Inflammatory diseases of female genital organs.

I. Relevance of the topic:

Inflammatory diseases of the female genital organs occupy one of the leading places in
the pathology of the genitals and are a common cause of disability, infertility and other
complications. Knowledge of etiology, methods of diagnostics and treatment of inflammatory
diseases of female genital organs is necessary for the doctor of any profile in his practical
activity.
Inflammatory diseases of female genital organs, sexually transmitted diseases, occupy
one of the leading places in gynecological morbidity. Of great importance is the wide range of
pathogens of these diseases. Sexually transmitted diseases often cause impaired reproductive
function and performance. Accordingly, future physicians should be acquainted with the features
of the etiology, pathogenesis, clinics, and treatment of sexually transmitted diseases.

II. Educational goals

In order to develop skills a student should know :
- general methods of examination of patients;
- generally clinical laboratory methods of research;
- special methods of research;
- the method of gynecological examination.

As a result of the class the student should be able to :

- to collect anamnesis (general, special, medical history);
- identify the main symptom Gynecological tech diseases;
- to carry out a gynecological examination;
- choose and carry out additional examinations of gynecological patients.

III. Basic background knowledge

- anatomical features of female genital organs.
- physiological features of female genital organs. physiological features of regulation of
the menstrual cycle.
- histological structure of external and i w nih hundred tevyh bodies.
- study of pharmacological preparations containing female and male sex
hormones. Writing recipes.

IV. Contents of educational material

Inflammatory diseases of the female genital organs remain one of the most pressing
medical problems of this century, due to the increasing number of clinical cases, reaching more
than half of all gynecological diseases; "Rejuvenation" and also affect the health of millions of
women of all ages.
The untimely or inadequate treatment of inflammatory diseases of the genital organs
leads to chronicity of the process and is the cause of infertility, ectopic pregnancies, pelvic pain ,
which cause suffering and even disability of women at the age of social activity.

Frequency
Patients with inflammatory diseases of the genital organs make up 60-65% of
gynecological patients who have gone to a women's consultation and 30% who are directed to
hospital treatment.
An important role in the occurrence of inflammatory diseases of the genitals is the so-
called normal genital microflora.
The vaginal microflora normally contains:
  rod-like flora: lactobacilli that support acidic environments; corinebacteria and
diphtheroids.
 coccal flora: anaerobic and in most aerobic cocci, hemolytic and non-hemolytic
streptococci beta- hemolytic streptococcus, enterococcus. Less common
are Klebsiella,enterobacteria and representatives of the species Rroteus , Escherichia coli, and
fungi of the genus Candida .
According to VA Shenderov, the normal activity of endogenous microflora provides:
 competition of microorganisms for nutrients.
 stimulation of mucosal epithelial motility and processes of its renewal on the
surface of the villi.
 production of short-chain fatty acids, peroxides , bacteriocins , lysozyme and
other antimicrobial substances.
 detoxification of antibiotics through their adsorption or biotransformation .
 induction of an immune response that has cross-reactions against pathogens.
 production of stimulants of immunogenesis and activators of phagocytic and
enzymatic activity.
The vaginal microflora is also affected by endogenous factors. Under the influence of
estrogens, the formation of glycogen and mucin increases, the vascularization of the vaginal
wall increases , which stimulates the virulent signs of pathogenic microbes. The number of
aerobes decreases in the pre-menstrual period, in the secretory phase of the cycle there is a
decrease in the number of conditionally pathogenic microorganisms and stimulation of the
growth of lactobacilli.
Genital microorganisms that are constantly present in the genital tract can become
virulent under favorable conditions and cause the development of inflammatory diseases of the
genitals. An obstacle to their activation and participation in inflammation are physiological
protective mechanisms :
1. Physiological desquamation and cytolysis of the surface cells of the vaginal
epithelium, which are caused by the action of ovarian hormones.
2. Non-specific antimicrobial mechanisms acting at the cellular level: phagocytosis by
macrophages and polymorphonuclear leukocytes. Non-specific humoral factors: iron-
binding plasma transferrin protein required for the growth of many bacteria; opsonins that
enhance cell phagocytic activity; lysozyme is a peptide that has antimicrobial activity; lysine,
which is secreted by platelets in the area of inflammation.
3. Immune mechanisms of protection against fungal, viral infection, intracellular bacterial
parasites. These include T-lymphocytes, immunoglobulins, the complement system.
Microcenosis of the cervical canal, especially its lower divisions, in healthy women is
virtually indistinguishable from microcenosis of the vagina, but the number of microorganisms
in the canal is less than in the vagina and aerobic-anaerobic associations prevail in it. That is,
local factors of protection in the cervical canal help to maintain sterility of the endometrium and
create optimal conditions for the development of healthy offspring.
For the upper parts of the reproductive system, the protective mechanisms at the level of
the cervical canal and endometrium are of particular importance . The mucus that accumulates in
the cervical canal is a kind of barrier that divides the lower and upper parts of the genital tract. In
the cervical mucus are antibacterial substances, antibodies to such microorganisms as
Escherichia coli, gonococci, salmonella, herpes simplex virus and Candida fungi . The uterus has
a protective function in the endometrium , which prevents the microorganisms from penetrating
the periodic abruption of its functional layer during menstruation.
Ways of spreading the infection. The penetration of infectious agents into the upper
genital tract occurs with the help of sperm, trichomonas, possible passive transport of
microorganisms, the last place is occupied by hematogenous and lymphogenous pathways.
The ability of aerobic and anaerobic bacteria, chlamydia and mycoplasma to attach to
sperm has been proven. The semen plays a particularly important role in the transmission of
gonorrhea. Chlamydia is usually attached to the sperm, whereby the more chlamydia, the more
sperm they attach. As the pH decreases , the phenomenon of adhesion of chlamydia increases.
Trichomonads also carry infections into the upper genital tract . The role
of trichomonads as vectors is indicated by the fact that it is impossible to
isolate trichomonads without communication with other microorganisms.
Factors contributing to genital infection. The penetration of infection into the upper
genital tract can be facilitated by intrauterine procedures
(probing, hysterosalpingography , hysteroscopy , pertubation , hydrotubation , genital surgery,
termination of pregnancy).
Intrauterine contraceptives are important in the spread of infection . The risk of
developing inflammatory processes of uterine appendages in women who
carry intrauterine contraceptives is increased 4-fold. Especially high risk is in women who have
not given birth. It is established that 2 days after the introduction of an intrauterine contraceptive,
the microbial contamination of the uterus increases dramatically.
The use of oral contraceptives, according to the researchers, reduces the risk of
inflammatory genital diseases.
With the onset of menstruation, the composition of genital microflora changes both
quantitatively and qualitatively, which plays a significant role in the occurrence of inflammatory
processes of the genitals. In the pre-menstrual period, the concentration of aerobic bacteria
decreases approximately 100 times, respectively, increasing the concentration of anaerobes. The
use of vaginal swabs during menstruation reduces oxygen access, which promotes the
development of pathogenic anaerobic populations and can provoke inflammation of the upper
genital tract.
The inflammatory process is the most common complication of artificial abortion. The
inflammation begins within the first 5 days after surgery, sometimes after 2-3 weeks. The risk
of post-abortion inflammatory processes is dramatically increased when pathogenic flora is
present in the cervical canal. The abortion operation itself leads to a weakening of the local
defense system: bacteria that make up the normal cervical and vaginal flora in certain conditions
can have pathological properties.
Postpartum infection is also important among the causes of inflammatory processes of the
genitals. Complicated pregnancy, childbirth, and especially caesarean section contribute to the
development of inflammation, and after planned caesarean sections 3-5 times less than after
emergency.
To risk factors include inflammatory diseases and gynecological
surgery. Vaginal hysterectomy is the highest risk since there is a direct correlation between the
development of inflammation and the contact between the vaginal environment and the
abdominal cavity.
In this regard, there are 4 degrees of purity of vaginal content:
The first degree of purity of the vagina. It is a variant of the norm for women leading a
sexual life and the only norm for girls and adolescents. The vaginal discharge is transparent,
reminiscent of well-cooked starch. The smear contains epithelial cells and a pure culture
of Dederlein's wand (a fairly thick gram-positive wand), the presence of single leukocytes and a
small amount of mucus. Acid release reaction ( pH 4.0-4.5). Such a picture of the contents of the
vagina of a healthy woman is rare.
The second degree of purity of the vagina . It is an option for women leading
a sexual life. Macroscopic selection of semi-liquid, grayish-white color. In smear
sticks Dederleyna becomes smaller, there is a different flora, mainly saprophytes ( Gram-
negative wand, Gram-positive diplococci, etc.), there are epithelial cells, leukocytes bit (10 in
view of the microscope), a large amount of mucus. The reaction of excretion remains acidic
( pH 4.5-5.0).
The third degree of purity of the vagina . Macroscopic excretion of yellowish, rare. In
the smear, a small number of Dederlein sticks , many diverse coccal flora (including streptococci
and staphylococci), many leukocytes, are epithelial cells. The reaction of excretion is weakly
acidic or slightly alkaline ( pH 5.0-7.2). This pattern of vaginal content is characteristic of the
inflammatory process in the vagina ( colpitis ).
The fourth degree of purity of the vagina . Macroscopically discharge thick, yellow,
purulent, in the case of trichomonas colpitis - foamy. In bacillus smear Dederleyna missing many
white blood cells and various pathogens and pus (staphylococcus and streptococcus, E. coli,
gonococci, Trichomonas ). Alkaline reaction ( pH > 7.5).
Classification of inflammatory diseases of the genitals:
In general, urogenital diseases are divided into: specific, non-specific and sexually
transmitted diseases.
1. By clinical course:
1) acute diseases
2) subacute diseases
3) chronic diseases
2. In severity:
1) Easy
2) average
3) heavy
3. By location:
1) inflammation of the genital organs of the lower division: vulva , bartolinin gland,
vagina, cervix, exocervicitis , endocervicitis ( vulvitis , bartolinitis, colpitis , vaginitis and
others)
2) inflammation of the upper genital organs, uterine, uterus, kltikovyny organs, the
peritoneum of the pelvis (endometritis, metroendometritis , panmetryt , perimetrity,
salpingitis, oophoritis , Gidrosalpinks , piosalpinks , piovarium , perysalpinhit ,
parametrit, pelvioperitonit )

NON-SPECIFIC INFLAMMATORY DISEASES OF FEMALE GENITAL

AUTHORITIES .
Nonspecific pelvic inflammatory diseases develop under the influence of conditionally
pathogenic microorganisms: streptococci (aerobes and anaerobes), staphylococci (aerobes and
anaerobes), Escherichia coli, enterococci, proteas, bacterroids, and more. Generally
inflammatory processes are caused by mixed flora.

