Chapter 12

Chapter 12

Inflammatory diseases of the genital organs (VZPO) in women occupy the 1st place in the structure of gynecological pathology and account for 60-65% of visits to antenatal clinics. Perhaps the number of cases is greater, since often with erased forms, patients do not go to the doctor. The increase in the number of VZPO in all countries of the world is a consequence of changes in the sexual behavior of young people, violations of the environment and a decrease in immunity.

Classification. According to the localization of the pathological process, inflammatory diseases of the lower (vulvitis, bartholinitis, colpitis, endocervicitis, cervicitis) and upper (endomyometritis, salpingo-oophoritis, pelvioperitonitis, parametritis) of the genital organs are distinguished, the border of which is the internal uterine os.

According to the clinical course, inflammatory processes are divided into:

Acute with severe clinical symptoms;

Subacute with blurred manifestations;

Chronic (with an unknown duration of the disease or a prescription of more than 2 months) in remission or exacerbation.

Etiology. VZPO can occur under the influence of mechanical, thermal, chemical factors, but the most significant is infectious. Depending on the type of pathogen, VZPO are divided into non-specific and specific (gonorrhea, tuberculosis, diphtheria). The cause of nonspecific inflammatory diseases can be streptococci, staphylococci, enterococci, Candida fungi, chlamydia, mycoplasmas, ureaplasmas, E. coli, Klebsiella, Proteus, viruses, actinomycetes, Trichomonas, etc. Along with absolute pathogens (gonococci, chlamydia, Trichomonas, Mycoplasma genitalia) in the occurrence of VZPO, an important role is played by opportunistic microorganisms that live in certain parts of the genital tract, as well as associations of microorganisms. Currently, inflammatory diseases in the genital tract are caused by a mixed microflora with a predominance of anaerobic non-spore-forming microorganisms. Pathogenic pathogens of VZPO are transmitted sexually, less often - household (mainly in girls when using common hygiene items). Sexually transmitted diseases include gonorrhea, chlamydia, trichomoniasis, herpes and papillomavirus infection, acquired immunodeficiency syndrome (AIDS), syphilis, anogenital warts, molluscum contagiosum. Conditionally pathogenic

Microorganisms become causative agents of VZPO under certain conditions that increase their virulence, on the one hand, and reduce the immunobiological properties of the macroorganism, on the other.

Factors preventing the entry and spread of infection in the body. In the genital tract, there are many levels of biological protection against the occurrence of infectious diseases. The first is the closed state of the genital slit.

The activation of opportunistic microorganisms and the spread of infection are prevented by the properties of the vaginal microflora - the creation of an acidic environment, the production of peroxides and other antimicrobial substances, inhibition of adhesion for other microorganisms, activation of phagocytosis and stimulation of immune responses.

Normally, the vaginal microflora is very diverse. It is represented by gram-positive and gram-negative aerobes, facultative and obligate anaerobic microorganisms. A large role in microbiocenosis belongs to lacto- and bifidobacteria (Dederlein sticks), which create a natural barrier to pathogenic infection (Fig. 12.1). They make up 90-95% of the vaginal microflora in the reproductive period. Breaking down the glycogen contained in the surface cells of the vaginal epithelium to lactic acid, lactobacilli create an acidic environment (pH 3.8-4.5), which is detrimental to many microorganisms. The number of lactobacilli and, accordingly, the formation of lactic acid decreases with a decrease in the level of estrogens in the body (in girls in the neutral period, postmenopause). The death of lactobacilli occurs as a result of the use of antibiotics, douching of the vagina with solutions of antiseptic and antibacterial drugs. The vaginal rod-shaped bacteria also include actinomycetes, corynebacteria, bacteroids, fusobacteria.

The second place in the frequency of detection of bacteria in the vagina belongs to cocci - epidermal staphylococcus, hemolytic and non-hemolytic streptococci, enterococci. Smaller amounts and less

Rice. 12.1. Microscopy of a vaginal smear. Vaginal epitheliocyte against the background of lactobacilli

there are enterobacteria, E. coli, Klebsiella, mycoplasma and ureaplasma, as well as yeast-like fungi of the genus Candida. Anaerobic flora prevails over aerobic and facultative anaerobic flora. The vaginal flora is a dynamic, self-regulating ecosystem.

General infectious diseases accompanied by a decrease in immunity, endocrine disorders, the use of hormonal and intrauterine contraceptives, the use of cytostatics disrupt the qualitative and quantitative composition of the vaginal microflora, which facilitates the invasion of pathogenic microorganisms and can lead to the development of inflammatory processes caused by opportunistic bacteria.

The cervical canal serves as a barrier between the lower and upper parts of the genital tract, and the border is the internal os of the uterus. Cervical mucus contains high concentrations of biologically active substances. Cervical mucus provides activation of non-specific defense factors (phagocytosis, synthesis of opsonins, lysozyme, transferrin, which are detrimental to many bacteria) and immune mechanisms (complement system, immunoglobulins, T-lymphocytes, interferons). Hormonal contraceptives cause thickening of the cervical mucus, which becomes difficult for infectious agents to pass.

The spread of infection is also prevented by the rejection of the functional layer of the endometrium during menstruation, along with the microorganisms that have got there. With the penetration of infection into the abdominal cavity, the plastic properties of the pelvic peritoneum contribute to the delimitation of the inflammatory process by the pelvic area.

Ways of spread of infection. The spread of infection from the lower genital tract to the upper can be passive and active. Passive include spread through the cervical canal into the uterine cavity, into the tubes and abdominal cavity, as well as the hematogenous or lymphogenous route. Microorganisms can also be actively transported on the surface of moving spermatozoa and Trichomonas.

The spread of infection in the genital tract is facilitated by:

Various intrauterine manipulations, in which infection is carried from the external environment or from the vagina into the uterine cavity, and then the infection enters through the fallopian tubes into the abdominal cavity;

Menstruation, during which microorganisms easily penetrate from the vagina into the uterus, causing an ascending inflammatory process;

childbirth;

Operations on the organs of the abdominal cavity and small pelvis;

Foci of chronic infection, metabolic and endocrine disorders, nutritional deficiencies or imbalances, hypothermia, stress, etc.

Pathogenesis. After the penetration of the infection in the lesion, destructive changes occur with the onset of an inflammatory reaction. Biologically active inflammatory mediators are released, causing microcirculation disorders with exudation and, at the same time, stimulation of proliferative processes. Along with local manifestations of the inflammatory reaction, characterized by five cardinal

signs (redness, swelling, fever, soreness and dysfunction), general reactions may occur, the severity of which depends on the intensity and prevalence of the process. Common manifestations of inflammation include fever, hematopoietic tissue reactions with the development of leukocytosis, increased ESR, accelerated metabolism, and intoxication of the body. The activity of the nervous, hormonal and cardiovascular systems, the indicators of the immunological reactivity of the hemostasiogram change, microcirculation is disturbed in the focus of inflammation. Inflammation is one of the most common pathological processes. With the help of inflammation, localization and then elimination of the infectious agent is ensured along with the tissue damaged under its influence.

12.1. Inflammatory diseases of the lower genital tract

Vulvitis- inflammation of the external genitalia (vulva). In women of the reproductive period, vulvitis often develops a second time - with colpitis, endocervicitis, endometritis, adnexitis. Primary vulvitis occurs in adults with diabetes, non-compliance with the rules of hygiene (diaper rash in obesity), with thermal, mechanical (trauma, abrasions, scratching), chemical effects on the skin of the external genitalia.

In acute vulvitis, patients complain of itching, burning in the vulva, sometimes general malaise. Clinically, the disease is manifested by hyperemia and swelling of the vulva, purulent or serous-purulent discharge, and an increase in inguinal lymph nodes. In the chronic stage, the clinical manifestations subside, periodically appear itching, burning.

Additional methods for diagnosing vulvitis include bacterioscopic and bacteriological examination of the discharge of the external genital organs to identify the causative agent of the disease.

Treatment vulvitis is to eliminate the concomitant pathology that caused it. Vaginal washing is prescribed with infusion of herbs (chamomile, calendula, sage, St. They use complex antibacterial drugs that are effective against many pathogenic bacteria, fungi, Trichomonas: polygynax ♠, terzhinan ♠, neo-penotran ♠, nifuratel (macmiror ♠) for insertion into the vagina daily for 10-14 days. Ointments with antiseptics or antibiotics are applied to the vulva area. After the inflammatory changes subside, to accelerate reparative processes, ointments with retinol, vitamin E, solcoseryl ♠, acto-vegin ♠, sea buckthorn oil, rosehip oil, etc. can be applied topically to accelerate reparative processes. Physiotherapy is also used: ultraviolet irradiation of the vulva, laser therapy. With severe itching of the vulva, antihistamines (diphenhydramine, chloropyramine, clemastine, etc.), local anesthetics (anesthetic ointment) are prescribed.

Bartholinitis- inflammation of the large gland of the vestibule of the vagina. The inflammatory process in the cylindrical epithelium lining the gland and surrounding tissues quickly leads to blockage of its excretory duct with the development of an abscess.

With bartholinitis, the patient complains of pain at the site of inflammation. Hyperemia and edema of the excretory duct of the gland are determined, with pressure, a purulent discharge appears. The formation of an abscess leads to a worsening of the condition. Weakness, malaise, headache, chills, fever up to 39 ° C appear, pains in the area of ​​the Bartholin's gland become sharp, pulsating. On examination, edema and hyperemia are visible in the middle and lower thirds of the labia majora and minora on the affected side, a tumor-like formation that closes the entrance to the vagina. Palpation of the formation is sharply painful. Surgical or spontaneous opening of the abscess contributes to the improvement of the condition and the gradual disappearance of the symptoms of inflammation. The disease can recur, especially with self-medication.

Treatment bartholinitis is reduced to the use of antibiotics, taking into account the sensitivity of the pathogen, symptomatic agents. Locally prescribed applications of anti-inflammatory ointments (levomekol ♠), applying an ice pack to reduce the severity of inflammation. In the acute phase of the inflammatory process, physiotherapy is used - UHF on the area of ​​the affected gland.

When an abscess of the Bartholin gland is formed, surgical treatment is indicated - opening the abscess with the formation of an artificial duct by suturing the edges of the mucous membrane of the gland to the edges of the skin incision (marsupialization). After the operation, the sutures are treated with antiseptic solutions for several days.

12.2. Infectious diseases of the vagina

Infectious diseases of the vagina are the most common in patients of the reproductive period. These include:

bacterial vaginosis;

Nonspecific vaginitis;

Vaginal candidiasis;

Trichomonas vaginitis.

According to modern concepts, the development of an infectious disease of the vagina occurs as follows. After adhesion to the epithelial cells of the vagina, opportunistic microorganisms begin to multiply actively, which causes the occurrence of vaginal dysbiosis. Later, as a result of overcoming the protective mechanisms of the vagina, infectious agents cause an inflammatory reaction (vaginitis).

Bacterial vaginosis (BV) is a non-inflammatory clinical syndrome caused by the replacement of lactobacilli of the vaginal flora with opportunistic anaerobic microorganisms. Currently, BV is considered not as a sexually transmitted infection, but as a vaginal infection.

nal dysbiosis. At the same time, BV creates the prerequisites for the occurrence of infectious processes in the vagina, so it is considered together with inflammatory diseases of the genital organs. BV is a fairly common infectious disease of the vagina, found in 21-33% of patients of reproductive age.

Etiology and pathogenesis. Previously, gardnerella was considered the cause of the disease, so it was called gardnerellosis. However, it was later found that Gardnerella vaginalis- not the only causative agent of BV; in addition, this microorganism is an integral part of the normal microflora. Violation of the microecology of the vagina is expressed in a decrease in the number of lactobacilli dominant in the norm and the rapid proliferation of various bacteria (Gardnerella vaginalis, Mycoplasma hominis), but above all - obligate anaerobes (Bacteroides spp., Prevotella spp., Peptostreptococcus spp., Mobiluncus spp., Fusobacterium spp. and etc.). Not only the qualitative, but also the quantitative composition of the vaginal microflora changes with an increase in the total concentration of bacteria.

The disease is predisposed to the use of antibacterial drugs, including antibiotics, the use of oral contraceptives and the use of IUDs, hormonal disorders with a clinical picture of oligo- and opsomenorrhea, inflammatory diseases of the genital organs, frequent change of sexual partners, decreased immunity, etc.

As a result of a violation of the vaginal microbiocenosis, the pH of the vaginal contents changes from 4.5 to 7.0-7.5, anaerobes form volatile amines with an unpleasant smell of rotten fish. The described changes disrupt the functioning of natural biological barriers in the vagina and contribute to the occurrence of inflammatory diseases of the genital organs, postoperative infectious complications.

Clinical symptoms. The main complaint in patients with BV is abundant homogeneous creamy gray vaginal discharge that sticks to the walls of the vagina (Fig. 12.2) and has an unpleasant "fishy" smell. There may be itching, burning in the vaginal area, discomfort during intercourse.

Microscopic examination of Gram-stained vaginal smears reveals "key" cells in the form of desquamated vaginal epithelial cells,

Rice. 12.2. Bacterial vaginosis

to the surface of which microorganisms characteristic of BV are attached (Fig. 12.3). In healthy women, "key" cells are not found. In addition, typical bacterioscopic signs of the disease are a small number of leukocytes in the field of view, a decrease in the number or absence of Dederlein sticks.

Diagnostic criteria for BV (Amsel criteria) are:

Specific vaginal discharge;

Detection of "key" cells in the vaginal smear;

pH of vaginal contents >4.5;

Positive amine test (appearance of a smell of rotten fish when potassium hydroxide is added to vaginal discharge).

BV can be diagnosed if three of the following criteria are met. Diagnosis is supplemented by a bacteriological research method with the determination of the qualitative and quantitative composition of the vaginal microflora, as well as a microscopic assessment of the relative proportion of bacterial morphotypes in a vaginal smear (Nugent criterion).

Treatment sexual partners - men in order to prevent recurrence of bacterial vaginosis in women is impractical. However, in men, urethritis is not excluded, which requires their examination and, if necessary, treatment. The use of condoms during treatment is not required.

Therapy consists of metronidazole, ornidazole, or clindamycin orally or intravaginally for 5 to 7 days. It is possible to use terzhinan ♠, nifuratel in the form of vaginal tablets or suppositories for 8-10 days.

After antibiotic therapy, measures are shown to restore the normal microbiocenosis of the vagina with the help of eubiotics - vagilak ♠, lactobacterin ♠, bifidumbacterin ♠, acylact ♠, etc. It is also recommended to use vitamins, biogenic stimulants aimed at increasing the overall resistance of the organism.

For immunotherapy and immunoprophylaxis of BV, the vaccine "SolkoTrichovak" ♠ was created, consisting of special strains of lactobacilli. The antibodies formed as a result of the introduction of the vaccine effectively destroy

Rice. 12.3. Microscopy of a vaginal smear. "Key" cage

they kill the causative agents of the disease, normalizing the vaginal microflora, and create immunity that prevents relapses.

Nonspecific vaginitis (colpitis)- inflammation of the vaginal mucosa, caused by various microorganisms, may result from the action of chemical, thermal, mechanical factors. Among the causative agents of vaginitis, opportunistic flora, primarily staphylococci, streptococci, Escherichia coli, non-spore-forming anaerobes, is of the greatest importance. The disease occurs as a result of an increase in the virulence of saprophytic microorganisms of the vagina with a decrease in the immunobiological protection of the macroorganism.

