Latent urogenital infections. Urogenital infections: a bouquet of unpleasant surprises. Diagnosis of urogenital infections in girls

For citation: Serov V.N., Baranov I.I. Treatment of urogenital infections in women in modern conditions // BC. 2004. No. 8. S. 564

At rogenital infections are common diseases in both outpatient and inpatient obstetric and gynecological practice. The causative agents of these infections are a wide range of different microorganisms. , and there are significant differences in etiology depending on the involvement of various parts of the genitourinary system. In particular, typical bacteria predominate in the etiology of cystitis and pyelonephritis: Escherichia coli and other enterobacteria, staphylococci, enterococci. At the same time, with infection of the vagina and cervical canal, the role of atypical microorganisms with predominantly intracellular localization increases, which, as a rule, are sexually transmitted: Chlamydia trachomatis, Mycoplasma spp., Ureaplasma urealyticum. Also of some importance Neisseria gonorrhoeae.

Urogenital infections have been known to man since time immemorial. At least, Hippocrates wrote about a disease very reminiscent of gonorrhea as early as the 5th century BC. e., and already in the II century, Galen described the full clinic of this disease and introduced the term "gonorrhea". Special X-ray paleontological studies have established the syphilitic nature of damage to the bones of skeletons from burials dating back to the 2nd century BC. e. The syphilis epidemic in Europe in the 15th-16th centuries claimed tens of thousands of lives and attracted the attention of not only doctors, but also the enlightened public. In Russia, syphilis appeared in early XVI century and although it was not as widespread as in Europe, nevertheless, the consequences of a syphilitic infection, the possibility of transmission to offspring drew attention to this problem of the luminaries of domestic science - N.I. Pirogov, S.P. Botkin and others.

The treatment of syphilis at that time was mainly carried out with mercury preparations, which were rubbed into various parts of the skin or even inhaled in the form of vapors. Of course, the severity of the course of syphilitic infection weakened, but the number of cases of damage to internal organs increased, nervous system as a result of the toxic effects of mercury. The first drug that combined the effectiveness of the treatment of syphilis and relatively greater safety than mercury was the famous drug salvarsan, synthesized by Ehrlich in 1909. This was a historical moment that marked the birth of the era of chemotherapy for infectious diseases.

In the 30s of the XX century, sulfa drugs were synthesized, which turned out to be very effective for the treatment of gonorrhea and other diseases. inflammatory diseases urogenital area, the etiology of which was still unknown at that time. However, the most effective in the fight against urogenital infections were antibiotics. The very first experience of treating syphilis with penicillin in 1943 by Mahoney, Arnold and Harris was extremely successful: even small doses of penicillin led to a stable cure for syphilis in humans and experimental animals.

Of all the causative agents of urogenital infections, gonococcus demonstrated the greatest adaptability to antibiotics, especially to penicillin. If in 1950 a single injection of 300,000 units of penicillin was sufficient for the treatment of acute gonorrhea, then in 1970, 3,000,000 units were needed to treat the same form of the disease.

Microflora resistance to various antibiotics is recorded everywhere, but the attitude to specific antibiotics depends on geographical regions, since the prescription of a certain spectrum of certain antibiotics for the treatment of inflammatory diseases of the female urinary tract, as well as other drugs, is very different in different countries and regions, and consequently, the mechanisms and degree of development of resistance will largely have a "geographical" character.

Principles of rational antibiotic therapy for urogenital infections in women:

1. The choice of an antibacterial drug should be based on:

The high sensitivity of the pathogen to this drug, that is, the absence of bacterial resistance;

The ability of the antibiotic not only to quickly penetrate into the inflammation-affected organs of the genitourinary system, but also to create therapeutically effective concentrations in the urine, cervical-vaginal secretions;

The least toxicity of the drug compared to others with the same antimicrobial activity;

The absence of contraindications to prescribing the drug to a particular patient (background pathology, compatibility with medicines concomitant therapy);

Good tolerance;

Absence pronounced influence on the microbiocenosis of the vagina and intestines;

Availability of purchase and use.

2. Route of administration and dosing regimen antibiotics should provide for the creation of its effective concentration in the focus of inflammation and maintaining it at the required level until a stable therapeutic effect.

3. Choice of the duration of the course of antibiotic therapy depends on the characteristics of the cycle of development and reproduction of pathogens, the nature of the course of the disease and the severity of the exacerbation, as well as on the individual tolerance of antibacterial drugs.

4 . When treating a urogenital infection in a woman, it is necessary examination and treatment of her sexual partner .

Main reasons for the growth of resistance microflora to antibiotics:

Irrational antibiotic therapy with the use of two or more antibiotics;

Incorrect selection of the dose of the drug and insufficient duration of therapy;

Long-term stay of patients in a hospital;

Frequent, uncontrolled use of antibacterial drugs, especially at home.

Currently, as the main factor determining the resistance of the microflora of the urogenital tract to antibiotics, the change biological properties microorganisms and their production of b-lactamases that destroy antibiotics (penicillins, cephalosporins). It is known that from 20 to 71% of strains of Escherichia coli, 58-100% of Klebsiella, 10-20% of Pseudomonas aeruginosa, 23% of Proteus, 80% of staphylococci produce b-lactamases.

The growth of bacterial resistance to antibiotics leads to the fact that the treatment of urogenital infections becomes more difficult, dictating the need to search for new therapeutic agents and introduce them into gynecological practice.

Factors that reduce the effectiveness of therapy and make it difficult to choose an antibacterial drug with urogenital infections are:

The growth of resistance of microorganisms to antibiotics;

An increase in the frequency of "problem" infections, diseases caused by intracellular microorganisms that are poorly controlled by antibacterial drugs;

The growth of allergic pathology;

Violation of the microbiocenosis of the body (gastrointestinal tract, urinary tract, skin and mucous membranes).

hallmark modern methods treatment of urogenital infections is the use of single (simultaneous) techniques. First choice drug for treatment acute gonorrhea is ceftriaxone, which has a pronounced antibacterial effect, practically does not side effects and at the same time has a preventive treponemicidal effect. Of the cephalosporins, cefixime and fluoroquinolones, ofloxacin and ciprofloxacin, are also used. It should be noted that fluoroquinolones are contraindicated in children and adolescents under 16 years of age, pregnant and lactating women.

Often, a double dose of azithromycin is prescribed for the treatment of gonorrhea in a woman, since the multiple nature of the lesion (cervix, urethra, rectum, etc.) is not ruled out. The most severe complication of gonorrhea in women is an ascending inflammatory process with a transition to the pelvic organs. This condition usually requires hospital treatment. The main drugs for the treatment of inflammatory diseases of the pelvic organs are ceftriaxone, ciprofloxacin, kanamycin, administered parenterally several times a day until the complete disappearance of clinical symptoms, after which broad-spectrum antibiotics (tetracyclines, fluoroquinolones, etc.) are prescribed orally for a week.