VULVIT

Vulvitis is an inflammation of the external genitals of a woman. There are primary and
secondary vulvitis . The appearance of the primary form is facilitated by non-observance of
genital hygiene, chemical, thermal, mechanical irritations, rashes, diabetes, and the
like. Secondary vulvitis occurs as a result of infection of the external genital organs by
pathogenic microorganisms contained in vaginal discharge in colpitis , cervicitis, endometritis.
In women of reproductive age, vulvitis occurs against the background of ovarian
hypofunction, avitaminosis, and is more common in postmenopausal girls and women .
Clinic
In acute vulvitis there is hyperemia and swelling of the external genitals, serous-purulent
layers. Patients complain of pain, itching, heartburn, often - a general weakness. In the chronic
stage, these manifestations subside but are periodically renewed.
Diagnosis .
It is based on the clinical picture described. To establish the pathogen, it is advisable to
carry out bacteriological and bacterioscopic examination of secretions. The inflammatory
process must be primary or secondary.
Treatment .
 First of all it is aimed at eliminating the disease, which is complicated by vulvitis . In the
acute period used decoction of chamomile flowers, a weak solution of potassium permanganate,
boric acid. In bacterial, fungal, parasitic hives, the preparation for treatment is selected
depending on the pathogen.

VULVOVAGINITIS

This disease is more common in girls 3-8 years of age and older. The emergence
of vulvovaginitis in girls is facilitated by acute infectious diseases, various endocrine disorders,
eating disorders, chronic diseases of the nasopharynx.
Classification. In girls, vulvovaginitis is divided into: bacterial, mycotic , trichomonas ,
viral.
Clinic. Clinically, vulvovaginitis is characterized by mild symptoms - hyperemia and
poor discharge.
Diagnosis. The diagnosis is made on the basis of examination and study of vaginal and
vulvar discharge.
Treatment. The treatment is aimed at eliminating the causes of the disease, rehabilitation
of foci of inflammation, hardening of the body.

BARTOLINITE

Bartolini - an inflammation of one or both of the two Bartolini andis ref glands located on
either side of the entrance to the vagina, labia for. Inflammation often occurs after an
infection , which Pereda S ARE during sexual intercourse , but in many cases
the inflammation is not transmitted sexually through .
Forms of bartolinite . Because of the volume and localization of the site lesions
distinguish such forms of bartolinite, such as:
- to anal and bullets and t - the infection got into the excretory duct of the gland and caused
its inflammation, there are no pronounced symptoms.
- to the essence of bartol of a new gland - at the closed excretory channel the secret of a
gland due to absence of an outflow accumulates in the educated cavity, suppuration the
fabric of the gland itself and the surrounding fiber is thus.
- abscess Bartoli and neo her cancer - the inflammatory process involved in
tissue bartolynovoy gland and surrounding tissue.
- x Bartholinitis - a chronic form of the disease is periodically exacerbated by factors such as
hypothermia, decreased immunity, menstruation, and so on. Outside of exacerbation,
there may be slight pain from the affected gland, discomfort during intercourse. During
the period of exacerbation, symptoms similar to those of acute bartholinitis occur.
Clinic . The main symptoms of bartholinitis include pain and soreness in the labia
(internal lips) , n aberration in the same place , and small discharge in the labia.
Diagnosis. The diagnosis is based on review data. In order to choose the most effective
treatment, the doctor may prescribe such studies as general blood, urine; screening
for urogenital infections, laboratory research secret Bartolo al ovo her cancer or abnormal
discharge from her and others.
Treatment. In most cases, after determining the cause that caused the development of
bartolinite, antibacterial therapy is selected taking into account the sensitivity of microorganisms
to antibiotics, treatment of the inflamed area with antiseptic agents, a course of physiotherapy
treatment may be prescribed. Treatment abscess Bartoli and neo her cancer surgery mostly -
carried disclosure cavity drainage and treatment, if necessary appointed medical
therapy. Gynecologists of the Central Medical Center of the Russian Academy of Sciences will
select the most effective and fast treatment of bartolinite. Treatment of
cysts Bartoli and neo her cancer as well, mainly surgical, outside the period of
exacerbation. Removal of cysts Bartoli and new th gland abscess and
disclosure Bartoli and neo her cancer is possible in a day hospital (no daily admission).
Removal of a cyst of a Bartolin gland appoint at:
 chronic bartholinitis ;
 accumulation in the gland of purulent discharge ;
 degeneration of glandular tissues ;
 the risk of sepsis;
 lack of effect of drug treatment ;
 discomfort during a walking and sexual life .

Removal of the cyst Bartholin gland necessary , to eliminate

the infection entire body during prolonged existence of cell inflammation and recurrence
of pathology .

ENDOCERVICITIS

Endocervicitis - inflammation of the mucous membrane of the canal of the cervix.

Endocervicitis is often combined with other inflammatory processes of the genitals. The
penetration of microorganisms is facilitated by cervical trauma during labor, abortion,
and intrauterine interventions .
Classification. It can occur in acute and chronic forms. The inflammatory process is
accompanied by swelling of the mucous membrane, the formation of infiltrates in
the subepithelial layer and stroma.
Infiltrates consist of leukocytes, lymphocytes and plasma cells. In the chronic stage, the
inflammatory reaction is not so pronounced, in places of epithelial detachment, its regeneration
begins. During regeneration, metaplasia of the epithelium and partial replacement of the
cylindrical epithelium by flat can occur .
Clinic. The main complaint is mucous-purulent discharge, which is occasionally
accompanied by dull abdominal pain, lower back. With a prolonged course of inflammation
spreads to the underlying tissues.
Treatment. Includes antibacterial therapy depending on the detected pathogen.

ENDOMETRITES.

Acute endometritis.
The disease occurs after abortions, births and various intrauterine procedures. In etiology,
there are associations of several anaerobes with aerobes.
Clinic. Symptoms of the disease occur 3-4 days after the infection: there is a fever,
chills; leukocytosis is detected in the blood, shift of the leukocyte formula to the left,
acceleration of ESR.
In vaginal examination: serous-purulent discharge from the cervical canal, uterus
spherical, enlarged, painful on palpation, soft-elastic consistency.
The diagnosis is based on:
1. History (abortion, complicated childbirth, etc.)
2. Clinical examination data
3. Bacteriological and bacterioscopic examinations.
Chronic endometritis.
The issue of chronic endometritis is debatable. The transition of acute endometritis to
chronic is considered doubtful.
Chronic endometritis is a clinical and anatomical concept. There are its
following morphological variants:
 1. atrophic, in which there is marked atrophy of the glands, stroma fibrosis, infiltration of
its lymphoid elements;
2. cystic , when fibrous tissue compresses the ducts of glands with the formation of
cysts;
3. hypertrophic - when there is hyperplasia of the mucous membrane.
As a result of changes in the hypothalamic-pituitary system, the endocrine function of the
ovaries is reduced and the ovulation process is impaired.
Clinic. The main symptom of the disease is uterine bleeding:
1. pre- and post-menstrual bleeding associated with impaired desquamation and
regeneration of the functional layer;
2. menstrual bleeding associated with increased vascular permeability of
the endometrium during ovulation. In patients with endometritis, there is often a change in
secretory function in the form of serous or serous-purulent discharge from the genital
tract. Complaints about aching lower abdomen are constantly reported.
In vaginal examination: serous discharge from the cervical canal, moderate enlargement
of the uterus, dense consistency.
Diagnosis. The diagnosis of chronic endometritis is based on:
1. Clinical manifestations
2. Diagnostic scraping of the uterine mucosa with subsequent histological examination of
the scrapers
3. Hysteroscopy
4. Ultrasound - there is an alternation of hyperechogenicity zones (0.1 to 0.2 cm in
diameter), which are areas of fibrosis, sclerosis and calcification , and zones of
reduced echogenicity .
Treatment. In chronic endometritis use sedative, desensitizing, vitamin
preparations. Physiotherapy procedures take a significant place in treatment. In the case of
undermined ovarian function and disease up to 2 years, the use of UHF magnetic field and
centimeter waves is shown; if the process progresses for more than 2 years pulsed ultrasound or
zinc electrophoresis is recommended.
In order to stop uterine bleeding, use hormonal hemostasis and the introduction into the
uterus of a solution of aminocaproic acid 5% by 3-5 ml for 5-7 days.
The remission stage shows spa treatment ( peloid - and balneotherapy).

Complications of chronic nonspecific diseases of the pelvic organs:

 impaired sexual and menstrual function of a woman
 infertility primary or secondary
 unauthorized abortion and premature birth
 fetoplacental insufficiency
 intrauterine infection of the fetus, perinatal pathology
 disability of a woman in the presence of pain.
Prevention:
 sanitary and educational work
 rational contraception
 termination of pregnancy with the help of mini
abortions, prostaglandins , antigestagens
 rational antibiotic therapy of acute pelvic inflammatory diseases, early
rehabilitation with the help of physiotherapy
 mandatory examination and treatment of a sexual partner.
General principles of treatment:
Stages:
1. Antibacterial, infusion , anti-inflammatory therapy.
2. Immunostimulatory and Vitamin Therapy.
 3. Resorption and physiotherapy.
4. Spa treatment 6 months after exacerbation of the process
Medical tactics.
1. Hospitalization of patients with acute forms of the disease or with chronic
exacerbation.
2. For exacerbation of chronic inflammation of the uterine
appendages, pyrogenic preparations and mucopolysaccharides of microbial
origin pyrogen , prodigiosan intramuscularly starting from 25-50 MPD for treatment of 7-8
injections, are used before the start of treatment . Gonovaccine at a dose of 200 million microbial
bodies, gradually increasing the dose but not more than 2 million bodies, at intervals of 1-2 days,
for up to 5 injections. Take into account the local reaction (pain and hyperemia at the site of
administration of the vaccine) and the general (pain in the inflammation, fever, malaise). With a
significant reaction to the introduction of these drugs, the dose is not increased, but left in the last
dose. A three-point analysis, a general blood count with the formula, sowing of flora and
sensitivity to antibiotics should be taken every day.
3. Antibacterial therapy, at the next stage of treatment, is carried out taking into account
the antibiotic course 7 days. Antibiotics are prescribed in combination with 2 and even 3, the
most common combination of semi-synthetic penicillins with
cephalosporins, macrolides with fluoroquinolones , depending on the flora. The
following antibiotics are used: clindamycin - 600 mg (4 ml) intravenously 4 times a day, or 150
mg 3 times a day in capsules, fortum ( ceftazidime ) - 1 g intramuscularly every 12
hours, augmentin 375 mg tablets 3 times a day; intravenously 1.2 g every 8 hours, doxycycline
1 capsule (100mg) 2 times a day, zinacef ( cefuroxime ) 750mg 3 times a day, intramuscularly
or intravenously.
4. Infusion therapy for the purpose of detoxification and improvement
of osmotic and oncotic properties of blood: reopolyglukin 200-400 ml, neogemodez 200 ml,
albumin 10% - 100 ml, plasma, isotonic saline and glucose solutions.
5. Anesthetics and non-steroidal anti-inflammatory drugs: Acetylsalicylic acid (aspirin)
0.325g 2-3 times a day; diclofenac sodium 2 ml intramuscularly once daily for 5 days; reopirin 5
ml intramuscularly every other day 2-3 injections; analgin 0.5g 3 times a day.
6. Desensitizing: Suprastin pills 0.025 3 times a day.
7. Immunomodulators and stimulants: decaris 150 mg once a day; ATP 1 ml 1%
solution intramuscularly ; aloe extract 1ml intramuscularly ; FBS 1ml intramuscularly .
8. At the stage of resolving therapy using vaginal swabs from 10% dimexide to novocaine
with antibiotics (that are administered parenterally ) trihopolom , lidasa ; or tampons with
Vyshnevsky liniment.
9. Vitamin therapy: ascorbic acid 5% 1 ml intramuscularly , ascorutin 0.5 3 times a day
inside. Groups of vitamins B, PP and others are preferably in the form of multivitamin tablets
with trace elements.
10. Cold on the abdomen in the acute phase for 20 minutes with a break of 30 minutes.
11. If purulent salpingitis and acute tubo-ovarian abscess are formed, surgical treatment
with active pelvic drainage in combination with comprehensive local and general antibiotic
therapy is shown .