In the acute stage of the disease, patients complain of itching, burning in the vagina, purulent or serous-purulent discharge from the genital tract, pain in the vagina during intercourse (dyspareunia). Vaginitis is often combined with vulvitis, endocervicitis, urethritis. During a gynecological examination, attention is drawn to swelling and hyperemia of the vaginal mucosa, which bleeds easily when touched, purulent overlays and pinpoint hemorrhages on its surface. In severe cases of the disease, desquamation of the vaginal epithelium occurs with the formation of erosions and ulcers. In the chronic stage, itching and burning become less intense, occur periodically, the main complaint is serous-purulent discharge from the genital tract. Hyperemia and edema of the mucous membrane decrease, in the places of erosion, infiltrates of the papillary layer of the vagina can be formed, found in the form of point elevations above the surface (granular colpitis).

An additional method for diagnosing vaginitis is colposcopy, which helps to detect even mild signs of the inflammatory process. To identify the causative agent of the disease, bacteriological and bacterioscopic examination of discharge from the vagina, urethra, and cervical canal is used. Microscopy of a vaginal smear reveals a large number of leukocytes, desquamated epithelial cells, abundant gram-positive and gram-negative flora.

Treatment treatment of vaginitis should be complex, aimed, on the one hand, at fighting infection, and on the other hand, at eliminating concomitant diseases and increasing the body's defenses. Etiotropic therapy consists in the appointment of antibacterial drugs that act on pathogens. For this purpose, both local and general therapy are used. Assign washing or douching of the vagina with solutions of dioxidine ♠, chlorhexidine, betadine ♠, miramistin ♠, chlorophyllipt ♠ 1-2 times a day. Prolonged douching (more than 3-4 days) is not recommended, because it interferes with the restoration of natural biocenosis and normal acidity of the vagina. With senile colpitis, it is advisable to use estrogens topically, which increase the biological protection of the epithelium (estriol - ovestin ♠ in suppositories, ointments).

Antibiotics and antibacterial agents are used in the form of suppositories, vaginal tablets, ointments, gels. Complex preparations of antimicrobial, antiprotozoal and antifungal action - terzhinan ♠, polygynax ♠, neo-penotran ♠, nifuratel, ginalgin ♠ - are widely used for the treatment of vaginitis. In anaerobic and mixed infections, betadine ♠, metronidazole, clindamycin, ornidazole are effective. Local treatment is often combined with general antibiotic therapy, taking into account the sensitivity of the pathogen.

After antibiotic therapy, it is necessary to prescribe eubiotics (Vagilak ♠, Bifidumbacterin ♠, Lactobacterin ♠, Biovestin ♠), which restore the natural microflora and acidity of the vagina.

Vaginal candidiasis is one of the most common diseases of the vagina of infectious etiology, in recent years its frequency has increased. In the United States, 13 million episodes of the disease are recorded every year - in 10% of the female population of the country; 3 out of 4 women of reproductive age have had vaginal candidiasis at least once.

Etiology and pathogenesis. The causative agent of the disease is yeast-like fungi of the genus Candida. Most often (85-90%) the vagina is affected by fungi candida albicans, less often - Candida glabrata, Candida tropicalis, Candida krusei and others. Fungi of the genus Candida are unicellular aerobic microorganisms. They form pseudomycelium in the form of chains of elongated cells, as well as blastospores - budding cells in the places of branching of pseudomycelium, which are elements of reproduction. The optimal conditions for the growth and reproduction of fungi are a temperature of 21-37 ° C and a slightly acidic environment.

Genital candidiasis is not a sexually transmitted disease, but is often a marker. Mushrooms are opportunistic flora that normally lives on the surface of the skin and mucous membranes, including the vagina. However, under certain conditions (decrease in general and local resistance, taking antibiotics, oral contraceptives, cytostatics and glucocorticosteroids, diabetes mellitus, tuberculosis, malignant neoplasms, chronic infections, etc.), it can cause a disease. At the same time, the adhesive properties of fungi increase, which attach to the cells of the vaginal epithelium, causing colonization of the mucous membrane and the development of an inflammatory reaction. Usually, candidiasis affects only the superficial layers of the vaginal epithelium. In rare cases, the epithelial barrier is overcome and the pathogen invades the underlying tissues with hematogenous dissemination.

According to the data obtained, when urogenital candidiasis recurs, the main reservoir of infection is the intestine, from where the fungi periodically enter the vagina, causing an aggravation of the inflammatory process.

There are acute (disease duration up to 2 months) and chronic (recurrent; disease duration - more than 2 months) urogenital candidiasis.

Clinic. Vaginal candidiasis causes complaints of itching, burning in the vagina, curdled discharge from the genital tract. Itching and burning worse after water procedures, sexual intercourse or during sleep. Involvement in the process of the urinary tract leads to dysuric disorders.

In the acute period of the disease, the skin of the external genitalia is secondarily involved in the inflammatory process. Vesicles form on the skin, which open up and leave erosions. Examination of the vagina and the vaginal portion of the cervix with the help of mirrors reveals hyperemia, swelling, white or gray-white curdled overlays on the walls of the vagina (Fig. 12.4). Colposcopic signs of vaginal candidiasis after staining with Lugol's solution * include small-dotted inclusions in the form of "semolina" with a pronounced vascular pattern. In the chronic course of candidiasis, secondary elements of inflammation predominate - tissue infiltration, sclerotic and atrophic changes.

The most informative in terms of diagnostic microbiological examination. Microscopy of a native or Gram-stained vaginal smear reveals spores and pseudomycelia of the fungus. A good addition to microscopy is the cultural method - the sowing of vaginal contents on artificial nutrient media. A cultural study allows you to establish the species of fungi, as well as their sensitivity to antimycotic drugs (Fig. 12.5).

Additional methods for vaginal candidiasis include the study of intestinal microbiocenosis, examination for sexually transmitted infections, analysis of the glycemic profile with a load.

Rice. 12.4. Discharge from the genital tract with candidiasis

Rice. 12.5. Microscopy of a vaginal smear

Treatment treatment of vaginal candidiasis should be complex, not only with the impact on the causative agent of the disease, but also with the elimination of predisposing factors. Recommend refusal to take oral contraceptives, antibiotics, if possible - glucocorticosteroids, cytostatics, carry out drug correction of diabetes. During the period of treatment and dispensary observation, the use of condoms is recommended.

For the treatment of acute forms of urogenital candidiasis, at the first stage, one of the drugs is usually used topically in the form of a cream, suppositories, vaginal tablets or balls: econazole, isoconazole, clotrimazole, butoconazole (gynofort ♠), natamycin (pimafucin ♠), ketoconazole, terzhinan ♠ , nifuratel, etc. within 6-9 days. In chronic urogenital candidiasis, along with local treatment, systemic drugs are used - fluconazole, itraconazole, ketoconazole.

In children, low-toxic drugs are used - fluconazole, nifuratel, terzhinan ♠. Special nozzles on the tubes allow you to apply the cream without damaging the hymen.

At the second stage of treatment, the disturbed microbiocenosis of the vagina is corrected.

The criterion of cure is the resolution of clinical manifestations and negative results of microbiological examination. If the treatment is ineffective, it is necessary to repeat the course according to other schemes.

Prevention vaginal candidiasis is to eliminate the conditions for its occurrence.

Trichomonas vaginitis refers to the most frequent infectious diseases, sexually transmitted, and affects 60-70% of women who are sexually active.

Etiology and pathogenesis. Trichomonas vaginalis is the causative agent (Trichomonas vaginalis)- the simplest oval-shaped microorganism; has from 3 to 5 flagella and an undulating membrane, with the help of which it moves (Fig. 12.6). Nutrition is carried out by endo-osmosis and phagocytosis. Trichomonas is unstable in the external environment and easily dies when heated above 40 ° C, drying, exposure to disinfectant solutions. Trichomonas are often companions of other sexually transmitted infections (gonorrhea, chlamydia, viral infections, etc.) and (or) causing inflammation of the genital organs (yeasts, mycoplasmas, ureaplasmas). Trichomoniasis is considered as a mixed protozoan-bacterial infection.

Rice. 12.6. Microscopy of a vaginal smear. Trichomonas

Trichomonas can reduce sperm motility, which is one of the causes of infertility.

The main route of infection with trichomoniasis is sexual. The contagiousness of the pathogen approaches 100%. The household route of infection is also not excluded, especially in girls, when using common linen, bedding, and also intranatally during the passage of the fetus through the infected birth canal of the mother.

Trichomonas are found mainly in the vagina, but can affect the cervical canal, urethra, bladder, excretory ducts of the large glands of the vaginal vestibule. Trichomonas can penetrate through the uterus and fallopian tubes even into the abdominal cavity, carrying pathogenic microflora on its surface.

Despite the specific immunological reactions to the introduction of Trichomonas, immunity after suffering trichomoniasis does not develop.

Classification. There are fresh trichomoniasis (prescription of the disease up to 2 months), chronic (sluggish forms with a duration of the disease of more than 2 months or with an unknown prescription) and trichomonas carriers, when pathogens do not cause an inflammatory process in the genital tract, but can be transmitted to a partner through sexual contact. Fresh trichomoniasis can be acute, subacute, or torpid (low-symptomatic). Urogenital trichomoniasis is also divided into uncomplicated and complicated.

Clinical symptoms. The incubation period for trichomoniasis ranges from 3-5 to 30 days. The clinical picture is due, on the one hand, to the virulence of the pathogen, on the other hand, to the reactivity of the macroorganism.

In acute and subacute trichomoniasis, patients complain of itching and burning in the vagina, abundant gray-yellow frothy discharge from the genital tract (Fig. 12.7). Foamy discharge is associated with the presence of gas-producing bacteria in the vagina. Damage to the urethra causes pain during urination

Rice. 12.7. Foamy discharge from the vagina with trichomoniasis

scans, frequent urge to urinate. In torpid and chronic diseases, complaints are not expressed or absent.

Diagnosis is helped by a carefully collected anamnesis (contacts with patients with trichomoniasis) and objective examination data. Gynecological examination reveals hyperemia, swelling of the mucous membrane of the vagina and the vaginal portion of the cervix, foamy purulent leucorrhoea on the walls of the vagina. Colposcopy reveals petechial hemorrhages, erosion of the cervix. In the subacute form of the disease, signs of inflammation are weakly expressed, in the chronic form they are practically absent.

Microscopy of vaginal smears reveals the pathogen. It is better to use a native rather than stained preparation, since the ability to determine the movement of Trichomonas under a microscope increases the likelihood of their detection. In some cases, fluorescence microscopy is used. In recent years, the PCR method has been increasingly used to diagnose trichomoniasis. 1 week before sampling, patients should not use anticystic drugs, stop local procedures. Successful diagnosis involves a combination of different techniques, repeated repetition of tests.

Treatment should be carried out to both sexual partners (spouses), even if Trichomonas is found only in one of them. During the period of therapy and subsequent control, sexual activity is prohibited or it is recommended to use condoms. Trichomonas carriers should also be involved in the treatment.

In acute and subacute trichomoniasis, therapy is reduced to the appointment of one of the specific antitrichomonas drugs - ornidazole, tinidazole, metronidazole. In the absence of the effect of treatment, a change in the drug or doubling the dose is recommended.

Ornidazole is the drug of choice for trichomonas vulvovaginitis in children.

In chronic forms of trichomoniasis that are difficult to respond to conventional therapy, the SolkoTrichovac vaccine * is effective, including special strains of lactobacilli isolated from the vagina of women infected with trichomoniasis. As a result of the introduction of the vaccine, antibodies are formed that destroy Trichomonas and other pathogens of inflammation that have antigens in common with lactobacilli. In this case, the normalization of the vaginal microflora occurs and a long-term immunity is created that prevents relapses.

The criteria for the cure of trichomoniasis are the disappearance of clinical manifestations and the absence of Trichomonas in secretions from the genital tract and urine.

Prevention trichomoniasis is reduced to the timely detection and treatment of patients and trichomonas carriers, personal hygiene, exclusion of casual sex.

Endocervicitis- inflammation of the mucous membrane of the cervical canal, occurs as a result of trauma to the cervix during childbirth, abortion, diagnostic curettage and other intrauterine interventions. Tropicity to the cylindrical epithelium of the cervical canal, especially

characteristic of gonococci, chlamydia. Endocervicitis often accompanies other gynecological diseases of both inflammatory (colpitis, endometritis, adnexitis) and non-inflammatory (ectopia, ectropion of the cervix) etiology. In the acute stage of the inflammatory process, patients complain of mucopurulent or purulent discharge from the genital tract, less often - of pulling dull pains in the lower abdomen. Examination of the cervix with the help of mirrors and colposcopy reveal hyperemia and swelling of the mucous membrane around the external pharynx, sometimes with the formation of erosion, serous-purulent or purulent discharge from the cervical canal. The chronicity of the disease leads to the development cervicitis with involvement in the inflammatory process of the muscle layer. Chronic cervicitis is accompanied by hypertrophy and compaction of the cervix, the appearance of small cysts in the thickness of the cervix (nabothian cysts - ovulae Nabothii).

Diagnosis of endocervicitis is helped by bacteriological and bacterioscopic examination of discharges from the cervical canal, as well as cytological examination of smears from the cervix, which allows detecting cells of cylindrical and stratified squamous epithelium without signs of atypia, inflammatory leukocyte reaction.

Treatment endocervicitis in the acute phase is the appointment of antibiotics, taking into account the sensitivity of pathogens. Topical treatment is contraindicated due to the risk of ascending infection.

12.3. Inflammatory diseases of the upper genital tract (pelvic organs)

endometritis- inflammation of the uterine mucosa with damage to both the functional and basal layers. acute endometritis, as a rule, it occurs after various intrauterine manipulations - abortion, curettage, the introduction of intrauterine contraceptives (IUDs), as well as after childbirth. The inflammatory process can quickly spread to the muscle layer (endomyometritis), and in severe cases, affect the entire wall of the uterus (panmetritis). The disease begins acutely - with an increase in body temperature, the appearance of pain in the lower abdomen, chills, purulent or sanious-purulent discharge from the genital tract. The acute stage of the disease lasts 8-10 days and ends, as a rule, with recovery. Less common is the generalization of the process with the development of complications (parametritis, peritonitis, pelvic abscesses, thrombophlebitis of the veins of the small pelvis, sepsis) or inflammation becomes subacute and chronic.

During a gynecological examination, purulent discharge from the cervical canal is determined, an enlarged uterus of a softish consistency, painful or sensitive, especially in the ribs (along the large lymphatic vessels). In a clinical blood test, leukocytosis, a shift of the leukocyte formula to the left, lymphopenia, and an increase in ESR are detected. Ultrasound scanning determines an increase in the uterus, blurring of the border between the endometrium and myometrium, a change in the echogenicity of the myometrium (alternating areas of increased and decreased echo density), expansion of the uterine cavity with hypoechoic contents and finely dispersed

ny suspension (pus), and with an appropriate history - the presence of an IUD or the remains of a fetal egg. The endoscopic picture during hysteroscopy depends on the causes that caused endometritis. In the uterine cavity, against the background of a hyperemic edematous mucosa, scraps of necrotic mucosa, elements of the fetal egg, remnants of placental tissue, foreign bodies (ligatures, IUDs, etc.) can be determined.