Treatment of pregnant women is carried out in a hospital at any gestational age with drugs from the groups of macrolides (azithromycin) and cephalosporins. Gonococcal conjunctivitis in children, including newborns, is successfully treated with ceftriaxone at the rate of 25-50 mg per 1 kg of body weight, but not more than 125 mg intramuscularly once.

One of the most problematic urogenital infections is chlamydia . About 80 million cases of various forms of chlamydia are officially registered annually in the world. Chlamydia, which cause an inflammatory process in the urogenital area, belong to the species Chlamydia trachomatis. In principle, this pathogen can also cause damage to other places covered with a cylindrical epithelium: the conjunctiva of the eyes, oropharynx, it can also enter the lower respiratory tract, causing pneumonia (this happens in newborns passing through the mother's birth canal infected with chlamydia). Most often though C. trachomatis it affects the urogenital area, rightfully considered one of the most common infections. According to some reports, the share C. trachomatis accounts for up to 70% of sexually transmitted infections.

Uncomplicated is considered to be only those cases of urogenital chlamydia, in which the inflammatory process is limited to the urethra in men and the cervical canal in women. All other manifestations of this infection, except for urethritis and endocervicitis, can be considered as complications. Their therapy in each individual case should be selected individually, depending on the nature of the lesion, the state of the macro- and microorganism.

The danger of this infection is the asymptomatic nature of the course, late diagnosis and the development of complications in both women and men, the main of which is infertility. Therefore, the treatment of urogenital chlamydia is given special attention by specialists. Currently, the greatest difficulty for therapy is the so-called persistent forms of chlamydia. Apparently, these are chlamydia, which are at the stage of elementary bodies, which, for unknown reasons, have stopped their further development. A similar condition is often observed after the treatment, when the clinical symptoms have passed, but chlamydia continues to be detected.

In this case, the exacerbation of the process may be associated with infection with gonococcus, Trichomonas and other pathogens, as well as hormonal disorders, immunodeficiency, instrumental interventions and other provoking factors. Long-term urogenital chlamydia leads to serious complications - salpingo-oophoritis, endometritis. Urogenital chlamydia in pregnant women contributes to infection of the fetus, premature birth, stillbirth.

Fundamental problems in the treatment of uncomplicated infections, as a rule, do not arise. If at right choice However, there are still failures of the antibiotic and the regimen for its use, this is rather evidence of an underestimation of the situation, mistakenly regarded as an uncomplicated process, than the ineffectiveness of the recommended therapy regimen.

Antibiotics of three pharmacological groups are used to treat chlamydial infection: tetracyclines, macrolides and fluoroquinolones. Tetracycline drugs were the first drugs for the treatment of chlamydial infection. However, it should be remembered that all tetracyclines are contraindicated in pregnancy and it is not advisable to use them for the treatment of urogenital infections in children under 8-9 years of age. Unfortunately, side effects are possible when using these drugs (nausea and vomiting are the most common). Important side effect tetracyclines - phototoxicity, which should be taken into account when prescribing on sunny days. The advantage of all tetracyclines over antibiotics of other groups is their relative cheapness.

Among the most active antichlamydial drugs are macrolides, in particular, erythromycin, which is prescribed for this infection at 500 mg 4 times a day for 7-14 days. However, when taking erythromycin, side effects from the gastrointestinal tract and abnormal liver function are often observed. Unlike tetracyclines, this group of antibiotics is expanding very actively due to the emergence of new drugs. Better than erythromycin, therapeutic efficacy and tolerability have recently introduced into wide practice the latest generation of macrolides - josamycin, clarithromycin and roxithromycin.

The only representative of azalides known today has a high therapeutic activity against chlamydia - azithromycin (Azithromycin-Akos , OJSC Sintez, Kurgan), which is a derivative of erythromycin containing an additional nitrogen atom. Due to this structural rearrangement, azithromycin was isolated into a separate group, called "azalides". Its antimicrobial activity is not inferior to modern macrolides and includes gram-positive and some gram-negative microorganisms, Bordetella pertussis, kinds Legionella, Chlamydia, Mycoplasma, Ureaplasma urealyticum, Listeria monocytogenes. An important feature of azithromycin is activity against bacteroids and enterobacteria, although it is weakly expressed. Azithromycin is similar in spectrum of antibacterial action to erythromycin, but it is more active against the following gram-positive and gram-negative strains of microorganisms: haemophilus influenzae(including ampicillin-resistant strains), H. parainfluenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, Borrelia burgdorferi, Chlamydia trachomatis, Toxoplasma gondii, Pneumocytis catarrhalis, Listeria, Streptococcus pyogenes, Streptococcus agalactiae, erythromycin- and penicillin-resistant strains Streptococcus pneumoniae and methicillin-resistant strains S. aureus. Resistant to azithromycin viruses, nocardia, brucella.

If we add to this the unique pharmacokinetic characteristics - a long half-life, high level absorption and stability in an acidic environment, the ability to be transported by leukocytes to the site of inflammation, a high and prolonged therapeutic concentration in infected tissues, as well as the ability to penetrate into the cell, it is clear why azithromycin (Azithromycin-Akos) is the drug of choice for the treatment of urogenital chlamydia . It has been demonstrated that a single dose of 1.0 g of azithromycin is not inferior in effectiveness to the standard 7-10-day course of treatment with antibiotics of other groups. For the first time, it became possible to effectively treat chlamydial infection with a single dose of an oral antibiotic.

The drug is also effective against treponema pallidum, which makes this antibiotic especially attractive when chlamydia is combined with early forms of syphilis. There are works on the successful treatment of gonorrhea. Western researchers report very high efficiency azithromycin for chancroid. Thus, the use of this drug allows you to control a number of other sexually transmitted infections.

To date, azithromycin ( Azithromycin-Akos ) is the only antibiotic that can be expected to cure uncomplicated chlamydial infection after a single use. This is convenient for both the doctor and the patient, especially when the patient's compliance with a complex treatment regimen is in question.

Alternative drugs include lomefloxacin, ofloxacin, etc. In the case of a proven persistent form of urogenital chlamydia, a woman is monitored for 2-3 months. (all sexual contacts must be protected). Sometimes during this time there is a spontaneous elimination of the pathogen from the body. In other cases, a combination of an immunocorrector (polyoxidonium) with an antibiotic is used.

IN last years slightly changed our understanding of the role mycoplasma infection in the occurrence of urogenital inflammatory processes. The usual finding of these pathogens during examination of a patient without any clinical manifestations is not an indication for treatment, since these microbes are found in the urogenital tract of healthy women and men. If there are clinical manifestations and the isolation of mycoplasmas in the form of monocultures, azithromycin 250 mg orally 1 time per day for 5-6 days, doxycycline 0.1 g 2 times a day for 7-10 days and other broad-spectrum antibiotics are prescribed. Pregnant women are prescribed erythromycin (starting from the II trimester).

