamydia.

Chlamydia are bacteria that live (parasitize) inside cells. They are recognized as the causative agent of numerous obstetric and gynecological inflammatory diseases. In this case, the course of the chlamydial process is often asymptomatic or low-symptom.

Chlamydia can cause:

• eye damage (conjunctivitis);

• joint diseases (Reiter's disease);

• pathology of the nervous system (encephalitis);

• lesions of the inner ear (vestibular apparatus, etc.);

• problems with the rectum in the form of proctitis;

• diseases of the genitourinary organs (urethritis, prostatitis, cystitis, cervicitis, adnexitis, epididymitis, etc.).

Trichomoniasis (trichomoniasis) takes 3rd place among the most common sexually transmitted diseases (after gonorrhea and chlamydia). Its causative agent is no longer a bacterium, but the simplest one is vaginal trichomonas, which is a highly mobile, flagellar unicellular microorganism that parasitizes the human urogenital tract.

It can live in the urethra, as well as in women in the vagina, and in men - in the prostate gland and seminal vesicles.

It has been established that trichomonads are able to absorb other pathogenic microorganisms that retain their vital functions within their body. Therefore, with superinfection - simultaneous infection with gonorrhea and trichomoniasis, it is impossible to cure the first without getting rid of the second.

Men who become infected usually do not feel any changes and do not go to the doctor. But in women, trichomoniasis is usually manifested by abundant grayish-yellow foamy discharge from the vagina, severe itching and burning sensation in the external genital area, which forces them to consult a gynecologist.

Trichomonas infection can cause infertility. Bank (1966) suggested that infertility due to Trichomonas infection is caused by infection of a man (sexual partner) and is not associated with the presence of Trichomonas in women. He drew attention to the fact that successful treatment of a woman does not lead to the onset of pregnancy, whereas after treatment of a man, pregnancy occurs in his partner.
It is believed that these protozoa simply eat sperm.

Recently, some viral diseases of the whole organism, one of the transmission routes of which is the sexual route, have been classified as STDs. This is a herpes infection, papillomatosis, viral hepatitis B, C and D, as well as AIDS

Herpetic genital tract infection is a viral disease that tends to be widespread. For example, in the United States, this disease has the character of an epidemic (there are up to half a million primary cases per year).

The causative agent of herpes genital tract infection is the herpes simplex virus (Herpes simplex virus HSV). Herpetic lesions were identified already in the 1st century AD by Roman doctors who observed herpetic eruptions on the lips. The first case of herpetic genital tract damage was registered in 1700. The herpes simplex virus was first described in 1912, and was first isolated from the female genital tract in 1946. The herpes simplex virus develops intracellularly. According to various studies, herpes virus infected 65-90% of the world's population.

Anogenital herpes infection (genital herpes) is a chronic recurrent viral disease transmitted primarily through sexual contact, characterized by exacerbation of lesions of the skin and mucous membranes of the genitals and urogenital tract.

Factors contributing to the exacerbation or manifestation of genital herpes include:

• decrease in immunological reactivity;

• hypothermia or overheating of the body;

• accompanying illnesses;

• some mental and physiological conditions (sex, menstruation);

• medical manipulations (abortion, insertion of an intrauterine device).

Condylomas - anogenital warts are benign warts with localization on the genitals and in the perianal (from Greek peri + anus - located around + anus) region - the region of the anus. The disease is characterized by a long latent course and the possibility of the appearance of clinically pronounced lesions after a long period of time after infection. The causative agent of the disease in more than 90% of cases is the human papillomavirus.

Anogenital warts occur in places exposed to trauma during sexual intercourse, and can be either single or multiple.

Some types of papilloma viruses have a very pronounced oncogenic effect. They cause cervical cancer in women and penile cancer in men.

Viral hepatitis B is also called serum hepatitis. This name is due to the fact that infection with hepatitis B virus can occur through the blood, and through an extremely small dose. Hepatitis B virus can be transmitted sexually, by injection with non-sterile syringes from drug addicts, from mother to fetus. This disease, by all indications of infection and the course of the infectious process in the body, is very similar to AIDS, only liver cells, hepatocytes, are affected with it.

Viral hepatitis C has a more malignant course and can also be transmitted sexually from a carrier of infection to a healthy person. A complete cure for hepatitis B and C does not always occur, and if the virus remains in the body, then there is a very high probability of developing cirrhosis and liver cancer.

The European Association for the Study of the Liver, which includes Russia, has developed the basic principles for the treatment and monitoring of hepatitis C patients. The basis of all treatment regimens is interferon alfa. The mechanism of action of this drug is to prevent infection of new liver cells. The use of interferon cannot guarantee complete recovery, however, treatment with it prevents the development of cirrhosis or liver cancer. The effectiveness of treatment is significantly increased if interferon is used in combination with ribavirin. A positive effect is achieved in 40-60% of cases.

Another group of conditions - vaginal dysbiosis is also identified with STIs, although their development occurs when local immunity is weakened.

Bacterial vaginosis develops due to the replacement of normal vaginal microflora, in particular H20 - producing lactobacilli, with a large number of obligate and facultative anaerobic conditionally pathogenic microorganisms (Bacteroides, Prevotella, Peptococcus, Mobiluncus, Gardnerella vaginalis, Mycoplasma homoma). . those microbes that are normally present in small quantities normally.