In case of violation of the outflow and infection of discharge from the uterus due to narrowing of the cervical canal by a malignant tumor, polyp, myomatous node, pyometra - secondary purulent lesion of the uterus. There are sharp pains in the lower abdomen, purulent-resorptive fever, chills. In a gynecological examination, there is no discharge from the cervical canal, an enlarged, rounded, painful body of the uterus is found, and an ultrasound scan shows an expansion of the uterine cavity with the presence of fluid with a suspension in it (according to the echostructure, it corresponds to pus).

Chronic endometritis occurs more often due to inadequate treatment of acute endometritis, which is facilitated by repeated curettage of the uterine mucosa due to bleeding, remnants of suture material after cesarean section, IUD. Chronic endometritis is a clinical and anatomical concept; the role of infection in maintaining chronic inflammation is very doubtful, however, there are morphological signs of chronic endometritis: lymphoid infiltrates, stromal fibrosis, sclerotic changes in spiral arteries, the presence of plasma cells, atrophy of the glands, or, conversely, mucosal hyperplasia with the formation of cysts and synechiae (unions) . In the endometrium, the number of receptors for sex steroid hormones decreases, resulting in the inferiority of the transformations of the uterine mucosa during the menstrual cycle. The clinical course is latent. The main symptoms of chronic endometritis include menstrual disorders - meno or menometrorrhagia due to a violation of the regeneration of the mucous membrane and a decrease in uterine contractility. Patients are disturbed by pulling, aching pains in the lower abdomen, serous-purulent discharge from the genital tract. Often in the anamnesis there are indications of violations of the generative function - infertility or spontaneous abortions. Chronic endometritis can be suspected on the basis of anamnesis, clinical picture, gynecological examination (slight increase and induration of the uterine body, serous-purulent discharge from the genital tract). There are ultrasound signs of chronic inflammation of the uterine mucosa: intrauterine synechia, defined as hyperechoic septa between the walls of the uterus, often with the formation of cavities. In addition, due to the involvement of the basal layer of the endometrium in the pathological process, the thickness of the M-echo does not correspond to the phase of the menstrual cycle. However, for the final verification of the diagnosis, a histological examination of the endometrium obtained during diagnostic curettage or a pipel biopsy of the uterine mucosa is required.

Salpingoophoritis (adnexitis) - inflammation of the uterine appendages (tubes, ovaries, ligaments), occurs in an ascending or descending way secondarily from inflammatory-altered abdominal organs (for example, with

appendicitis) or hematogenous. With ascending infection, microorganisms penetrate from the uterus into the lumen of the fallopian tube, involving all layers (salpingitis) in the inflammatory process, and then in half of the patients, the ovary (oophoritis) along with the ligamentous apparatus (adnexitis, salpin-goophoritis). The leading role in the occurrence of adnexitis belongs to chlamydial and gonococcal infections. Inflammatory exudate, accumulating in the lumen of the fallopian tube, can lead to an adhesive process and closure of the fimbrial region. There are saccular formations of the fallopian tubes (sactosalpinx). The accumulation of pus in the tube leads to the formation of a pyosalpinx (Fig. 12.8), serous exudate - to the formation of a hydrosalpinx (Fig. 12.9).

With the penetration of microorganisms into the tissue of the ovary, purulent cavities (ovarian abscess) can form in it, when they merge, the ovarian tissue melts. The ovary turns into a sac-shaped formation filled with pus (pyovar; Fig. 12.10).

Rice. 12.8. Pyosalpinx. Laparoscopy

Rice. 12.9. Hydrosalpinx. Laparoscopy

Rice. 12.10. Piovar. Laparoscopy

One form of complication of acute adnexitis is a tubo-ovarian abscess (Fig. 12.11), resulting from the melting of the adjacent walls of the pyovar and pyosalpinx.

Under certain conditions, through the fimbrial section of the tube, as well as as a result of rupture of an ovarian abscess, pyosalpinx, tubo-ovarian abscess, the infection can penetrate into the abdominal cavity and cause inflammation of the peritoneum of the small pelvis (pelvioperitonitis) (Fig. 12.12), and then other floors of the abdominal cavity (peritonitis) (Fig. 12.13) with the development of abscesses of the rectovaginal cavity, interintestinal abscesses.

The disease most often occurs in women of the early reproductive period, leading an active sex life.

Clinical symptoms acute salpingo-oophoritis (adnexitis) includes pain in the lower abdomen of varying intensity, fever up to 38-40 ° C, chills, nausea, sometimes vomiting, purulent discharge from the genital tract, dysuric phenomena. The severity of clinical symptoms is due, on the one hand, to the virulence of pathogens, and on the other hand, to the reactivity of the macroorganism.

Rice. 12.11. Tuboovarian abscess on the left. Laparoscopy

Rice. 12.12. Pelvioperitonitis. Laparoscopy

Rice. 12.13. Peritonitis. Laparoscopy

On general examination, the tongue is moist, covered with a white coating. Palpation of the abdomen may be painful in the hypogastric region. Gynecological examination reveals purulent or sanious-purulent discharge from the cervical canal, thickened, edematous, painful uterine appendages. During the formation of pyosalpinx, pyovar, tubo-ovarian abscesses in the area of ​​the uterine appendages or posterior to the uterus, motionless, voluminous, painful formations without clear contours, uneven consistency, often forming a single conglomerate with the body of the uterus, can be determined. In the peripheral blood, leukocytosis, a shift of the leukocyte formula to the left, an increase in ESR, the level of C-reactive protein, and dysproteinemia are detected. In the analysis of urine, an increase in the content of protein, leukocyturia, bacteriuria is possible, which is associated with damage to the urethra and bladder. Sometimes the clinical picture of acute adnexitis is erased, but there are pronounced destructive changes in the uterine appendages.

Bacterioscopy of smears from the vagina and cervical canal reveals an increase in the number of leukocytes, coccal flora, gonococci, trichomonads, pseudomycelium and spores of a yeast-like fungus. Bacteriological examination of secretions from the cervical canal does not always reveal the causative agent of adnexitis. More accurate results are obtained by microbiological examination of the contents of the fallopian tubes and the abdominal cavity obtained during laparoscopy, laparotomy or puncture.

Ultrasound scanning can visualize dilated fallopian tubes, free fluid in the pelvis (inflammatory exudate). The value of ultrasound increases with formed inflammatory tubo-ovarian formations (Fig. 12.14) of irregular shape, with fuzzy contours and heterogeneous echostructure. Free fluid in the pelvis most often indicates a rupture of the purulent formation of the uterine appendages.

In the diagnosis of acute adnexitis, laparoscopy is the most informative. It allows you to determine the inflammatory process of the uterus and appendages, its severity and prevalence, to conduct a differential diagnosis of diseases accompanied by an "acute abdomen" to determine the correct tactics. In acute salpingitis, edematous hyperemic fallopian tubes, the outflow of serous-purulent or purulent exudate from the fimbriae (Fig. 12.15) and its accumulation in the rectovaginal cavity are detected endoscopically. The ovaries may be enlarged as a result of secondary involvement in the inflammatory process. The pyosalpinx is visualized as a retort-like thickening of the tube in the ampullar section, the walls of the tube are thickened, edematous, compacted, the fimbrial section is sealed, there is pus in the lumen. Piovar looks like a volumetric formation of the ovary with a purulent cavity with a dense capsule and fibrin overlay. During the formation of a tubo-ovarian abscess, extensive adhesions are formed between the tube, ovary, uterus, intestinal loops, and the pelvic wall. The prolonged existence of a tubo-ovarian abscess leads to the formation of a dense capsule, delimiting

Rice. 12.14. Tuboovarian inflammatory formation. ultrasound

Rice. 12.15. Acute salpingitis. Laparoscopy

purulent cavity (cavities) from the surrounding tissues. When such purulent formations rupture, there is a perforation on their surface, from which pus enters the abdominal cavity (Fig. 12.16). These changes in the internal genital organs, revealed during laparoscopy in the case of acute inflammation of the uterine appendages, can also be noted during abdominal dissection, performed to remove the focus of inflammation. Obtaining purulent contents from volumetric formations of the uterine appendages during their puncture through the posterior vaginal fornix under ultrasound control also indirectly confirms the inflammatory nature of the disease.

Rice. 12.16. Rupture of the right-sided pyosalpinx. Laparoscopy

Chronic salpingoophoritis (adnexitis) is a consequence of acute or subacute inflammation of the uterine appendages. The reasons for the chronicity of the inflammatory process include inadequate treatment of acute adnexitis, a decrease in the reactivity of the body, and the properties of the pathogen. Chronic salpingo-oophoritis is accompanied by the development of inflammatory infiltrates, connective tissue in the wall of the fallopian tubes and the formation of hydrosalpinxes. Dystrophic changes occur in the ovarian tissue, due to the narrowing of the lumen of the blood vessels, microcirculation is disrupted, resulting in a decrease in the synthesis of sex steroid hormones. The consequence of acute or subacute inflammation of the uterine appendages is an adhesive process in the small pelvis between the tube, ovary, uterus, pelvic wall, bladder, omentum and intestinal loops (Fig. 12.17). The disease has a protracted course with periodic exacerbations.

Patients complain of dull, aching pain in the lower abdomen of varying intensity. Pain can radiate to the lower back, rectum, thigh, i.e. along the pelvic plexus, and be accompanied by psycho-emotional (irritability, nervousness, insomnia, depressive states) and autonomic disorders. Pain intensifies after hypothermia, stress, menstruation. In addition, in chronic salpingo-oophoritis, there are menstrual dysfunctions such as menometrorrhagia, opso- and oligomenorrhea, premenstrual syndrome, caused by anovulation or corpus luteum insufficiency. Infertility in chronic adnexitis is explained both by a violation of steroidogenesis in the ovaries and by a tubal-peritoneal factor. Adhesions in the uterine appendages can cause an ectopic pregnancy. Frequent exacerbations of the disease lead to sexual disorders - decreased libido, dyspareunia.

Exacerbations of chronic adnexitis occur due to increased pathogenic properties of the pathogen, reinfection, and a decrease in the immunobiological properties of the macroorganism. With an exacerbation, pain intensifies, general well-being is disturbed, body temperature may rise,

Rice. 12.17. Adhesive process in chronic adnexitis. Laparoscopy

marked purulent discharge from the genital tract. An objective study reveals inflammatory changes in the uterine appendages of varying severity.

Diagnostics chronic salpingoophoritis can be extremely difficult, since chronic pelvic pain with periodic intensification is also found in other diseases (endometriosis, ovarian cysts and tumors, colitis, pelvic plexitis). Certain information that allows to suspect chronic inflammation of the uterus can be obtained from a bimanual examination of the pelvic organs, ultrasound of the pelvic organs, hysterosalpingography and HSG. During a gynecological examination, it is possible to determine the limited mobility of the body of the uterus (adhesions), the formation of an elongated shape in the area of ​​​​the uterine appendages (hydrosalpinx). Ultrasound scanning is effective in diagnosing volumetric formations of the uterine appendages. Hysterosalpingography and HSG help to identify the adhesive process in case of tubal-peritoneal infertility factor (accumulation of a contrast agent in closed cavities). Currently, hysterosalpingography is used less and less due to the large number of diagnostic errors in the interpretation of x-rays.

With a long course of the disease with periodic pains in the lower abdomen, with the ineffectiveness of antibiotic therapy, laparoscopy should be resorted to, which allows you to visually determine the presence or absence of signs of chronic adnexitis. These include adhesions in the pelvis, hydrosalpinx. The consequences of acute salpingo-oophoritis, more often of gonorrheal or chlamydial etiology, are considered adhesions between the surface of the liver and the diaphragm - the Fitz-Hugh-Curtis syndrome (Fig. 12.18).

Pelvioperitonitis (inflammation of the peritoneum of the small pelvis) occurs a second time when pathogens penetrate from the uterus or its appendages into the cavity of the small pelvis. Depending on the pathological contents in the small pelvis, serous-fibrinous and purulent pelvic peritonitis are distinguished. The disease begins acutely, with the appearance of sharp pains in the lower abdomen,

Rice. 12.18. Fitz-Hugh-Curtis syndrome. Laparoscopy

increase in body temperature up to 39-40 ° C, chills, nausea, vomiting, loose stools. Physical examination reveals a moist, white-coated tongue. The abdomen is swollen, takes part in the act of breathing, on palpation it is painful in the lower sections; in the same place, the symptom of Shchetkin-Blumberg irritation of the peritoneum is expressed to varying degrees, tension of the anterior abdominal wall is noted. Palpation of the uterus and appendages during gynecological examination is difficult due to severe pain, the posterior fornix of the vagina is smoothed due to the accumulation of exudate in the rectovaginal cavity. Changes in the clinical analysis of blood are characteristic of inflammation. Of the additional diagnostic methods, transvaginal ultrasound scanning should be indicated, which helps to clarify the condition of the uterus and appendages, to determine the free fluid (pus) in the small pelvis. The most informative diagnostic method is laparoscopy: hyperemia of the peritoneum of the small pelvis and adjacent intestinal loops with the presence of purulent contents in the rectovaginal cavity is visualized. As acute phenomena subside as a result of the formation of adhesions of the uterus and appendages with the omentum, intestines, bladder, inflammation is localized in the pelvic area. When puncturing the abdominal cavity through the posterior fornix of the vagina, inflammatory exudate can be aspirated. Conduct bacteriological analysis of the obtained material.

Parametritis- inflammation of the tissue surrounding the uterus. It occurs when the infection spreads from the uterus after childbirth, abortion, curettage of the uterine mucosa, operations on the cervix, when using an IUD. The infection penetrates into the parametric tissue by the lymphogenous route. Parametritis begins with the appearance of an infiltrate and the formation of a serous inflammatory exudate at the site of the lesion. With a favorable course, the infiltrate and exudate resolve, but in some cases, fibrous connective tissue develops at the site of inflammation, which leads to a displacement of the uterus towards the lesion. With exudate suppuration, purulent parametritis occurs, which can be resolved by the release of pus into the rectum, less often into the bladder, abdominal cavity.

Clinical picture parametritis is caused by inflammation and intoxication: fever, headache, feeling unwell, dry mouth, nausea, pain in the lower abdomen, radiating to the leg or lower back. Sometimes infiltration of the parametrium leads to compression of the ureter on the side of the lesion, impaired passage of urine, and even the development of hydronephrosis. In the diagnosis of the disease, an important role is played by a bimanual and rectovaginal examination, which determines the smoothness of the lateral fornix of the vagina, a dense, motionless, low-painful parametrium infiltrate at the site of the lesion, sometimes reaching the pelvic wall. Percussion over the superior anterior iliac spine on the side of the parametritis reveals dullness of percussion sound (Genter's symptom). In the blood, leukocytosis is noted with a shift of the leukocyte formula to the left, an increase in ESR. Additional methods for diagnosing parametritis are ultrasound of the pelvic organs, CT and MRI.

With suppuration of parametric fiber, the patient's condition deteriorates sharply - chills, hectic fever appear, and symptoms of intoxication intensify. In the case of the development of fibrotic changes in the region of the parameter, a dense cord is palpated, the uterus is displaced towards the lesion.

Gynecological peritonitis (diffuse lesion of the peritoneum), along with sepsis, is the most severe form of manifestation of the inflammatory process of the internal genital organs and is characterized by the phenomena of severe endogenous intoxication and multiple organ failure, referred to as the systemic inflammatory response syndrome.