Urogenital trichomoniasis caused by protozoa Tr. vaginalis and is currently one of the most common inflammatory diseases of the vagina. Trichomoniasis is characterized by multifocal lesions of various parts of the genitourinary system, a protracted course and a tendency to relapse. In women, vaginitis, urethritis, cervicitis are most often observed. Patients complain of profuse foamy discharge of a purulent nature and a greenish color from the genital tract, pain, itching in the vulva and dysuric phenomena. The mucous membrane of the vestibule of the vagina and the vaginal part of the cervix are hyperemic, edematous, bleed easily. In addition to severe discomfort, trichomoniasis can lead to the development of inflammatory processes in the pelvic organs, reproductive disorders and pregnancy complications. In chronic trichomonas vaginitis, local inflammatory changes appear slightly.

The main drugs for the treatment of trichomoniasis are metronidazole and some of its derivatives (ornidazole, tinidazole). Metronidazole is prescribed 500 mg orally 2 times a day for 7 days, ornidazole 500 mg orally 2 times a day for 5 days. Tinidazole refers to single-use drugs and is administered orally 2 g once (preferably at bedtime). Ornidazole can also be administered as a single regimen - 1.5 g orally at night. You should be aware that metronidazole and tinidazole drugs are incompatible with alcohol intake, which patients should be warned about (ornidazole does not have this drawback). If treatment fails, the dose of the drug can be increased: tinidazole orally 2 g 1 time per day for 3 days. In the treatment of children, metronidazole is prescribed: at the age of 1 to 6 years - 1/3 tablet orally 2-3 times a day; 6-10 years - 125 mg orally 2 times a day; 11-15 years - 250 mg orally 2 times a day for 7 days. Ornidazole in a daily dose of 25 mg per 1 kg of body weight is prescribed in 1 dose at night. Treatment of pregnant women is carried out not earlier than from the second trimester of pregnancy. Ornidazole 1.5 g orally once at bedtime or tinidazole 2 g orally once at night is usually prescribed.

Anatomical and physiological features of the body of women cause more frequent development compared to men pyelonephritis And urinary tract infections . The basis for the treatment of urinary tract infections in women is adequate antibiotic therapy. During periods of exacerbation of the disease, methods are used to improve microcirculation and correct the developing DIC, detoxification. During the period of remission, phytotherapy is carried out. Antibacterial therapy should be carried out in the presence of clinical and / or laboratory signs of a bacterial infection, since sometimes the symptoms may be sparse. The empirical approach is based on the choice of an antibacterial agent that maximally covers the possible spectrum of microorganisms that are most often the causative agents of this disease of a certain localization. In the empirical approach, the localization and nature (acute, chronic) of the infection are decisive.

A distinction is made between 1st-line agents or agents of choice that are considered optimal (amoxicillin), as well as 2nd-line agents or alternative agents. Amoxicillin (Amosin® , JSC Sintez, Kurgan) belongs to the group of semi-synthetic aminopenicillins. It is characterized by a wide spectrum of antimicrobial action, activity against not only coccal flora, which is affected by natural penicillins, but also gram-negative bacteria, mainly of the intestinal group - Escherichia coli, which is the most common cause of acute infections of the urinary system. That's why Amosin ® can be widely used to treat uncomplicated infections Bladder and urinary tract.

The drug can also be recommended for use in pregnant women (given its safety for the fetus), in particular, with asymptomatic bacteriuria. As a result of targeted treatment, the incidence of pyelonephritis, as well as premature birth and the birth of children with low body weight in such patients is significantly reduced.

In patients with chronic infectious diseases of the kidneys, especially in inpatients, the value of Escherichia coli as an etiological factor decreases, while the proportion of other gram-negative microorganisms, often multiresistant, and staphylococcus increases. In these patients, it is preferable to use combinations of b-lactam antibiotics with b-lactamase inhibitors, fluoroquinolones, II-III generation cephalosporins.

After receiving the results of a bacteriological study of urine, identifying the causative agent of the infectious process and determining its sensitivity, it is possible to conduct targeted antibiotic therapy. Targeted therapy allows you to choose a drug with a less wide spectrum of antimicrobial activity and, accordingly, with a lower risk of therapy complications (superinfection, multiple resistance, etc.). Of the two drugs with the same spectrum of antimicrobial activity in the treatment of women, especially during pregnancy, the least toxic agent should be chosen.

In case of urinary tract infection, it is advisable to prescribe agents that create high and stable concentrations in the urine. When prescribing drugs, it is necessary to take into account kidney function, which can be reduced, especially in pregnant women. Dosing of antibacterial agents excreted mainly in the urine should be carried out taking into account the functional state of the kidneys and body weight of patients. If the body weight of the patient significantly exceeds (> 90 kg) or less (< 50 кг) средней массы тела, то суточную дозу антибиотика следует изменить:

D \u003d (D 70 x M) / 70,

where D 70 is the daily dose of the drug for a patient weighing 70 kg (from the table), M is the patient's body weight.

In the treatment of patients with kidney infection, the appointment of two or more antibacterial agents is sometimes required, especially in the presence of multiple pathogens, the presence of resistant microorganisms. There are favorable combinations of antibacterial agents, leading to an increase in the antimicrobial effect of each of the drugs, and dangerous combinations when the risk of severe side effects is significantly increased. The weakening of the antimicrobial effect is possible with a combination of bactericidal and bacteriostatic drugs. Grade clinical effect antibacterial agent is carried out within 48-72 hours of treatment. The full clinical effect implies a combination of clinical cure and bacteriological elimination.

Criteria for the positive effect of antibiotic therapy:

early (48-72 hours): positive clinical dynamics - reduction of fever, intoxication; sterility of urine after 3-4 days of treatment;
late (14-30 days): persistent positive clinical dynamics in the course of antibiotic therapy - normalization of temperature, no recurrence of fever, chills; no recurrence of infection within 2 weeks. after the end of antibiotic therapy; negative results of bacteriological examination of urine on the 3-7th day after the end of antibiotic therapy or the identification (persistence) of another pathogen;
final (1-3 months): absence of repeated urinary tract infections within 2-12 weeks. after the end of antibiotic therapy.

Prevention of exacerbation of infection is carried out in patients with chronic pyelonephritis that occurs without severe exacerbations or against the background of constantly acting provocative factors (for example, in the presence of a stone in the renal pelvis). As a rule, antibacterial agents are prescribed in short courses of 7-10 days every month for 0.5-1 year. Usually, in the interval between courses of antibacterial agents, herbal treatment is carried out. Bacteriostatic antibacterial agents are used - sulfonamides, nitrofurans, nalidixic acid. Against the background of such therapy, it is not possible to identify the pathogen, the microorganism that was present at the beginning changes, and its resistance to antibacterial drugs also changes. Therefore, it is desirable to carry out therapy sequentially with drugs from different groups, alternating antibacterial agents with a different spectrum of antibacterial activity.