SALPINGOFORITIS

It is one of the most frequent localizations of pelvic inflammatory diseases.

Pathogenesis. The inflammatory process begins with the mucous membrane of the tube,
which extends to the muscular membrane. Microbes with the content fallopian tube penetrate
and infect end of abdominal serous cover tube ( perysalpinhit ), ovarian epithelium and
surrounding peritoneum ( peryoforyt ). After rupture of the follicle, an inflammatory process
occurs in the ovary - salpingitis, which, due to the adhesion of the fimbriae and the development
of the compounds, leads to the development of the hydrosalpinx and then to the piosalpinx .

Acute salpingoophoritis .
There are 4 stages of the disease ( Monit , 1982)
I. Acute endometritis and salpingitis without signs of pelvic inflammation.
II. Acute endometritis and salpingitis with signs of peritoneal irritation.
III. Acute salpingoophoritis with occlusion of the fallopian tubes and development
of tubo-ovarian formation.
IV. The rupture of tubo-ovarian formation.
In the clinical picture of acute salpingitis there are 2 phases: And - toxic, clinical
manifestations due to the influence of aerobic flora; in the second phase anaerobic flora joins,
which leads to the aggravation of the symptoms and the development of complications. In this
phase, tuboovarian formations with purulent contents are formed , which threaten perforation.
Clinic. Complaints of fever, worsening of general condition, severe abdominal pain,
chills, dysuric phenomena. In the first days of the disease, the abdomen is painful, tense on
palpation, the phenomenon of muscular protection may appear.
In vaginal examination: discharge from the cervical canal serous-purulent, plentiful,
appendages for palpation painful, increased in size, pasty, their mobility is limited, the contours
of the appendix are not clear enough.
In blood tests - shift of leukocyte formula to the left, leukocytosis, acceleration of ESR.

Diagnosis. The diagnosis is based on:

1. History.
2. Bimanual vaginal examination.
3. Clinical and laboratory examination data.
4. Ultrasound (makes it possible to detect tumor formation in uterine appendages).
5. Laparoscopy (in severe cases even a diagnostic laparotomy ).

Chronic salpingoophoritis .
It is most often the result of untreated acute salpingoophoritis . The chronic stage of the
process is characterized by the presence of infiltrates, the loss of physiological functions of the
mucous and muscular membranes of the fallopian tube, the development of connective tissue,
sclerotic processes with impaired uterine patency, and the connective process around the ovaries.

Clinic. Major complaints of dull, aching pain, which are exacerbated by

cooling, intercurrent illness, before or during menstruation. Characteristic irradiation of pain by
the mechanism of viscerosensory and viscerocutaneous reflexes. The pain, of course, is felt at the
bottom of the abdomen, inguinal areas, in the area of the sacrum, in the vagina, along the course
of the pelvic nerves.
Menstrual dysfunction is observed in 40-55% of patients
( polymenorrhea , oligomenorrhea , algodysmenorrhea ). Anatomical and functional changes in
the fallopian tubes and ovarian hypofunction are often the cause of infertility. There are also
pathological terminations of pregnancy - unauthorized abortion, ectopic pregnancy. Disorders of
sexual function (painful coitus , decreased libido) noted 35-40% of patients. Often there is a
presence of whiteness that occurs in connection with
concomitant colpitis and endocervicitis . Changes in the nervous system often lead to the
development of neurotic conditions, decreased performance.
Two variants of exacerbation of chronic salpingoophoritis are noted :
1. increases pathological secretion, exudative process in uterine appendages, increases the
number of leukocytes, accelerates ESR;
 2. There are complaints about the increase of pain, deterioration of health, decrease of
working capacity, lability of mood, objective indicators of exacerbation are absent.

Diagnosis. The diagnosis is based on:

1. History (acute adnexitis after abortion, complicated childbirth, hypothermia, etc.).
2. According to the results of the clinical examination.
3. The vaginal examination reveals changes from minor soreness and severity
of appendages to tubo-ovarian formations.
4 . Ultrasound (severity of echomalus , hydrosalpinx , etc.).
5 . Hysterosalpingography (to determine the anatomical changes of the uterine tubes).

Treatment of chronic salpingoophoritis . An important principle of treatment is the

combination of local therapeutic procedures with the simultaneous treatment
of extragenital diseases and disorders of nervous, vascular and other systems. During
exacerbation, a hypo-allergenic diet, restriction on carbohydrates and salts
is recommended . Total calorie content not exceeding 2300 kcal / day.
Indications for antibiotics:
1. In the period of exacerbation, if the clinic shows signs of inflammatory reaction;
2. If antibiotic therapy was not performed in the acute stage;
3. In the course of conducting physiotherapy procedures activating blood circulation and
enzyme systems, if there is a risk of exacerbation of the process.
Medications are used according to the testimony - sedative - Pavlov's medicine 1
tablespoon 3 times a day, trioxazine 0.25 3 times a day; desensitizing - tavegil 0.001 3 times a
day; immunomodulators - decaris 150 mg / day for 3 days a week; vitamins.
Physiotherapy procedures play an important role in treatment: ultrasound is
used during remission , which has a fibrinolytic and analgesic effect; as well as high frequency
pulse currents. After achieving the effect, it is recommended to use a magnetic field of high or
ultra high frequency, vaginal swabs of ozokerite, as well as balneotherapy - baths,
vaginal irrigation with sulfide, sodium chloride and other mineral waters.
For relative hyperostrogeny , electrophoresis of iodine or iodine with zinc, radon water
and iodine bromine is recommended . When ovarian hypofunction is shown the use of vibration
massage, ultrasound in pulsed mode, copper electrophoresis; mud, ozokerite, mineral
water. Treatment with physical factors is advisable to use with regional massage, therapeutic
gymnastics, psychotherapy.

PARAMETERITIS

Parametritis - inflammation around uterine tissue. The disease can be mono-microbial

and poly-microbial. It occurs most often after abnormal births, abortions, operations on the
genitals. The main route of infection is lymphogenous . In the course of the parameter there are 3
stages: infiltration, exudation, compaction. Exudate is mostly serous, and suppuration is rare. In
particularly severe cases, the infiltrate rises retroperitoneally , reaching parametric fiber.
Clinic. Constant dull pain in the abdomen, in the sacrum, lumbar, which appears earlier
than objective changes, as well as fever up to 38-39 degrees, tachycardia, headache, thirst, dry
mouth, impaired health, sleep disturbance, appetite. In vaginal examination to determine the
expressive soreness of the uterus, you can find infiltrate.
Treatment . Suitable are the use of antibacterial drugs , desensitizing therapy, general-
purpose therapy according to the general principles of treatment of inflammation of the uterine
appendages. If you suspect suppuration infiltrate spend his puncture through the vagina. The
presence of pus in the punctate is an indication of its opening and drainage parameter .
Rehabilitation of patients. For rehabilitation of patients it is necessary to use
physiotherapy procedures, spa treatment.
 PELVIOPERITONITIS

Pelvioperitonitis - inflammation of the entire peritoneum of the

pelvis. Pelvioperitonitis usually occurs secondarily. The primary lesion may be in the fallopian
tubes, ovary, uterus, pelvic tissue. Almost always it accompanies the development
of piosalpink , piovar or purulent tubo-ovarian tumor. The infection can spread through
the canalicular pathway - from the fallopian tube with salpingitis (mainly in gonococcal
infection) by the lymphogenous , hematogenous pathway and by the spread.
Classification. The nature of inflammation distinguish serous- fibrinous and
purulent pelvioperitonitis . In the acute stage of serous-fibrinous process there are disorders of
microcirculation, hyperemia, peritoneal edema. There is a serous exudate to which fibrin,
leukocytes, albumin are mixed. In the center of
inflammation, histamine , kinins accumulate , pH changes . Sometimes with
purulent pelvioperitonitis, delineation is very slow or does not occur at all - widespread
peritonitis develops.
Clinic. The disease is accompanied by high fever, severe abdominal pain, chills, nausea,
vomiting. The abdomen is swollen in the lower parts, muscle tension, positive symptoms of
peritoneal irritation are found. In vaginal examination determine the tenderness and rigidity of
the posterior vault, with a displacement of the cervix there is a sharp pain.
Basic principles of treatment
1) antibacterial therapy
2) correction of water-electrolyte balance,
3) correction of acid-alkaline state,
4) physiotherapy procedures.

SEPTIC SHOCK

Septic shock - sepsis is associated with a condition characterized by the development

of circulatory failure manifested arterial hypotension , increased levels of lactate greater than
2 mmol / l (despite adequate infusion ), needs the support of blood pressure by means
of vasopressors .
According to the International Consensus on the Determination of Sepsis and Septic
Shock (Sepsis-3) the diagnosis of sepsis can be established when there are:
• foci of infection;
• SOFA index ≥2 points.
The quick SOFA scale - an easy way to identify patients suspected of infection -
includes the following options:
• systolic blood pressure ≤100 mm Hg. Art .;
• tachypnea (respiratory rate ≥22 / min);
• Consciousness score (Glasgow Coma Scale ≤13).
Clinic septic th shock in :
• sepsis;
• hypotension requiring treatment vasopressors to maintain mean arterial pressure
at a level not less than 65 mm Hg. Art .;
• serum lactate level exceeds 2 mmol / l after
adequate infusion therapy.
Basic principles of treatment .
Treatment and resuscitation of patients with sepsis and septic shock should be started as
soon as possible. Immediate priority is the identification and control of the source of infection, as
well as therapy with appropriate antibacterial agents.
According to updated guidelines 2018 r. Be within the first hour to
begin infusion therapy, measuring the concentration of lactate in the blood serum (as a marker of
disease severity), start typing vasopressors and broad-spectrum antibiotics, bacteria carry
out logical blood tests (before antibiotic treatment).
There is a widespread belief that infusion therapy should begin with a crystalloid solution
or normal saline or buffer saline solution, such as a Hartman solution . For patients who do
not respond to crystalloids, albumin may be added (evidence of its benefit remains
doubtful). Hydroxyethyl starch should not be used because it increases the risk of acute kidney
damage and death.
The average blood pressure in patients with septic shock who require
therapy vasopressors should be more than 65 mm Hg. Art. In a study in comparing a target
systolic blood pressure of 65-70 mm Hg. Art. and a pressure of 80-85 mm Hg. c., levels of
mortality were the same, but in those groups where achieved a higher pressure, found an
increased risk of atrial fibrillation.
Norepinephrine is the most commonly used vasopressor . Vasopressin can be added
to norepinephrine if necessary to reach the target systolic blood pressure level. Addition
of levosimendan to standard therapy has not been shown to have an effect on organ dysfunction
or mortality, but is associated with more side effects.
The recommendations currently suggest that glucocorticosteroids should not be used if
hemodynamics has been restored
by adequate vasopressor support. If hemodynamic instability persists despite adequate therapy,
hydrocortisone at 200 mg / day can be given intravenously .

