Belmo

The reasons

Signs of a catcher

Treatment

Forecast

Belmo (synonym – leikoma) – the process of corneal clouding caused by its cicatricial changes.

The reasons

  • Keratitis (viral, tuberculosis, etc.);
  • Injuries (injuries, chemical and thermal burns);
  • Eye surgery;
  • 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 .

Treatment

Minor corneal opacities (clouds) do not require treatment.

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 opacities.

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 leucorrhoea.

Forecast

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

Symptoms of phenylketonuria

Diagnostics

Phenylketonuria treatment

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 adrenal glands).

Symptoms of phenylketonuria

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Phenylketonuria appears in the first year of life. The main symptoms at this age are:

  • lethargy child;
  • lack of interest in the environment;
  • sometimes irritability;
  • anxiety;
  • regurgitation;
  • disorders of muscle tone (usually muscle hypotonia);
  • convulsions;
  • 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.

Diagnostics

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 urine;
  • 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.

Phenylketonuria treatment

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 from phenylketonuria.

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 latter.

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 offspring.

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

Kinds

The reasons

Diagnosis of Down Syndrome Risk

Symptoms in newborns

Down syndrome treatment

Complications and prognosis

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 stature).

Kinds

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%.

The reasons

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 performed.

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 methods:

  • 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 determination.

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 extended.

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 development.

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:

  • Cerebrolysin ;
  • piracetam ;
  • B vitamins;
  • aminolone .

Complications and prognosis

Complications of Down syndrome include:

  • congenital heart defects;
  • infectious diseases;
  • leukemia;
  • early dementia ( Alzheimer’s disease );
  • respiratory arrest during sleep;
  • obesity.

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

The reasons

Manifestations

Treatment of neurofibromatosis

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 reasons

The disease is caused by a mutation of the “nf1” gene on the 17q chromosome.

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

Manifestations of neurofibromatosis type I

Diagnostic criteria (for the diagnosis, you must have at least two criteria):

  • 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 plexiform neurofibroma;
  • enhanced color in the axillary and inguinal areas;
  • optic nerve glioma;
  • 2 or more Lisha nodules – colored iris hamartomas;
  • 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 organs.

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 II

Diagnostic criteria:

  • bilateral neuromas of the VIII pair of cranial nerves (according to tomography)

OR:

  • the closest relative with diagnosed neurofibromatosis type II (mother, father, brother, sister, child), in combination with:
  • unilateral neuroma of the eighth pair of cranial nerves

OR:

2 signs from listed below:

  • neurofibroma
  • meningioma
  • 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, meningioma).

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 injections

Cystic fibrosis

Symptoms of cystic fibrosis

Diagnostics

Cystic fibrosis treatment

Complications of cystic fibrosis and their therapy

Forecast

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,
  • nasal polyps,
  • persistent current chronic sinusitis,
  • chronic bronchitis,
  • recurrent   pancreatitis,
  • respiratory failure.

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.

Diagnostics

  • 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 is examined.

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 drainage.

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.

Forecast

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 immunity.

Trichomoniasis

Kinds

The reasons

Symptoms of trichomoniasis

Diagnostics

Trichomoniasis treatment

Complications and prognosis

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%.

Kinds

We post beautiful pictures. Because Life is Beautiful.

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 reasons

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:

  • endocrine disorders;
  • metabolic disorders;
  • hypovitaminosis;
  • bacterial contamination of the vagina, accompanied by a change in its acidity;
  • menstruation and postmenstrual period.

Symptoms of trichomoniasis

Manifestations in women

Acute form

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 greenish.

When extending the process to the urethra, there are signs of urethritis (pain and burning during urination).  

Perhaps the appearance of aching pain in the lower abdomen (with the defeat of the uterus and appendages). Also characterized by pain during intercourse.

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 disease.

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 (trichomoniasis).

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).

Diagnostics

Recognition of trichomoniasis contributes to history (urethritis in her husband, the duration of the disease, relapses, etc.) and data from an objective examination.

From laboratory diagnostic methods used:

  • microscopic examination of native smears from the vagina, urethra and cervix (reliable only with rapid microscopy of fresh smears);
  • microscopic examination of stained Gram smears;
  • 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 expensive analysis).

Differential diagnosis of trichomoniasis is carried out with such diseases as: bacterial vaginosis, nonspecific colpitis, chemical and allergic colpitis.

Trichomoniasis treatment

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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 pathology.

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 with provocation).

Complications and prognosis

Complications of trichomoniasis in women:

  • adnexitis and endometritis ;  
  • cystitis and pyelonephritis; 
  • infertility;
  • fetal fetal death;
  • premature labor and miscarriages ;  
  • low birth weight.

Complications in men:

  • prostatitis, vesiculitis, orchitis; 
  • infertility;
  • cystitis and pyelonephritis . 

The prognosis for timely and quality treatment of trichomoniasis is favorable.

Syphilis

Kinds

The reasons

Symptoms of syphilis in men and women

Hidden syphilis

Syphilis during pregnancy

Diagnostics

Treatment of syphilis in men and women

Complications and prognosis

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.

Kinds

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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;
  • visceral syphilis;
  • syphilis of the nervous system.

