Infections

Video: Normal vaginal discharge. Inflammation of the vagina.

Treatment of various infections in gynecology is the "bread" of modern commercial gynecology. In my practice, I simply use American and European standards of treatment and diagnostics - and, oddly enough, there is an effect. In this publication, I would like to simply and briefly talk about what and how is diagnosed and how in most cases it is treated.

Before clarifying this issue, I would like to dispel a few myths:

  • there is no diagnosis of "gardnerellosis" - now this condition is called "bacterial vaginosis"
  • there are no "treatment programs - chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis, gardnerellosis, etc." 17-30 thousand per disease
  • human papillomavirus type 16.18 - does not mean that you will definitely have cervical cancer
  • the regimen for the treatment of infections cannot include 5-7-10 drugs

Let's figure it out!

So, according to WHO (World Health Organization), there are only 5 sexually transmitted infections:

  • Syphilis
  • Gonorrhea
  • Chlamydia
  • Trichomoniasis
  • HIV

Other pathogens, such as herpes and human papillomavirus, are associated with diseases that are predominantly sexually transmitted.

For such pathogens as: ureaplasma and mycoplasma - so far there has not been a place, we will talk about them below.

The causative agents of infections are specific (all of the above) and non-specific (intestinal flora, skin)

Further, inflammatory diseases of the female genital organs are divided into:

  • Vulvovaginitis (inflammation of the vagina and external genitalia)
  • Cervicitis (inflammation of the cervix)
  • Inflammatory diseases of the pelvic organs (PID) these include: endometritis (inflammation of the mucous membrane of the uterus), salpingitis (inflammation of the tubes), salpingo-oophoritis (inflammation of the tubes and ovaries). Endomiometritis (inflammation of the mucous and muscular membrane of the uterus) panmetritis (inflammation of the entire uterus) and as a complication pelvic peritonitis (inflammation of the pelvic peritoneum)

Now let's figure out what vaginitis is - that is, if you have bad vaginal discharge, then this (with the exception of rare cases) can be:

  • Trichomoniasis
  • Bacterial vaginosis (in other words, violation of the flora)
  • Vulvovaginal candidiasis (thrush)

Rarely:

  • Atrophic vaginitis (in older women due to hormone deficiency)
  • Chemical or allergic (irritation)

And that's it!!! More world medicine does not classify anything. Only these reasons (I repeat, with the exception of rare cases) can lead to inflammation of the vagina.

However, discharge from the genital tract may be due to inflammation of the cervix and pelvic organs.

Inflammation of the cervix is ​​most often caused by:

  • Gonococci (causative agents of gonorrhea)
  • Chlamydia (causative agents of chlamydia)

Human papillomaviruses and others can cause inflammation of the cervix, but with somewhat different manifestations.

With inflammation of the pelvic organs, there may also be discharge from the genital tract, but there will be other symptoms.

To summarize:
If you have unusual discharge from the genital tract, then it can only be: bacterial vaginosis, trichomoniasis, vulvovaginal candidiasis (thrush), gonorrhea, chlamydia, or manifestations of pelvic inflammatory disease. Rare conditions are not considered.

Now about diagnostic methods ... (most of all deceptions are here)

In normal gynecological practice, only 4 methods for diagnosing infections are needed.

  • Bacterioscopy of a smear (this is a regular smear for flora)
  • Bacteriological seeding (at the same time, the resulting material is sown on special media and sensitivity to antibiotics is determined)
  • PCR - (polymerase chain reaction method) - allows you to determine the DNA of the pathogen
  • Serological methods - allow, by the specific reaction of the body to an infection, to confirm its presence, determine the stage (acute, chronic)
  • Everything, this arsenal is quite enough to diagnose all the necessary infections.

    Now more about each method.

    Bacterioscopy smear

    This method only shows:

    • The presence or absence of inflammation (by the number of leukocytes) - ATTENTION! a lot of leukocytes in the absence of inflammation may be the result of getting into a blood smear.
    • Diagnose the following diseases (gonorrhea, trichomoniasis, thrush, bacterial vaginosis)
    • Detect non-specific flora (in case of inflammation caused by non-specific microorganisms)
    • Describe the state of the normal flora of the vagina

    Thus, with a regular smear, you should make or exclude the following diagnoses:

    • Gonorrhea
    • Bacterial vaginosis (although there are 4 criteria for making this diagnosis in clinical practice, the characteristic color of the discharge, the fishy smell and the presence of key cells in the smear are sufficient)
    • Vulvovaginal candidiasis (thrush)
    • Suspect the presence of an inflammatory process in the pelvic organs (leukocytosis, nonspecific flora)
    • Trichomoniasis (difficult diagnosis: flagella fall off in a dried smear of trichomonads and they become indistinguishable from macrophages (ordinary blood cells), so the diagnosis can not be made, see about trichomoniasis below)

    Bacteriological culture

    This method allows you to determine the composition of the flora and the amount of the pathogen (that is, a lot of it or a little), and in addition, to establish which antibiotics it is most sensitive to.