Additional strategies for treating sepsis and septic shock

The target respiratory volume is 6 ml / kg body weight. If sepsis
is associated with acute respiratory distress syndrome, the target
respiratory volume is 6 ml / kg, plateau pressure is 30 cm H 2 O
Mechanical ventilation
in lying position for 16 h
daily. Extracorporeal membrane oxygenation can reduce
mortality in very severe patients

Pharmacological prophylaxis using unfractionated heparin or

Prevention of low molecular weight heparin is recommended in the absence of
venous thromboembolis contraindications to the use of these drugs. Recommendations
m for non-drug prevention: stockings to combat embolism and
consider passive and early mobilization

Early onset of enteral nutrition is recommended . Early feeding

should begin within 48 hours. If enteral nutrition is not fully
Food
established within a week, the parenteral route should be
considered

The target blood glucose level is 6-10 mmol / l. Measurements

Glucose control should be made every 1-2 hours until the insulin dose is selected
and then every 4 hours in patients receiving insulin infusion.

Raise bed head 30-45 ° for patients with mechanical

Early mobilization ventilation. Active and early mobilization should begin as soon
as the patient is in a sufficiently stable condition

SEPTICEMIA
 Septicemia is a form of sepsis characterized by the absence of purulent metastases as
with septicemia and a rapid course .
Septicemia is characterized by an increase in vascular-tissue permeability, the
development of fibrinoid changes in the walls of blood vessels, allergic vasculitis, with which
the manifestations of hemorrhagic syndrome are significantly associated.
Etiology
The causative agents of this disease are pathogenic bacteria, rarely cause a variety of
fungi or viruses. Germs can enter the body through small open wounds, as well as the
progression of various inflammatory processes, such as sinusitis or inflammation of the kidneys
( lymphogenous and hematogenous).
In addition to bacteria, poisonous substances that they secrete (toxins) spread throughout
the body. They cause damage to organs, tissues or systems, and cause toxic shock.
Classification
Depending on the causes, there are several forms of blood contamination: septicemia
and septicopemia .
Septicemia is characterized by the appearance of purulent foci at different loci of the
internal organs or tissues of the body. Staphylococcus aureus and Pseudomonas aeruginosa are
the main causative agents . The disease proceeds moderately, without a clear expression of any
symptoms.
Hemorrhagic septicemia is a very rare type of infection. It is characterized by
inflammation of the skin, joints, bones, and bone marrow. The disease causes
a pasteurellal microbe , the transmission pathway is from pets. The virus enters the body through
bites, scratches. At the site of skin damage, a seal is formed which causes severe pain.
In turn, this type of blood contamination is divided into several forms:
 skin - inflammation of the skin of the person, the skin gets a red tint, there is
swelling. Touching the bite or scratching area causes a person to experience severe pain;
 pulmonary - a pathological process is observed in the bronchi and
lungs. Symptoms include severe cough with sputum discharge and chest pain;
 septic - as the virus spreads with the flow of blood, the pathological process is
exposed to more organs and tissues.
Bacterial septicemia - a special type of sepsis, a characteristic feature of which is the
appearance of purulent tumors on the heart valves. There is also an increase in the size of the
spleen and kidney damage. Most often cause streptococci and staphylococci disease.
Diplococcal septicemia - infection occurs from penetration into the body
of diplococcus . This process is accompanied by inflammation of the lungs, intestines and
joints. A person is exposed to this form of illness very rarely.
Streptococcal septicemia is a consequence of infectious diseases that have been caused
by different groups of this bacterium.
Viral septicemia is a rare type of sepsis found in humans. The disease affects the internal
organs and systems, causes the formation of hemorrhage under the skin or mucous membranes.
Septicemia unspecified - a generic concept that includes a wide range of diseases of
unknown nature. Such a diagnosis is made when it is impossible to determine the exact type of
microorganisms that caused the disease. In most cases, death occurs because rapid illness can be
fatal faster than treatment will begin.
Clinic
 high temperature,
 cold,
 delirium,
 shortness of breath with the development of respiratory failure,
 accelerated heart rate.
Diagnosis .
 Diagnosis is based on the study of blood tests, content from the focus of the inflammatory
process, as well as carried out bacteriological sowing to clarify the sensitivity of bacteria to
antibiotics. Hardware research includes ultrasound required to detect internal organ damage
Principles of treatment
Septicemia therapy should be performed only in a hospital setting. Treatment of the
disease is similar to the elimination of infectious diseases, but when choosing medicines should
take into account the causes of this disease. Often patients are prescribed:
 antibiotics and antiviral drugs to determine which microorganism has become the
pathogen;
 medicines to reduce the general intoxication of the body;
 medicinal substances aimed at the correction of disturbed processes in the body;
 glucose solution - with strong intoxication of the body;
 hormonal drugs;
 antipyretics.
In cases of hemorrhagic septicemia, in which abscesses are formed on the internal organs,
a medical intervention is prescribed - opening and purification of abscesses, removal of affected
areas, washing of purulent wounds with antiseptics.
During treatment, the patient should be provided with maximum rest and diet. In severe
human condition, this process is carried out intravenously. Septicemia is characterized by a
lightning current, so fatalities occur in more than half of cases. In addition, people who have
suffered a blood infection may remain disabled.
There is no specific prevention of the disease, as no one is protected from the penetration
of bacteria into the body through scratches or bites. Prevention is the timely treatment of
infectious diseases and treatment of the skin in case of violation of its integrity by antiseptic
substances.

SPECIFIC INFLAMMATORY DISEASES OF FEMALE GENITAL

AUTHORITIES
Bacterial vaginosis .
Parameter Norm Candidiasis Bacterial vaginosis Trichomoniasis

Symptoms Missing Itching, Unpleasant odor, Excretion,

soreness, dyspareunia heartburn,
contact
bleeding, dyspar
eunia , dysuria

When Selection of Hyperemia and Removal of white- Selection of

viewed white or milky swelling of the mucous gray color, in the yellow-green
color, with a membrane, thick form of a thin film color, hyperemia
normal odor of discharge white, covering the walls of the mucous
1 to 4 ml per cheesy in of the vagina membrane of the
day nature, tightly layered cervix.
on the walls of the
vagina, cervix.
pH of the 4.0 - 4.5 4.0 - 4.5 4.5 5.0 - 6.0
vagina
Nitrate test Negative Negative Positive (more Often positive
often in 70-80% of
women)
Native micro PMN / EC <1, LLP / EC <1 rod flora PMN / EC <1, ALT ++++,
scopy wand, epithelium ++ decrease mixed flora,
epithelium +++ +, pseudo (40%), prne in coli flora, motile trichomon
dstavlenyy not Candid increase as (60% of
aalbicans in cocobacilli , key patients)
cells found in 20%
of epithelial cells

Microscopy Negative Pseudophytes Negative Negative

of smears
stained with
10%
potassium
hydroxide
Other tests Negative Cultural research Cultural research Cultural
with a research, PCR
negative
result of
microscopy
Differential Physiological l Contact or Trichomoniasis , Purulent
diagnosis eucorrhoea allergic dermatitis atrophic vaginitis, desqua
or desquamative vag mative vaginitis,
initis atrophic
vaginitis, flat
erosive lichen.
 The disease is characterized by the appearance of a large number of whites with
unpleasant odor in the absence of pathogenic pathogens (gonococci, trichomonas , candida ), as
well as the absence of visual signs of inflammation of the vaginal mucosa.
Bacterial vaginosis can be regarded as vaginal dysbiosis which
underlies microbiocenosis disorders . Normal pH of vaginal secretion is 3.8-4.2, which is due to
the production of lactic acid strains of lactobacilli . When destabilizing the ecosystem (hormonal
disorders, antibiotic therapy , immunological shifts, etc.) there is a sharp decrease in the number
of lactobacilli , an increase in vaginal pH more than 4.5. This creates the conditions for the
massive reproduction of such microorganisms as gardnerella , obligate anaerobic bacteria, the
vegetation of which further inhibits lactoflora and stimulates the growth of various opportunistic
microorganisms.
Clinic. The main symptoms of bacterial vaginosis are significant whites with an
unpleasant odor. Since the onset of the disease, they have a liquid consistency, white or grayish
in color. With a long course of the disease they turn yellowish -green in color, denser and often
resemble cottage cheese, a little stringy, evenly distributed over the walls of the vagina.
The amount is whiter on average - 20 ml per day. Some patients experience local
discomfort. Feeling itchy in the vulva , dyspareunia . In bacterial vaginosis there are no signs of
inflammation of the vaginal walls, mucous membrane of the usual pink color. The
colposcopic picture is characterized by the presence of dystrophic changes.
Diagnosis . Practical diagnosis of dysbiotic conditions of the vagina causes considerable
difficulties; it consists of a set of clinical features and laboratory tests.
The diagnosis requires the presence of three symptoms of ohms from the following
four Amsel criteria (1983) :
1. Liquid homogeneous creamy secretions (sometimes foamy).
2. Positive amine test (presence of "fish odor" after adding a drop of 10% KOH
solution).
3. The presence of "key cells" (exfoliated vaginal epithelial cells covered with small
Gram negative sticks) by direct smear microscopy.
4. pH meter vaginal discharge - shift the pH of vaginal discharge> 4.5.

The main diagnostic criteria for Amsel

Treatment is carried out in two stages .

The first stage is optimization of physiological vaginal content and correction of local and
general immunity: instillation into the vagina of 100 ml of 2-3% lactic or boric acid daily for 7
days. Lactic acid lowers the pH of the vagina, restores acidic environment, creates unsatisfactory
conditions for the reproduction of anaerobes and gardnerells , restores lactoflora .
Phase II - restoration of normal microbial biocenosis of the vagina. For this purpose,
topical application of biological products ( lactobacterin , apilak, bifidumbacterin , bifidin ) is
carried out on tampons. The drugs are used intravaginally at 2.5-3 doses 2 times a day at 10-12
hour intervals. The course of treatment 7-10 days.
Used as vahilak in vaginal capsules to restore laktoflory and trihovahilak for
immunization markerovanymy lactobacilli with trichomoniasis and bacterial vaginosis .