Postoperative wound infections in obstetric and gynecological patients worsen the results of surgical treatment, increase the duration of hospitalization and the cost of inpatient treatment. One of the effective approaches to reduce the frequency of postoperative suppuration, along with the improvement of surgical technique and compliance with the rules of asepsis and antisepsis, is antibiotic prophylaxis. Experimental and clinical studies conducted in recent years have convincingly shown that rational antibiotic prophylaxis in certain situations can reduce the incidence of postoperative infectious complications from 20-40% to 1.5-5%. At present, the feasibility of antibiotic prophylaxis during obstetric and gynecological operations is beyond doubt; the literature discusses questions not about whether an antibiotic is needed at all, but which antibiotic should be used and in what mode from the point of view of maximum clinical efficacy and pharmacoeconomic feasibility.

According to the Committee on Antimicrobials of the American Society for Surgical Infection, prophylactic use of antibiotics is the administration of antibiotics to a patient before microbial contamination of the surgical wound or the development of a wound infection, as well as in the presence of signs of contamination and infection, when the primary method of treatment is surgery, and the purpose of antibiotic prescription is minimize the risk of wound infection. In other words, antibiotic prophylaxis, unlike antibiotic therapy, implies the appointment of an antibacterial agent in the absence of an active process and high risk infection in order to prevent it.

In the mechanism of development of inflammatory diseases after caesarean section, the degree and nature of colonization of the urinary tract by microorganisms, disruption of natural relationships in the vaginal microcenosis, changes in hormonal status, and a decrease in general and local immunity are of great importance. The invasion of microbes inhabiting the vagina into the internal genital organs is especially active during surgery. The widespread and not always justified use of cephalosporins and aminoglycosides in obstetric practice has led to a sharp increase in the etiological significance of opportunistic microorganisms that are not sensitive to these antibiotics. Therefore, in recent years it has become widespread antibiotic prophylaxis for caesarean section . It has been proven that the traditional prolonged intramuscular course (from 3 to 5 days) of antibiotic prophylaxis of infectious complications allows several times to reduce the incidence of postpartum endometritis after cesarean section. However, this technique also has a number of significant drawbacks. First of all, a statistically significant increase in the frequency of allergic reactions compared with short courses. In addition, it should be noted that long-term prophylactic administration of antibiotics in therapeutic dosages contributes to the emergence of antibiotic-resistant strains of microorganisms, as well as a sharp change in the clinical picture of postpartum endometritis (late clinical manifestation, erased forms of the disease), which greatly complicates its diagnosis and treatment. A short intravenous course of antibiotic prophylaxis of postpartum endometritis with cephalosporins is practically devoid of these disadvantages. But a significant decrease in the frequency of infectious complications compared with a prolonged course with its use was not noted, which is obviously due to the low activity of cephalosporins against enterococci and bacteroids, the main pathogens of postpartum endometritis at present.

The most effective, according to our data, is short intravenous prophylactic course of amoxicillin/clavulanate , a drug active against both facultative and obligate anaerobes. Our Center adopted the following methodology: amoxicillin/clavulanate at a dose of 1.2 g is administered intravenously to a woman after the fetus is removed and the umbilical cord is clamped, and then after 12 and 24 hours. The use of amoxicillin/clavulanate made it possible to minimize the overall incidence of infectious complications after caesarean section. It should also be emphasized that, in addition to providing a pronounced clinical effect and excellent tolerance, the use of this drug is also very beneficial in economic terms, since the cost of antibiotics is reduced by 4-5 times.

Thus, the main problem of recent years is the wide spread of resistant forms of pathogenic microorganisms and the decrease in the effectiveness of a number of antibiotics. The effectiveness of antibiotics decreases over time because microorganisms become resistant to antibiotics. Moreover, these resistant pathogens can cause disease in other people, and resistance factors are easily transmitted from one microorganism to another, which ultimately leads to the emergence of such pathogens that are resistant to all available antibiotics.

After the euphoria of the 70-80s of the last century, when it seemed that victory over infections had been achieved, it became obvious that the available antibiotics were rapidly losing their effectiveness. Therefore, recent years are characterized by increased work in the field of creating new antibacterial drugs. Prospects for antibiotic therapy are associated not so much with new antibiotics, but with the optimization of the use of existing drugs. The range of antibiotics registered in our country is quite wide, and new drugs are needed only in cases where they help overcome resistance to existing compounds or there is improved safety, a more convenient route of administration, less frequency of administration, etc. Optimization of antibiotic therapy both in a hospital and in a polyclinic is impossible without the development of clinical microbiology, knowledge of pharmacoepidemiology and pharmacoeconomics of antibacterial drugs. It is necessary to monitor antibiotic resistance and its mechanisms with the provision of recommendations to practitioners, obstetricians and gynecologists.

A ban on over-the-counter antibiotics is also needed, stopping antibiotics when viral infections. It makes sense to reduce the use of co-trimoxazole, ampicillin, oxacillin, fluoroquinolones, gentamicin with an increase in the specific proportion of penicillins (amoxicillin, amoxicillin / clavulanate), macrolides (clarithromycin, azithromycin), oral cephalosporins. In obstetric and gynecological hospitals, it is necessary to have a local antibiotic resistance passport and an antibiotic formulary developed on its basis, taking into account pharmacoeconomic indicators. The oral route of administration of antibiotics should also be more actively used, and stepwise (parenteral-oral) therapy should be introduced.

Ultimately, the prospects for antibiotic therapy for urogenital infections in women can be viewed quite optimistically, and the urologist and obstetrician-gynecologist will not remain defenseless against infections. A timely diagnosed infection, adequate therapy not only for the patient, but also for her partners provide etiological sanitation in almost 95-97% of cases. The remaining cases require a more individualized approach, taking into account the sensitivity of the microflora to the antibiotics used, the presence of associated infections of the urogenital tract, and other circumstances. However, in any case, the doctor will never be the absolute winner in this fight. Therefore, we must use the arsenal of antibiotics that we currently have as reasonably and efficiently as possible, and with great responsibility take a reasonable approach to the use of new drugs.

Urogenital infections- this term should be recognized as the most accurate. Use of the term " hidden infections”, does not define the exact list of infectious factors. All infections of the urogenital tract should be divided into absolutely pathogenic - Sexually Transmitted Infections (STIs), which include pathogens of gonorrhea, chlamydia, trichomoniasis, syphilis, genital herpes, mycoplasma genitalium (Mycoplasma genitalium). The second group consists of conditionally pathogenic microorganisms, i.e. those bacteria and fungi that are present in healthy people, but under certain conditions become the cause of inflammation. The second group includes streptococci, staphylococci, E. coli, Klebsiella, enterococcus and many others. The term "hidden infections" is misleading for both the patient and the doctor himself. For when microbes from the group of opportunistic pathogens are detected, the treatment of sexual partners is impractical, the treatment of the organ in which these bacteria caused inflammation (urethritis, prostatitis, cystitis, etc.)

Sexually Transmitted Infections (STIs)

Gonorrhea - (Gonococcal infection)- a human sexually transmitted infectious disease caused by gonococci (Neisseria gonorrhoeae) - Gram-negative diplococci, which are bean-shaped, immobile, pyogenic bacteria that do not form spores. Currently, gonorrhea occurs infrequently, however, erased and asymptomatic forms, combined with antibiotic resistance, are features of the modern course of gonorrhea.