In the development of peritonitis, it is customary to distinguish 3 stages: reactive, toxic and terminal. The reactive stage, which lasts about a day, is characterized by hyperemia, peritoneal edema, exudation with the formation of fibrin, impaired vascular permeability with hemorrhagic manifestations of varying intensity, as well as signs of initial intoxication. On examination, patients are excited, complain of pain throughout the abdomen, aggravated by a change in body position, fever, chills, nausea, and vomiting. On examination, the skin is pale with a gray tint, tachycardia is noted, the tongue is dry, coated with a coating. The abdomen is tense, its palpation is sharply painful in all departments, the symptoms of peritoneal irritation are positive, intestinal motility is slowed down. In blood tests, moderate leukocytosis with a shift of the formula to the left is revealed. In the toxic stage, which lasts about 2 days, the symptoms of intoxication increase, and local manifestations of peritonitis become less pronounced. The condition of patients is severe, they become lethargic, adynamic. Repeated vomiting and severe intestinal paresis lead to disturbances in the water-electrolyte balance, acid-base state, hypo- and dysproteinemia. Leukocytosis with a shift to the left increases. In the terminal stage, which occurs after 2-3 days, symptoms appear that indicate a deep lesion of the central nervous system, the consciousness of patients is confused, facial features are pointed, the skin is pale gray, cyanotic, with drops of sweat (Hippocrates' face). Growing symptoms of multiple organ failure. The pulse becomes weak, arrhythmic, hypotension and bradycardia, severe shortness of breath, oliguria, vomiting of stagnant contents, constipation is replaced by diarrhea.

Treatment of inflammatory diseases of the internal genital organs carried out in a hospital. The nature and intensity of complex therapy depend on the stage and severity of the inflammatory process, the type of pathogen, the immunobiological resistance of the macroorganism, etc. It is important to create mental and physical rest, adherence to a diet with a predominance of easily digestible proteins and vitamins. An ice pack is placed on the hypogastric region.

The central place belongs to antibiotic therapy. The drug is chosen taking into account the spectrum and mechanism of action, pharmacokinetics, side effects, as well as the etiology of the disease. In connection with the polymicrobial etiology of inflammation, drugs or combinations thereof that are effective against most possible pathogens should be used. For the purpose of therapy of acute inflammatory processes of internal genital

organs use inhibitor-protected antibiotics of the penicillin series (amoxicillin / clavulanate ♠, piperacillin / tazobactam, ampicillin / sulbactam), third-generation cephalosporins (ceftriaxone, cefotaxime, cefoperazone, cefixime), fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin), aminoglycosides (gentamicin, -mycin, amikacin), lincosamines (lincomycin, clindamycin), macrolides (spiramycin, azithromycin, erythromycin), tetracyclines (doxycycline).

The possibility of participation of gonococci and chlamydia in the acute inflammatory process of the internal genital organs suggests a combination of antibiotics that are effective against these microorganisms. It is advisable to combine antibiotics with nitroimidazole derivatives (metronidazole), highly active in the treatment of anaerobic infections. With a pronounced inflammatory process, antibacterial drugs begin to be administered parenterally and continue for 24-48 hours after the onset of clinical improvement, and then administered orally. In complicated forms of the disease, carbapenem antibiotics - imipenem or meropenem with the widest spectrum of antimicrobial activity can be used. The total duration of antibiotic therapy is 7-14 days.

In order to prevent and treat a possible fungal infection, it is recommended to include antimycotic drugs (fluconazole, ketoconazole, itraconazole) in the complex of therapy. The patient should be strongly advised to refrain from unprotected intercourse until she and her partner have completed the full course of treatment and examination.

With a pronounced general reaction and intoxication, infusion therapy is prescribed to detoxify, improve the rheological and coagulation properties of blood, eliminate hypovolemia, electrolyte disorders (isotonic solutions of sodium chloride and glucose, Ringer's solution *, rheopolyglucin *, glucose-novocaine mixture, fraxiparine *, clexane *), restoration of the acid-base state (sodium bicarbonate solution), elimination of dysproteinemia (plasma, albumin solution). Infusion therapy, by reducing blood viscosity, improves the delivery of antibiotics to the focus of inflammation and increases the effectiveness of antibiotic therapy.

Mandatory in the treatment of severe forms of inflammatory processes of the internal genital organs is the normalization of the function of the gastrointestinal tract.

In order to reduce sensitization to tissue decay products and microbial cell antigens, it is necessary to use antihistamines. Symptoms of inflammation (pain, swelling) effectively reduce NSAIDs (indomethacin, diclofenac - voltaren *, ibuprofen, piroxicam). To correct impaired immunity and increase the nonspecific resistance of the body, γ-globulin, levamisole, T-activin, thymalin ♠, thymogen ♠, α-interferon, interferon, stimulators of the synthesis of endogenous interferon (cycloferon ♠, neovir ♠, tilorone - amiksin ♠) should be used ), etc.), ascorbic acid, vitamins E, group B, adaptogens.

In severe situations, to restore disturbed homeostasis, they resort to efferent (extracorporeal) methods of treatment - plasma

mapheresis, hemosorption, peritoneal dialysis, ultrahemofiltration. Regardless of the etiology of inflammation, reinfusion of blood irradiated with UV rays is extremely effective. The procedure has a multilateral effect: eliminates hemorheological and coagulation disorders, promotes hemoglobin saturation with oxygen, detoxifies the body, activates the immune system, and has a bactericidal and virocidal effect.

In the acute phase of the inflammatory process, physiotherapy can be prescribed - UHF currents to the hypogastric region, subsequently, when the signs of inflammation subside, - electrophoresis of potassium iodide, copper, zinc, magnesium, hydrocortisone phonophoresis, exposure to an alternating electromagnetic field, laser therapy.

In the treatment of endometritis, it is advisable to carry out hysteroscopy with washing the uterine cavity with antiseptic solutions, removing, if necessary, the remains of the fetal egg, placental tissue, and foreign bodies.

The effectiveness of the ongoing conservative therapy is assessed after 12-24 hours. The lack of effect in patients with pelvioperitonitis in these terms, the increase in local and general symptoms of inflammation, the inability to exclude the rupture of a purulent tubo-ovarian formation are indications for surgical treatment.

With pyosalpinx, pyovars, it is possible to perform a puncture of purulent formations through the posterior fornix of the vagina under the control of ultrasound scanning. When puncturing, aspiration of the contents is carried out, followed by bacteriological examination and washing of purulent cavities with antiseptics or antibiotic solutions. This tactic allows you to eliminate the acute effects of the inflammatory process and, if necessary, perform organ-preserving operations in the future.

The best results in the treatment of acute inflammatory diseases of the uterine appendages are obtained by laparoscopy. The value of the latter, in addition to assessing the severity and prevalence of the inflammatory process, lies in the ability to produce lysis of adhesions, open or remove purulent tubo-ovarian formations, perform directed drainage and sanitation of the abdominal cavity, perform intra-abdominal perfusion and infusion of various medicinal solutions. To preserve the reproductive function, dynamic laparoscopy is advisable (Fig. 12.19), during which various therapeutic manipulations are performed: separation of adhesions, aspiration of pathological effusion, washing of the abdominal cavity with antiseptics. Dynamic laparoscopy increases the effectiveness of anti-inflammatory therapy, prevents the formation of adhesions, which is especially important for patients planning pregnancy.

Transsection (lower median laparotomy) is indicated for rupture of a purulent tubo-ovarian formation, peritonitis, intra-abdominal abscesses, treatment failure within 24 hours after drainage of the abdominal cavity using a laparoscope, if it is impossible to perform laparoscopy. Laparotomy access is also used in patients with purulent tubo-ovarian formations in pre- and postmenopause, if necessary, removal of the uterus.

Rice. 12.19. Pyosalpinx on the 2nd day after opening. Laparoscopy

The volume of the operation is determined by the age of the patient, the degree of destructive changes and the prevalence of the inflammatory process, comorbidities. Extirpation of the uterus with appendages on one or both sides is performed if the uterus is a source of inflammation (endomyometritis, panmetritis when using the IUD, after childbirth, abortion and other intrauterine interventions), there are concomitant lesions of the body and cervix, with diffuse peritonitis, multiple abscesses in abdominal cavity. In patients of reproductive age, one should strive for organ-preserving operations or, in extreme cases, to preserve ovarian tissue. Surgical intervention ends with drainage of the abdominal cavity.

In a patient with acute inflammatory disease of the genital organs, it is necessary to identify sexual partners and offer them to be tested for gonorrhea and chlamydia.

Treatment of chronic inflammatory diseases of the internal genital organs includes the elimination of pain, the normalization of menstrual and reproductive functions.

Therapy of exacerbations of chronic inflammation of the uterine appendages is carried out in a antenatal clinic or in a hospital according to the same principles as the treatment of acute inflammation.

The main role in the treatment of chronic inflammatory diseases of the internal genital organs without exacerbations belongs to physiotherapy. Drug therapy is aimed at increasing the immunobiological resistance of the body, eliminating the residual effects of the inflammatory process, pain. NSAIDs are used (predominantly administered rectally), vitamins, antioxidants, immunostimulants, stimulants of endogenous interferon synthesis. At the same time, menstrual irregularities are corrected, including with the help of hormonal drugs.

Restoration of reproductive function is possible after laparoscopic separation of adhesions, fimbrioplasty, salpingostomy, which are performed in patients under 35 years of age. With the ineffectiveness of the operational

Treatment of tubal-peritoneal infertility shows in vitro fertilization (IVF).

Gonorrhea

Gonorrhea- an infectious disease caused by gonococcus (Neisseria gonorrhoeae), with a predominant lesion of the genitourinary organs. Every year, the disease is registered in 200 million people. Transferred gonorrhea often causes both female and male infertility.

Etiology and pathogenesis. Gonococcus is a paired bean-shaped coccus (diplococcus) that is not Gram-stained; is located necessarily intracellularly (in the cytoplasm of leukocytes). Gonococci are highly sensitive to environmental factors: they die at temperatures above 55 ° C, when dried, treated with antiseptic solutions, under the influence of direct sunlight. Gonococcus remains viable in fresh pus until dry. In this regard, infection occurs mainly through sexual contact (from an infected partner). The contagiousness of the infection for women is 50-70%, for men - 25-50%. Much less common is infection by household means (through dirty linen, towels, washcloths), mainly in girls. The possibility of intrauterine infection remains controversial. The gonococcus is immobile, does not form spores, and is attached to the surface of epithelial cells, spermatozoa, and erythrocytes by means of thin tubular filaments (pilae). Outside, gonococci are covered with a capsule-like substance that makes them difficult to digest. The pathogen can survive inside leukocytes, trichomonads, epithelial cells (incomplete phagocytosis), which complicates the treatment. With inadequate treatment, L-forms can be formed that are insensitive to the drugs that caused their formation, antibodies and complement as a result of the loss of part of the antigenic properties. The persistence of L-forms makes it difficult to diagnose and treat, and contributes to the survival of the infection in the body. In connection with the widespread use of antibiotics, many strains of gonococcus have appeared that produce the enzyme β-lactamase and, accordingly, are resistant to the action of antibiotics containing the β-lactam ring.

Gonococci mainly affect parts of the genitourinary system lined with cylindrical epithelium - the mucous membrane of the cervical canal, fallopian tubes, urethra, paraurethral and large vestibular glands. With genital-oral contacts, gonorrheal pharyngitis, tonsillitis and stomatitis can develop, with genital-anal contacts - gonorrheal proctitis. When an infection enters the mucous membrane of the eyes, including when the fetus passes through an infected birth canal, there are signs of gonorrheal conjunctivitis.

The vaginal wall, covered with stratified squamous epithelium, is resistant to gonococcal infection. However, if the epithelium becomes thinner or becomes loose, gonorrheal vaginitis may develop (during pregnancy, in girls, in postmenopausal women).

Gonococci quickly fix on the surface of epithelial cells with the help of pili, and then penetrate deep into the cells, intercellular gaps and subepithelial space, causing destruction of the epithelium and an inflammatory reaction.

Gonorrheal infection spreads more often along the length (canalicular) from the lower parts of the genitourinary tract to the upper ones. Adhesion of gonococcus to the surface of spermatozoa and enterobiasis inside Trichomonas, which are active carriers of infection, often contribute to promotion.

Sometimes gonococci enter the bloodstream (usually they die due to the bactericidal properties of the serum), leading to a generalization of the infection and the appearance of extragenital lesions, primarily the joints. Gonorrheal endocarditis and meningitis develop less frequently.

In response to the introduction of a gonorrhea infection, antibodies are produced in the body, but immunity does not develop. A person can become infected and get sick with gonorrhea many times; this is due to the antigenic variability of gonococcus. The incubation period of gonorrhea ranges from 3 to 15 days, less often - up to 1 month.

There are the following types of gonorrhea infection: gonorrhea of ​​the lower genitourinary system, upper genitourinary system and pelvic organs and gonorrhea of ​​other organs. Gonorrhea of ​​the lower genitourinary system includes damage to the urethra, paraurethral glands, glands of the vestibule of the vagina, mucous membrane of the cervical canal, vagina, gonorrhea of ​​the upper genitourinary system (ascending) - damage to the uterus, appendages and peritoneum.

Fresh gonorrhea is also distinguished (lasting up to 2 months), which is divided into acute, subacute, torpid (oligosymptomatic or asymptomatic with scanty exudate, in which gonococci are found), and chronic (lasting more than 2 months or of unknown duration). Chronic gonorrhea can occur with exacerbations. Gonococcal carriage is possible when the pathogen does not cause the appearance of exudate and there are no subjective disorders.

Clinical manifestations. Gonorrhea of ​​the lower genitourinary system is often asymptomatic. Severe manifestations of the disease include symptoms of dysuria, itching and burning in the vagina, pus-like creamy discharge from the cervical canal. On examination, hyperemia and swelling of the mouth of the urethra and cervical canal are found.

Gonorrhea of ​​the upper section (ascending) usually causes a violation of the general condition, complaints of pain in the lower abdomen, fever up to 39 ° C, nausea, sometimes vomiting, chills, loose stools, frequent and painful urination, menstrual irregularities. The spread of infection beyond the internal os is facilitated by artificial interventions - abortion, curettage of the uterine mucosa, probing of the uterine cavity, taking endometrial aspirate, cervical biopsy, insertion of an IUD. An acute ascending inflammatory process is often preceded by menstruation, childbirth. An objective examination reveals purulent or sanious-purulent discharge from the cervical

canal, enlarged, painful, soft uterus (with endomyometritis), edematous painful appendages (with salpingo-oophoritis), pain on palpation of the abdomen, symptoms of peritoneal irritation (with peritonitis). An acute inflammatory process in the uterine appendages is complicated by the development of tubo-ovarian inflammatory formations up to the occurrence of abscesses (especially in women using

VMK).

At present, the gonorrheal process does not have typical clinical signs, since mixed infection is detected in almost all cases. Mixed infection lengthens the incubation period, promotes more frequent recurrence, and complicates diagnosis and treatment.

Chronization of the inflammatory process leads to disruption of the menstrual cycle, the development of adhesions in the pelvis, which can lead to infertility, ectopic pregnancy, miscarriage, chronic pelvic pain syndrome.

