Belmo (synonym – leikoma) – the process of corneal clouding caused by its cicatricial changes.
Keratitis (viral, tuberculosis, etc.);
Injuries (injuries, chemical and thermal burns);
Congenital corneal opacities.
Signs of a catcher
The belt may occupy part or all of the cornea. The influence of the catcher on the sight depends
mainly on its location, size and intensity. Thus, when a cloud is formed as a result of improper
refraction of light rays, a distorted or indistinct image of objects appears. The corneal spot at its central location leads to a
significant decrease in visual acuity.
Actually, an eyesore, especially as a result of an
alkali burn, may be accompanied by a sharp decrease in visual acuity, up to the
preservation of only light perception.
When located around the periphery, the cataract
affects the visual acuity less than when localized in the center of the cornea
against the pupil.
The surface of the leprechaun, formed after the
ulcerative processes of the cornea or mechanical damage, is uneven, the cornea
in the area of the leprechaun is often thinned.
When an ulcer or a penetrating wound of the cornea as a result of subsequent scarring, the cornea is welded to the iris, which leads to the deformation of the pupil, the development of a secondary glaucoma .
Minor corneal opacities (clouds) do not require
Treatment of corneal spots and the actual cataract is
only operative. Corneal plasty is used, which allows, in
a significant number of cases, to restore vision even with dense extensive
Drug treatment is carried out only with residual inflammatory processes in
the cornea. The choice of drugs
depends on the cause of the disease; they prescribe, for example, anti-tuberculosis,
antiviral drugs, which in some cases leads to some enlightenment of the
The prognosis for surgical treatment is favorable. In case of thorny spot after severe chemical
and thermal burns, due to the development of possible complications, the
prognosis is doubtful.
Phenylketonuria is the most common metabolic disorder. On average, 1 in 8,000 people are
subject to phenylketonuria.
The basis of the disease is the lack of an enzyme that converts
phenylalanine into tyrosine (tyrosine prevents the deposition of fat, reduces
the level of appetite, improves the function of the pituitary, thyroid and
Symptoms of phenylketonuria
Phenylketonuria appears in the first year of life. The main symptoms at this age are:
lack of interest in the environment;
disorders of muscle tone (usually muscle
signs of atopic dermatitis;
there is a characteristic
“mouse” smell of urine.
At a later age, patients with phenylketonuria are characterized by delayed
psychoverbal development, microcephaly is often noted.
Phenylketonuria is characterized by the following phenotypic features:
hypopigmentation of the skin, hair, iris. In some patients, one of the manifestations of
pathology may be scleroderma .
Epileptic seizures occur in almost half of patients with phenylketonuria,
and in some cases may be the first sign of illness.
The diagnosis of suspected phenylketonuria is based on a combination of
genealogical data, results of clinical and biochemical examination:
possible related marriage of parents of
a sick child;
similar pathology in siblings or
siblings (brothers or sisters);
convulsions, muscle tone disorder;
eczematous skin changes;
hypopigmentation of hair, skin, iris;
a kind of “mouse” smell of
elevated blood phenylalanine level>
900 μmol / l;
the presence in the urine of
phenylpyruvic, phenyl milk, phenylacetic acid;
Felling positive test.
Currently, for the diagnosis of phenylketonuria, molecular genetic methods
for detecting a gene defect have been developed and introduced.
Diagnosis in newborns (screening)
Due to the high prevalence of phenylketonuria, the severity of clinical
manifestations and the real possibility of preventive treatment,
phenylketonuria was among the first hereditary metabolic disorders included in
the list of hereditary diseases recommended by the World Health Organization
for early detection among newborns.
For the early diagnosis of phenylketonuria in Russia, a mass examination of
children in maternity hospitals with the determination of the level of
phenylalanine in the blood is carried out.
Blood sampling is performed on newborns aged 4–5 days. Less commonly, the subject is urine.
The main treatment for phenylketonuria is diet therapy, which restricts the
intake of protein and phenylalanine.
The main criterion for the adequacy of the diet for phenylketonuria is the
level of phenylalanine in the blood, which should:
at an early age be 120–240 µmol / l;
in preschool children, do not exceed 360
µmol / l;
for schoolchildren – not to exceed 480
µmol / l;
in children of older school age, an increase
in blood phenylalanine up to 600 µmol / l is permissible.
The diet is built by sharply limiting
the supply of protein products of animal and vegetable origin and,
consequently, phenylalanine. To facilitate calculations, it is considered that 1 g of the conditional
protein contains 50 mg of phenylalanine.
In the treatment of phenylketonuria, products rich in protein and
phenylalanine are completely excluded: meat, fish, cheese, cottage cheese,
eggs, legumes, etc. The diet of patients includes vegetables, fruits, juices,
and special low protein foods – amylophenes.
For the correction of protein nutrition and replenishment of amino acid
deficiencies in phenylketonuria, special therapeutic products are prescribed:
protein hydrolysates: nofelan (Poland),
apone (USA), lofenolak (USA);
mixtures of L-amino acids, devoid of
phenylalanine, but containing all other essential amino acids: phenyl-free
(USA), tetrafen (Russia), P-AM universal (UK).
Despite the enrichment of amino acid mixtures and protein hydrolysates with
mineral and other substances, patients with phenylketonuria need additional
prescription of vitamins, in particular group B, mineral compounds, especially
those containing calcium and phosphorus, iron preparations and microelements.
In recent years, the need to use carnitine preparations (L-carnitine, elkar
in an average daily dose of 10–20 mg / kg mass for 1-2 months, 3-4 courses per
year) for the prevention of its insufficiency was justified for those suffering
In parallel, the treatment of phenylketonuria is carried out by medical
pathogenetic and symptomatic treatment with nootropic drugs, drugs that improve
vascular microcirculation, according to indications – anticonvulsants.
Therapeutic gymnastics, general massage, etc. are widely used.
Comprehensive rehabilitation of children with phenylketonuria provides special
methods of pedagogical influences in the process of preparing for school and
school education. Patients need the help
of a speech therapist, a teacher, in some cases a defectologist.
Great controversy raises the question of the duration of diet in the
treatment of phenylketonuria. Recently, most doctors have taken the point of view of the need for
continuous implementation of dietary recommendations. Examination of children who stopped
dieting at school age, and children who continued to receive diet therapy,
clearly showed a significantly higher level of intellectual development of the
In older patients with phenylketonuria, including adolescents, of course, a
gradual expansion of the diet is possible due to improved tolerance to
phenylalanine. Nutrition correction
is usually carried out by introducing into the diet a limited amount of
cereals, milk and some other natural products containing relatively moderate
amounts of phenylalanine. During the period of
expansion of the diet, the neuropsychological status of children is evaluated electroencephalogram , the level of phenylalanine in the blood.
At the age of over 18–20 years, a further expansion of the diet is carried
out; however, in the adult period, patients are advised not to use high-protein
products of animal origin.