Chlamydia - (Chlamydia infection) is a sexually transmitted infection caused by Chlamydia trachomatis. Chlamydia rarely causes vivid symptoms, and therefore patients learn about their disease late, often after the development of complications from the genital organs. Chlamydia is treated quite effectively. The duration and volume of treatment is determined by the absence or presence of complications.

Trichomoniasis - (Urogenital trichomoniasis)- a sexually transmitted infection caused by Trichomonas vaginalis. Distinctive feature disease is a feature of the pathogen - according to the classification, it is the simplest microorganism. In the treatment of this infection, antiprotozoal drugs are used, antibiotics against Trichomonas are not effective.

Mycoplasma genitalium is a sexually transmitted pathogen that can cause urethritis in both sexes, cervicitis and pelvic inflammatory disease (PID) in women. A feature of the microorganism is its difficult isolation by the cultural method (method of inoculation on nutrient media). The only possible diagnostic method in a wide range of medical practice are methods that detect DNA (RNA) of a microorganism - these are PCR, PCR-RT, NASBA.

Primary syphilis

Syphilis- an infectious disease caused by pale treponema (Treponema pallidum), transmitted mainly through sexual contact, characterized by damage to the skin, mucous membranes, nervous system, internal organs and musculoskeletal system. Unlike other infections, it has a longer incubation period, which can be even longer if the patient has been prescribed antibiotics for another sexually transmitted infection (eg, chlamydia). Therefore, after any sexual infection, an examination for syphilis should be prescribed, taking into account the named features of the disease.

Genital warts (anogenital (venereal) warts)- a viral disease caused by the human papillomavirus (HPV) and characterized by the appearance of growths on the skin and mucous membranes of the external genitalia, urethra, vagina, cervix, perianal region, anus. Treatment is to remove warts. The most preferred methods are laser techniques. The CLINIC is equipped with a laser device - eCO2™ Lutronic. A UNIQUE method of laser injection of cytostatic drugs into the skin in the treatment of warts and condylomas of a large area; procedure with short term recovery is absolutely painless.

To prevent relapse, immunomodulators with antiviral activity are used. We also conduct a study of the immune status with the determination of individual sensitivity to immunomodulatory drugs.

A group of opportunistic microorganisms - present in the norm and in healthy people, the pathogenic properties of this group of bacteria appear under certain conditions.

Mycoplasmas and ureaplasmas (the term myrjplasmosis/ureaplasmosis is often used)- Mycoplasma hominis and Ureaplasma urealyticum, Ureaplasma parvum (the designation Ureaplasma spp. is used to designate two species at once) are conditionally pathogenic microorganisms, the manifestation of pathogenic properties of which occurs under certain conditions. Ureaplasmas can cause urethritis in men (U. urealyticum) and cervicitis, cystitis, PID, as well as pregnancy complications, postpartum and post-abortion complications in women.

Ureaplasma and M. hominis can be detected in healthy individuals (in 5-20% of cases). Treatment of these infections is carried out only after a comprehensive examination and exclusion of the role of other infections, primarily from the group of STIs.

E. coli, Enterococcus, Klebsiella, Streptococcus - microorganisms, also related to opportunistic pathogens, are normally found in the intestine. Often identified as the cause of inflammation of the bladder (cystitis), prostate(prostatitis), vagina (vaginitis) and other diseases. In diagnostics, not only a simple isolation of the pathogen by the cultural method is required, it is also necessary to prove the fact of inflammation - according to elevated level leukocytes (in smears or prostate secretions).

HUGI is a chronic urogenital infection. Urogenital infections include those that are active in the human genitourinary system. Early diagnosis of urogenital infection will help to avoid dangerous consequences and the transition of the anomaly into a chronic form.

Chronic urogenital infections and sexually transmitted infections (STIs) are different. STIs act through the genitourinary system and may target other organs. Urogenital infection often occurs without symptoms or does not affect the body at all.

Possible consequences of HUGI:

cancer of the genital organs;
infertility;
miscarriage;
infection of the fetus during pregnancy;
pathology of the development of the child;
abnormal kidney function.

pathogens

Urogenital infections differ in that they can be transmitted not only sexually, but also through household and contact routes. The group of these infections is huge, but the most common and dangerous are herpes, and. Sometimes there is a mixture of infections.

Symptoms of infection

Since infections often affect the urethra, the signs will be characteristic of pyelonephritis or cystitis:

problems with urination;
discomfort in the urethra;
pain in the lower back and in the pubic area;
blood and pus in the urine;
elevated temperature.

Sometimes HUGI provoke cervical cancer, inflammation of the ovaries or fallopian tubes, erosive processes. Then the symptoms will be different:

itching or burning in the vagina;
pain during sex;
mucous or purulent discharge;
the presence of blood in the secretions;
pain in the lower back and pubic region.

In men, urogenital infections are most often caused by prostatitis. It is also possible inflammation of the seminal vesicles or testicles. The symptoms of inflammation in men are:

pain in the perineum;
heaviness in the testicles;
purulent discharge;
itching on the head of the penis;
discomfort during urination and ejaculation;
problems with ejaculation;
redness and inflammation of the red flesh.

Urogenital infections require new treatments. The problem is aggravated every year, more and more people suffer from chronic infection.

Importance of the examination

Urogenital infections are the causative agents of many dangerous diseases that develop without symptoms. This contributes to the transformation of the disease into a chronic form and the occurrence of complications. Some may be irreversible. Every day of delay reduces the chances of successful treatment.

HUGI provoke inflammation of the genital organs, which lead to infertility. Chronic inflammation causes the formation of adhesions in the pelvis, which can cause uterine obstruction, ectopic pregnancy, infection of the fetus in the womb, miscarriage, many malformations. Diseases such as endocervicitis, prostatitis, urethritis, pyelonephritis and cystitis should be treated on time. Launched inflammation affects reproductive function and cause potency, abnormal ejaculation and other pathologies.

Diagnosis of infections is also necessary because some microorganisms are extremely active and dangerous. So the human papillomavirus of the oncogenic type provokes cancer of the vagina, cervix and even the penis.

Foci of infection can spread their influence even beyond the affected organ. Urogenital infections contribute to the development of arthritis, pharyngitis, conjunctivitis.

Diagnosis of HUGI

Laboratory tests make it possible to make the correct diagnosis and form a competent treatment strategy. It is necessary to take tests and check the body's reaction to the infection. The test is called an enzyme immunoassay or complement fixation test (ELISA).

Getting rid of HUI is much easier than getting rid of infections in other organs. You can easily find out the cause, and urogenital infections in most cases occur due to one type of microorganism, which means that you do not need to combine drugs. Only regular preventive examinations will help protect yourself from dangerous urogenital infections.