The main methods of laboratory diagnosis of gonorrhea are bacterioscopic and bacteriological, aimed at identifying the pathogen. In bacterioscopic examination, gonococcus is identified by pairing, intracellular location and gram-negativity (Fig. 12.20). Due to the high variability under the influence of the environment, gonococcus can not always be detected by bacterioscopy. The bacteriological method is more suitable for detecting erased and asymptomatic forms of gonorrhea, as well as infections in children and pregnant women. Sowing material produced on artificial nutrient media. When the material is contaminated with extraneous accompanying flora, the isolation of gonococcus becomes difficult, therefore, selective media with the addition of antibiotics are used. If it is impossible to inoculate immediately, the material for research is placed in a transport medium. Cultures grown on a nutrient medium are subjected to microscopy, their properties and sensitivity to antibiotics are determined. Material for microscopy and culture is taken from the cervical canal, vagina, urethra.

Rice. 12.20. Microscopy of a vaginal smear. Gonococcus inside neutrophils

Treatment. Sexual partners are subject to treatment if gonococci are detected by a bacterioscopic or cultural method. The main place is given to antibiotic therapy, while the growth of gonococcus strains resistant to modern antibiotics should be taken into account. The reason for the ineffectiveness of treatment may be the ability of gonococcus to form L-forms, produce β-lactamase, and remain inside the cells. Treatment is prescribed taking into account the form of the disease, the localization of the inflammatory process, complications, concomitant infection, the sensitivity of the pathogen to antibiotics.

Etiotropic treatment of fresh gonorrhea of ​​the lower genitourinary system without complications consists in a single use of one of the antibiotics: ceftriaxone, azithromycin, ciprofloxacin, spectinomycin, ofloxacin, amoxiclav ♠, cefixime. For the treatment of gonorrhea of ​​the lower genitourinary system with complications and gonorrhea of ​​the upper and pelvic organs, it is suggested to use the same antibiotics for 7 days.

At the time of treatment, alcohol and sexual intercourse are excluded. It is strongly recommended to use a condom during the follow-up period. With a mixed infection, you should choose the drug, dose and duration of its use, taking into account the selected microflora. After the end of treatment with antibacterial drugs, it is advisable to prescribe eubiotics intravaginally (vagilak ♠, lactobacterin ♠, bifidum-bacterin ♠, acilact ♠).

Treatment of gonorrhea in children is reduced to the appointment of ceftriaxone or spectinomycin once.

With fresh acute gonorrhea of ​​the lower parts of the genitourinary system, etiotropic treatment is sufficient. In the case of a torpid or chronic course of the disease in the absence of symptoms, antibiotic treatment is recommended to be supplemented with immunotherapy, physiotherapy.

Immunotherapy of gonorrhea is divided into specific (gonovacine *) and non-specific (pyrogenal ♠, prodigiosan ♠, autohemotherapy). Immunotherapy is carried out after subsiding of acute events against the background of ongoing antibiotic therapy or before the start of antibiotic treatment (with subacute, torpid or chronic course). Immunotherapy is not indicated for children under 3 years of age. In general, the use of immunomodulating agents in gonorrhea is currently limited and should be strictly justified.

The principles of therapy for acute forms of ascending gonorrhea are similar to those in the treatment of inflammatory diseases of the internal genital organs.

Criteria of cure gonorrhea (7-10 days after the end of therapy) are the disappearance of the symptoms of the disease and the elimination of gonococci from the urethra, cervical canal and rectum according to bacterioscopy. It is possible to conduct a combined provocation, in which smears are taken after 24, 48 and 72 hours and the discharge is cultured after 2 or 3 days. The provocation is divided into physiological (menstruation), chemical (lubrication of the urethra with a 1-2% solution of silver nitrate, cervical canal - with 2-5% of its solution), biological (intramuscular

the introduction of gonovaccine * at a dose of 500 million microbial bodies), physical (inductothermia), alimentary (spicy, salty foods, alcohol). Combined provocation combines all types of provocation.

The second control study is carried out on the days of the next menstruation. It consists in bacterioscopy of discharge from the urethra, cervical canal and rectum, taken 3 times with an interval of 24 hours.

At the third control examination (after the end of menstruation), a combined provocation is performed, after which a bacterioscopic (after 24, 48 and 72 hours) and bacteriological (after 2 or 3 days) examination is performed. In the absence of gonococci, the patient is removed from the register.

With an unknown source of infection, it is advisable to conduct serological tests for syphilis, HIV, hepatitis B and C (before treatment and 3 months after its completion).

Many experts dispute the expediency of provocations and multiple follow-up examinations and propose to reduce the period of observation of women after a full-fledged treatment of gonococcal infection, since the clinical and economic sense of routine measures is lost with the high effectiveness of modern drugs. At least one follow-up examination after the end of treatment is recommended to determine the adequacy of therapy, the absence of symptoms of gonorrhea, and the identification of partners. Laboratory control is carried out only in case of ongoing disease, with the possibility of re-infection or resistance of the pathogen.

Sexual partners are involved in the examination and treatment if sexual contact occurred 30 days before the onset of symptoms of the disease, as well as persons who were in close household contact with the patient. For asymptomatic gonorrhea, sexual partners who had contact within 60 days prior to diagnosis are examined. Children of mothers with gonorrhea are subject to examination, as well as girls in case of detection of gonorrhea in persons caring for them.

Prevention is the timely detection and adequate treatment of patients with gonorrhea. For this purpose, preventive examinations are carried out, especially for employees of children's institutions, canteens. Pregnant women who are registered in the antenatal clinic or applied for termination of pregnancy are subject to mandatory examination. Personal prevention comes down to personal hygiene, the exclusion of casual sex, the use of a condom. Prevention of gonorrhea in newborns is carried out immediately after birth: 1-2 drops of a 30% solution of sulfacetamide (sulfacyl sodium *) are instilled into the conjunctival sac.

Urogenital chlamydia

Urogenital chlamydia is one of the most common sexually transmitted infections. The number of patients with chlamydia is steadily increasing; 90 million cases of the disease are registered annually in the world. The widespread prevalence of chlamydia is due to the blurred clinical

symptoms, the complexity of diagnosis, the emergence of antibiotic-resistant strains, as well as social factors: an increase in the frequency of extramarital sex, prostitution, etc. Chlamydia is often the cause of non-gonococcal urethritis, infertility, inflammatory diseases of the pelvic organs, pneumonia and neonatal conjunctivitis.

Chlamydia are unstable in the external environment, they easily die when exposed to antiseptics, ultraviolet rays, boiling, and drying.

Infection occurs mainly through sexual contact with an infected partner, transplacental and intrapartum, rarely through household

Rice. 12.21. Chlamydia life cycle: ET - elementary bodies; RT - reticular bodies

through toilet items, linen, a common bed. The causative agent of the disease shows a high tropism for the cells of the cylindrical epithelium (endocervix, endosalpinx, urethra). In addition, chlamydia, being absorbed by monocytes, are carried with the blood stream and deposited in tissues (joints, heart, lungs, etc.), causing a multifocal lesion. The main pathogenetic link of chlamydia is the development of a cicatricial adhesive process in the affected tissues as a result of an inflammatory reaction.

Chlamydial infection causes pronounced changes in both cellular and humoral immunity. Consideration should be given to the ability of chlamydia, under the influence of inadequate therapy, to transform into L-forms and (or) change their antigenic structure, which makes it difficult to diagnose and treat the disease.

Classification. Allocate fresh (disease duration up to 2 months) and chronic (disease duration more than 2 months) chlamydia; cases of carriage of chlamydial infection were noted. In addition, the disease is divided into chlamydia of the lower parts of the genitourinary system, its upper parts and organs of the small pelvis, chlamydia of other localization.

Clinical symptoms. The incubation period for chlamydia varies from 5 to 30 days, averaging 2-3 weeks. Urogenital chlamydia is characterized by polymorphism of clinical manifestations, the absence of specific signs, asymptomatic or low-symptomatic long-term course, and a tendency to relapse. Acute forms of the disease were observed in mixed infections.

Most often, chlamydial infection affects the mucous membrane of the cervical canal. Chlamydial cervicitis often remains asymptomatic. Sometimes patients note the appearance of serous-purulent discharge from the genital tract, and when urethritis is attached, itching in the urethra, painful and frequent urination, purulent discharge from the urethra in the morning (symptom of "morning drop").

Ascending urogenital chlamydial infection determines the development of salpingo-oophoritis, pelvioperitonitis, peritonitis, which do not have specific signs, except for a protracted "erased" course during chronic inflammation. The consequences of the transferred chlamydia infection of the pelvic organs are the adhesive process in the area of ​​the uterine appendages, infertility, ectopic pregnancy.

Extragenital chlamydia should include Reiter's disease, which includes the triad: arthritis, conjunctivitis, urethritis.

Chlamydia in newborns is manifested by vulvovaginitis, urethritis, conjunctivitis, pneumonia.

Due to the scarce and (or) non-specific symptoms, it is impossible to recognize the disease on the basis of the clinical picture. The diagnosis of chlamydia is made only by the results of laboratory research methods. Laboratory diagnosis of chlamydia is to identify the pathogen itself or its antigens. The material for the study are scrapings from the cervical canal, urethra, from the conjunctiva. Microscopy of smears stained according to Romanovsky-Giemsa makes it possible to identify the pathogen in 25-30% of cases. At the same time, elementary bodies are stained red.

In order to clarify the diagnosis and determine the phase of the disease, detection of chlamydial antibodies of classes A, M, G in the blood serum is used. In the acute phase of chlamydial infection, the IgM titer rises, with the transition to the chronic phase, IgA titers increase, and then IgG. The decrease in titers of chlamydial antibodies of classes A, G during treatment is an indicator of its effectiveness.

Treatment. All sexual partners are subject to mandatory examination and, if necessary, treatment. During the period of treatment and dispensary observation, one should refrain from sexual intercourse or use a condom.

In uncomplicated chlamydia of the urinary organs, one of the antibiotics is recommended: azithromycin, roxithromycin, spiramycin, josamycin, doxycycline, ofloxacin, erythromycin for 7-10 days.

With chlamydia of the pelvic organs, the same drugs are used, but not less than 14-21 days. Preferably, the appointment of azithromycin - 1.0 g orally 1 time per week for 3 weeks.

Newborns and children weighing up to 45 kg are prescribed erythromycin for 10-14 days. For children under 8 years old weighing more than 45 kg and over 8 years old, erythromycin and azithromycin are used according to adult treatment regimens.

In connection with a decrease in the immune and interferon status in chlamydia, along with etiotropic treatment, it is advisable to include interferon preparations (viferon ♠, reaferon ♠, kipferon ♠) or endogenous interferon synthesis inducers (cycloferon *, neovir *, sodium ribonucleate - ridostin ♠, tilorone) . In addition, antioxidants, vitamins, physiotherapy are prescribed, and vaginal microbiocenosis is corrected with eubiotics.

The criteria for cure are resolution of clinical manifestations and eradication. Chlamydia trachomatis according to laboratory studies conducted after 7-10 days, and then after 3-4 weeks.

Prevention urogenital chlamydia is the identification and timely treatment of patients, the exclusion of accidental sexual contact.

Genital herpes

Herpes is one of the most common human viral infections. Herpes simplex virus (HSV) infection is 90%; 20% of the world's population has clinical manifestations of

feces. Genital herpes is a sexually transmitted chronic relapsing viral disease.

Etiology and pathogenesis. The causative agent of the disease is the herpes simplex virus serotypes HSV-1 and HSV-2 (more often - HSV-2). The herpes virus is quite large, DNA-containing, unstable in the external environment and quickly dies when dried, heated, and exposed to disinfectant solutions.

Infection occurs through sexual contact from infected partners who are not always aware of their infection. Recently, the oral-genital route of infection has been of great epidemiological importance. Contagiousness for women reaches 90%. The household route of infection transmission (through toilet items, underwear) is unlikely, although it is not excluded. Herpetic infection can be transmitted from a sick mother to a fetus transplacentally and intranatally.

The virus enters the body through damaged mucous membranes of the genital organs, urethra, rectum and skin. Blisters appear at the injection site. HSV, getting into the bloodstream and lymphatic system, can settle in the internal organs, the nervous system. The virus can also penetrate through the nerve endings of the skin and mucous membranes into the ganglia of the peripheral and central nervous system, where it persists for life. Periodically migrating between the ganglia (in genital herpes, these are the ganglia of the lumbar and sacral sympathetic chain) and the surface of the skin, the virus causes clinical signs of a relapse of the disease. The manifestation of a herpes infection is facilitated by a decrease in immunoreactivity, hypothermia or overheating, chronic diseases, menstruation, surgical interventions, physical or mental trauma, alcohol intake. HSV, having neurodermotropism, affects the skin and mucous membranes (face, genitals), the central nervous system (meningitis, encephalitis) and the peripheral nervous system (ganglioliths), eyes (keratitis, conjunctivitis).

Classification. Clinically distinguish between the first episode of the disease and relapses of genital herpes, as well as the typical course of infection (with herpetic eruptions), atypical (without eruptions) and virus-carrying.

Clinical symptoms. The incubation period is 3-9 days. The first episode of the disease proceeds more rapidly than subsequent relapses. After a short prodromal period with local itching and hyperesthesia, the clinical picture develops. The typical course of genital herpes is accompanied by extragenital symptoms (viremia, intoxication) and genital signs (local manifestations of the disease). Extragenital symptoms include headache, fever, chills, myalgia, nausea, and malaise. Usually these symptoms disappear with the appearance of blisters on the perineum, the skin of the vulva, in the vagina, on the cervix (genital signs). Vesicles (2-3 mm in size) are surrounded by an area of ​​hyperemic edematous mucosa. After 2-3 days of existence, they open with the formation of ulcers covered with grayish-yellow

purulent (due to secondary infection) plaque. Patients complain of pain, itching, burning at the site of injury, heaviness in the lower abdomen, dysuria. With severe manifestations of the disease, subfebrile temperature, headache, and an increase in peripheral lymph nodes are noted. The acute period of herpetic infection lasts 8-10 days, after which the visible manifestations of the disease disappear.

Currently, the frequency of atypical forms of genital herpes has reached 40-75%. These forms of the disease are erased, without herpetic eruptions, and are accompanied by damage not only to the skin and mucous membranes, but also to the internal genital organs. There are complaints of itching, burning in the affected area, leucorrhoea, not amenable to antibiotic therapy, recurrent erosion and leukoplakia of the cervix, habitual miscarriage, infertility. Herpes of the upper genital tract is characterized by symptoms of nonspecific inflammation. Patients are concerned about periodic pain in the lower abdomen; conventional therapy does not give the desired effect.

In all forms of the disease, the nervous system suffers, which manifests itself in neuropsychiatric disorders - drowsiness, irritability, poor sleep, depressed mood, decreased performance.

The frequency of relapses depends on the immunobiological resistance of the macroorganism and ranges from 1 time in 2-3 years to 1 time every month.

Diagnosis of genital herpes is based on anamnesis data, complaints, and the results of an objective study. Recognition of typical forms of the disease is usually not difficult, since the vesicular rash has characteristic signs. However, ulcers after the opening of herpetic vesicles should be distinguished from syphilitic ulcers - dense, painless, with smooth edges. Diagnosis of atypical forms of genital herpes is extremely difficult.

Highly sensitive and specific laboratory diagnostic methods are used: virus cultivation in a chicken embryo cell culture (gold standard) or viral antigen detection by ELISA; immunofluorescent method, using PCR. The material for the study is discharge from herpetic vesicles, vagina, cervical canal, urethra. A simple determination of antibodies in the blood serum to the virus is not an accurate diagnostic criterion, since it reflects only HSV infection, including not only genital ones. The diagnosis established only on the basis of serological reactions may be erroneous.