Especially strictly suited to the diet of girls suffering from
phenylketonuria, and women in the reproductive period. This kind of patient with
phenylketonuria must continue dietary treatment to ensure the birth of healthy
In recent years, a method has been developed to reduce the level of
phenylalanine in the blood by taking a drug containing plant phenylalanine hydroxylase.
Down syndrome is a genetic abnormality
that is explained by the tripling of chromosome 21. If a person normally
has 23 pairs or 46 chromosomes, then with Down syndrome there is a triple
amount of the 21st chromosome instead of the two.
The disease was first described by
doctor John Down in 1866 and therefore named after the author.
Down syndrome is a fairly common
pathology, it is observed in one child among 700-800 births. It is impossible to
say who suffers most often from this genetic abnormality: boys or girls, the
percentage of sick children is the same in both cases.
Characteristic manifestations of Down
syndrome is a lag in mental and physical development (in particular, short
There are three forms of chromosomal
abnormalities in Down syndrome:
trisomy – occurs in 90% of cases. Trisomy is the presence of an additional 21st chromosome: instead of the two put
three. Occurs in violation of cell division in the process of development of the
egg or sperm. A similar phenomenon is observed in all human cells;
Mosaicism – only a part of the cells have an extra 21st chromosome, it looks like a
mosaic of normal and pathological cells. This defect is associated with impaired
cell division after conception. The frequency of the disease reaches 2-3%;
translocation – rearrangement of part of the chromosome in the 21st pair. That is, there are
only two chromosomes, as it should be, but only a section of one chromosome in
the 21st pair is attached to the other (extra shoulder). The frequency of
diagnosis is 4%.
To date, only two causes of Down
syndrome have been identified.
The first is the age of the mother, and
the older the woman becomes, the higher the risk of having a child with this
pathology (after 30 years it is 1: 1000, and after 42 years – 1:60). This is due to the
aging of the eggs: as you know, their number is laid during the period of the
formation of the fetus.
Another, more rare, cause is heredity
(Down syndrome by translocation type of the 21st pair of chromosomes). It becomes clear that
closely related marriages have a certain value, as well as the presence of a
relative with Down syndrome in the family. In addition, scientists note the
connection between the age of the grandmother, in which she gave birth to a
daughter, and the chance to get a grandson with Down syndrome. The older grandmother
was, the higher the risk of having a grandchild with this anomaly. The value of the
father’s age is also not denied (the risk factor is men over 45).
Diagnosis of Down Syndrome Risk
Diagnosis of Down syndrome is carried
out even during pregnancy, at the stage of gestation.
An important indication is the age of a
woman (30 years and older). In the first trimester spend Fetal ultrasound (in the period of
10-14 weeks) to determine the width of the neck and collar space (the norm is 2
mm) and the presence / absence of the nasal bone. These signs are not characteristic and
do not give a 100% guarantee of the disease. Then blood test for hCG level is
In the second trimester, for a period of
16–18 weeks, a triple test is conducted: determination of hCG, alpha- fetoprotein ( AFP ) and estriol . With reduced rates,
women are placed in a high-risk group and recommend invasive examination
choriontsentez (chorionic villus biopsy for about 13 weeks);
amniocentesis (analysis of amniotic fluid after 18 weeks, during the survey there is a
high risk of abortion and infection);
cordocentesis (fetal cord blood analysis, performed after 18 weeks).
After childbirth, the diagnosis is
established on the basis of characteristic clinical signs and karyotype
Symptoms in newborns
The doctor may suspect Down syndrome
immediately after the birth of the child on the basis of characteristic signs. However, an accurate
diagnosis is established after determining the karyotype (chromosome set).
“Dunyaty”, for the most part, have a
flat face with a Mongoloid cut of the eye and a skull of a shortened rounded
shape (brachycephaly). The presence of a vertical skin fold that covers the inner corner of the
eye (epicantus) is noted on the eyes.
There are increased mobility of the
joints and hypotonia, due to which the child’s mouth is ajar and the tongue is
The back of the head of children is
flattened, a shortened neck with a head of small size and vertically set ears
with adherent lobes, there are dental anomalies.
Over the age of 8 years, eye diseases often develop ( cataracts, glaucoma ). The nose of the “Downey” is also flattened, often takes place strabismus and a short nose.
On the palm there is one transverse fold,
and the little finger is shortened and curved.
Often these babies have congenital heart and digestive tract defects, symptomatic epilepsy and chest deformity.
Sick children can reach medium height,
but often their physical development is lagging due to impaired skeletal
All patients with this pathology have
mental retardation to one degree or another.
Down syndrome treatment
The treatment of Down syndrome is
lifelong, it consists not in getting rid of chromosomal pathology, but in the
treatment of associated diseases and malformations. For example, with
congenital heart defects, surgery is performed.
A group of various medical specialists
is involved in the treatment of “Down”: a pediatrician, a psychiatrist and a psychologist,
a cardiologist, a gastroenterologist, an endocrinologist, a speech therapist,
an optometrist, a dentist, and others.
Parents of children with Down syndrome
should understand and know that this anomaly is not a sentence, and, moreover,
no one is guilty of having such a child.
The main treatment is aimed at social
and family adaptation. With careful care and patience, children learn simple human skills (sit,
walk, talk). They can attend both general education and special schools (preferably both). In ordinary school, a
child learns to communicate with other children, develops and seeks to imitate
classmates in everything. Subsequently, these children can receive secondary vocational education. The main thing in the
care of a special child is the attention and love of parents.
To support the central nervous system,
“Downyatas” are prescribed drugs that improve blood circulation in the brain:
Complications and prognosis
Complications of Down syndrome include:
congenital heart defects;
early dementia ( Alzheimer’s disease );
respiratory arrest during sleep;
The life expectancy of people with this
pathology is low, about 49-50 years, but recently it has increased: even in the
twentieth century, such patients lived for about 25 years. They are able to
create families, but men cannot have children. As a rule, people with Down syndrome
receive secondary education and work.
Neurofibromatosis is a group of hereditary diseases with characteristic
changes on the skin, in the nervous system, often in combination with
abnormalities in other organs and systems.
Currently, there are 6 types of neurofibromatosis, of which the most
important are neurofibromatosis type I (Recklinghausen disease) and
neurofibromatosis type II (neurofibromatosis with bilateral neuromas of the
VIII pair of cranial nerves).
The disease is caused by a mutation of the “nf1” gene on the 17q
Men and women are affected equally often.
About half of the cases are due to new mutations. There is an assumption that the gene
“nf1” is included in the group of genes that suppress the growth of
tumors. The decrease or
absence of the protein neurofibromin, the production of which is controlled by
the nf1 gene, leads to cell degeneration.