Bacterial vaginosis is a common clinical syndrome of women of reproductive age, the detection rate of which in the group of sexually active women reaches 60%. The reasons for the development of the disease remain unclear, however, there are a number of factors affecting the composition of the vaginal microflora, these are:

• antibiotic therapy, cytostatics,

• radiation therapy;

• frequent washing of the vagina;

• malformations or anatomical defects after ruptures in childbirth, surgical interventions;

• foreign bodies in the vagina, uterus (the presence for a long time of vaginal tampons or diaphragms, intrauterine devices, etc.);

• use of spermicides;

• hormonal changes during puberty, pregnancy, after childbirth and abortion;

• ingress of pathogenic microorganisms from the digestive tract.

Under the influence of adverse factors, there is a violation of the composition of the vaginal microflora. A decrease in the number of lactobacilli leads to a decrease in the concentration of lactic acid and an increase in pH. Anaerobic microorganisms produce amino acids that break down to volatile amines. Their formation causes the appearance of an unpleasant odor of secretions.

The main symptoms of vaginosis are homogeneous discharge from the genital tract, often with an unpleasant odor, especially after intercourse or during and after menstruation. With a progressive course of the disease, the discharge can acquire a yellowish-greenish color, becomes more dense and evenly distributed along the walls of the vagina. In 20-30% of cases, itching and burning in the external genitalia, dysuria are noted. According to studies, 24-32% of women have an asymptomatic course of bacterial vaginosis.

Bacterial vaginosis can cause adverse pregnancy outcomes.

Gardnerellosis is one of the varieties of bacterial vaginosis, in which microbes, gardnerella, receive the greatest reproduction. Currently, such a diagnosis does not exist, but it is still found in almost all STI leaflets.

Gardnerellosis is by definition a vaginal dysbiosis. Therefore, men are wrong to make such a diagnosis. Иногда возбудители гарднереллеза вызывают уретрит у мужчин, который проявляется жжением и болью при мочеиспускании. В этом случае необходимо лечение. В остальных случаях (при выявлении Gardnerella vaginalis точными методами или гарднереллезе у половой партнерши) в лечении мужчин необходимости нет.

Кандидоз гениталий представляет собой инфекционное заболевание мочеполовой системы, обусловленное дрожжеподобными грибами рода Candida. Особенностью данного заболевания является длительное течение и склонность к рецидивированию - повторению обострений. К наиболее частым формам кандидоза гениталий у женщин относится вульвовагинит (от лат. vulvovaginitis - наружных половых органов и влагалища воспаление), у мужчин - баланопостит (от греч. balanoposthitis — головки полового члена и крайней плоти воспаление). Возбудителем его служат дрожжеподобные грибы рода Candida.

Этот гриб выявляется у здоровых женщин, однако при изменении микробиоценоза влагалища и нарушении барьерных механизмов местного иммунитета может приобретать патогенные свойства.

К факторам риска развития кандидоза гениталий относятся длительная терапия антибиотиками, гормонами, использование иммунодепрессантов, лучевая терапия, тяжелые инфекционные заболевания, беременность, заболевания ЖКТ и эндокринной системы, в частности сахарный диабет.

Симптомы генитального кандидоза у женщин: густые, белые, творожистые, иногда жидкие, сливкообразные выделения из влагалища; зуд в области вульвы и влагалища; гиперемия, отечность и сухость слизистой оболочки вульвы и влагалища, иногда мелкие пузырьки, эрозии и трещины; у части больных наблюдается дизурия.

Симптомы кандидоза гениталий у мужчин: умеренный зуд и жжение в области наружных половых органов; отечность, гиперемия, поверхностное шелушение, белесоватый налет на головке полового члена и на внутреннем листке крайней плоти.

При половом контакте можно заразиться болезнями, вызываемыми паразитами (от греч. parasites - нахлебник, около еды) - организмами, использующими в качестве источника питания и (или) часто среды обитания другие организмы, нанося им в большинстве случаев вред. К ним относят педикулез, или заражение лобковыми вшами, и чесотку, которая развивается из-за попадания на тело клещей — чесоточных зудней.

При любых подозрительных симптомах необходимо всегда обращаться к врачу, потому что только он может выставить правильный диагноз и назначить лечение под контролем анализов среди большого разнообразия ИППП.

Основными принципами лечения ИППП являются:

• одновременное лечение сексуальных партнеров,

• исключение незащищенных сексуальных контактов во время лечения,

• строгое соблюдение всех врачебных рекомендаций.

Чтобы избежать заражения ИППП, а также связанных с ними физических страданий и психических стрессов, необходимо вести ЗОЖ. Необходимо помнить, что:

• лучший половой партнер - любимый, постоянный и единственный;

• при случайных половых связях всегда используется презерватив;

• занятия сексом под воздействием алкоголя или наркотиков снижают самоконтроль.

Test questions and tasks

1. Что такое венерические болезни и чем они отличаются от урогени-тальной инфекции?

2. Что вам известно о сифилисе?

3. Расскажите о гонорее, как одном из самых распространенных ЗППП.

4. Что такое трихомониаз и как он протекает?

5. Что такое вагиноз и почему он возникает?

6. Какие вирусные инфекции передаются половым путем?

7. Назовите методы профилактики венерических заболеваний.

8. Запомните новые термины и определения, встретившиеся Вам при изучении данной темы.
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Венерические болезни и их профилактика

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