Treatment. Sexual partners of a patient with genital herpes are screened for HSV and treated for clinical signs of infection. Until the disappearance of the manifestations of the disease, it is recommended to refrain from sexual intercourse or use condoms.

Since there are currently no methods for eliminating HSV from the body, the goal of treatment is to suppress the reproduction of the virus during an exacerbation of the disease and the formation of stable immunity to prevent recurrence of herpes infection.

For the treatment of the first clinical episode and in case of recurrence of genital herpes, antiviral drugs (acyclovir, valaciclovir) are recommended for 5-10 days.

An integrated approach involves the use of non-specific (T-activin, thymalin ♠, thymogen ♠, inosine pranobex - groprinosin ♠), myelopid * according to standard schemes and specific (anti-herpetic γ-globulin, herpes vaccine) immunotherapy. An extremely important link in the treatment of herpes is the correction of violations of the interferon system as the main barrier to the introduction of a viral infection into the body. A good effect is given by inducers of the synthesis of endogenous interferon: poludan ♠, cycloferon ♠, neovir ♠, tilorone. Interferon preparations are used as replacement therapy - viferon ♠, kipferon ♠ in rectal suppositories, reaferon ♠ intramuscularly, etc.

In order to prevent relapses, a herpes vaccine, interferonogens, as well as antiviral and immune drugs are used. The duration of therapy is determined individually.

The criteria for the effectiveness of treatment are the disappearance of clinical manifestations of the disease (relapse), the positive dynamics of the titer of specific antibodies.

genital tuberculosis

Tuberculosis- an infectious disease caused by mycobacterium (Koch's bacterium). genital tuberculosis, as a rule, it develops a second time, as a result of the transfer of infection from the primary lesion (more often from the lungs, less often from the intestines). Despite the progress of medicine, the incidence of tuberculosis in the world is increasing, especially in countries with low living standards. The defeat of the genitourinary organs is in the first place among the extrapulmonary forms of tuberculosis. It is likely that tuberculosis of the genital organs occurs much more often than is recorded, since lifetime diagnosis does not exceed 6.5%.

Etiology and pathogenesis. From the primary focus, with a decrease in the body's immune resistance (chronic infections, stress, malnutrition, etc.), mycobacteria enter the genital organs. The infection spreads mainly by the hematogenous route, more often during primary dissemination in childhood or during puberty. With tuberculous lesions of the peritoneum, the pathogen enters the fallopian tubes by lymphogenous or contact routes. Direct infection through sexual contact with a patient with genital tuberculosis is only theoretically possible, since the stratified squamous epithelium of the vulva, vagina and vaginal portion of the cervix is ​​resistant to mycobacteria.

In the structure of genital tuberculosis, the first place in frequency is occupied by damage to the fallopian tubes, the second - to the endometrium. Tuberculosis of the ovaries and cervix is ​​less common, and tuberculosis of the vagina and external genitalia is extremely rare.

In the lesions, morphohistological changes typical of tuberculosis develop: exudation and proliferation of tissue elements, caseous necrosis. Tuberculosis of the fallopian tubes often ends with their obliteration, exudative-proliferative processes can lead to the formation of pyosalpinx, and when the muscular layer of the fallopian tubes is involved in a specific proliferative process, tubercles (tubercles) are formed in it, which is called nodose inflammation. In tuberculous endometritis, productive changes also predominate - tuberculous tubercles, caseous necrosis of individual sections. Tuberculosis of the uterine appendages is often accompanied by involvement in the process of the peritoneum with ascites, intestinal loops with the formation of adhesions, and in some cases, fistulas. Genital tuberculosis is often associated with urinary tract infections.

Classification. In accordance with the clinical and morphological classification, there are:

Chronic forms - with productive changes and mild clinical symptoms;

Subacute form - with exudative-proliferative changes and significant lesions;

Caseous form - with severe and acute processes;

Complete tuberculous process - with encapsulation of calcified foci.

clinical picture. The first symptoms of the disease may appear already during puberty, but mostly women aged 20-30 suffer from genital tuberculosis. In rare cases, the disease occurs in older or postmenopausal patients.

Genital tuberculosis has a mostly blurred clinical picture with a wide variety of symptoms, which is explained by the variability of pathological changes. A decrease in generative function (infertility) is the main, and sometimes the only symptom of the disease. The causes of infertility, more often primary, include endocrine disorders, damage to the fallopian tubes and endometrium. In more than half of the patients, menstrual function is disturbed: amenorrhea (primary and secondary), oligomenorrhea, irregular menstruation, algomenorrhea, less often meno- and metrorrhagia occur. Violations of menstrual function are associated with damage to the parenchyma of the ovary, endometrium, as well as tuberculosis intoxication. A chronic disease with a predominance of exudation causes subfebrile temperature and pulling, aching pain in the lower abdomen due to adhesions in the pelvis, damage to nerve endings, vascular sclerosis and hypoxia of the tissues of the internal genital organs. Other manifestations of the disease include signs of tuberculous intoxication (weakness, periodic fever, night sweats, loss of appetite, weight loss) associated with the development of exudative or caseous changes in the internal genital organs.

In young patients, genital tuberculosis can begin with signs of an "acute abdomen", which often leads to surgical interventions due to suspected acute appendicitis, ectopic pregnancy, ovarian apoplexy.

Due to the absence of pathognomonic symptoms and the blurring of clinical symptoms, the diagnosis of genital tuberculosis is difficult. A correctly and carefully collected anamnesis with indications of a patient’s contact with a patient with tuberculosis, past pneumonia, pleurisy, observation in a tuberculosis dispensary, the presence of extragenital foci of tuberculosis in the body, as well as the occurrence of an inflammatory process in the uterine appendages in young patients who did not live sexually, especially in combination with amenorrhea, and prolonged subfebrile temperature. A gynecological examination sometimes reveals an acute, subacute or chronic inflammatory lesion of the uterine appendages, most pronounced with a predominance of proliferative or caseous processes, signs of an adhesive process in the small pelvis with displacement of the uterus. Gynecological findings are usually non-specific.

To clarify the diagnosis, a tuberculin test (Koch's test) is used. Tuberculin* is injected subcutaneously at a dose of 20 or 50 IU, after which the general and focal reactions are assessed. The general reaction is manifested by an increase in body temperature (more than 0.5 ° C), including in the cervical region (cervical electrothermometry), increased heart rate (more than 100 per minute), an increase in the number of stab neutrophils, monocytes, a change in the number of lymphocytes, an increase in ESR. The general reaction occurs regardless of the localization of the tuberculous lesion, focal - in its zone. Focal reaction is expressed in the appearance or intensification of pain in the lower abdomen, swelling and pain on palpation of the uterine appendages. Tuberculin tests are contraindicated in active tuberculosis, diabetes mellitus, severe liver and kidney dysfunction.

The most accurate methods for diagnosing genital tuberculosis remain microbiological, which allow detecting mycobacterium in tissues. Examine secretions from the genital tract, menstrual blood, scrapings of the endometrium or washings from the uterine cavity, the contents of inflammatory foci, etc. The material is sown on special artificial nutrient media at least three times. However, the inoculation of mycobacteria is low, which is explained by the peculiarities of the tuberculosis process. A highly sensitive and specific method for detecting the pathogen is PCR, which allows you to determine the DNA sections characteristic of Myco-bacterium tuberculosis. However, the test material may contain PCR inhibitors, leading to false negative results.

Laparoscopy allows you to identify specific changes in the pelvic organs - adhesions, tuberculous tubercles on the visceral peritoneum covering the uterus, tubes, caseous foci in combination with inflammatory changes in the appendages. In addition, during laparoscopy, it is possible to take material for bacteriological and histological examination, as well as, if necessary, to carry out surgical correction: lysis of adhesions, restoration of patency of the fallopian tubes, etc.

Histological examination of tissues obtained by biopsy, separate diagnostic curettage (it is better to carry it out in 2-3 days

before menstruation), reveals signs of tuberculous lesions. A cytological method is also used to study aspirate from the uterine cavity, smears from the cervix, which makes it possible to detect Langhans giant cells specific for tuberculosis.

Diagnosis of genital tuberculosis is helped by hysterosalpingography. On radiographs, signs characteristic of tuberculous lesions of the genital organs are revealed: displacement of the body of the uterus due to adhesions, intrauterine synechia, obliteration of the uterine cavity (Asherman's syndrome), uneven contours of the tubes with closed fimbrial sections, expansion of the distal sections of the tubes in the form of a bulb, a clear change in the tubes , cystic dilatations or diverticula, tubal stiffness (lack of peristalsis), calcifications. Plain radiographs of the pelvic organs reveal pathological shadows - calcifications in the tubes, ovaries, lymph nodes, foci of caseous decay. To avoid exacerbation of the tuberculous process, hysterosalpingography is performed in the absence of signs of acute and subacute inflammation.

Diagnosis is complemented by ultrasound scanning of the pelvic organs. However, the interpretation of the data obtained is very difficult and is available only to a specialist in the field of genital tuberculosis. Other diagnostic methods are less important - serological, immunological. Sometimes the diagnosis of tuberculous lesions of the internal genital organs is made during abdominal surgery for alleged volumetric formations in the area of ​​​​the uterine appendages.

Treatment genital tuberculosis, as well as tuberculosis of any localization, should be carried out in specialized institutions - anti-tuberculosis hospitals, dispensaries, sanatoriums. Therapy should be comprehensive and include anti-tuberculosis chemotherapy, means of increasing the body's defenses (rest, good nutrition, vitamins), physiotherapy, and surgical treatment according to indications.

The treatment of tuberculosis is based on chemotherapy using at least three drugs. Chemotherapy is selected individually, taking into account the form of the disease, the tolerability of the drug, and the possible development of drug resistance in Mycobacterium tuberculosis.

It is advisable to include antioxidants (Vitamin E, sodium thiosulfate), immunomodulators (interleukin-2, Methyluracil * , levamisole), a specific drug tuberculin *, vitamins of group B, ascorbic acid in the complex of treatment.

Surgical treatment is used only according to strict indications (tubo-ovarian inflammatory formations, ineffectiveness of conservative therapy in active tuberculosis, fistula formation, dysfunction of the pelvic organs associated with severe cicatricial changes). The operation itself is not curative as the TB infection persists. After surgery, chemotherapy should be continued.

Prevention. Specific prophylaxis of tuberculosis begins already in the first days of life with the introduction of the BCG* vaccine. Revaccination is carried out at 7, 12, 17 years under the control of the Mantoux reaction. Another measure of specific

Physical prevention is the isolation of patients with active tuberculosis. Non-specific prevention involves general health measures, increasing the body's resistance, improving living and working conditions.

Acquired Immunodeficiency Syndrome(AIDS) - disease caused by the human immunodeficiency virus (HIV). 3-4 million new cases of infection are registered annually. In the 25 years since the discovery of the virus, the disease has spread throughout the world. According to statistics, in 2006 more than 25 million died and 40 million were registered as HIV-infected (37 million are adults, more than 1/3 of them are women). In Russia, the first case of the disease was noted in 1986. At the moment, about 400 thousand infected people live in Russia, but in reality, according to experts, from 800 thousand to 1.5 million people, which is 1-2% of the adult population country. All the measures that are being taken in the world to stop the HIV infection are not working, although they may be curbing its spread.

Etiology and pathogenesis. HIV was discovered in 1983; it belongs to the family of RNA retroviruses, subfamily of lentiviruses (slow viruses). Lentiviral infections are characterized by a long incubation period, low-symptomatic persistence against the background of a pronounced immune response, and cause multi-organ damage with an inevitable fatal outcome. HIV has a unique type of reproduction: thanks to the enzyme reversetase, genetic information is transferred from RNA to DNA (reverse transcription mechanism). The synthesized DNA is integrated into the chromosomal apparatus of the affected cell. Target cells for HIV are immunocompetent cells, and primarily T-lymphocytes-helpers (CD-4), as they have receptors on the surface that selectively bind to the virion. The virus also infects some B-lymphocytes, monocytes, dendritic cells, and neurons. As a result of damage to the immune system, characterized by a sharp decrease in the number of T-helpers, an immunodeficiency state occurs with all the ensuing consequences.

Humans are the only source of HIV infection. The virus can be isolated from blood, saliva, semen, breast milk, cervical and vaginal mucus, tears and tissues. The most common route of spread of the virus (95%) is unprotected both vaginal and anal sex. Sufficient permeability of the tissues of the endometrium, vagina, cervix, rectum and urethra for HIV contributes to infection. The danger of anal sexual intercourse is especially great because of the vulnerability of the single-layer epithelium of the rectum and the possible direct entry of the virus into the blood. Homosexuals are one of the main risk groups for AIDS (70-75% of those infected). Sexually transmitted diseases increase the likelihood of HIV transmission due to damage to the epithelial layers of the genitourinary tract.

The vertical route of transmission of HIV infection from mother to fetus is realized both as a result of transplacental transmission (during pregnancy) and with the help of an intranatal mechanism (during childbirth), and postnatally - during breastfeeding.

Possible parenteral transmission of the virus through contaminated blood or its components, with organ and tissue transplants, using non-sterile syringes and needles (often among drug addicts).

The impossibility of HIV infection through ordinary household contacts, insect bites, food or water has been proven.

clinical picture. Among those infected, young people (30-39 years) usually predominate. Clinical manifestations are determined by the stage of the disease, concomitant infections.

In the initial stages, half of those infected have no symptoms. Approximately 5-6 weeks after infection, 50% of patients develop an acute phase with fever, general weakness, night sweats, lethargy, loss of appetite, nausea, myalgia, arthralgia, headache, sore throat, diarrhea, swollen lymph nodes, diffuse maculopapular rash, peeling of the skin, exacerbation of seborrheic dermatitis, recurrent herpes.

Laboratory primary infection can be confirmed by ELISA or by determining specific antibodies (IgG, IgM), as well as DNA and RNA in PCR. Antibodies in the blood usually appear 1-2 months after infection, although in some cases they are not detected even for 6 months or more. Regardless of the presence or absence of symptoms, patients during this period can become a source of infection.

The stage of asymptomatic HIV carriage can last from several months to several years and occurs regardless of the presence of a febrile stage in the past. There are no symptoms, but the patient is contagious. In the blood, antibodies to HIV are determined.

In the stage of persistent generalized lymphadenopathy, lymph nodes increase, primarily cervical and axillary. Possible candidal lesions of the mucous membranes of the oral cavity, chronic persistent vaginal candidiasis lasting up to 1 year or more.

The stage of development of AIDS (the stage of secondary diseases) expresses the crisis of the immune system, an extreme degree of immunodeficiency, which makes the body defenseless against infections and tumors, which are usually safe for immunocompetent individuals. Serious opportunistic infections come to the fore, the spectrum and aggressiveness of which is growing. Increased susceptibility to malignant tumors. AIDS-associated infections include pneumocystis pneumonia, cryptococcosis, recurrent generalized salmonellosis, extrapulmonary tuberculosis, herpes infection, etc. Secondary infections, together with tumors, determine a wide range of clinical manifestations of AIDS involving all tissue systems in the pathological process. At the last stage of the disease, prolonged (more than 1 month) fever, significant weight loss, damage to the respiratory organs (pneumocystis-

pneumonia, tuberculosis, cytomegalovirus infection), damage to the gastrointestinal tract (candidiasis stomatitis, chronic diarrhea). Patients have neurological disorders (progressive dementia, encephalopathy, ataxia, peripheral neuropathy, toxoplasmic encephalitis, cerebral lymphoma), skin manifestations (Kaposi's sarcoma, multifocal herpes zoster).