Manifestations of neurofibromatosis type I
Diagnostic criteria (for the diagnosis, you must have at least two
6 or more spots on the skin of
“coffee with milk”, each in diameter more than 5 mm in a child and
more than 15 mm in an adult;
2 or more neurofibromas (any) or 1
enhanced color in the axillary and
optic nerve glioma;
2 or more Lisha nodules – colored iris
Pronounced bone abnormalities in the
form of dysplasia of the main bone, thinning of the cortical layer of long
bones with or without pseudoarthrosis;
The closest relative to the diagnosed
neurofibromatosis type I (mother, father, brother, sister, child).
In patients with type I neurofibromatosis, an increased risk of developing
malignant tumors is observed: neuroblastomas, gangliogliomas, sarcomas,
leukemias, Wilms tumors.
The peculiarity of the disease is the specific sequence of symptoms
depending on the patient’s age, which makes it difficult to diagnose type I
neurofibromatosis in early childhood. From birth or the first years of life, there may be
only some signs of neurofibromatosis type I (large pigment spots, plexiform
neurofibromas, skeletal lesions). Other symptoms may appear much later (by 5–15 years).
Neurofibromas are the most pronounced manifestation of Recklinghausen’s
disease, their number sometimes reaching several thousand; Plexiform neurofibromas can be gigantic,
weighing more than 10 kg. These cosmetic
defects, as a rule, most of all disturb patients. In addition, neurofibromas are associated with an
increased risk of transformation into a malignant tumor. When placed in the chest, in the
abdominal cavity, in the orbit, they lead to dysfunction of the adjacent
From time to time, the number and size of neurofibromas in response to
various stimuli, among which the leading place is occupied by: hormonal changes
in the body, adolescence, pregnancy period or after childbirth, as well as
trauma or serious illness. Very often, surgical interventions, certain cosmetic procedures,
physiotherapeutic procedures (for example, massage, warming) contribute to the
growth of neurofibromas. But often the disease
progresses against the background of apparent well-being.
Manifestations of neurofibromatosis type
bilateral neuromas of the VIII pair of
cranial nerves (according to tomography)
the closest relative with diagnosed
neurofibromatosis type II (mother, father, brother, sister, child), in
unilateral neuroma of the eighth pair of
2 signs from listed below:
glioma (astrocytoma, ependymoma)
schwannoma (incl. spinal)
juvenile posterior subcapsular cataract .
Concomitant manifestations of type II neurofibromatosis (but not diagnostic
criteria): epileptic seizures, skin manifestations (“coffee with milk” spots,
skin neurofibromas), multiple spinal tumors (ependymoma, schwannoma,
Treatment of neurofibromatosis
The Central Healthcare Institute of the
Ministry of Health of the Russian Federation proposed the following treatment
regimen for neurofibromatosis type I: ketotifen is prescribed in 2-4 mg short
courses for two months. To avoid
complications, in the first two weeks of taking the drug, it is recommended to
use phencarol in parallel, 10–25 mg three times a day.
As a drug that reduces the rate of cell division, tigazon is used in a dose
of at least 1 mg per kilogram of body weight or aevit to 600,000 IU, taking
into account tolerability. Also courses use lidaza (mucopolysaccharidase) at a dose of 32–64 U,
depending on the age intramuscularly, every other day, for a course of 30
Cystic fibrosis is a genetic disease caused by a mutation of the gene for
the transmembrane regulator of cystic fibrosis.
It is characterized by a violation of the secretion of the excretory glands
of vital organs, with primarily affection of the respiratory and
gastrointestinal tract, severe course and unfavorable prognosis.
First allocated in 1936 by the Viennese pediatrician Guido Fanconi .
Symptoms of cystic fibrosis
Common signs of cystic fibrosis:
physical development lag,
recurrent chronic respiratory diseases,
persistent current chronic sinusitis,
Manifestations of cystic fibrosis are associated with a defect in protein
synthesis, which acts as a chloride channel, which is involved in the
water-electrolyte metabolism of the cells of the respiratory tract,
gastrointestinal tract, pancreas, liver, reproductive system. As a result, the secret of most glands
of external secretion thickens, its secretion becomes difficult, changes occur
in the organs, the most serious – in the bronchopulmonary system.
In the walls of the bronchial tree, chronic inflammation of varying severity develops, the connective tissue framework is destroyed, bronchioles form and bronchiectasis. In conditions of constant obstruction by viscous sputum, bronchiectasis becomes common, hypoxia increases, pulmonary hypertension develops and the so-called “pulmonary heart”.
Bronchopulmonary changes predominate in the picture of the disease and
determine the prognosis in 95% of patients.
1/3 of the patients have a prolapse of the rectum, but with the appointment
of an adequate dose of modern digestive enzymes, this complication passes on
its own within 1.5–2 months.
In patients of school age, the first manifestations of cystic fibrosis can be “intestinal colic”, which cause bloating, repeated vomiting, constipation .
After the appointment of enzymes intestinal manifestations are relegated to the background, giving way to the pulmonary. Chronic usually develops gradually bronchitis. Already in the neonatal period and infancy there is a cough, asthma attacks, shortness of breath, and sometimes vomiting. Periodically there is a painful strong cough, especially at night. The mucus is viscous, sometimes purulent.
Since all organs containing mucus-forming glands are affected, colitis syndrome is typical, chronic cholecystitis, sinusitis.
Sweat test: ionophoresis with
pilocarpine. An increase in
chlorides of more than 60 mmol / l is a probable diagnosis; chloride concentration> 100 mmol / l
– reliable diagnosis. At the same time, the
difference in the concentration of chlorine and sodium should not exceed 8–10
mmol / l. A test for final
diagnosis should be positive at least three times. Sweat test is necessary for every child
with a chronic cough.
Chymotrypsin in the stool: the sample is
not standardized – standard values are developed in a specific laboratory.
Determination of fatty acids in the
stool: normally less than 20 mmol / day. Limit values are 20–25 mmol / day. The sample is positive while reducing
the function of the pancreas by at least 75%.
DNA diagnostics is the most sensitive
and specific. False results are
obtained in 0.5–3% of cases. In Russia, relatively expensive.
Prenatal DNA diagnostics: study of small
intestinal alkaline phosphatase isoenzymes from amniotic fluid is possible from
18–20 weeks of gestation. False positive and
false negative values are obtained in 4% of cases.
Cystic fibrosis treatment
Treatment of cystic fibrosis requires an integrated approach. Once again it should be emphasized that
it should be held in specialized centers and under their control. Visits to the doctor should occur at
least once every 3 months.
Anthropometric data, respiratory function, general blood and urine tests
are evaluated. analysis of feces , analysis of sputum for flora and its
sensitivity to antibiotics. According to the indications, chest x-rays, echography of the liver and heart are performed, and the immune status
First of all, a correction is made in the treatment and rehabilitation
regime. It is necessary to
effectively clean the bronchial tree from viscous sputum, fight infection and
ensure good physical development of the patient.