The reasons

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:

  • prostitutes;
  • promiscuous sex workers;
  • homosexuals;
  • drug addicts;
  • hemophilia patients ; 
  • people who prefer group sex;
  • antisocial elements of society;
  • patients with gonorrhea . 

Symptoms of syphilis in men and women

Incubation period

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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.

Primary syphilis

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 labia;
  • 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.

Secondary syphilis

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:

  • malaise;
  • 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;
  • weakness;
  • bone pains;
  • headache;
  • visual impairment.

Often there is syphilitic tonsillitis (sore throat, hoarseness).  

Without treatment, secondary syphilis lasts 1-2 years.

Tertiary syphilis

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 destroyed.  

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

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 healthy one.

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.

Hidden syphilis

Separately worth noting hidden syphilis. Allocate:

  • 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 years.

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 treated.

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 trimester;
  • premature birth ;
  • fetal death;
  • death of the newborn in the first days or hours after birth;
  • infection of the newborn when passing through the birth canal;
  • congenital syphilis.

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;
  • mental retardation.

Diagnostics

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 important.           

From laboratory methods using serological reactions (blood from a vein):

  • Wasserman reaction (RW);
  • precipitation microreaction;
  • immunofluorescence (REEF);
  • the reaction of immobilization of pale treponem (RIBT);
  • enzyme-linked immunosorbent assay (ELISA);

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 serological reactions.

Treatment of syphilis in men and women

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Syphilis treatment is carried out only in the hospital by venereologist.

For this purpose, use antibiotics:

  • penicillin (bicillin, benzylpenicillin, procaine):
  • erythromycin series (sumamed);
  • tetracycline;
  • oxacillin;
  • doxycycline;
  • ceftriaxone.

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 a hospital.

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 nervous system:

  • meningitis;
  • hydrocephalus;
  • neuritis;
  • deafness;
  • blindness;
  • stroke.

Development is also possible:

  • osteoarthritis;
  • IHD ( stenocardia and myocardial infarction );  
  • syphilitic pneumonia; 
  • gastritis;
  • hepatitis, up to hepatic coma and death.

In primary syphilis in men, the occurrence is not excluded:

  • balanitis;
  • balanoposthitis;
  • phimosis;
  • 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.

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With congenital syphilis, the prognosis is favorable, provided that there is adequate early treatment.

Gonorrhea

The reasons

Kinds

Symptoms of gonorrhea in women and men

Diagnostics

Gonorrhea treatment

Consequences and prognosis

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 disease.

The reasons

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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.

Kinds

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 (gonococcal pharyngitis).

The course of the disease is divided into fresh, chronic and latent gonorrhea.

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 diagnosed.

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 frequent.

After intercourse, a bloody drop may occur.

On examination, hyperemia (redness) of the foreskin and penis head is noticeable.

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 manifestations.

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.

Diagnostics

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:

Smear microscopy

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 Gram.

Cultural method

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 to antibiotics.

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 membranes.

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 treatment

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 alcohol.

Acute gonorrhea

Etiotropic treatment (elimination of the cause of the disease) consists in getting rid of gonococci and consists in prescribing antibacterial drugs.

With fresh gonorrhea are appointed.

  • fluoroquinolone antibiotics (ciprofloxacin, abactal, ofloxacin),
  • cephalosporins (ceftriaxone, cefixime),
  • macrolides (azithromycin, josamycin),
  • tetracyclines (unidox).

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 background).    

Chronic form

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 months.

Consequences and prognosis

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Running gonorrhea is dangerous by the development of complications.

Among women:

  • endometritis , adnexitis ; 
  • obstruction of the fallopian tubes and infertility in women;
  • bartholinitis in women; 
  • pelvioperitonitis and tubo-ovarian abscess (in women);
  • ectopic pregnancy.

In men

  • prostatitis ;
  • inflammation of the testes and seminal vesicles;
  • violation of spermatogenesis;
  • impotence;
  • male infertility

The prognosis for the timely treatment of fresh gonorrhea is favorable, with chronic gonorrhea, both in men and women, is relatively favorable. 

Genital herpes

Kinds

The reasons

Symptoms of genital herpes

Genital herpes and pregnancy

Diagnostics

Treatment of genital herpes

Consequences and prognosis

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.

Kinds

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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 women;
  • 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 reasons

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;
  • homosexual contact;
  • rejection of condoms;
  • reduced immunity;
  • hypovitaminosis;
  • the use of intrauterine devices;
  • artificial abortion with curettage of the uterus;
  • constant stress;
  • overwork;
  • hypothermia;
  • infection with other infections, both sexually and common;
  • climate change.

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 as:

  • heaviness in the abdomen;
  • an increase in the inguinal lymph nodes;
  • malaise;
  • temperature rise;
  • headache.

If the urethra and the bladder are involved in the process, then signs of dysuria and the appearance of blood in the urine are expressed.

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 death.   

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.

Diagnostics

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 staphylococcal impetigo.      

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 immunoperoxidase method.

Treatment of genital herpes

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The treatment of genital herpes is engaged in a dermatovenerologist.

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:

  •  foscarnet (pyrophosphate analogue);
  •  valacyclovir;
  •  alpizarin;
  •  panavir

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.

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