    Tank culture is most often taken from the vagina, cervical canal and uterine cavity.

    When it is advisable to take a tank. sowing:

    • If a smear contains many leukocytes and nonspecific flora
    • In an infertility treatment program or before a planned pregnancy (culture is taken from the cervical canal and uterine cavity)
    • If ureaplasma is detected in PCR (inoculation is carried out on a special medium)
    • In the treatment of all types of PID

    In general, this is all, there are no more common indications. It is not advisable to prescribe tank seeding in other cases, or just like that.

    PCR

    This is the most common diagnostic method at the moment and it is with it that most of the confusion is associated.

    This diagnostic method allows you to determine the DNA of the pathogen, that is, when using this method, we answer only one question - if the material contains at least a few specific fragments of the microorganism.

    What this means is that a positive result can be even if there are very few microorganisms and if the microorganism has already died (but the DNA remains).

    When this matters - if the control after treatment is carried out too early (dead microorganisms remain) - it can be decided that the treatment was not effective. In another case, make a diagnosis, despite the fact that the causative agent of the disease is extremely small (this matters when it comes to the need for treatment of ureaplasmosis).

    What infections does it make sense to diagnose using PCR:

    • Chlamydia (they are not detected in a smear)
    • human papillomavirus
    • herpes simplex virus
    • Cytomegalovirus (important mainly before or during a planned pregnancy)
    • Ureaplasma (Parva only, T960 - no)
    • Mycoplasma?

    Everything, other pathogens are diagnosed in a regular smear or do not matter at all. And there is no point in determining by PCR (gonorrhea, bacterial vaginosis or thrush) It is extremely rare, in controversial cases it is possible, but it is extremely inappropriate for everyone. Therefore, when you are offered to take a PCR test for 10-15, then 20 pathogens - remember - this is not advisable !!!

    Serological methods

    When using this method, it is determined whether there has ever been or whether there is currently an organism in contact with a specific pathogen. This evaluates the number of special blood proteins (immunoglobulins), which are of several classes. As a rule, three classes are defined M, G and A. What does the presence of each of these classes of immunoglobulins indicate?

    • Immunoglobulins of class M (IgM) - appear in the blood first, immediately after contact of the body with the pathogen, they gradually increase, and then disappear. That is, the presence of IgM indicates that the disease is in an acute stage and is taking place in your body at the moment.
    • Class G immunoglobulins (IgG) - in fact, reflect the memory of the immune system about contact with the pathogen - this means that their presence indicates that you once had this disease, the disease has passed the acute phase (IgM has already disappeared). That you have been vaccinated or have immunity to this pathogen. RV casinos that players are looking for every day. So whether you love playing the best online slots for fun or are looking for some serious real money online slots, we have everything you need, including the best welcome bonuses and other great promotions. Fast payouts and secure banking on your account. computer or on the go via mobile phone, 24/7 customer support and much more!
    • Immunoglobulin class A (IgA) - this immunoglobulin is mainly responsible for providing local mucosal immunity, but its soluble form is important in increasing its titer in the blood in the diagnosis of chlamydia.

    The titers (concentrations) of the immunoglobulins described above are different and these indicators can be interpreted in different ways. It happens that the titer of immunoglobulin is doubtful and it is difficult to draw a conclusion from such an analysis.

    So, using the serological method, you can determine:

    • the presence of an acute stage of the disease (presence of IgM)
    • the presence of immunity to a specific pathogen (presence of Ig G; for example, rubella, hepatitis, etc.)
    • establish the fact of a recent illness (high IgG levels)
    • the fact of carriage (for example, for herpes - the presence of IgG)

    Now let's see how it works in practice - the most common cases.

    Vulvovaginal candidiasis (thrush)

    Simitomas: itching, white cheesy discharge
    Analyzes: an examination and a general smear are enough
    Treatment: usually 1-2 doses of fluconazole are enough (150 mg each - diflucan, diflanzon, etc.) or suppositories - the range is large. Nothing extra is required.