Kinesitherapy includes positional
drainage, klopf- massage, vibration, special breathing
exercises, active breathing cycles, forced respiratory techniques, autogenic
It is necessary to use bronchodilators , mucolytics , if possible – amiloride (sodium blocker) and / or “ pulmozyme ” (DNA-ase).
With the defeat of the lungs – the frequent use of antibiotics. They should be prescribed for early
signs of inflammation with a course of up to 2-3 weeks.
Mucolytics (drugs that dilute
sputum) – an essential attribute of the treatment of cystic fibrosis. They are prescribed both orally and by
inhalation: N-acetylcysteine 300–1200 mg / day. Bronchoscopic administration of mucolytics with subsequent suction of secretions and antibiotics
at the end of the bronchial lavageprocedure is an effective way of
endoscopic drug administration.
In cases of bronchospastic syndrome – inhalation of beta-mimetics, as well
as corticosteroids (in inhalation) in order to reduce inflammation in the
lungs, nonsteroidal anti-inflammatory drugs.
These drugs reduce the inflammatory reactions of the bronchial tree, which sometimes do more harm than the infectious agent itself. From this point of view, the use of alpha- antitrypsin, a serum leukocyte protease inhibitor, is justified .
, a serum leukocyte protease inhibitor, is justified .
In the countries of North America and in Europe, a lung transplant or heart-lung complex is being transplanted, and genetically engineered approaches are being developed to correct the function of the mutant gene by using pneumotropic viruses with genetic structures embedded in them. In 1998, a program of gene therapy for cystic fibrosis was started.
With the defeat of the pancreas, constant enzyme therapy is necessary.
Pancreatin, mezim- forte, panzitrat , creon are effective (incrementally). The dose is individual. Usually start with 2-6 thousand units. lipase per kg mass / day. Increase gradually, based on the characteristics of the chair, the child’s weight indicators. Excess doses lead to irritation of the intestinal mucosa, inflammation.
Good effect in liver damage (cholestasis, pre-cirrhosis, cirrhosis ) provides the appointment of ursosan in combination with taurine, which promotes the removal of bile acids, which facilitate the digestion of fats.
Nutrition should exceed the age caloric norms by 10–15%, the introduction
of multivitamins and trace elements is mandatory. Protein diet without fat restriction, but with
adequate replacement therapy with modern enzymes. Weight loss or a flat weight curve indicates poor
enzyme support or an exacerbation of the chronic bronchopulmonary process.
Bacteriological examination of sputum with an antibiotic or a pharyngeal smear once in 6 months and after an
exacerbation of the bronchopulmonary process or when the color of the sputum
changes (green, blood).
The study of glycolized hemoglobin – in children over 8 years old 1-2 times a year. With impaired glucose tolerance – more often.
Radiography of the chest organs to do with exacerbation of the bronchopulmonary process, especially if you suspect pneumonia. As control – once a year.
An echocardiogram (especially of the right sections, the pulmonary artery)
at least once a year.
ECG: 1-2 times a year, according to indications – more often.
Functional tests of the lungs: the function of external respiration
(usually from 6 years) and blood gases – 1 time per month and after the
exacerbation of the bronchopulmonary process.
Body plethysmography : from 8 years old –
1–2 times a year, according to indications – more often.
If liver cirrhosis is suspected – ultrasound, liver function, prothrombin, less often – a biopsy.
Complications of cystic fibrosis and their therapy
Polypas nose. Steroids inhalation or in the form of ointment applications. Surgical treatment is impractical (the probability of recurrence is high).
Pneumothorax. Develops in older children and adults. The likelihood of recurrence is high. Rest is necessary, with a volume of less than 10% of pulmonary – a minimum of manipulation. With intense pneumothorax – drainage, pleural puncture.
Atelectasis. Are required bronchoscopy with bronchoalveolar lavage and the introduction of mucolytics , antibiotics, breathing exercises.
Pneumonia. General principles of therapy. Draining activities are extremely important.
Hemoptysis. It looks like an admixture of blood to sputum, most often due to lesions of the bronchial mucosa. In case of pulmonary hemorrhage (300 ml and more simultaneously or more than 100 ml in 3 days) – angiographic embolization or occlusion of a bleeding vessel. In case of failure – vessel ligation or resection of a segment (lobe).
Pulmonary heart. With adequate therapy, it develops only in adults. They also characterized by heart rhythm disturbances. Preferably the use of corinfar , nifedipine .
Aspergillosis. Associated with hormone therapy. If aspergillas are found in the sputum by chance and do not manifest clinically, then treatment is not required. Therapy is prescribed for common bronchiectasis , enlargement of the bronchi, increase in pulmonary symptoms, especially with signs of torpid obstruction, increase in total immunoglobulin E ( IgE total ) and specific immunoglobulin E.
Allergy and asthma . In 25–48% of patients a combination of cystic fibrosis and asthma is observed.
Solefacial dehydration. It can be not only in newborns, but also in children of different ages and in adults, especially in the hot season. Prevention – drink plenty of fluids and sufficient intake of salts (3–8 g / day).
Diabetes. It develops very slowly, gradually. It is observed in 2% of children and in 15% of adults with cystic fibrosis.
Gastric and bleeding from esophageal varicose veins (in case of liver cirrhosis). Endoscopic sclerotherapy is performed. varicose veins, partial resection of the spleen, shunting operations.
Gallbladder stones .
Partial intestinal obstruction with thick, viscous stools. In case of occlusion that does not require surgery, washing with gastrographin , gipakom , N-acetylcysteine. In the absence of effect – surgical intervention.
Pneumatosis intestinal walls can be detected randomly and by themselves do not require intervention.
Rectal prolapse with adequate enzyme replacement therapy is very rare.
Pulmonary osteoarthropathy. Along with the deformations of the terminal phalanges, pain may appear in the long tubular bones. To alleviate the condition, nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac, etc.) are prescribed.
Chest deformities develop as a result of lung damage.
Patients with good physical development have a better prognosis for cystic
fibrosis. They are more active,
better tolerate exercise, have better indicators of respiratory function and
Trichomoniasis (trichomoniasis) is an infectious disease of the urogenital
system, which is caused by trichomonas vaginalis.
Some authors attribute trichomoniasis to venereal diseases, although the
disease is not included in the list of sexually transmitted diseases.
The prevalence of trichomoniasis is quite wide, annually about 170 million
people are infected with it (only data from the people examined are taken into
account). According to WHO statistics, trichomoniasis affects up to 10% of
the population in developed countries, and in developing countries up to 40%.
In World , the following classification of trichomoniasis is adopted:
fresh trichomoniasis: acute, subacute
and torpid (low symptom) forms;
chronic trichomoniasis (disease duration
2 months or more or not installed);
trichomonadal carriage (absence of
symptoms when trichomonads are detected in the vagina or in sperm).