»» No. 3-4 "99 »» New Medical Encyclopedia N.G. Koshelev - Honored Scientist of the Russian Federation, dr honey. Sci., Professor, Leading Researcher, Institute of Obstetrics and Gynecology. BEFORE. Otta RAMN

M.A. Bashmakova - Dr. med. Sci., Professor, Leading Researcher, Institute of Obstetrics and Gynecology. BEFORE. Otta RAMN

T.A. Pluzhnikova - leading researcher of the St. Petersburg city scientific and practical center for the prevention, diagnosis and treatment of miscarriage, Ph.D. honey. Sciences

One of the most common causes of miscarriage (NB) is urogenital infection (UGI). It causes a large percentage of pregnancy complications (preeclampsia, threatened miscarriage, polyhydramnios, pyelonephritis of pregnant women, placental insufficiency, placental abruption, etc.), intrauterine lesions of the fetus and newborn.

EI Research Institute of Obstetrics and Gynecology. BEFORE. Otta RAMS has been dealing with the problem of the impact of infectious diseases on the reproductive function of a woman, the fetus and the newborn for almost half a century.
In 1953 S.M. Becker first raised the issue of intrauterine infection. Listeriosis, toxoplasmosis, and the role of chronic tonsillitis were studied in detail. In the 60-70s, a number of scientific developments were carried out devoted to the study of candidal infection, streptococci.
E.K. Aylamazyan (1995) writes that in recent decades there has been a change in the causative agents of genital infections. Listeriosis and toxoplasmosis are rare. Currently, pathogens of chronic infections that are the cause of miscarriage and its unfavorable outcome for the fetus are being actively studied - genital mycoplasmas, chlamydia, group B streptococci.

Over the past 10 years, the frequency of bacterial vaginosis (BV) in the general population of St. Petersburg residents is 20% (EF Kira, 1998).
According to the obstetric and gynecological clinic of the Military Medical Academy, BV in the dynamics of pregnancy is: in the first trimester - 28.9%, in the second - 9.9% and in the third - 7.4%, and urogenital candidiasis, respectively, 15.7; 11.6 and 9.1% (I.A. Simchera, 1998-1999).
The asymptomatic course of BV during pregnancy occurs 2.5 times more often than outside of pregnancy (A.N. Strizhakov et al., 1998). UHC in healthy pregnant women of St. Petersburg is detected in 32.2% (I.A. Simchera).
Among gynecological patients suffering from inflammatory processes, chlamydial infection is found in 30%, among women with infertility - in 50%, in women with tubal infertility - up to 60%.
In 80% of pregnant women, chlamydia is latent.
The overall percentage of newborns infected with chlamydia reaches 9.8%.
The frequency of isolation of Chlamydia trachomatis from the internal organs of perinatally dead fetuses is 17%.
The consequences of untreated genital chlamydia are: chronic inflammatory diseases of the uterine appendages, tubal infertility, ectopic pregnancy, adverse pregnancy outcomes (non-developing pregnancy, spontaneous miscarriages, premature birth), intrauterine infection of the fetus.

Over 90% of the world's population is infected with the herpes simplex virus (HSV), of which up to 20% have certain clinical manifestations of the infection.
Genital herpes is caused by two serotypes of herpes simplex virus: HSV-1 and HSV-2 (HSV-2 is the most common).
The risk of neonatal infection of a newborn depends on the form of genital herpes in the mother and ranges from 0.01 to 75.00%.

Etiology and pathogenesis

The onset of pregnancy is accompanied by a change in the immune status of the woman. Immunodeficiency develops, which, with the threat of termination and miscarriage, is aggravated. Therefore, the susceptibility of a pregnant woman to infectious diseases is very high. In addition, diseases that occur latently (chronic tonsillitis, pyelonephritis, etc.) are often exacerbated during pregnancy. This increases the frequency of complications of pregnancy and childbirth, adverse outcomes for the fetus and newborn.

In the vagina of a healthy non-pregnant woman, aerobic and anaerobic microorganisms are normally present: lactobacilli, corynebacteria, epidermal staphylococcus, bacteroids, lactic streptococci, etc. In healthy pregnant women, already in the first trimester of pregnancy, there is a decrease in the number of their species and quantity: the number of corynebacteria, bacteroids, streptococci, staphylococci decreases, and the number of lactobacilli and bifidobacteria increases (E.F. Kira, Yu.V. Tsvelen, I.A. Simchera, 1998).

A feature of the causative agents of genital infections is their frequent associations. So, genital mycoplasmas are found together with opportunistic flora, fungi of the genus Candida, Trichomonas, gonococci; chlamydia - with gonococci, genital herpes virus, group B streptococci.

Clinic

An assessment of the role of asymptomatic infection and colonization of the genitourinary organs by various microorganisms, as well as a manifest infection of the genitals, showed that some of the non-developing pregnancies, spontaneous miscarriages, and premature births are based on an infectious process of a focal nature in the endometrium and cervix - chlamydia, mycoplasma, or in the genitourinary organs - group B streptococci, gram-negative flora.

During pregnancy, bacterial vaginosis and urogenital candidiasis (UGC) are common, which can cause complications in the course of pregnancy and cause miscarriage.

Since the term "bacterial vaginosis" was officially adopted in the world in 1984, and in Russia it was recognized in 1990, let us dwell in more detail on the characteristics of this disease.

Bacterial vaginosis (BV) is a polymicrobial infectious disease caused by a decrease or disappearance of lactobacilli and an increase in the number of anaerobes and other microbes by 100-1000 times. Its etiological factor is the association of anaerobic microorganisms (EF Kira). Perhaps the presence of gardnerella. Currently, the issue of sexually transmitted diseases (STDs) is very acute. Among the 20 pathogens of this group of diseases, the most common cause of miscarriage are:
- genital mycoplasmas,
- group B streptococci
- chlamydia,
- simple genital virus type II,
- cytomegalovirus (CMV).

Colonization or infection of the genitals of a pregnant woman caused by mycoplasmas (Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium) often does not go unnoticed. The frequency of detection of M. hominis in pregnant women for many years remains approximately the same and is 17-20%. The frequency of occurrence of U. urealyticum in pregnant women is 25-30%. More often, colonization of the vagina by mycoplasmas is observed when its biocenosis changes in the direction of an increase in representatives of potentially pathogenic microorganisms. Do genital mycoplasmas always cause pathological processes in the body of pregnant women? Do they always lead to miscarriage? - To date, these questions have not been fully clarified.

In pregnant women at risk of miscarriage, group B streptococci (GBS) are excreted in the urine in 4.8% of cases. For a long time (according to our data, up to 3 years - S.L. Zatsnorskaya, 1995), these microorganisms can persist in the urogenital tract of a woman. With repeated pregnancies, infection of the fetal egg with the same serotype is possible, which can cause a non-developing pregnancy or septic abortion. Transmission of group B streptococci from mother to fetus is observed in 37.0% of cases. As you know, at present, genital chlamydia often occurs in women during their reproductive peak - at the age of 20 to 30 years and even younger.