TRIHOMONIASIS

Trichomoniasis is caused by vaginal trichomonads - the simplest belonging to the

flagellar class. Pathogens are sexually transmitted in the presence of trichomonads in the urinary
canal of men. Extrauterine infection is rare . The development of trichomoniasis is facilitated
by extragenital and gynecological (chronic salpingo-oophoritis ) diseases, endocrine disorders,
metabolic disorders, hypovitaminosis, bacterial contamination of the vagina, accompanied by a
decrease in the acidity of its content. Trichomonas colpitis corresponds to III or IV degree of
vaginal cleanliness (II degree is rare). Trichomonads multiply intensively during and after
menstruation, which is associated with changes in the acidity of the vaginal content. The
incubation period is 3-30 days.
In most cases, urogenital trichomoniasis is a multifocal disease. The main parasite of
trichomonads is the vaginal mucosa, but they are often immersed in the urethra and
bladder. Trichomoniasis clinic is characterized by duration, if not properly treated in a timely
manner.
Classification . Given the duration of the disease, distinguish:
1. fresh trichomoniasis , which emit acute, subacute and malosymptomatic forms;
2. chronic - characteristic torpid course and limitation of the disease for 2 months;
3. Trichomonadonosity - no symptoms in the presence of trichomonas in the vaginal
contents.
Clinic. In acute and subacute forms of the disease, patients complain of abundant, white,
itching, heartburn in the external genital area. The study uses mirrors to find many liquid, often
foamy, purulent whites that cover the vaginal wall and accumulate in the posterior
vault; hyperemia and edema of the vaginal mucosa and vagina of the cervix.
Chronic trichomoniasis is characterized by the duration and recurrence of the
disease. The occurrence of relapses contribute to the violation of sexual hygiene, reduced
endocrine function of the ovaries, extragenital diseases that reduce the body's resistance to
infection. Signs of the inflammatory process are little pronounced, are revealed
by colposcopy (focal expansion of the capillaries, diffuse hyperemia). Diagnosis is made after
microscopy of native and colored preparations.
Treatment. When treating trichomoniasis , the following principles should be
followed:
1. simultaneous treatment of the patient and her partner
2. prohibition of sexual life during treatment.
3. elimination of factors that reduce the body's resistance.
4. the use of antitromonadic substances against the background of general and local
hygiene procedures.
Patients are to be treated for all forms of the disease.
With protytryhomonadnyh matters most
effective metronidazole ( flahil , trihopol , orvahil , Klion ) fazyzhyn ( tinidazole ). With
fresh trichomoniasis metronidazole is used according to the scheme: on the first day of treatment
0.5g 2 times a day, on the second day - 0.25 g 3 times a day, the next 4 days 0, .25 g 2 times a
day. Metronidazole is also available in tablets of 0.5 g for administration to the vagina for 10-20
days. Tinidazole is administered orally after meals at a single dose of 2000 mg (4 tablets of 500
mg).
Less effective agents: trichomonacid and nitazole . Trichomonacid is taken orally ( 0.3
g per day in 2-3 doses for 3-5 days) and topically ( suppositories of 0.05 g for 10
days). Nitazole ( trichocide ) is used in the form of suppositories of 0.12 g 2 times a day and
inside 1 tablet (0.12 g) 3 times a day.
It is also recommended to administer tampons after syringe with a 2.5% suspension
of nitazole . Locally also use vaginal tablets " Klion- D" 1 tablet per day for 7 days.
Cure control is carried out during 2-3 menstrual cycles. At the end of the course of
treatment, women should be under clinical observation.

CANDIDOSIS OF THE VIRGIN

Candidomycosis is an infectious disease of the skin, mucous membranes and internal

organs, caused by conditionally pathogenic yeast fungi of the genus Candida . The
causative kandydomikozu often the species C. Albicans , less C. Tropicalis ,
C pseudotropicalis and others.
 Pathogenesis. The disease develops in the presence of the following factors: chronic
diseases, immunodeficiency states, endocrine diseases, hypovitaminosis, caries, pre-irradiation,
mucosal injuries, long-term antibiotic therapy , which leads to the development of intestinal
dysbiosis. Due to the effect of these factors there is an increased reproduction of yeast fungi, and
further - their penetration from the surface of the mucous membranes and skin into the
tissues. This leads to their necrotization and the formation of local pathological foci.
Increased attention to urogenital candidiasis is due to the frequent transmission
of yeast fungi from mothers to children when passing the maternity tract, the possibility of
infection of maternity hospital staff, the possibility of sexual infection, the constant increase in
the number of patients with this mycosis among gynecological patients, as well as gynecological
patients was treated with antibiotics, steroid hormones and cytostatics.
Clinic. The most constant symptom is prystupopodibna itching, which can be enhanced
with a slight touch to the mucosa, frequent complaints of heartburn, often with a strong vaginal
exudative forms. The number of secretions may be different, and in the chronic course they may
be absent. In secretions mushrooms sometimes are not found, and on the walls of the vagina are
found in large numbers.
Classification. There are the following clinical forms of vulvitis :
1. Acute and subacute catarrhal-membranous vulvitis , manifested by cyclic itching with
sharp exacerbation in the pre-menstrual period. On examination of the genitals revealed intense
or moderate hyperemia with a crimson-bluish tint. The rash has the appearance of small thin-
walled vesicles, in violation of the integrity of which erosion with polycyclic contours is
formed .
2. Chronic catarrhal candidiasis vulvitis with complaints of constant moderate
itching. The mucous membranes are in a state of constant congestive infiltration.
3. Chronic leukoplakia vulvitis (atypical form).
4. Chronic cruvaceous vulvitis .
5. Chronic pruriginous vulvitis .
6. Mixed acute candida- bacterial vulvitis .
Forms of candidiasis colpitis :
1. Acute or subacute catarrhal-exudative-membranous colpitis . Diffuse congestive
hyperemia, edema, dryness of the mucous membranes, creamy vaginal discharge are detected.
2. Acute
and subacute mixed catarrhal- exudative candidiasis- bacterial colpitis . Extensive erosion of the
vaginal part of the cervix, eroded ectropion and erosion on the vaginal walls. White rich, foamy,
purulent with unpleasant odor.
3. Subacute and chronic catarrhal candidiasis of colpitis . It is characterized by a small
congestive hyperemia of the vaginal mucous membranes and vaginal part of the cervix. Vaginal
exudate has the character of creamy whites in small numbers.
4. Chronic asymptomatic candidiasis of colpitis . In some
patients petechiae or hemorrhages of small size are noted . Vaginal discharge in a small amount
of translucent, without odor.
Treatment. The sexual partners of patients with candidiasis should receive
appropriate anticancer therapy even in the absence of clinical signs of candidiasis.
1. You should exclude other fungal lesions, such as skin, hair, nails, etc. This requires an
appropriate course of treatment.
2. Bare hair in the genital area. Daily shower with tight wash of genital soap and
crotch. Deny sexual intercourse for the duration of treatment.
3.Oral administration of one of the drugs: nizoral 0.2g 2 times a day for 10 days,
or orungal , or pimafucine .
4. Local therapy: vaginal globules of pimafucine , gyno-travogen , with mixed flora
of polygenics , in association with trichomonas - clone -D, ginalgin , naxogin ; respectively, 1-2
globules per day for 10-12 days.
 5. External genitalia to both partners to grease with
creams: nizoral , clotrimazole , pimafucin .
6. In the periods between courses of treatment, syringe with 2% soda solution is
recommended, with 10 drops of 5% iodine per 1 liter of solution,
or potassium permanganate solution 1: 5000.
7. At expressed forms of candidiasis, or at ineffectiveness of treatment, the course of
therapy is repeated three times, taking into account the menstrual cycle.
8. Cure control: three times after menstruation, vaginal smears are taken.
Chlamydiosis.
Chlamydial infection is caused by microorganisms belonging to the
genus Chlamydia - obligate parasites capable of intracellular development. At present, the genus
Chlamydia includes 3 species: Chlamidia trachomatis , psittaci , pneumoniae . The latter is the
causative agent of anthroponious infection, which is transmitted from person to person without a
mediator. Chlamydia contains DNA and RNA, synthesizing its own DNA protein. But ensuring
the metabolism of the microorganism is mainly due to the life of the owner.
Chlamydia infected 500 million to 1 billion people. The frequency of infection of
gynecological patients is 4-30%, in the presence of adnexitis it is equal to 20-30%,
of colpitis and endocervicitis - up to 10%.
Pathogenesis. Chlamydial infection causes a number of diseases of the eyes, urogenital
tract, in newborns - lower respiratory tract. Chlamydia can be caused by acute
salpingitis, perigepatitis . In obstetric and gynecological practice, chlamydial cervicitis, salpingo-
oophoresis , endometritis , pelvioperitonitis , infertility are isolated . Chlamydial infection of the
genital organs complicates the course and outcome of pregnancy. Infected women in 50% of
cases transmit infection to newborns with consistent development of chlamydia in them .
Clinic. Chlamydia is not always accompanied by clinical manifestations. The main
complaints of patients are pain in the right hypochondrium and lower abdominal aching
character, irradiating into the waist and inguinal areas. Periodic cramping pains with irradiation
at the hips, dysuric phenomena; disorders of menstrual function in such patients were not
observed.
Diagnosis:
1.Fabrication of smears on Romanovsky - Gimze ;
2. Enzyme-linked immunosorbent assay using fluorescein-
isothiocyanate- labeled monoclonal antibodies ;
3. Immunofluorescence method.
Treatment. Major advances in the treatment of
uncomplicated urogenital chlamydiosis achieved after application of azithromycin (1 g
once orally ), doxycycline (0.1 g, 2 times a day for 7-10 days) and erythromycin (0.5 g, 4 times a
day far during 7 days).
Rovamitsyn is a 16-membered macrolide , prychynyayuchy
expressed antyhlamidiynu action (minimum concentration of 0.025 to 1 mL) rovamitsyn gives
less severe adverse reactions such as cardiac arrhythmias, neurosensory disorders. Control tests
to determine the effectiveness of treatment is carried out one month after receiving antibiotics.

UREOPLASMOSIS

Ureaplazmosis - a disease causing microorganisms

it Ureaplasma urealyticum ( Ureaplasma urealitikum ) belonging to gram-negative
bacteria without cell walls .
Ureaplasmas can live in the body for years without causing any symptoms and leading to
disease. Asymptomatic carriers ureaplasmas is widespread and appears in approximately 70 % of
sexually active women and men; ureaplasma is predominantly part of the normal genital
microflora of men and women. The disease begins when the concentration
of microorganisms exceeds a certain threshold .
The main ways of transmission:
- pin (during birth from mother to child, where they can be stored all life , being in an
inactive state ;
- sexual (currently remains the most common option);
- household.

Clinic
Symptoms appear within 3-5 weeks of infection . Patients complain of discomfort in the inguinal
area, itching with urination, excretion of the urethra, scanty transparent discharge from the
vagina, abdominal pain (with inflammation of the uterus and appendages), dyspareunia , fever. It
should be noted that ureaplasmosis exhibits minor symptoms that are of little concern to patients,
and often does not occur at all (especially in women).

Diagnosis would be based on :

1. bacteriological sowing - a method called the "gold standard" in the detection and
determination of the amount in the biological material of any microorganism, incl. bacteria of the
genus Ureaplasma , using diagnostic test kits, " ureaplasmas -seredovysche" " ureaplasmas -
ACH" "ureaplasmas-50", " urea / Miko- Screen -ACH."
2. PCR, which allows to determine the type of ureaplasm by the presence in the sample of their
DNA. Using the real- time PCR method, it is possible to determine not only the presence but
also the amount of DNA required in the sample , which is very important for
the clinical interpretation of the results obtained ;
3. c erolohichni methods ( ELISA analysis , the method of fluorescent antibodies ) in
the present time is not used .