The causative agent of urogenital trichomoniasis is trichomonas vaginalis,
which belongs to the simplest single-celled organisms. In the human body
live still mouth and intestinal Trichomonas, but trichomoniasis causes only
vaginal. Trichomonas are not stable in the external environment and die
quickly when they are dried, but it is possible to maintain their activity in a
wet sphere (linen, washcloths, towels).
Trichomoniasis is transmitted through sexual intercourse, although
non-sexual infection is also not excluded: a vertical transmission route of the
pathogen during childbirth, when the fetus passes through an infected birth
canal. Domestic route of transmission of Trichomonas vaginalis is
currently subject to doubt. Many authors argue that infection through
towels, swimsuits, etc. is possible.
It is known that trichomoniasis is often combined with other sexually transmitted infections ( gonorrhea , mycoplasmosis , chlamydia ), which is explained by the ability of protozoa to phagocytosis (ingestion of pathogens of other infections). Also established the role of Trichomonas in the spread of HIV infection.
Factors contributing to the development of urogenital trichomoniasis:
bacterial contamination of the vagina,
accompanied by a change in its acidity;
menstruation and postmenstrual period.
Symptoms of trichomoniasis
Manifestations in women
In acute and subacute forms of trichomoniasis, women complain of copious,
frothy leucorrhoea with an unpleasant odor, itching and burning sensation in
the region of the external genital organs. Bleach can be yellowish or
When extending the process to the urethra, there are signs of urethritis (pain and burning during
Perhaps the appearance of aching pain in the lower abdomen (with the defeat
of the uterus and appendages). Also characterized by pain during
In severe itching, sleep disturbance is noted.
During gynecological speculum examination reveals an abundance of foamy,
leucorrhoea puruloid that covers the vaginal wall and accumulate in the
posterior fornix, and redness and edema of the mucosa of the vagina and cervix
( cervicitis ). A characteristic
colposcopic symptom of cervicitis is the so-called “strawberry
cerviks” – multiple point hemorrhages on the mucous membrane of the
vaginal part of the cervix.
Symptoms of the chronic form
Chronic trichomoniasis is characterized by the duration and recurrence of
The occurrence of relapses contribute to violations of personal hygiene,
reduced endocrine function of the ovaries, chronic diseases.
In chronic trichomoniasis, patients complain of leucorrhoea, sometimes
itching. Signs of the inflammatory process are little pronounced.
Trichomoniasis in men
In men, the effects of trichomoniasis are insignificant or absent
All symptoms of the disease are associated with urethritis (pain and
itching during urination and sexual intercourse, pain in the urethra, heavy
discharge from the urethra, and frequent urination).
Recognition of trichomoniasis contributes to history (urethritis in her
husband, the duration of the disease, relapses, etc.) and data from an
From laboratory diagnostic methods used:
microscopic examination of native smears
from the vagina, urethra and cervix (reliable only with rapid microscopy of
microscopic examination of stained Gram
culture method (seeding mucus and
urethra contents on nutrient media, but requires 4 to 7 days);
PCR (polymerase chain reaction) –
isolation of Trichomonas DNA from a detachable urethra or vagina (very
Differential diagnosis of trichomoniasis is carried out with such diseases
as: bacterial vaginosis, nonspecific colpitis, chemical and allergic colpitis.
The treatment of trichomoniasis in women is carried out by a gynecologist
and venereologist, in men a venereologist and urologist. The duration of
treatment is 7-14 days.
Therapy of the disease is carried out with drugs of the 5-nitroimidazole
group (metronidazole, trichopol, tergynan, flagel, tinizadol, and others).
The doctor determines the dose and duration of treatment depending on the
duration of the disease, the severity of the symptoms and the accompanying
Metronidazole and other protivotrihomonadny drugs are prescribed both in
the local form, and for oral administration. Topical treatment in the form
of creams, ointments and suppositories that are inserted into the vagina or
they lubricate the urethra in men (Klion-D, terginan, betadine).
Treatment of trichomoniasis in pregnant women with an imidazole group is
prescribed only from the second trimester (penetrate through the
placenta). Treatment with other antitrihomonadny means (trichomonocide,
trichocide in candles) is possible, but they are less effective.
After the main therapy, the intestinal microflora and vagina are restored
by eubiotics (lactobacterin, bifidumbacterin).
It is important to remember that during the treatment period alcohol intake
and sex life are completely excluded.
The control of cure is carried out after 10 days of taking drugs of the
type metronidazole, and then within three months after menstruation (preferably
Complications and prognosis
Complications of trichomoniasis in women:
adnexitis and endometritis ;
cystitis and pyelonephritis;
fetal fetal death;
premature labor and miscarriages ;
low birth weight.
Complications in men:
prostatitis, vesiculitis, orchitis;
cystitis and pyelonephritis .
The prognosis for timely and quality treatment of trichomoniasis is
Syphilis is a chronic disease and belongs to venereal diseases. The
former name of syphilis is lues (“French”, Gallic disease).
Syphilis affects all organs and systems, starting with the skin and mucous
membranes and ending with internal organs, joints, bones, nervous and
cardiovascular systems (depending on the stage of the disease).
Despite the successful treatment of sexually transmitted diseases and the active education of the population in our time, the incidence of syphilis in World continues to grow in comparison with the XX century. Both men and women as well as a child can get it. Especially dangerous is considered to be a congenital form of the disease.
Among venereologists adopted the following classification:
primary seronegative syphilis;
primary seropositive syphilis;
secondary fresh syphilis;
secondary latent syphilis;
secondary recurrent syphilis;
tertiary active syphilis;
tertiary latent syphilis;
early congenital syphilis;
late congenital syphilis;
latent congenital syphilis;
syphilis of the nervous system.
Syphilis is caused by treponema pallidum, which lives only 3 minutes in the
external environment. Therefore, the main mode of transmission of the
disease is sexual. Infection of the fetus is possible intrauterine
(vertical path) or intranatally, when the child passes through the birth canal
of the mother.
Domestic transmission is rare, infection is possible from people with the
tertiary stage of syphilis, when the pale treponema falls on dishes, linens,
towels, etc. from disintegrating gum. Transmission of syphilis by
hematogenous by blood transfusion is not excluded.
It is not uncommon and cases of infection of medical professionals in
contact with the blood of the patient. Infection is possible through
“bloody” objects: a common toothbrush, a razor, a manicure set, and more.
Risk group for syphilis:
promiscuous sex workers;
hemophilia patients ;
people who prefer group sex;
antisocial elements of society;
patients with gonorrhea .
Symptoms of syphilis in men and women
The average incubation period for syphilis is 3-6 weeks. It can be
shortened to 8–15 days (with one-stage infection from two sources, for example,
sexually and through household) and can be extended to 108–190 days with antibiotic
therapy after infection.