Life expectancy after the appearance of the first signs of AIDS does not exceed 5 years.

Diagnosis of HIV infection is made on the basis of prolonged fever, weight loss, swollen lymph nodes, and AIDS-associated diseases.

Laboratory diagnostics consists in the detection of virus-specific antibodies by ELISA. If the result is positive, an immunochemical analysis is performed. Additionally, PCR can be used. Antibodies to HIV are necessarily determined in patients during inpatient treatment, in pregnant women, donors, in patients at risk, in workers of a number of professions (doctors, trade workers, children's institutions, etc.), therefore, the diagnosis of HIV infection is established at an early stage in the absence of any or clinical manifestations. Immunological studies allow assessing the degree of immunosuppression and monitoring the effectiveness of the treatment. For this purpose, the number of T-helpers is determined, as well as the ratio of T-helpers / T-suppressors (CD4 / CD8), which steadily decreases with the progression of the disease.

Treatment it is recommended to start as early as possible (before deep damage to the immune system) and continue as long as possible. Currently, antiretroviral drugs that suppress viral replication are used: reverse transcriptase inhibitors (zidovudine, phosphazid, zalcitabine, nevirapine) and HIV protease inhibitors (saquinavir, indinavir, ritonavir). Endogenous interferon inducers are also used. With the development of AIDS-associated diseases, appropriate treatment is resorted to. Unfortunately, at present, a complete cure for patients with HIV infection is impossible, but timely therapy can prolong their life.

Prevention. Since HIV infection is not curable radically, prevention becomes the main method of struggle. Of particular importance is the identification of those infected with HIV. There is a mandatory examination of blood donors, pregnant women, patients with sexually transmitted diseases, homosexuals, drug addicts, patients with a clinical picture of immunodeficiency. It is strongly recommended to use a condom during sexual intercourse with casual or infected partners. To prevent transmission of infection to the fetus and newborn from a sick mother, the following measures are indicated: the use of antiretroviral drugs during pregnancy, delivery by caesarean section and refusal to breastfeed. With a high probability of HIV infection, chemoprophylaxis is indicated. An HIV vaccine is being tested to protect a person from contracting the virus.

test questions

1. The main causative agents of inflammatory diseases of the genital organs of women.

2. Classification of inflammatory diseases of the female genital organs according to the clinical course, according to the localization of the process.

3. List the factors contributing to the spread of infection in the genital tract, and the ways of its spread.

4. Specify the factors that prevent infection from entering the genital tract and spreading it in the body.

5. Expand the etiology, pathogenesis, clinical symptoms, diagnosis and principles of treatment of bacterial vaginosis, vaginal candidiasis, trichomonas vaginitis.

6. Describe the etiology, pathogenesis, clinical symptoms, diagnosis and principles of therapy for inflammatory diseases of the internal genital organs.

7. What are the etiology, pathogenesis, clinical picture, diagnosis and treatment of gonorrhea?

Gynecology: textbook / B. I. Baisova and others; ed. G. M. Savelyeva, V. G. Breusenko. - 4th ed., revised. and additional - 2011. - 432 p. : ill.

Photo: valuavitaly/depositphotos.com

Gynecological diseases may not manifest themselves for a long time and show up already in an advanced stage. However, there are the most common symptoms observed in most problems of the female genital area.

Causes of gynecological diseases

All causes of gynecological diseases are divided into external and internal.

External factors include:

• Stress, neurosis, depression.
• The deteriorating environmental situation, which is observed in large cities.
• Early onset of sexual activity.
• Frequent change of sexual partners.
• Non-compliance with hygiene rules and the development of infectious diseases.
• Uncontrolled frequent use of antibiotics.

Internal factors include:

• Pathologies of the development of female internal organs, for example, a doubling of the vagina or a bicornuate uterus.
• Atypical location of the genitals.
• Hormonal diseases.
• Spontaneous miscarriages or abortions, in which medical interventions were performed, in particular, curettage of the uterus.

Main symptoms

All diseases of the gynecological profile are divided into 3 groups. The first group includes diseases associated with the development of infection in a woman's body. The second group includes the pathology of the endocrine system and hormonal imbalance. The third group includes diseases with the development of hyperplastic or dystrophic changes, a tumor process.

There are symptoms that occur in any disease from each group. This:

• Beli - pathological discharge of a whitish color, their amount depends on the activity of the process.
• Bleeding occurring outside of menses. They can occur both in the middle of the menstrual cycle, and at other times. Bleeding is very strong, and there are spotting or completely insignificant. Sometimes appear immediately after intercourse.
• Itching or burning in the genital area. The burning sensation is minor, delivering only slight discomfort. And it can be unbearable and painful.
• Unpleasant sensations during intercourse, up to pain and inability to have sex because of this.
• Discomfort or pain during urination.
• In some cases, erosions or ulcers can be found on the genitals, which indicates the presence of a gynecological problem.
• Another symptom is pain in the lower abdomen, they are of a different nature: bursting, pulling or pressing.

As a result of gynecological diseases, miscarriage, secondary infertility, miscarriages may occur.

Women's diseases (in three groups)

The first group, diseases caused by infections, are more often diagnosed as a result of the following reasons:

• STIs are sexually transmitted infections. A special place among them is given to gonorrhea, trichomoniasis, candidiasis, or thrush, chlamydia.
• Diseases of viral etiology that can be caused by the genital herpes virus, HIV, cytomegalovirus or human papillomavirus.
• Pyoinflammatory diseases: colpitis, endometritis, adnexitis, cervicitis, pelvioperitonitis, vulvitis and others.

Symptoms of diseases of the first group - the presence of white, purulent discharge, soreness during intercourse and urination, itching and burning in the genital area, as well as erosion and ulcers. The development of inflammatory processes is facilitated by any infections, abortions, childbirth, hypothermia, manipulations of an operational and diagnostic nature (curettage of the uterus, probing of the uterine cavity, hysteroscopy, hydrotubation, hysterosalpingography, etc.), non-observance of personal hygiene, excessive use of antibiotics.

The presence of an intrauterine device (IUD) can also contribute to the spread of infection. When using it, the risk of developing inflammatory processes increases by 4-5 times. Often the fault is the incorrect use of intravaginal tampons.

The second group of gynecological diseases that arose as a result of hormonal or endocrine disorders. Symptoms:

• Violation of the menstrual cycle.
• Absence of menstruation or amenorrhea.
• A decrease or increase in the menstrual cycle, menstruation may become scanty or plentiful, spotting may appear outside of menstruation.

As a result of hormonal disorders, dysfunctional uterine bleeding can occur, that is, a woman’s periods become acyclic and irregular. Secondary infertility develops.

The third group includes tumor processes. It is not necessary that these processes be malignant. This also includes cystic formations in the ovaries, uterine fibroids, changes in the cervix, such as pseudo-erosion, erosion and ulcerative changes. Among the signs in the third group of diseases, women often note pain during intercourse, bleeding from the genital tract after intimacy, bleeding not associated with menstruation.

Despite the specific symptoms of gynecological diseases, there are diseases that either do not manifest themselves in any way, or the signs are so non-specific that a woman can be treated for something else.

It is these diseases that most often cause complications, since they usually begin to be treated when they are already in a neglected state. That is why it is so important to undergo a preventive examination by a gynecologist at least twice a year.

Inflammatory processes

The inflammatory process in women can develop in the external and internal genital organs. Inflammatory processes in the external genital organs include bartholinitis, vaginitis and vulvitis. Inflammation of the internal genital organs: endometritis, cervicitis, salpingitis, oophoritis, adnexitis, pelvioperitonitis.

Causes and symptoms

The cause of inflammatory processes in women are infections. There are few symptoms of inflammation: pain in the lower abdomen, abnormal vaginal discharge, which has an uncharacteristic texture, color and unpleasant odor, swelling of the tissues. If you notice any of the symptoms, you should consult a doctor.

Inflammatory processes of the female genital organs can be chronic and acute. If the disease is in the acute stage, the symptoms will be pronounced: there may be severe pain in the lower abdomen, the temperature rises. However, the disease can also bypass the acute stage and develop immediately from the chronic one. Then the symptoms will be transient, that is, they will change in strength: severe pain will be replaced by a temporary lull, then return again, etc. The disease can go into a chronic stage if the inflammation is not completely cured or treatment is not started.

Bartholinitis

Bartholinitis is an inflammation of the Bartholin's gland (this is a large gland in the vestibule of the vagina). It occurs as a result of non-compliance with hygiene, infections that are sexually transmitted. The disease is asymptomatic.

Vaginitis

Vaginitis (colpitis) is an inflammatory process of the vaginal mucosa. The disease is accompanied by abundant purulent, mucous or purulent-mucous discharge from the vagina, burning, itching, pain and hyperemia of the vaginal mucosa. Vaginitis can have a different nature, and the symptoms depend on it. So, with trichomonas vaginitis, abundant foamy and purulent discharge, burning, itching are observed. With fungal (candidiasis) colpitis - white, curdled discharge, burning and itching in the vaginal area. This is common in women of childbearing age.

In girls, the disease is accompanied by inflammation of the external genitalia. If colpitis is caused by a foreign object entering the vagina, then the discharge may contain an admixture of blood. With bacterial vaginitis, girls experience scanty discharge, itching.

Vulvitis

Vulvitis - inflammation of the vulva, external genitalia: pubis, small and large labia, vaginal vestibule, clitoris and hymen. Usually the disease is typical for girls and older women. The cause may be scratching, trauma or cracks in the epithelial cover of the vulva, in girls - pinworms. It can be acute and chronic. In acute vulvitis, burning, severe itching, pain, hyperemia and swelling of the genital organs, plaque on them are noted. In the chronic stage, symptoms usually disappear, but return intermittently and are mild. However, the chronic stage can again turn into an acute one, and exacerbations will become more frequent and more difficult to treat.

Vulvovaginitis

Vulvovaginitis is a simultaneous inflammation of the vulva (vulvitis) and vagina (vaginitis). This form of the disease is very common.

Adnexitis

This is an inflammatory process in the appendages of the uterus, that is, the ovaries (oophoritis) or fallopian tubes (salpingitis). The inflammatory process can be caused by staphylococci, mycoplasmas, gonococci, chlamydia and other pathogenic microorganisms. The causative agent of infection can enter the ovaries or fallopian tubes along with blood from the genital organs, where the inflammatory process initially developed. Adnexitis can develop due to childbirth, abortion, sexually transmitted infections, non-compliance with personal hygiene rules and due to weakened immunity. The disease is asymptomatic.

Endocervicitis (cervicitis)

Inflammatory process of the mucous membrane of the cervix. The causes are Escherichia coli, gonococci, staphylococci, streptococci, sexually transmitted infections, ruptures during childbirth, cervical erosion, incorrect birth control pills.

Even in the acute stage of the disease, symptoms can be very mild. Usually these are discharge (leucorrhea), itching, increased vaginal discharge, hyperemia of the uterine mucosa, and pain in the lower abdomen can rarely occur. The disease can become chronic if left untreated. Symptoms of a chronic disease are almost invisible.

endometritis

This is an inflammatory process of the mucous membrane of the uterus. The cause may be a fungal, bacterial or viral infection. The first symptoms usually appear 3-4 days after infection. The disease can occur in acute and chronic form.

In the acute form of inflammation, the following are noted: weakness, fever, ESR (erythrocyte sedimentation rate ) elevated, pain in the lower abdomen, purulent liquid discharge (sometimes with ichor), on palpation, the uterus is enlarged and dense, and painful sensations also occur. The acute stage lasts 10 days. If you start treatment on time, then a full recovery quickly occurs. If the treatment is carried out incorrectly, endometritis becomes chronic. The main danger of this is that it can lead to disruption of the menstrual cycle, the development of bleeding, miscarriage, aching pain in the lower abdomen, intrauterine adhesions.

Adhesions are the cause of infertility

In gynecology, this disease is given a separate place.

Adhesions (adhesive disease) - constrictions on the fallopian tube resulting from surgery or an inflammatory process. The initial function of adhesions is to prevent the inflammatory process from spreading throughout the body. However, having fulfilled their positive function, they cause great harm to the woman's body: they do not allow the pelvic organs to work correctly, and can also lead to infertility. There are three stages of the disease:

• Stage 1: Adhesions are located around the ovary, fallopian tube, or other area without interfering with egg capture.
• Stage 2: Adhesions are between the ovary and fallopian tube or other organs and may interfere with egg capture.
• 3rd stage: there is a torsion of the fallopian tube, a violation of the patency, or the capture of the egg is completely blocked.

The disease is asymptomatic. The only manifestation of the disease is the inability of a woman to become pregnant. With this problem, patients turn to gynecologists, as a result, adhesive disease is detected.

Cervical erosion

The second most common disease that gynecologists have to deal with is cervical erosion. As a result, the mucous membrane of the cervix begins to gradually ulcerate, and healthy cells gradually degenerate into precancerous ones. This disease occurs in one in three women. Often it is almost asymptomatic or makes itself felt with barely perceptible pain and smearing sanious discharge after intercourse.

uterine fibroids

This disease annoys women after the age of 45. The condition is characterized by the fact that muscle cells begin to grow pathologically into the wall of the uterus. There is no vaginal discharge or any pain. But abundant menstrual flow with this pathology is a common occurrence.

Cyst or tumor of the ovaries

Also, gynecologists often diagnose either tumors or cysts. Women also do not complain about pain, but heavy menstrual bleeding is almost always present. Very often, this disease is detected absolutely by accident, during a routine routine examination. The sooner a tumor process or cyst is detected, the easier it will be to get rid of them. Moreover, even the most common human papillomavirus can transform into cancerous tumors.

Persistent menstrual irregularities

The menstrual cycle can either be greatly reduced or greatly increased, and secondary amenorrhea often also occurs. This complication is often the result of an inflammatory process affecting the ovaries. It goes without saying that all these complications most negatively affect a woman's ability to conceive and bear a child.

Prevention of gynecological diseases

It is important to visit the gynecologist regularly in order to detect the disease in a timely manner.

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Diseases of the reproductive system or so-called gynecological diseases are the most common among women. Depending on the type of pathogen, they can be inflammatory, venereal and tumor-like. Not all women immediately react to the appearance of minor symptoms of gynecological diseases, many delay the visit to the gynecologist for a long time and start the disease.

Meanwhile, the earlier the woman goes to the doctor, the more likely it is to completely get rid of the health problem. This is especially true in cases where the pathological process is malignant. For the timely detection of a gynecological disease, every woman under 30 years of age should visit a gynecologist at least once a year, and those who are older - once every 6 months. In addition, in order to prevent serious health problems, it is necessary to have a general understanding of the symptoms of gynecological diseases.

The most common symptoms of diseases of the genital area in women- this is pain in the lower abdomen, vaginal discharge, itching, burning and menstrual irregularities.