The basic material from a count in the laboratory to identify Ureaplasma different methods are
scrapings of the urogenital tract, the first portion freely released urine. Biological sampling shall
be carried out not earlier than 14 days after the end of the administration of antibacterial
preparations.
Treatment. At the end of the course of drug therapy (two weeks later), a control examination is
carried out, including the study of microbiocenosis in the vagina, and after a month and a half -
repeated PCR and bacteriological analysis.
Treatment of ureaplasmosis is usually done on an outpatient basis. Because the causative agent
of this disease is easily adapted to different antibiotics , sometimes even several courses
of treatment do not produce results. In pregnant women , drugs
are used tetracycline ( tetracycline , doxycycline ), fluoroquinolones ( ofloxacin , pefloxacin )
and macrolides ( azithromycin , jazamycin , clarithromycin ). During pregnancy, you
can use only some of the macrolides , and drugs tetracycline and fluoroquinolones
are contraindicated .
The recommended regimen for jazzamycin : 500 mg 3 g / day for 7-10 days .
This drug is characterized
by proven efficacy against chlamydial , ureaplasmic and mycoplasma infections of
the urogenital tract, as well as a favorable safety profile ( no pathological effects on the motility
and microflora of the intestine, minimal risk of drug interactions ).

GONORRHEA
 It is a sexually transmitted disease, caused by the
gonococcus Neisseria gonorrhoeae . Gonococcus is a specific parasite of a person characterized
by a triad: intracellular location (in a leukocyte), legume and Gram negative
staining. Gonococcus does not form a true toxin, only after death is released endotoxin, which
causes degenerative - destructive changes in tissues, the formation of strictures.
The main route of infection is sexual. Most sources of infection are patients
with torpid chronic form of gonorrhea, honokokonosiyi . Very rarely, the infection occurs
through the household path through household items - linen, towels. Infection of the fetus is
possible in the pre-natal period when gonococci penetrate the fetus during its passage through
the genital tract.
There is no real immunity for gonorrhea. Patients who have already had the disease may
become infected with gonorrhea repeatedly, the course of reinfection is as acute as the first
disease. Gonorrhea is characterized by a predominant impression of the mucous organs of the
urogenital system, more often where there is a cylindrical epithelium.
Classification. Classification of gonorrhea is based on three principles ah :
the prescription of the disease , the nature of the clinical course , the localization of the process.
By prescription of disease distinguish:
1. fresh form - it includes all cases with a limitation of the disease up to 2 months.
2. chronic - the disease has a limitation period of more than 2 months or with an
unspecified period.
Ok remo produce a latent form ( gonococoniosis ), when there are no external signs of the
disease, but patients have gonococci.
According to the clinical course, there are forms:
1. acute-onset of the disease no more than 2 weeks ago
2. podgostra- from 2 to 8 weeks
3. torpidna- is characterized by the erased onset and course of the inflammatory process,
poor secretions from the urethra and cervix, where the gonococci are located.
By localization distinguish:
- gonorrhea of the lower division ( vulvitis , urethritis, bartholinitis, endocervicitis ,
proctitis)
- gonorrhea of the upper division (ascending): endometritis,
salpingitis, oophoritis , salpingo-oophoritis , pelvioperitonitis . The border between the upper and
lower divisions is the internal yawn of the cervix.
The incubation period is 3-4 days, sometimes up to 8 days. The spread of gonococci is
most often ascending - the urethra, cervix, endometrium , fallopian tubes, peritoneum, or
hematogenous and lymphogenous pathways.
Clinic. Lower gonorrhea is characterized by the presence of mucous or mucous-purulent
character. Patients complain of itching, heartburn in the affected area, walking pain; in the
presence of gonorrheal urethritis - dysuric phenomena (burning pain at the beginning of
urination), in the case of rectum - tenesmus , heartburn in the anus. Objectively mucous in the
lesion area - hyperemic , swollen with slight hemorrhage. For endoservicitis pain characteristic,
discharge pus, mucous-purulent greenish-yellow, viscous, often accompanied by blockage of
ductless glands with the formation of retention cysts - ovula Nabothi , which may be in for a long
time gonococci.
In gonorrhea of the upper division, in contrast to the lower, there is a worsening of the
general condition of the patient, fever up to 38-39 C, nausea, vomiting, cramping pain in the
lower abdomen, in the sacrum, in the waist, secretion of blood-purulent, mucous-
purulent. Bimanual research is dramatically painful. Menstrual disorders. Frequent occurrence of
complications: piosalpinks , tubo-ovarian abscesses, gonococcal metastases to other organs and
systems. There is a characteristic discrepancy in blood tests between high ESR and relatively low
leukocytosis, or even a normal leukocyte count. Chronic forms of gonorrhea are not
characterized by the severity of the clinical picture, the detection of gonococci by methods of
provocation.
Diagnosis.
1. Data of anamnesis: complaints, prescription of disease, connection with sexual life,
features of the course, nature of menstrual and childbearing function.
2. Bacterioscopic examination: smears are taken from the urethra , the cervical canal, the
rectum and stained with Gram. If necessary, smears taken from the large glands of
the lobby , scan glands. Urine sediment is analyzed. In cytobacterioscopic examination of smears
distinguish the following pictures:
- smear a large number of leukocytes, no flora, intracellular, extracellular gonococci
(characteristic of acute gonorrhea).
- large number of leukocytes, no flora, no gonococci (suspected gonorrhea). Flora is
more often displaced by the existing but undetected gonococcus.
- a small amount of leukocytes and a variety of microbial flora (smear is not typical for
gonorrhea).
3. The cultural method is more informative - sowing of excretions on the nutrient medium
of ascites-agar, ascites- broth .
4. Of great importance in the diagnosis of primary chronic forms belongs to the methods
of provocation, which is based on the artificial formation of conditions of increased circulation
and the allocation of gonococci on the surface of the mucous membranes.
Methods of provocation.
 Chemical - lubricate the urethra to a depth of 1 to 2 cm and rectum 4 cm 1-2% silver
nitrate solution, cervical canal - 5% silver nitrate to a depth of 1.5 cm.
 Thermal - conduct diathermy, inductothermia, paraffin, ozokerite applications, UHF
every day (3 days). Every day an hour after warming up, there is a selection for laboratory
testing.
 Physiological - smears taken during the days of greatest bleeding during menstruation.
 Mechanical - massage the urethra through the back wall on a metal bougie.
 Alimentary - after consuming spicy, salty food, beer.
 Biological - the introduction of gonovaccine 500 million microbial bodies.
 Combined.
5. In the diagnosis of gonorrhea, changes in the blood are significant - a significant
increase in ESR in moderate leukocytosis, lymphocytosis , eosinophilia .
6. Recently, the most sensitive method of diagnosis is molecular biological
- polymerase chain reaction, which is based on the detection of the pathogen in the presence of
its DNA in cell culture.
Treatment. The treatment of patients with gonorrhea should be comprehensive with an
individual approach to each patient. It includes antibacterial, immunostimulatory , topical anti-
inflammatory therapy. Treatment of acute gonorrhea is carried out in the hospital. Prescribe bed
rest throughout the feverish period, mechanically and chemically sparing diet (saline,
spicy). Treatment should be started with a shock dose of antibiotic to create a higher
concentration in the lesion.
Augmentin with fresh uncomplicated gonorrhea is administered 375 mg every 8 hours, at
a rate of 1.875 g . For complicated and chronic gonorrhea for the first 3 days 750 mg of the drug
every 8 hours, the other 2 days 375 mg every 8 hours.
Sulacillin is administered intramuscularly at 1.5 g at 8 hour intervals. Course dose in
fresh forms - 6 g , chronic and complicated - 9 g .
Cefobid intramuscularly 1g per day, for fresh forms 3 g , for others - 5 g .
For the effective treatment of patients with torpid and chronic forms of gonorrhea
stimulation of specific and nonspecific reactivity of the organism is used: the gonococcal vaccine
is administered intramuscularly with an interval of 1-2 days, each time increasing the dose by
150-300 mln of microbial bodies. The single dose can be increased to 1.5-2 billion microbial
bodies and the number of injections to 6-8. In acute complications of gonorrhea, vaccination is
started with 200 million microbial bodies. In torpid and chronic form - local vaccination in the
submucosa of the uterus, urethra from 50 million to 150-200 million microbial
bodies. Antibiotics are prescribed during and at the end of vaccination.
Contraindications: active tuberculosis, organic lesions of the cardiovascular system,
kidneys, liver, allergic diseases, menstruation. It is not advisable to administer to people with III
(B) and IV (AV) blood groups, because gonococci and gonococcal vaccine contain a substance
similar to human group isoantigen B and have a specific cytopathogenic effect on human
erythrocytes.
To stimulate nonspecific resistance of the person use pyrogenal intramuscular
injection every other day, starting from 50-100 MPD (minimum pyrogenic doses), increasing the
dose of each subsequent injection, depending on the temperature response by 10-15 MPD, at the
rate of 6-8 in ' actions. The maximum single dose is 80-100 MPD. Prodigiosan is
administered intramuscularly in a single dose, starting with 15 MPD for a course of 4 injections
at 4-5 day intervals. The maximum single dose is 75 MPD. Tymaktyn sublingually to 0.1 g 1
time per course 3 days. Tactivin - 0.01% 0.5 mg p / wk every other day, 7-8
injections. Levamisole - cycles of 150 mg once a day for 3 days, 4 days break, the cycle is
repeated, for a course of 4 cycles.
Patients with complicated and chronic gonorrhea are prescribed injections
of aloe , fibroids , vitreous body, reinfusion irradiated with laser light of their own blood.
Local treatment in the acute stage contraindicated. Assign vaginal trays 2-5%
of protargol , chlorophyllipto , solution of furacillin . When urethritis - washing the urethra with
a solution of potassium permanganate 1: 5000, 1: 10000, instillation of 1-2% protargol,
lubrication of the mucous membrane 1% silver nitrate, cervicitis - 2% silver nitrate.
Curability is determined 7-10 days after the end of antibiotic treatment, examining the
discharge from the urethra, the cervix, the rectum. In the absence of gonococci spend a combined
provocation for 3 days investigate the selection. In the absence of gonococci - discharged before
the onset of menstruation. During menstruation, smears are taken again, and at the end -
provocation is again carried out with a study of vaginal discharge for 3 days. In the absence of
gonococci - patients are withdrawn.