The primary signs of the disease manifest themselves in the form of a
so-called hard chancre, which occurs in the damaged area of the skin or
mucous membrane upon contact with the pathogen.
Hard chancre is a deep, painless (characteristic symptom) ulcer without
bleeding, bordered by even, slightly elevated surfaces. The ulcer has a
flat bottom and regular rounded shape. Its sizes are various, from 1 to 4
mm, it is not soldered to surrounding fabrics and dense to the touch.
In women, hard chancre can be localized:
on the clitoris;
on the posterior commissure of the
between the big and small sexual lips;
on the walls of the vagina;
on the crotch;
near the anus;
and even on the cervix.
In men, it is formed:
on the penis, usually in the foreskin or
near / inside the urethra;
in the anal area;
in the rectum (in homosexuals).
It is possible to place a hard chancre in the mouth region (tongue), on the
lips and in the throat (with oral-genital contacts).
There is also an atypical course of primary syphilis:
indurative (stagnant) edema, occurs on
the genitals: the clitoris or scrotum, is accompanied by a bluish color, the
holes remain after pressing;
chancre-felon (arises on the nail
phalanges of the hand and looks like the usual felon , the hallmark is soreness);
chancre-amygdale (an increase in the
tonsil on one side with characteristic pain when swallowing).
A primary period of 6–8 weeks continues until a rash
appears. Approximately one week after the onset of hard chancre, regional
lymph nodes (inguinal or submandibular) are enlarged.
Primary syphilis goes through 2 stages: seropositive and
seronegative. Serological reactions (Wasserman reaction, ELISA) are
negative in the seronegative period, they become positive 3-4 weeks after the
appearance of a hard chancre.
Since the appearance of the characteristic rash on the skin and mucous
membranes in the form of pale pink spots (Venus necklace) or multiple petechiae
(hemorrhages), secondary syphilis begins.
The rash is localized mainly on the chest and back, but it is also possible
to spread it throughout the body. The emergence of a rash is due to
penetration of the pathogen from the affected regional lymph nodes in the blood
vessels and its spread throughout the body.
Swollen lymph nodes is generalized, they are dense, painless and cold to
the touch, not soldered to the surrounding tissues.
At this stage, patients note:
temperature increase to subfebrile numbers (within 37-38 ° C);
classic cold symptoms (cough, runny nose) and / or conjunctivitis.
Rashes in 1-2 weeks fade and disappear. A hidden secondary period
begins. With the weakening of the body’s defenses, the rash returns again
(recurrent secondary syphilis), and this happens repeatedly, with each
subsequent relapse, its elements increase in size and merge.
The hematogenous treponema “journey” in the body involves the internal organs in the pathological process: syphilitic forms of diseases such as meningitis, gastritis, hepatitis, myocarditis and others develop.
This period is characterized by focal or diffuse alopecia (hair loss on the
head, eyelashes, eyebrows).
Secondary syphilis is accompanied by:
periodic temperature rises;
Often there is syphilitic tonsillitis (sore throat, hoarseness).
Without treatment, secondary syphilis lasts 1-2 years.
In the absence of treatment of secondary syphilis, the disease passes into
the tertiary stage, which lasts for years, up to 10-20 years.
In this case, the patient on the skin, mucous membranes, internal organs
and bones form hillocks-gumma, which eventually disintegrate and disfigure a
person (failed nose, hillocks on the skull, etc.).
The most dangerous manifestation of tertiary syphilis is the defeat of the
spinal cord and brain with the development of dementia, spinal marrow
(staggering gait), syphilitic meningitis.
Pathology concerns all internal organs and systems: syphilitic endarteritis
and aortitis develops, optic nerve atrophy with a progressive decline in
vision, syphilitic endocarditis occurs with valvular lesions, bones and so on are
Serological reactions to the tertiary stage of syphilis are either negative
or weakly positive.
This period is considered a late late syphilis, and patients become
infectious to others only through household items.
Household syphilis is characterized by the fact that the disease is not
transmitted sexually, but through household items, during surgical procedures,
blood transfusion or breastfeeding by a woman, first a sick child, and then a
Hard chancre occurs in everyday syphilis not on the genitals, but in the
places of contact of the damaged skin and mucous membrane with an infected
object (in the mouth, on the face, on the fingers, etc.).
Secondary household syphilis proceeds in the same way as normal.
early latent syphilis (from the period
of primary syphilis to the recurrence of a rash with a secondary one), which
lasts about 2 years;
late latent syphilis (tertiary syphilis
with damage to internal organs) with an infection duration of more than 2
Hidden syphilis is either asymptomatic, or without obvious signs: hard
chancre in the reach of the eye or slightly stained and almost imperceptible
rash. The latent syphilis comes to light only at delivery of analyzes
during physical examination.
Syphilis during pregnancy
Inspection of syphilis during pregnancy is carried out three times to all
women (at the first appearance in the antenatal clinic, in the period of 28-30
and 38-40 weeks).
Infection can occur both before and during pregnancy. Regardless of
the time and duration of the process, all pregnant women with syphilis are
Therapy is no different from standard regimens: penicillin antibiotics are
prescribed (they are safe during pregnancy). If syphilis is detected in
the first 12 weeks, it is not necessary to terminate the pregnancy, especially
if it is desired.
Untreated syphilis can lead to the following complications:
spontaneous abortion in the first
premature birth ;
death of the newborn in the first days
or hours after birth;
infection of the newborn when passing
through the birth canal;
Congenital syphilis is characterized by the birth of a child with wrinkled
yellowish-gray skin with a typical rash (syphilitic pemphigus ), with a lesion of the musculoskeletal
system, an enlarged liver and spleen, anemia, and various malformations. Later, after reaching 2 and more years old,
other signs develop:
bone damage (saber tibia);
dental problems (Getchinson’s teeth);
impaired vision and hearing;
Primary syphilis must be distinguished from cervical erosion (in women), genital herpes , trichomonas ulcerations, and soft chancre. Secondary syphilis has similar symptoms
with toxicoderma, a rash with other infectious diseases ( measles , scarlet fever , rubella ), genital warts , alopecia , psoriasis and fungal infections of the
skin. Therefore, differential diagnosis is
From laboratory methods using serological reactions (blood from a vein):
Wasserman reaction (RW);
the reaction of immobilization of pale
enzyme-linked immunosorbent assay
Microscopy of smears taken from a hard chancre or rash elements is also performed.
To confirm the diagnosis, it is necessary to conduct 2 different
Treatment of syphilis in men and women
Syphilis treatment is carried out only in the hospital by venereologist.
The duration of treatment for primary syphilis is on average 10-15 days,
secondary and latent tertiary syphilis – 20-28 days.
Prevention of congenital syphilis (if a woman has been ill and treated in
the first trimester of pregnancy) is carried out from 16 weeks. Early
congenital syphilis is treated with penicillins for two weeks, late congenital
syphilis – for 28 days.