    Bacterial vaginosis
    Symptoms: white creamy discharge, fishy smell
    Analyzes: an examination and a general smear are sufficient (gardnerella and key cells are in smears), PCR and other studies are redundant.
    Treatment: 2 options: trichopol (metronidazole) or ornidazole (ornidazole) 500 mg 2 times a day after meals or suppositories dalacin (clindamycin) - 3-5 days. Everything.

    Trichomoniasis

    Symptoms: watery frothy discharge from the genital tract
    Analyzes: examination, smear (often not found in a smear), PCR (may not show), there is a reliable method - to look at a smear immediately after taking it in drops, but almost no one does it.
    Treatment: only two drugs: metronidazole (Trichopol) and ornidazole (Tiberal) - are taken equally at 500 mg twice a day after meals - 5 days. In 90% of cases this is enough.

    Trichomoniasis - video version:

    Gonorrhea

    Symptoms: greenish-yellowish discharge, may just be cloudy
    Analyzes: examination, smear, PCR can be supplemented
    Treatment: usually 1-2 injections are sufficient (for example, Rocephin 1 g intramuscularly 1 time per day for 2 days)
    Usually, gonorrhea is combined with chlamydia and / or trichomoniasis, so Trichopolum or Tiberal is added to the treatment for 5 days and PCR is taken for chlamydia - if chlamydia is detected, the treatment is supplemented.

    Chlamydia

    Symptoms: Usually no symptoms, or just a more profuse discoloration
    Analyzes: PCR, can be supplemented with a blood test for IgG and Ig A to chlamydia
    Treatment: several options: azithromycin (Sumamed) 1 gr. on the 1st-3rd-7th and 14th day of treatment once; Wilprofen (jozomycin) 1 t 2 times a day for 10-14 days (or 1 tab. 3 times a day for 10 days) - many different schemes. There are other regimens with other antibiotics, but they are used less often. Important - no immunomodulators, enzymes, etc.

    Herpes

    Symptoms: painful blisters that burst and form erosions in their place.
    Analyzes: examination, PCR, blood for IgG and Ig M to herpes.
    Treatment: acyclovir, valtrex - regimens and doses are different
    Important: a few days before the appearance of bubbles and after complete healing, you can infect your partner with herpes.

    A few words about ureaplasmas and mycoplasmas. First, a little overview.

    Ureaplasmas and mycoplasmas

    Video: Ureaplasma

    The role of these pathogens in gynecological and urological practice is rather ambiguous. It so happened that in our country, with the advent of PCR diagnostics, these pathogens became on a par with sexually transmitted infections, and the most diverse schemes for their treatment began to be developed.

    At the same time, the attitude of the West to these pathogens remained calm.

    Until now, in America and European countries, routine screening of patients for the presence of these pathogens is not carried out. The detection of ureaplasmas and mycoplasmas is recognized as laborious, and is mainly carried out in scientifically oriented laboratories. Nevertheless, there is attention to these pathogens in the West.

    Ureplasmas and mycoplasmas are considered commensals (live normally) in the genital tracts of both men and women. According to various sources, ureaplasma is detected in more than 60% of sexually active women.

    Much attention is paid to ureaplasma infection in relation to its role in obstetric pathology. Separate studies show the importance of this pathogen in the formation of such conditions as: chorionamnionitis, premature rupture of membranes, premature birth, fetal malnutrition. It is important to note that ureplama in all these cases was detected in the amniotic fluid and not in the cervical canal.

    The role of ureplasma infection was revealed in the formation of pneumonia in newborns and chronic lung diseases, regardless of the type of delivery. This pathogen is detected in the trachea of ​​newborns, to a greater extent in those born before 34 weeks. So in newborns weighing less than 2500 gr. ureplasma will be excreted in 34% of cases.

    At the same time, in full-term children, ureaplasma lung infection is a rarity. In particular, this is due to the fact that the frequency of ureplasmic chorionamnianitis (inflammation of the amniotic membranes) is higher up to 32 weeks. The presence of chorionamnionitis affects the transplacental passage of immunoglobulins, which leads to a higher infection rate in premature newborns.

    You have noticed that I do not use immunomodulators and other drugs in any treatment regimen.

    It is no secret that Western medicine does not use immunomodulators in the treatment of inflammatory diseases. All immunomodulating and immunostimulating drugs presented on our market are exclusively of domestic production. None of these drugs have passed clinical trials according to the GCP format, and it is this research format, accepted throughout the world, that provides evidence of the effectiveness of drugs and determines the full range of possible side effects. The design of such studies is very complex and the requirements for drugs are high. Such studies are usually international, multicentre and placebo-controlled.