Profound hormonal changes during pregnancy, altered immunological reactivity can affect the clinical picture of the disease, activate the infection, adverse effect on the course, outcome of pregnancy, on the fetus and newborn child. The frequency of occurrence of urogenital chlamydia among pregnant women, according to our data, is 6.7-8.0%. The transmission of the pathogen to the child is possible both in the presence and in the absence of obvious clinical manifestations of infection in the mother (the probability of its transmission is 50-70%). The fetus is infected both by direct contact with the mother's birth canal, and in utero: by ingestion or aspiration amniotic fluid. It should be especially noted that the frequency of perinatal fetal mortality in the group of women with genital chlamydia is 5.45%. Research Institute of Obstetrics and Gynecology. BEFORE. Otta RAMS first described latent endometritis of chlamydial etiology (AM Savicheva, 1991). They can also cause antenatal infection of the fetus, spontaneous miscarriages, non-developing pregnancies, and premature births. In studies by electron microscopy, antigens to chlamydia and mycoplasmas were found in the placental tissue (L.B. Zabzhitskaya, 1998).

In perinatal pathology, viruses of the herpetic group play a certain role, taking into account the severity of the consequences of intrauterine infection of the fetus.

The study of cytomegalovirus infection (CMV) showed that among pregnant women there is a high frequency of the so-called immune layer (92% of women have antibodies to CMV). Risk groups for the development of intrauterine infection among pregnant women and their newborns were established. Research Institute of Obstetrics and Gynecology. BEFORE. Ott RAMS for the first time gave an estimate of the risk of developing intrauterine cytomegaly in pregnant women in St. Petersburg, equal to 0.5-1.0%. According to the literature, with CMV, the frequency of miscarriages reaches 31.5% (N.A. Farber et al., 1990).

In the development of pathological processes in the urogenitals, leading to miscarriage, a significant role is played not so much by pathogenic microorganisms obtained by a woman from the outside (chlamydia, gonococci), but by opportunistic bacteria that inhabit the genital organs normally, which may be due to altered immunological reactivity during pregnancy .

When assessing the opportunistic microflora in women with miscarriage and in the presence of inflammatory diseases of the vagina, the following are distinguished:
- yeast-like fungi of the genus Candida (mainly Candida albicans) - in 12%,
- group D streptococci - in 31.5%,
- Staphylococcus aureus - in 1.5%.

In addition, in some cases, with disturbed microbiotic processes, Escherichia coli, Klebsiella, and anaerobic microorganisms are released into the vagina.

Of particular note is the fact that during pregnancy, the cells of the vaginal epithelium become more elastic and proliferate, releasing a large amount of glycogen. At the same time, the number of lactobacilli and yeast-like fungi increases in the vagina. As the gestational age increases, the number of these microorganisms increases. This provision is of great importance in the appointment of etiotropic antimycotic therapy. Normally, 40-60% of pregnant women find yeast-like fungi in the vagina. Only in the presence of mycelium and vegetative forms of yeast-like fungi, with an appropriate clinical picture of the disease, antifungal drugs should be prescribed.

With urogenital infection, the frequency of pregnancy complications is high, especially miscarriage (Table 1).

Table 1
FEATURES OF THE COURSE OF PREGNANCY DURING UROGENITAL COLONIZATION OF INFECTION (according to the D.O. Ott Research Institute of Obstetrics and Gynecology)

NATURE OF COMPLICATIONS	MYCOPLASMA (%)	UREAPLASMA (%)	CHLAMYDIA (%)	CANDID (%)	STREPTOCOCCIS B (%)	BACTERIAL VAGINOSIS (%)
Threat of abortion	66.0	67.5	31.7	48.0	32.1	58.0
Non-developing pregnancy	8.0	1.2	0.9	-	3.2	8.0
Spontaneous abortions	9.4	6.2	11.0	3.5	31.1	8.0
preterm birth	16.0	8.8	12.7	13.5	24.7	13.8
Polyhydramnios	17.0	12.5	8.2	10.0	8.7	18.1
Pyelonephritis of pregnant women	21.4	7.0	8.2	-	29.7	-
Preeclampsia	49.0	23.7	47.3	17.0	72.4	-
Untimely rupture of amniotic fluid	39.0	12.5	27.7	21.0	44.1	48.7

When the endometrium is affected by infectious agents, the process of placentation and development of the placenta is disturbed, which contributes to the development of secondary placental insufficiency. They can affect the placenta (placentitis) and membranes (chorionamnionitis), cause the formation of pathogenic immune complexes, which significantly impairs the function of the placenta as an organ that provides the fetus with adequate nutrition and respiration, which in turn leads to developmental delay and fetal hypotrophy, and premature excitation of labor. activities.

In the presence of a urogenital infection, childbirth is often complicated by untimely discharge of amniotic fluid (OV), an anomaly of labor activity, fever during childbirth, and hypoxia of the intrauterine fetus. The percentage of NEs is especially high when gram-negative flora or genital infection is detected in the urine (3-4 times higher than in healthy women in labor). NOV contributes to the occurrence of amniotic infection and the development of chorionamnionitis. This has an adverse effect not only on the mother, but also on the fetus. In childbirth, weakness of labor activity often develops (with mycoplasma infection) or rapid delivery - with group B streptococci.

Of great importance in the outcome of pregnancy and childbirth for the fetus and newborn with infectious diseases of the mother is the treatment of the pregnant woman and the woman in labor, as well as the method of delivery.

Treatment of urogenital infection

Urogenital infection is one of the main causes of miscarriage. Therefore, when planning pregnancy, a comprehensive comprehensive examination of future parents is necessary to identify obvious and hidden foci of infection, the nature of the pathogen and conduct etiotropic therapy.

When pregnancy occurs in women at risk for miscarriage, a comprehensive microbiological examination should be carried out and, if UGI is detected, appropriate treatment should be carried out.

Treatment of infectious diseases in pregnant women should be complex with individual approach to every patient. It includes antibacterial and desensitizing general strengthening therapy, measures aimed at increasing the immunological reactivity of the pregnant woman, normalizing liver function, preventing and treating complications of pregnancy and childbirth, preventing intrauterine infection of the fetus, its hypoxia and malnutrition.

Antibacterial therapy is carried out taking into account the nature of the pathogen and its sensitivity to the drug, the pharmacokinetics of the drugs used, the gestational age at the time of treatment and the condition of the fetus. The appointment of eubiotics is mandatory (Tables 2 and 3).

table 2
ANTIBACTERIAL AND ANTIVIRAL DRUGS USED IN PREGNANCY

MICROORGANISMS

NYSTATIN

PIMAFUCIN

erythromycin

SUMAMED

VILPRAFEN

ROVAMYCIN

RULID

MACROPEN

CLACID

AMPICILLIN

Benzylpenicillin

OXACILLIN

GENTAMICIN

CEPHALOSPORINS

LINCOMYCIN

SULFADIMESINE

ETAZOL

NITROFURANS

NITROXOLINE

METRONIDAZOL

NALIDIXIC ACID

ACYCLOVIR

Anaerobes

Gardnerella

Trichomonas

M. hominis

U. urealyticum

Gonococci

Chlamydia

streptococci

coli

Staphylococci

Candida

Klebsiella

V. herpes

+ - effective against this pathogen

When prescribing treatment for women with UGI, sexual partners are subject to examination and treatment. It is recommended to abstain from sexual activity until cured.