Preventive treatment (for persons who have been in contact with a patient,
but who have not yet been infected) is treated with bicillin twice a week.
All patients with syphilis should be aware of criminal liability in case of
intentional infection of a partner, and must also provide all information about
persons with whom they have had sex. In case of refusal of treatment, the
patient is forcibly (if necessary with the help of the police) hospitalized in
Control tests after the treatment of primary, secondary, early latent and
congenital syphilis pass after 1, 3, 6, 12, 24 months. After late latent
and tertiary syphilis therapy, monitoring is needed after 12 and 24 months.
Complications and prognosis
To the terrible complications of syphilis include damage to the central
Development is also possible:
IHD ( stenocardia and myocardial infarction );
hepatitis, up to hepatic coma and death.
In primary syphilis in men, the occurrence is not excluded:
gangrene of the penis.
The prognosis depends on the stage of the process, the effectiveness of
treatment and the presence or absence of damage to the internal organs, nervous
system and bones.
In primary and early secondary syphilis, the prognosis is
favorable. The following stages lead to the disability of the patient and
the occurrence of his aesthetic defects.
With congenital syphilis, the prognosis is favorable, provided that there
is adequate early treatment.
Gonorrhea is an infectious and highly contagious disease in which the
mucous membranes of the urogenital tract are affected, but infection of the
oropharynx or rectum is also possible. Both men and women suffer from this
It causes gonorrhea gonococcus (Neisseria gonorrhoeae), so named after the
physician-researcher Albert Neisser. The disease is transmitted only from
a sick person to a person.
The main route of transmission of gonorrhea is sexual (genital), but
infection with anogenital and oral contact is possible.
In addition, the vertical pathway of infection is known – during childbirth
the child is infected, passing through the birth canal of the sick mother.
The household transmission path is not excluded, but its reliability has not been established, since the pathogen is unstable in the external environment.
There are genital and extragenital (not sexual) gonorrhea. Genital
gonorrhea is characterized by lesions of the urinary organs.
The group of extragenital gonorrhea includes:
gonorrhea anorectal localization
(inflammation of the rectum),
gonorrhea of the bone and muscular
systems (gonorrheal arthritis),
gonorrheal damage to the conjunctiva of
the eye (gonoblina),
gonorrheal defeat of the pharynx
The course of the disease is divided into fresh, chronic and latent
Fresh gonorrhea is said when infection occurred less than 2 months
ago. Fresh gonorrhea is divided into acute, subacute and torpid (there are
no complaints, but there are insignificant secretions).
If the infection occurred more than 2 months ago, chronic gonorrhea is
Latent or latent gonorrhea has no clinical manifestations.
Symptoms of gonorrhea in women and men
The first signs of the disease appear 2–14 days after infection (incubation
period). But in some circumstances (for example, treatment with
antibiotics, the presence of good immunity) the first manifestations of the
disease occur in 1-2 months.
Gonorrhea in men
The disease in men begins with the defeat of the urethra. Patients
complain of discomfort (burning and itching) that occurs during
urination. Also urination becomes painful.
If you press on the head of the penis there is a drop of pus. With the
involvement of the posterior part of the urethra, urination becomes more
After intercourse, a bloody drop may occur.
On examination, hyperemia (redness) of the foreskin and penis head is
The inguinal lymph nodes are often inflamed, they grow and become painful.
In the case of an ascending infection, gonorrhea spreads to the prostate
gland, affects the seminal vesicles and testicles. At the same time, fever
may occur, aching pain in the lower abdomen and erection problems occur.
Gonorrhea in women
More than half of the infected women have gonorrhea without marked clinical
At the very beginning of the disease, the urethra, vagina and cervix are
involved in the process. Inflammation of the urethra occurs with
pronounced signs: there are pale yellow discharge from the urethra, a feeling
of itching and burning in this area, urination becomes painful.
When gonorrheal vaginitis and cervicitis from the genital tract, purulent,
greenish leucorrhoea with an unpleasant odor, sometimes a curd consistency , are secreted . There is also a burning sensation
and itching, soreness during intercourse.
In case of irritation with infected secretions of the vulva, it becomes inflamed, red and swollen, and an itchy perineum joins.
When viewed in the mirrors marked hyperemia (redness) of the cervix and
purulent discharge from the cervical canal.
If the infection rises higher, the uterus and its appendages are affected.
Gonorrhea in women must be differentiated from other sexually transmitted
infections ( trichomoniasis , candidiasis , bacterial vaginosis ).
In men, with urethritis and prostatitis of another infectious or non-infectious etiology.
The diagnosis of gonorrhea is established on the basis of the
characteristic complaints of the patient and the typical clinical signs
established during the examination.
But to confirm the disease it is necessary to conduct laboratory tests:
For taking smears, material is taken from the urethra, the cervical canal,
the vagina and the anus. Before this, the doctor treats the listed
anatomical structures with a swab dipped in saline. Before taking the
test, it is necessary to refrain from urinating and stop taking antibacterial
drugs for 4-5 days. All strokes are taken in duplicate. The first
batch of smears is stained with methylene blue, and the second according to
The essence of the cultural (bacteriological) method consists in planting
secretions from the urogenital tract organs on nutrient media. The
conclusion is given after 7 days, but gives a 100% result. In
addition, this method allows to determine the sensitivity of the planted gonococci
Immune fluorescence response
The method consists in painting smears with special dyes, after which the
gonococci glow under a microscope.
Linked immunosorbent assay
The essence of the method consists in identifying antibodies to the pathogen,
and for the analysis are taken not swabs, but urine.
Polymerase Chain Reaction (PCR)
For PCR, you can use smears from the anatomical structures of the urinary
tract and urine. The method is effective, but expensive.
If chronic gonorrhea is diagnosed (repeated and ineffective treatment,
negative results of bacterioscopic and bacteriological analyzes), provocative
tests are carried out, after which the pathogen is detected on the mucous
There are chemical, biological, thermal, nutritional and physiological
provocations. For the most accurate result, a combined provocation is
carried out (simultaneous carrying out of two or more samples). Smears
after provocation are taken in a day, two and three.
Gonorrhea is usually treated by a dermatovenereologist. But in some
cases (for example, complicated gonorrhea), the gynecologist deals with the
treatment of the disease in women and the urologist in men.
Uncomplicated gonorrhea is treated on an outpatient basis, all other cases are
hospitalized. Treatment is indicated to both sexual partners, regardless
of the results of the tests. For the period of therapy, it is necessary to
observe sexual rest, the rules of personal hygiene (compulsory hand washing
after using the toilet and taking a shower), and refusing spicy food and
Etiotropic treatment (elimination of the cause of the disease) consists in
getting rid of gonococci and consists in prescribing antibacterial drugs.