GENITAL HERPES

Classification. In clinical practice, the following variants of the course

of herpetic infection due to HSV -1/2 are distinguished : herpetic mucous membranes, eyes,
skin (eg herpes eczema), genital herpes, lesions of the central nervous system, visceral lesions
and generalized herpes. HSV-1 is called " labial herpes", HSV-2 is " genital herpes", but 10-
15% of genital herpes cases are due to HSV-1.
Clinic. Primary infection with herpes simplex virus 1 st ( herpes simplex virus - HSV -1) or
2nd type ( HSV -2) can be asymptomatic course or lead to clinical manifestations. D iahnoz
confirmed on the basis of the presence of typical vesicular lesions that can be localized to
the genital lips, the clitoris, in the area of the rear soldering around the anus and rectum.
Diagnosis.
1. Laboratory confirmation is recommended in all patients with suspected genital herpes using
methods that directly demonstrate the presence of genital virus ( urogenital (u / g) scraping )
( Ib , A ).
2. asymptomatic patients is not recommended to carry in / g scraping , since it is
unlikely or confirm the status of the carrier ( Ib , A).
3. HSV DNA detection is considered the gold standard of diagnosis ( Ib , A).
4. Methods for detection of
viral antigen, such as direct immunofluorescence and ELISA analysis is usually
not recommended ( Ib , A).
5. Asymptomatic patients are not recommended for serologic diagnosis ,
but may be useful in such patient groups (IV, C) .
6. To confirm the presence of herpes virus infection can be applied serological tests: detection
of antibodies against antigenically unique glycoproteins gG 1 and gG 2 .
Treatment. The first episode of genital herpes is often associated with a long illness. The
therapy can be highly effective and should be initiated as before , based only on clinical data .
Osnovnm direction terapiyiyi herpesvirus infection is the application of
paragraph rotyvirusn s oral s preparation s rate on 5-10 days :
 acyclovir 400 mg three times a day ;
 acyclovir 200 mg five times a day ;
 famciclovir 250 mg three times a day ;
 valacyclovir 500 mg twice daily ( Ib , A)
For polehshennnya of the patient indicated the appointment of
local anesthetics ( ice okayin ) for the application area of sexual organs , in the form of a
gel or ointment . In women with severe dysuria immersion in water or saline solution can alleviat
e symptoms .
For the treatment of recurrent genital herpes, the following treatment regimens have
been reversed :
to short course :
 acyclovir 800 mg 3 times a day for two days ;
 famciclovir 1 g 2 times a day for one day;
 valacyclovir 500 mg twice daily for three days ( Ib , A).
and an alternative five-day course :
 acyclovir 400 mg 3 times a day for 3-5 days ;
 acyclovir 200 mg 5 times a day ;
 valacyclovir 500 mg 2 times a day ;
 famciclovir 125 mg 2 times a day .

CYTOMEGALOVIRUS INFECTION
Cytomegalovirus infection (CMVI , cytomegaly ) belongs to infectious processes with
unique features of interaction at the level of "virus - infected cell" and "virus - immune
system". Despite the almost common infection with the cytomegaly virus (like other herpes
viruses ), clinical manifestations of infection occur very rarely - except in the presence of
immunodeficiency. In different countries, the incidence of cytomegalovirus (CMV)
infection ranges from 45 to 98%.
Particularly dangerous is congenital cytomegaly , which is formed as a result of
intrauterine transmission of the virus, so 1-1.5% of fetuses are infected. When infection of the
fetus in the early stages of pregnancy may it intrauterine death and spontaneous ( spontaneous )
abortions. In more recent dates disease can cause birth defects development at the same
time 10% of infected newborns show lesions of the
nervous system ( microcephaly , delayed mental development , seizures ), of vision ( chorioretini
tis ), liver and spleen ( hepatosplenomegaly , jaundice , thrombocytopenia ).
Ways of transmitting the virus. The CMV reservoir in nature is exclusively human ,
diseased or carrier . Ways of transmission of the virus are diverse : it is found in
the blood , urine , faeces , secretions and biopsies of almost all tissues of the body .
The main routes of transmission of the cytomegaly virus include:
- contact- household ,
- transfusion ,
- intranatal ,
- sexual ,
- transplantation ,
- air-drop .
Proved transmission of infection from sick mother to the child during the time of childbirth and
breast feeding .
Clinic. Primary infection in term infants without congenital immunodeficiencies and in adults
(except in pregnant and immunocompromised patients) is almost
always subclinical . Cytomegaly is regarded as a classic "opportunistic" infection, that is,
activated only against the background of immunodeficiency. The reason for the activation
of CMV
is often a sudden hormonal changes - pregnancy , ovariectomy . In immunocompetent persons,
the infection usually has an asymptomatic course . In some cases,
the clinical picture resembles infectious mononucleosis caused by
the Epstein- Barr virus . In immunocompromised individuals, cytomegalovirus infection can af
fect various organs and systems with the development
of pneumonia , myocarditis , encephalitis , aseptic meningitis , thrombocytopenia , hemolytic ane
mia , gastritis, hepatitis, retinitis and the like . The disseminated form of
CMV often develops . The most common manifestation of CMV
with AIDS is retinitis (85%), rarely - esophagitis , colitis , poliradykulopatiya , ventrykuloentsefa
lit .

Diagnosis Establishing a diagnosis of CMV infection is based on detection of the symptoms

of affection relevant bodies with simultaneous detection of the virus in them. The examination
is performed by virological , cytological and serological methods.
For the diagnosis of CMV should be used not less than 2-
3 laboratory tests . Explore saliva , bronchoalveolar washings , urine, cerebrospinal fluid ,
blood, breast milk, sectional material , biopsies . In connection with termolabilnistyu virus materi
al for the study must be delivered to the laboratory no later than by four hodyny from the date of
collection. Over recent years, wide distribution received ELISA method, which allows
to detect antigen and CMV -specific antibodies of class G and N. Detection of IgG is of
secondary importance and should be carried out simultaneously with the detection of IgM ,
especially to the diagnosis of primary infection . When it
detects IgG analysis of their avidity ( ability to retain antigen) can help in
the differentiation between active and persistent infection . Indicator index avidity (IA) and
35% points on an acute infection , from 36 to 41% - on the stage of recovery , more than 42% -
in the presence of serum blood vysokoavidnyh antibodies to CMV.

Treatment. Effective treatment is possible only with the simultaneous use of effective antiviral
agents and the correction of the cellular link of the immune response.
In alacyclovir ( valtrex ) at a daily dose of 2-3 g allows to ensure its sufficient concentration in
the tissues , and therefore the effectiveness of treatment.
G ancyclovir ( cymeven at a dose of 5-10 mg / kg / day intravenously) is today a truly highly
effective etiotropic agent for the treatment of cytomegalovirus infection.
Among the new but not well-studied nucleoside agents are famvir ( famciclovir 500-1000 mg /
day) and denavir ( penciclovir ).
In recent years, the number of thymic peptides
of synthetic origin has increased significantly . Effective thymomimetics is
considered thymosin ( thymosin α-1, zadaxin ), which is used in immunodeficiency states
with predominant cellular damage , in the complex therapy of hepatitis B and
C, cytomegalovirus and other herpes virus infections
Recombinant interferon analogues or inducers of its synthesis are prescribed in the case
of reduced production of this cytokine in the body . Among the indications for use
of drugs recombinant interferon - acute and chronic viral diseases . In
such cases, it can have both etiotropic ( antiviral )
and pathogenetic ( immunostimulatory ) effect . Unfortunately, the use of interferon in
CMVI has not been sufficiently studied to date and is limited to several pilot studies .

HUMAN PAPER VIRUS (HPV)

The virus papilloma human - is a common infection of the genital tract. This pathogen
is found in almost every sixth inhabitant of the planet . When infected,
the pathogen enters the epithelial cells , disrupting the process of division , activates
the development of various diseases . Preferably , the virus affects the organs of
the urogenital system , the anorectal region.
The disease , which occur during infection with HPV:

1. Formation of acute warts.

2. Development of papillomatosis of the respiratory tract.
3. Defeat genital organs with the development of tumor process .

At the present time we know more than 100 types of HPV. Some of
them relatively safe for the health of humans , others can activate the development of
cancer processes . Most often the clinical signs of the disease in the first stages
are not manifested . Usually the first symptoms occur after the action of the triggering factors .

For oncology activity such viruses are classified in :

1. Strains with high oncogenic risk (18, 16, 31, 33, etc.)
2. Strains with low oncogenic risk (6, 11, 32, 40-44, 72)

Nyzkoonkohenni strains of viruses lead to the appearance of warts

and papillomas skin covers on the surface of the
body . Vysokoonkohenni strains cause formation of warts in the anogenital area , on the surface
of cervical cancer in women and the sexual member of males . Long-term effect on the
body 16,18, 31.33 types of the virus can lead to dysplasia, cervical cancer
and more dangerous disease - cancer of the cervix of the uterus . However , even when there is
a high-oncogenic risk in the body of HPV, the oncological pathology does
not always develop . Timely appeal to experienced physicians for diagnosis correctly chosen trea
tment will allow you had not faced with dangerous clinical manifestations of the
virus papilloma human .
The main ways of transmission

1. in ertykalnyy - during a passage in tribal ways women are infected

with HPV, the newborn can become infected .
2. and utoinokulyatsiynyy - autoinfection ( transfer from one area of the
body to another ) at the time of epilation or shaving .
3. for ontaktno or water -
in irus papilloma man some time remains viable in the surrounding environment . Therefore,
it is possible to become infected after visiting public places ( sauna , sports hall, swimming
pool ).
4. for ontaktnyy - mo zhlyve infection through the wound surface on the
skin or mucous membranes ( ssadna , wounds, bruises ).
5. s tate - the most common path of infection .
Diagnosis.

To diagnose the presence of HPV is necessary stages for this using a number of
physical , laboratory and instrumental studies .

1. Medical examination . With its help it is possible to detect the presence

of warts. At detection of a wart in an anogenital area , the research of
a cervix is obligatory . Also possible of ureteroscopy .
2. Colposcope me . They carry out specific tests with acetic acid and a
solution of iodine . With their help you can determine the presence of abnormal cells , signs
of HPV infection and cancer of the cervix of the uterus.
3. Cytological examination . Take smears of the mucous membrane of
the uterus on Papanicolaou . This is a screening study for the presence
of precancerous and cancer cells in the vaginal or cervical wall .
4. Histological examination of the tissues and the detection of sexually
transmitted diseases that are often associated with HPV infection may also be
performed. The high diagnostic value of a PCR. With its help you can identify the strain
of HPV.

Treatment. It is impossible to remove the virus completely from the patient's body. The doctor
can only deal with the effects of the life of the infectious agent . As general therapy,
symptomatic agents, antivirals and drugs that stimulate immune processes can be
used. To fight with different kinds of warts can be applied :

1. Cryodestruction , electrocoagulation , burning laser or chemical substa

nces . These methods are effective for getting rid of acute warts.
2. To remove the affected area on the surface of the cervix ( dysplasia ,
warts) used electrosurgical methods of treatment .