    The very idea of ​​​​an immunomodulator is not bad, however, it is implemented too primitively. "Spurring" the immune system in order to activate the natural mechanisms of fighting infection - this is how the main task of these drugs is regulated. However, the immune system is much more complex than it first appears.

    When an irritating factor is introduced into the body, no one knows what state the immune system is in. Activation of a nonspecific response to an irritant should theoretically improve the therapeutic effect of antibacterial drugs by transferring the entire immune system to an activated position.

    But the problem is that it is not possible to study to what extent the immune system is activated in each individual patient, how long this response lasts, what mechanisms are activated in parallel. How quickly this system is depleted and what the opposite effect of this "emergency boost" will be.

    It can easily be assumed that the rapid clinical effect of such doping may be reversed by a higher frequency of relapses of the disease due to the depletion of the immune system. In addition, activation of autoimmune processes is possible, and the most unpleasant thing is delayed effects - the risk of developing malignant diseases of the immune system.

    Although all of the listed possible consequences of treatment will never happen, but the peculiarity of introducing a drug to the market requires its long-term study and proof of its safety. This has not been done for immunomodulators. Drugs jumped to the market too quickly, and the system for recording the side effects of drugs practically does not work in our country. That is why we still do not know what percentage of complications that have already occurred.

    Thus, I would like to once again turn to common sense and ordinary logic. In our country, we have all the drugs that the Western public uses to treat their patients, without the use of immunomodulators and other aids, and their patients are cured. So why take the risk and try out preparations that do not have reliable safety certificates recognized all over the world.

    Necessary and unnecessary analyzes (video)


    Things to know (Q&A)

    What is infectious inflammation?

    Inflammation is a process by which your body's white blood cells and the things they make protect you from infection from outside invaders, such as bacteria and viruse

    What are the 5 signs of inflammation due to infection?

    Five cardinal signs characterize this response: pain, heat, redness, swelling, and loss of function . Not all five cardinal signs are present in every case of inflammatio

    What is difference between infection and inflammation?

    Infection refers to the invasion and multiplication of bacteria or viruses within the body, while inflammation is the body's protective response against infection

    What infection causes inflammation?

    Some factors and infections that can lead to acute inflammation include: acute bronchitis , appendicitis and other illnesses ending in “-itis” an ingrown toenail. a sore throat from a cold or flu.
    ...
    Acute inflammation

    • exposure to a substance, such as a bee sting or dust.
    • an injury.
    • an infection.

    What causes inflammatory infections?

    Several things can cause chronic inflammation, including: untreated causes of acute inflammation , like an infection or injury. an autoimmune disorder, which involves your immune system mistakenly attacking healthy tissue. long-term exposure to irritants, like industrial chemicals or polluted air.

    What is the difference between inflammatory and infectious?

    You may hear the words infection and inflammation together, but they mean very different things. Infection refers to the invasion and multiplication of bacteria or viruses within the body, while inflammation is the body's protective response against infection

    Can there be inflammation without infection?

    An inflammatory response can also occur when the immune system goes into action without an injury or infection to fight. Since there's nothing to heal, the immune system cells that normally protect us begin to destroy healthy arteries, organs and joint

    How is inflammation related to infection?

    When inflammation happens, chemicals from your body's white blood cells enter your blood or tissues to protect your body from invaders. This raises the blood flow to the area of injury or infection. It can cause redness and warmth

    What are the 5 classic signs of inflammation?

    The Five Cardinal Signs of Inflammation: Calor, Dolor, Rubor, Tumor … and Penuria (Apologies to Aulus Cornelius Celsus, De medicina, c.

    What are the signs of inflammation caused by an infection?

    Symptoms of inflammation include: Redness . A swollen joint that may be warm to the touch . Joint pain .
    ...
    Inflammation may also cause flu-like symptoms including:

    • Fever.
    • Chills.
    • Fatigue/loss of energy.
    • Headaches.
    • Loss of appetite.
    • Muscle stiffness.

    What is the main cause of inflammation in the body?

    Possible Causes

    The most common reasons for chronic inflammation include: Autoimmune disorders , such as lupus, where your body attacks healthy tissue. Exposure to toxins, like pollution or industrial chemicals. Untreated acute inflammation, such as from an infection or injury.

    What infections cause chronic inflammation?

    Chronic inflammation can result from the following: Failure of eliminating the agent causing an acute inflammation such as infectious organisms including Mycobacterium tuberculosis , protozoa, fungi, and other parasites that can resist host defenses and remain in the tissue for an extended period.

    What are inflammatory infections?

    Inflammation disease is when the immune system attacks the body's own tissues , resulting in inflammation. Rheumatoid arthritis is an example of an inflammatory disease.