Table 3
TREATMENT OF UROGINETAL INFECTIONS

CHARACTER UGI	OUTSIDE OF PREGNANCY	IN PREGNANCY
Bacterial vaginosis	1. Antibiotics (kpindamycin - locally and systemically) 2. Synthetic antimicrobials (metranidazole) 5. Vitamins	1. Antibiotics (clindamycin - locally and systemically) * 2. Synthetic antimicrobials (metronidazole)* 3. Eubiotics (systemically and locally) 5. Vitamins *, reduction of course doses compared to the state outside of pregnancy
Urogenital candidiasis	1. Antibiotics (natamycin (pimafucin), nystatin, levorin, amphoglucamine) 2. Imidazole preparations, applied topically (clotrimazole (bifonazole, canesten), miyunazopl (gyno-dactarin), econazole (gyno-pevaril), isoconazole (gyno-travogen)) 3. Thiazole drugs (fluconazop (difmocan), itraconazole (orungal), terzhinan) 4. Combined preparations, applied topically (polygynax, pimafucort, klion D) 6. Immunomodulators (licopid, polyoxidonium, etc.) 7. Vitamins	1. Antibiotics (natamycin (pimafucin), nystatin) 2. Imidazole preparations are applied topically (clotrimazole (bifonazole, canesten), miconazole (gyno-dactarin), isoconazole (gyno-travogen)) 3. Combined preparations, applied topically (polygynax, pimafukort, terzhinan) 4. Non-specific agents (sodium tetraborate in glycerin, Castelliani liquid, etc.) 5. Eubiotics (systemically and locally) 8. Plant Based Adaptogens 9. Vitamins
Mycoplasmosis	1. Antibiotics (doxyciplin, erythromycin, macropen, azithromycin, pefmoxacin) are applied systemically. Locally - dalacin 3. Immunomodulators (licopid, polyoxidonium, etc.) 4. Vitamins	1. Antibiotics (erythromycin, in case of intolerance - macrofoam, azithromycin), are used systemically. Locally - dalacin 2. Eubiotics (systemically and locally) 4. Vitamins
Chlamydia	1. Antibiotics (tetracycline, doxycycline, macropen, azithromycin (Sumamed), erythromycin, spiramycin (rovamycin), rulid, clarithromycin (clacid) 2. Synthetic antimicrobials (ofloxacin) 3. Antimycotic drugs 4. Immunomodulators (licopid, polyoxidonium, etc.) 5. Eubiotics (systemically and locally) 6. Vitamins 7. Hepatoprotectors (Essentiale Forte, Corsil, Methionine) 8. Topical treatment	1. Antibiotics (erythromycin, vilprafen, rovamycin, azithromycin (sumamed), rulid, macropen, clarithromycin (clacid) 2. Antimycotic drugs 3. Adaptogens of plant origin 4. Eubiotics (systemically and locally) 5. Vitamins 6. Hepatoprotectors (Essentiale Forte, Corsil, Methionine) 7. Treatment of concomitant complications of pregnancy 8. Prevention and treatment of placental insufficiency 9. Topical treatment
herpetic infection	1. Antivirals(acyclovir, famvir, valaciclovir, alpyrazine, flocozide, ribamidin, etc.) 2. Interferon and its inducers (interlock, poludan, alpha2-interferon (reaferon), cycloferon (comedone), ridostin; viferon - suppositories) 3. Vitamins C, E 4. Immunomodulators (licopid, etc.) and adaptogens of plant origin 6. Herpetic vaccines	1. Antiviral drugs (with disseminated forms, acyclovir is used) 2. Interferons (Viferon-1 from 28-34 weeks of pregnancy, Viferon-2 from 35-40 weeks of pregnancy) 3. Vitamins C, E 4. Adaptogens of plant origin 5. Preparations for external use (acyclovir, megosin, gosipol, oxolinic ointment, tebrofein ointment, alterazine ointment, epigen intimo) In the presence of herpetic eruptions on the genitals of the mother for 2 months. before delivery, a caesarean section is indicated to prevent neonatal herpes

* - antibacterial drugs are used after 12 weeks of pregnancy

Sexually transmitted infections pose the greatest danger, as in rare cases a person can recognize them on their own. That is why the issue of timely testing and diagnosis of urogenital infections becomes relevant.

Before moving on to the main infections, it is worth saying that the concept of sexually transmitted diseases and urogenital infections is almost the same thing.

So, there are three ways to find out if you have some kind of infection:

This is the delivery of bacteriological seeding, or as it is simply called bacteriological seeding. It is usually taken from a smear, feces, blood, etc.
Linked immunosorbent assay. This is a more accurate analysis compared to bacteriological culture, as it allows you to identify the infection at various stages, be it the incubation period, prodromal, and others.
polymerase chain reaction. This is the most accurate method for determining the type of infection, and its presence. Urogenital infections by PCR are detected in just a few days.

Why should timely diagnosis of urogenital infections be carried out? Health is above all. All people should be guided by this motto, because sexual contact can be excellent, but, then, not very pleasant.

So, you need to regularly take tests for the presence of urogenital infections because:

They very easily pass into the chronic stage, while not showing themselves in any way.
They can cause a number of diseases associated with the genitourinary system. For example, cystitis, salpingitis, etc.
Adhesions may begin to form.
In most cases, a neglected disease has to be treated for a very long time, and this affects the sex life.
Some infections can lead to the development of cancer.
If you start the infection, it will easily pass to other vital organs.

In addition, the treatment of urogenital infections is not an easy task. In most cases, you have to resort to antibiotics, which in itself is not useful for the body, since there are a number of side effects.

With the timely delivery of all tests, it is possible to identify initial stage development of such dangerous UGI as:

Trichomonas. This infection leads to male infertility. And most importantly, in men, if we compare them with women, the presence of this infection is asymptomatic. That is why a man simply does not know that he is a carrier of Trichomonas.
Chlamydia. The most common genital infection, which proceeds almost asymptomatically, thereby causing great harm to the body
Gonorrhea. The lesions in this infection are colossal, but its main difference from the above infections is that within a few days after contact with an infected person, the first symptoms of manifestation will appear.
Mycoplasma. It can influence the development of such inflammatory diseases as prostatitis, vaginitis, etc.
Herpes. This is a real problem in modern world, as every day more and more people are exposed to this infection
Papilloma.

It is recommended to take tests for the presence of urogenital infections in several cases:

If there was unprotected intercourse, and at the same time you partly changed partners
If the drug was injected intravenously
If you have recently had a blood transfusion

Passing tests on time means feeling responsible for yourself and your body, since it is much easier to treat infections at the initial stage than when it has passed into the chronic stage. Yes, and knowing whether you are a carrier is also important.