TUBERCULOSIS

One of the extrapulmonary localizations of tuberculosis is genital tuberculosis. According

to clinical observations and experimental studies, lesions of the genital organs are a secondary
process, not an independent disease. Genital tuberculosis is often combined with pulmonary
tuberculosis, rarely with tuberculosis of the bowel and peritoneum.
Tuberculosis agent is a genus of mycobacteria in the class
of schizomycetes actinomycetes . From the primary focus, mycobacteria are introduced into the
genital system mostly by hematogenous route, rarely by lymphogenous or peritoneal
tuberculosis. Often the uterine tubes are affected, which is related to the peculiarities of their
blood supply, which is performed by the uterine and ovarian arteries with numerous anastomoses
that slow down blood circulation. This feature contributes to the sedimentation of mycobacteria
in the tissues of the tubes.
Classification .
I. By localization : tuberculosis of the fallopian tubes, uterus, ovaries, vagina and vulva.
II. In the presence of anatomical and functional changes:
1. With anatomic and functional changes
2. No anatomical and functional changes.
III. By the nature of the changes.
1. Productive.
2. Proliferatively exudative.
3. Caseous decay.
4. scar - adhesive form.
IV. In the course .
1. Acute
2. Subacute .
3. Chronic.
The first signs of the disease often occur during puberty. In most patients the process runs
with scanty symptoms. Often the only complaint is infertility or menstrual disorders.
Uterine tuberculosis is often bilateral. The affected epithelium of the epithelium is
sometimes twisted , the fimbriae of the tubes stick together, resulting in sactosalpinx . Pipe
extended its ampullar channel retortopodibno expanding. The development of sclerotic changes
leads to deformation of the tubes, violation of their function.
In uterine tuberculosis, the mucous membrane is most often affected,
rarely myometrium . For a long time the process is localized in the functional layer, the rejection
of which occurs during menstruation. Later, fibrous processes develop, and fusions are formed
that deform the uterine cavity. In case of a caseous form, a pyometer may form when narrowing
the inner throat and joining a secondary infection . Endometrial tuberculosis in the stage of
sclerosis may be the cause of uterine form of amenorrhea.
Cervical tuberculosis occurs as a descending process with endometrial involvement . It
can be in productive or ulcerative form.
Ovarian tuberculosis occurs less frequently than previous forms. The process affects the
ovarian epithelium and the peritoneum nearby ( perioforitis ).
Diagnosis . Anamnesis:
 High index of infectious diseases transferred in childhood.
 contact with tuberculosis patients.
 the presence of residual specific changes or their effects in the lungs or other
organs.
 the occurrence of inflammatory processes in uterine appendages at puberty before
the onset of sexual life.
 primary amenorrhea in the presence of bilateral salpingoophoritis in a young
patient.
In bimanual study in productive form - increased additives, limited their mobility, pain
reaction; at microwave changes - poorly .
Subcutaneous administration of tuberculin (tuberculin test). A common reaction is
observed at all tuberculosis sites. Focal reaction - increased pain in the lower abdomen, pastosity,
pain in the appendix of the uterus, with a pronounced reaction - tension of the abdominal
muscles. The focal reaction lasts for 2 days.
Sowing of the genital tract on mycobacterium tuberculosis (at least 3 studies)
Hysterosalpingography : lengthening and extension of the cervical canal and
isthmus, synechia , deformation, partial or complete obliteration of the uterine cavity, rigidity of
the tubes, diverticulum-like extensions in the ampoule , non-homogeneous shadows in the distal
sections of the fallopian tubes. Radiographically in tuberculosis of the fallopian tubes -
inequality of the contours of closed and thickened in the ampoule department, rigidity, absence
of peristalsis, sharpness of contours; the presence of tendril-like
extensions, hydrosalpinx with diverticulum contours, calcification .
Laparoscopy : The tuberculous nature of the disease is revealed by the presence of
tubercles on the visceral peritoneum, which covers the appendages of the uterus, as well as foci
of encapsulated caseosis .
Diagnostic uterine scraping with histological and microbiological examination. Giant
cells ( Landghans cells , which are characteristic of the tuberculous process) are found in smears
among leukocytes, lymphocytes and erythrocytes .
The menstrual blood is taken three times during one period.
Bacterioscopic , bacteriological examination of the secretion of the cervix , ulcerative
surfaces, exudate after puncture of the posterior vault.
Radiographic examination of the lungs .
Sowing of urine on mycobacterium tuberculosis (urine is collected by a catheter).
Treatment (chemotherapy).
Group I drugs (most effective):
Rifampicin - daily dose of 10 mg / kg once a day 30 minutes before meals, for
intravenous administration, dissolve the ampoule of the drug in 2.5 ml of water for injection with
125 ml of 5% glucose, apply daily or 2-3 times a week; ftivazide - 0.5 2-3 times a day, after
meals; isoniazid - 0.3 - 2-3 times a day (10-15mg / kg).
Group II drugs (average efficacy ):
Ethambutol - 25 mg / kg, three times a day; ethionamide - in tablets of 0.25g 3 times a
day, in candles - 1.5g, intravenously 0.5-0.75g once a day; florimycin - dissolve in 3-4 ml of
0.25% novocaine and at a dose of 0.75-1 g intramuscularly 4-5 times a week; cycloserine - 0.25g
3-4 times a day inside.
Group III drugs (moderate activity):
PASC 0.2 g / kg per day, more often prescribed 3g 3-4 times a day. A 3% solution of
PASC is administered intravenously at a dose of 300-500 ml.
New multicomponent drugs with fixed doses of several major anti-tuberculosis drugs
have been created. These drugs are well tolerated when used properly. It is also important that
their use is convenient for patients and medical staff. These drugs include:
Rifater , riffin , tricot , isoside , tebesium .
Indications for surgical treatment:
1. Casual appendix lesions, piosalpinks , brewery
2. The presence of fistula
3. Active process in case of ineffective conservative therapy
4. Inactive process with significant scar and ligament changes that impair the
functions of the pelvic organs
5. Tuberculosis in combination with gynecological diseases
(tumors, endometriosis , etc.) requiring surgery.

Management of patients with tubuovarian tumors . Conducted antibacterial,

desensitizing, anti-inflammatory, detoxification, immunostimulatory therapy. The choice of
antibiotics is made according to generally accepted principles. Puncture punctures due to the
posterior arch of the vagina , suction of purulent contents and administration of the antibiotic
are preferred. Transvaginal drainage of abscess under ultrasound control can be performed . It
is possible to empty the abscess with laparoscopy , the pus aspirated , wash the cavity with
antiseptic and antibiotic.
Indications for surgical treatment of tubo-ovarian abscess:
1. no effect of complex treatment using puncture or laparoscopic drainage for 2-3 days
2. suspicion of abscess perforation.
 The volume of surgical intervention is solved individually and depends on the spread
of the process, the presence of comorbidities, the age of the woman.
Rehabilitation of women who have undergone inflammatory processes . There are
three levels of rehabilitation: the first - clinical recovery, disappearance of anatomical
changes, normalization of the blood picture; the second is the restoration of the endocrine
function of the reproductive system; the third is the restoration of adaptation-
protective mechanisms and reproductive function. According to the level of rehabilitation, it
is necessary to observe the stage and sequence of therapeutic measures . The basis of the
rehabilitation method of treatment in the period of stable remission should be based on the
principle of exposure to physical and non-drug factors, taking into account the peculiarities of
menstrual cyclical processes in the body.

V. Plan of organization of the class

Organizational moment 2% of study time
Motivation of the topic 3% of study time
Control of the initial level of knowledge 20% of study time
Independent work of students 35% of study time
Control of the final level of knowledge 20% of study time
Assessment of student's knowledge 15% of study time
Teacher generalization, homework, remarks 5% of study time

VI. The main stages of the lesson

The study room controls the initial level of knowledge of the material using tables and
models. The questions of general and special methods of examination of gynecological patients
are considered. According to the drawings, various methods of examination of gynecological
patients are studied. The phantom introduces students to the method of gynecological
examination.
Then the classes are held in the department, where students are divided into subgroups of
2-3, curated patients under the guidance of a teacher in the gynecological department.
In the second half of the class is determined the final level of learning the material by
solving situational problems.
1. Preparatory stage - motivation of the topic, control of the basic and basic level
of knowledge, assignment of the task for independent work.
2. The main stage is the independent work of students under the supervision of the
teacher: work with educational literature at a low level of basic knowledge, as well as with
textbooks. Curation of gynecological patients. Independent solution of situational tasks and
their preparation. Argumentation of the plan for conducting and examination of
gynecological patients.
3. The final stage is the control of the final level of knowledge, generalization,
evaluation of each student's work. Tasks home.

VII. Methodological support.

Venue classes - classrooms , women consult a tion, the separation of operational and
conservative gynecology, laboratory.
Equipment - tables, slides, models, tools.

VIII. Control questions and tasks

1. Frequency of inflammatory diseases of female genital organs. Classification.
2. The clinical meaning of the concept of normal microbiocenosis of a woman's
vagina.
3. Physiological protective mechanisms in the female genital system.
4. Ways of spreading the infection.
 5. Factors contributing to genital infection.
6. Vulvitis, vaginitis, endocervicitis.
7. Endometritis. Clinic. Diagnosis. Treatment.
8. Clinic and course of salpingoophoritis. Features of therapy.
9. Modern phased general principles of treatment of inflammatory diseases of
female genital organs.
10. Complications of inflammatory diseases of female genital organs. Features of
medical tactics.
11. Pelviopreitonitis.
12. The parameter.
13. Prevention of inflammatory processes of female genital organs.
14. Ethiopathogenesis, clinic, modern trichomoniasis therapy
15. Bacterial vaginosis. Modern views on etiology and diagnostics.
16. Clinic and principles of bacterial vaginosis treatment.
17. Vaginal candidiasis. Pathogens and pathogenesis of candidiasis.
18. Clinical forms of vulvitis and forms of candidiasis colpitis.
19. Modern principles of treatment of candidiasis
20. Chlamydia Clinic. Diagnosis. Treatment.
21. Gonorrhea. Ethiopathogenesis. Classifications. Clinic.
22. Diagnosis and modern therapy of gonorrhea.

Recommended Books
1. Golota V.Ya., Beniuk V.O. Women's counseling. - K. DrUk , 2003.
2. Golota V.Ya., Moskalenko LD, Dindar OA Operative obstetrics. K. Oranta, 2006.
3. Mikhailenko OT, Stepankivska GK Gynecology - K.: Health, 2000.
4. Smetnik VP, Tumilovich LG Non-surgical gynecology - St. Petersburg, 2001
5. Zaporozhan VM, Tsegelsky MR Obstetrics and Gynecology - K.: Health, 1996
6. Ministry of Health of Ukraine Order No. 582 of 15.12.2003 “On approval of
clinical protocols on obstetric and gynecological care”
7. Order of the Ministry of Health of Ukraine No. 286 of June 7, 2004 “Methods for
diagnosis, treatment and prevention of sexually transmitted infections”
8. Ministry of Health of Ukraine Order No. 582 of 15.12.2003 “On approval of
clinical protocols on obstetric and gynecological care”
9. Order of the Ministry of Health of Ukraine of 31.12.2004 “On approval of clinical
protocols on obstetric and gynecological care”
10. Article Patel R., Kennedy OJ, Clarke E. et al. (2017) European guidelines for the
management of genital herpes. Int . J. STD. AIDS, 28 (14): 1366-1379.
11. Article by Mendizabal JE, Bassam BA Gullian- Barre syndrome and cytomegalovirus
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