The course of treatment lasts 7, maximum 10 days. It is advisable to
combine the treatment with antibiotics that are active against chlamydia and ureaplasma (since gonorrhea often occurs on their
Chronic gonorrhea is treated much longer.
At first, gonovaccine is administered by courses of 6-8-10 intramuscular
injections and drugs that stimulate nonspecific immunity (pyrogenal,
ribonuclease) and only after that antibiotic therapy is given.
Control tests are taken after the end of treatment and monthly for three
Consequences and prognosis
Running gonorrhea is dangerous by the development of complications.
endometritis , adnexitis ;
obstruction of the fallopian tubes and infertility in women;
bartholinitis in women;
pelvioperitonitis and tubo-ovarian abscess (in women);
inflammation of the testes and seminal
violation of spermatogenesis;
The prognosis for the timely treatment of fresh gonorrhea is favorable,
with chronic gonorrhea, both in men and women, is relatively favorable.
Genital or genital herpes refers to viral
diseases. This disease is one of the most common among sexually
transmitted infections. Almost 99% of the world’s population is believed
to be infected with the herpes simplex virus. This disease occurs equally
in both women and men.
Depending on the clinical manifestations of genital
herpes can be:
primary infection, that is, signs of herpes appeared
for the first time;
recurrent infection, that is, the clinical picture of
the disease is repeated more than once;
asymptomatic, that is, a person does not suffer from
herpes, but is a virus carrier.
Genital herpes by the characteristics of the
symptoms is divided into typical and atypical.
The disease usually goes through 3 stages:
Stage 1 – external genital organs are affected;
Stage 2 – affected vagina, cervix, urethra in men and
Stage 3 – the internal organs are involved in the
pathological process: in women, the uterus, appendages, bladder, in men, the
prostate gland and bladder.
The causative agent of the disease is herpes simplex
virus (HSV), which is divided into type 1 HSV and type 2 HSV. As a rule,
genital herpes causes a 2nd type of virus.
The disease is transmitted only sexually, household
path is excluded. The spread of infection is promoted by all types of
sexual contacts, both traditional sexual, anogenital and oral-genital. Therefore,
infection with oral-genital contacts with a carrier partner of HSV type 1 is
possible, especially if there are clinical manifestations of herpes in the lips
and mouth cavity.
Predisposing factors for infection with the herpes simplex virus include:
promiscuous sex life;
rejection of condoms;
the use of intrauterine devices;
artificial abortion with curettage of the uterus;
infection with other infections, both sexually and
Symptoms of genital herpes
The period from infection with HSV to the onset of
clinical signs can last from 3 to 26 days. Symptoms of genital herpes in
men and women are generally similar.
As a rule, the external genital organs are involved in
the pathological process: in men, the bubbles are located on the head of the
penis, on the foreskin, along the entire length of the penis, in the groin and
scrotum; in women, vesicles are localized on the pubis, labia, in the area
of the buttocks and thighs. During homosexual contacts in men, the
buttocks and the anus are affected.
First, vesicles are formed against the background of
reddish and edematous skin and mucous membrane at the site of
infection. Their appearance is preceded by itching and burning. The
size of the bubbles reaches 2-3 mm, sometimes they form a spot, the area
of which takes 0.5-2.5 cm. At this stage of the disease, vesicles do not last
long, after 3 days they burst, and ulcers appear in their place. Sometimes
they are covered with a bloom of yellow and then a crust. These wounds
heal within 2, maximum 4 weeks, without scarring.
Patients of both sexes may experience symptoms such
heaviness in the abdomen;
an increase in the inguinal lymph nodes;
If the urethra and the bladder are involved in the
process, then signs of dysuria and the appearance of blood in the urine are
For atypical forms of genital herpes, the erased or
abortive (short) course of the disease is characteristic. This affects not
only the external genitalia, but also internal: the uterus, appendages,
prostate, seminal vesicles. Most often, patients complain of persistent
itching and burning, women have leucorrhoea, which is not amenable to
treatment. At the same time, vesicles and edema may be absent on the
genitals, only red (hyperemic) spots are visible.
Genital herpes and pregnancy
Especially dangerous is infection with genital herpes
or relapse of the disease in the first and last trimesters of
pregnancy. Infection can cause spontaneous miscarriage , missed abortion, premature birth or the birth of
a child with developmental abnormalities. In addition, when passing
through the birth canal of a woman with obvious clinical signs of infection,
infection with the virus and the baby is possible, which can lead to his
Therefore, pregnant women with an atypical form of
infection during the last 6 months are examined (mucus from the cervical canal)
for the presence of HSV antigen. If it is found, a planned cesarean
section is performed.
First and foremost, differential diagnosis aims to
distinguish between genital herpes and primary syphilis. Also, the disease should be distinguished from pemphigus, recurrent thrush, lichen planus and
The diagnosis is established on the basis of
anamnesis, characteristic complaints and clinical signs. In addition,
additional laboratory research methods are used to detect HSV or its antibodies
in the blood.
To identify the HSV DNA, material is collected from
several sites: the cervix, urethra, etc. The analysis also includes a
discharge of the prostate, urine, and so on. It is then sown on biological
media to detect the virus, or the presence of the HSV antigen is determined
using a polymerase chain reaction. Laboratory tests of blood are used to
detect antibodies of class M and G: analysis of fluorescent antibodies and
Treatment of genital herpes
The treatment of genital herpes is engaged in a
In order to eliminate the virus (remove it from the
blood), alleviate the clinical manifestations and reduce the frequency of
relapses, antiviral drugs are used in tablets and injections (systemic
therapy), as well as in ointments, creams and gels.
The most commonly prescribed antiviral is zovirax
(acyclovir). It is prescribed including during pregnancy.
No less effective are:
The duration of treatment depends on the form of the
disease and clinical manifestations and is usually 1 – 1.5 months. Six
months later, a second course.
In addition, the first stage of therapy includes the
appointment of immunomodulatory drugs:
interferon and its analogs: viferon, genferon;
interferon inducers, for example: lavomax, cycloferon,
antiherpetic immunoglobulin, taktivin and others.
In the second stage of the disease, antiviral drugs
are applied topically against the background of the administration of vitamins
B1 and B6, autohemotherapy and the use of fortifying agents (tinctures of
ginseng, eleutherococcus, echinacea).
The third stage of treatment is to conduct vaccine
herpetic vaccine. And after the recurrence of the disease should take at
least 2 months.
Consequences and prognosis
The most dangerous genital herpes during pregnancy,
possible complications were considered by us above.
Genital herpes is also likely to:
secondary infection of ulcers with the
development of creeping phlegmon;
acute urinary retention;
synechiae in the region of the genital lips
(their fusion of varying degrees);
infertility in both men and women (with
affection of the internal genital organs);
sexual problems are not excluded.
It is impossible to get rid of genital herpes, treatment
is aimed at reducing the frequency of relapses and preventing complications, so
the prognosis for the disease is relatively favorable.