Let's look at each of them separately:
1. Lower abdominal pain. Pain in the lower abdomen caused by inflammatory diseases, as a rule, are aching, as during menstruation, and sharp and paroxysmal pains signal rupture of the fallopian tube, cyst torsion, ectopic pregnancy, and serious problems with the ovaries. Cramping pains most often occur during miscarriages or changes in the state of the fibromatous node in the uterine cavity. "Gnawing" pain during sleep can be a symptom of cervical cancer, endometriosis and progressive uterine fibroids. For most women, pain in the lower abdomen occurs during 1-3 days of menstruation, and in nature they can vary from moderate to severe. Severe menstrual pain is usually observed in girls during adolescence, when the cycles are just beginning. And in women over the age of 24, severe menstrual pain is usually a symptom of a hormonal imbalance in the body.

2. Vaginal discharge. In addition to the onset of menstruation, the cause of the appearance of women can be inflammatory, infectious and viral diseases of the genital organs, endometriosis, uterine fibroids, cysts and the onset of menopause. The color of vaginal discharge can be white, red, brown-yellow, dark brown and gray. Normally, women should not have any vaginal discharge between periods, except for slight transparent whites. And the allocation of whiter is a normal phenomenon, it is observed in every woman. Therefore, do not be upset if you find yellowish spots from discharge on your underwear. These are whites, they do not cause any discomfort and have no smell, and before ovulation their number usually increases. However, an unpleasant odor and spotting from the vagina between periods is an alarming symptom. If they are creamy white in color and cause itching, burning in the vulva, then these are signs of thrush - the most common gynecological disease. But these same symptoms can also be observed with vulvovaginitis - an inflammatory disease of the genital organs.

Cause monthly bleeding between periods, endometriosis and uterine fibroids are most common, but these diseases can also be asymptomatic. Abnormal vaginal spotting in women older than 40 may indicate the onset of perimenopause. For any changes in the color, quantity, consistency and smell of vaginal discharge, you should consult a gynecologist, only he can determine their nature and prescribe treatment.

3. Itching and burning of the external genitalia. These symptoms most often occur with infectious gynecological diseases, sexually transmitted. For example, with gonorrhea, trichomoniasis, chlamydia and candidiasis (). But diseases of viral etiology, such as human papillomavirus, HIV and genital herpes, can also cause itching and burning of the vulva. Sometimes discomfort and discomfort in the genitals occur due to the development of purulent-inflammatory diseases, diabetes mellitus and the onset of menopause.

4. Menstrual irregularity. Menstrual irregularities include amenorrhea or absence of menstruation, shortening or lengthening of the cycle, scanty periods, and heavy bleeding. They can be caused by hormonal and endocrine changes in the body. And most often, menstrual irregularities are observed in women in the period preceding menopause.

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Women's health is very fragile, negligent attitude towards it can lead to a lot of problems in the future. Gynecologists strongly recommend that women undergo an examination twice a year for prevention purposes, even if nothing bothers them. Many dangerous diseases occur in a latent form and destroy health, while a woman is unaware of it.

Types of gynecological diseases and their manifestation

There is a wide variety of diseases that are unique to the female sex. Each of them has its own distinctive features. Some appear immediately, while others can wage a silent war for years and lead to infertility or even death.

Classification of diseases:

Regardless of age, there are certain gynecological diseases in women, the list and symptoms of which you will learn below.

Colpitis

Colpitis- an inflammatory process affecting the mucous tissues in the vagina. The disease develops against the background of the reproduction of pathogenic microflora: fungi of the genus Candida, staphylococcus, streptococcus, Escherichia coli.

The course of the disease can be acute and chronic. Colpitis occurs most often in women of childbearing age, but can also develop in children and the elderly.

Causes of a different nature activate the active reproduction of pathogenic flora. There are two types of colpitis:

Symptoms:

• pain and discomfort in the vagina and in the area of ​​the labia, burning;
• profuse discharge, sometimes with a characteristic smell of rot;
• painful urination;
• swelling and redness of the genitals.

Vulvitis

Vulvitis- an inflammatory disease that affects the area of ​​\u200b\u200bthe female genital organs. The following are exposed to infection: clitoris, labia, vaginal opening. The disease develops against the background of a weakened immune defense with a concomitant violation of the integrity of the skin of this area.

The cause of the development of vulvitis is most often pathogenic organisms: yeast fungi, E. coli, streptococci, etc. Sometimes inflammation can develop on the background of STDs.

Symptoms:

• swelling in the external genital area;
• redness, itching and burning when touched, after urination or sexual intercourse;
• purulent discharge from the vagina.

cervicitis

cervicitis- an inflammatory process that affects the tissues of the cervix. The disease is accompanied by purulent or cloudy discharge, discomfort during sexual intercourse, pulling pains in the lower abdomen. Chronic cervicitis leads to insolvency of the cervix and the spread of the inflammatory process above.

Cervicitis rarely occurs as an independent disease, most often it occurs due to acute vulvitis, vaginitis, colpitis, etc.. The disease is provoked by pathogenic flora that enters the cervix.

Certain factors increase the risk of developing cervicitis: trauma during delivery, a history of abortion, the installation of an intrauterine device, the use of contraceptives.

Symptoms:

1. Acute cervicitis accompanied by turbid discharge. There is swelling of the cervix, small hemorrhages.
2. Chronic cervicitis accompanied by cloudy mucous discharge, pseudo-erosion is formed on the cervix. Its surface becomes thicker, cysts may form. Swelling and redness in the chronic form are not so pronounced.

Candidiasis

Candidiasis(thrush) is the most common disease of the female reproductive system. Its causative agents are fungi, which are called Candida. Candidiasis is not a sexually transmitted disease. It develops due to increased reproduction of fungi, against the background of a weakened immune system.

Symptoms:

• white discharge with a sour smell, having a curd consistency;
• swelling of the genital organs;
• increased discomfort on contact with water, after intercourse.

Myoma

uterine fibroids is a common and complex disease. It is a neoplasm consisting of benign cells. Fibroids are nothing more than overgrown muscle fibers.

Uterine fibroids, contrary to popular belief, never develop into cancer.

Doctors cannot say the exact cause of the development of fibroids, however, there are risk factors:

Symptoms of uterine fibroids:

• increase in the menstrual cycle;
• excessive bleeding during menstruation, the appearance of blood clots;
• pain in the pelvis, back, legs;
• frequent urination;
• pain during sexual intercourse;
• an increase in the size of the abdomen.

Adnexitis

Adnexitis- an inflammatory process occurring in the appendages. The causative agents of the disease are various microorganisms and bacteria. The process can proceed both acutely and in a chronic form, frequent relapses are possible.

Symptoms:

endometriosis

endometriosis- a disease in which the endometrium, lining the inner surface of the uterus, grows beyond its limits. New cells undergo the same changes during the menstrual cycle as the endometrium itself.

The disease is inherent in women childbearing age, according to the frequency of cases, it is inferior only to uterine myoma.

In endometriosis, endometrial cells can be found in the cervix, vagina, ovaries, and fallopian tubes.

Doctors and scientists cannot yet name the exact cause of the development of the disease. There is an opinion that endometrial cells enter the nearby genital organs along with blood clots.

Therefore, this disease is often associated with operations, difficult childbirth and abortions.

Symptoms:

• pain in the lower abdomen, radiating to the sacrum and lower back;
• excessive bleeding during menstruation;
• thick, dirty discharge after the end of menstruation.

Endometriosis is dangerous because 40-43% of cases lead to infertility. Another complication of the disease is various inflammatory processes, due to the fact that blood can accumulate in one area and not go outside, as in a normal cycle.

Dysplasia- a pathological condition in which the number of layers and the structure of the cellular structure that covers the epithelium of the cervix changes.

Dysplasia is a disease that, under a combination of circumstances, can cause the development of a malignant tumor.

A common cause of dysplasia is HPV(human papillomavirus), or rather, certain of its strains, which belong to the group of high oncogenic risk.

From the moment of the development of the disease, before its transformation into cancer, about 10 years can pass. During this time, there may be no symptoms.

Symptoms:

• copious, odorless discharge, having a light milky color;
• discomfort and pain during and after sexual intercourse, discharge of blood streaks after intimacy;

is one of the most common malignant diseases. There are two groups of women at risk: aged 40-50 years and 55-65 years.

It is possible to prevent the disease, because it is preceded by various precancerous conditions.

Causes of the disease:

Symptoms:

• vaginal discharge with streaks of blood;
• exacerbated cervicitis, colpitis;
• purulent discharge;
• violation of the monthly cycle;
• pain during and after intercourse.

Ovarian cyst

Ovarian cyst has the form of a sac filled with fluid and located in one or both ovaries. Its dimensions can be several centimeters or be up to 25 cm in diameter.

It is formed when a mature egg cannot leave the ovary during ovulation. As a result, it begins to stretch and fill with liquid.

Symptoms:

Treatment options

Modern medicine has a large arsenal of knowledge and opportunities for the treatment of various gynecological diseases. You can even deal with severe female diseases in gynecology, inflammation, treatment depends on the stage of the disease and the variety.

Any therapy begins with a set of studies that allows you to accurately determine the diagnosis and choose the treatment. Women are prescribed various medications, very often these can be antibiotics, which, if they are not effective enough, can be replaced. In complicated cases resort to surgical intervention.

After surgical treatment, a woman is recommended to visit a sanatorium.

Proper and timely treatment allows a woman to maintain health, and rest in a sanatorium, restore vitality.

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Female gynecological diseases are a set of pathologies that form as a result of an infectious lesion, incorrect location or defective development of a woman's genital tract. Pathological changes in the genital area have a strong influence on the entire body, but various ailments (nervous, endocrine, infectious) can also contribute to the occurrence of negative processes in the genitals.

Adnexitis

Inflammatory or infectious disease affecting the fallopian tubes and pelvic organs. This disease can contribute to the development of an ectopic pregnancy or even lead to infertility.

The disease is provoked by adhesions on the fallopian tubes formed as a result of the course of the disease. The cause of the occurrence can be infectious diseases (flu, pneumonia, tuberculosis), sexually transmitted diseases, hypothermia, abortion, chronic stress.

There are several forms of adnexitis:

• chronic - develops as a result of an untreated disease;
• acute - mainly occurs against the background of an inflammatory process provoked by an infection;
• subacute - rarely occurs with inflammation of a tuberculous nature;
• purulent - mainly occurs due to complications of gonorrhea;
• bilateral - inflammation of both appendages due to infection;
• right-sided - only the right organs are affected;
• left-sided - only the left organs.

Signs (symptoms) of this gynecological disease of acute and subacute forms in women are:

• excessive sweating;
• fever, chills, temperature above 38 degrees;
• purulent discharge;
• difficult urination;
• stomach hurts when pressed;
• severe pain in the sacral region are cramping in nature;
• intoxication.

The chronic form is characterized by:

• the presence of pain during intimacy and defecation;
• aching, dull pain in the sacral region;
• mucopurulent discharge;
• dysmenorrhea (severe pain during menstruation);
• temperature above 38 degrees during periods of exacerbation.

Ovarian apoplexy

A painful condition in which there is a sudden violation of the integrity (rupture) of the tissues of the ovary.

The disease can develop against the background of another disease, for example, oophoritis, polycystic ovaries, inflammation of the appendages, varicose veins of the ovary, abortion. Apoplexy can be provoked by sports, excessive physical activity, abdominal trauma, horseback riding, violent sexual intercourse and other processes that increase intra-abdominal pressure.

• cramping or constant pain, localization of which occurs in the lower abdomen;
• nausea;
• tachycardia;
• cold sweat;
• shock of 1-3 stages, depending on the severity of the course;
• development of internal bleeding (weakness, pallor, slow pulse, fainting, vomiting, chills).

Bacterial vaginosis

A pathological condition provoked by a qualitative and quantitative imbalance of the vaginal microflora. For a long time, the disease may not show clinical signs.

The causes of the disease can be abrupt changes in hormone levels, the use of antibacterial drugs, a decrease in immune responses.

Symptoms that characterize the disease:

• a large amount of discharge with a sharp unpleasant odor, often white;
• discomfort when urinating;
• periodic or constant itching, which worsens during critical days;
• discomfort during intimacy;
• bonding of the labia minora.

Bartholinitis

The disease is an inflammation of the Bartholin's gland, located at the vestibule of the vagina, its function is the production of mucous secretions. Basically, the disease is localized on one side.

The most common pathogens are gonococcus, Escherichia coli, staphylococcus aureus, Trichomonas vaginalis, chlamydia, mixed genus infection, or fungi of the genus Candida. Pathogenic microorganisms settle in the layers of the gland and lead to tissue destruction.

Symptoms of bartholinitis:

• inflammation in the excretory duct of the gland (initial stage);
• blockage of the excretory duct;
• small discharge of mucopurulent nature;
• formation of a cyst, abscess;
• pain during intimacy;

The acute and chronic forms are characterized by:

• temperature up to 40 degrees;
• general malaise;
• sharp pain in the area of ​​the inflamed gland;
• discomfort or pain when walking;
• possible enlargement of the inguinal lymph nodes.

vaginismus

The pathological condition is characterized by an involuntary sudden contraction of the convulsive nature of the muscle fibers that surround the entrance to the vagina and the muscles of the pelvic floor. In this case, it is impossible to introduce the male genital organ into the vaginal cavity and conduct sexual intercourse. Women cannot predict or control the manifestation of this condition.

The main reason for the development of the disease is considered a strong psycho-emotional shock.

Symptoms:

• severe pain when touched or in contact with the genitals;
• uncontrolled spasms in the lower abdomen, thighs, muscle fibers of the vagina.

Ectopic pregnancy

Pathology, when a fertilized egg does not enter its destination, that is, the uterus, but is fixed outside it.

The reasons for the development of an ectopic pregnancy can be adhesions or scars on the walls of the fallopian tubes, which are provoked by diseases such as genital infections, inflammation or mechanical damage (abortion).

The main signs of the disease:

• vaginal bleeding;
• unilateral pain in the lower abdomen;
• frequent and severe vomiting and nausea;
• pain during defecation or urination;
• shoulder pain due to bleeding;
• fatigue;
• increased sweating;
• dizziness;
• pallor.

Vulvitis

A condition where a woman's external genitalia (vulva) become inflamed. The vulva consists of the labia majora, labia minora, clitoris, outer urethra, and the entrance to the vagina.

The cause of the secondary form of the disease are inflammatory processes passing from the vagina. The primary form can be provoked by a violation of the hygiene rules of the intimate area, contact of a third-party object or unwashed hands with the reproductive organs. The attenuation of hormonal function often provokes the development of the disease in women after 55 years.

For the acute and chronic forms of the disease, the symptoms are the same, but in the second case they appear very violently. Main signs:

• pain in the vulva, aggravated by intimacy, urination;
• swelling and redness of the outer part of the reproductive organs;
• an increase in the sebaceous glands;
• burning of the genitals;
• temperature rise;
• the formation of plaques and plaque on the outer part of the genital organs;
• the formation of bubbles with liquid on the genitals inside.

Prolapse of the vagina and uterus

A disease due to which there is a change in the position of the uterus (shifts outside the vagina) or vagina. It often manifests itself when straining.

The cause of this anomaly may be underdevelopment of the pelvic muscles, weakening of the fixing apparatus of the uterus, age-related changes, multiple births, sexual infections or operations, paralysis of some nerves of the sacral region.

At the initial stage, there are practically no symptoms, but with the development of the disease, the following signs are observed:

• pain in the pelvic area;
• dryness of the walls of the vagina;
• difficulty urinating;
• incontinence;
• thinning or thickening of the walls of the mucous membrane;
• polyps;
• leukoplakia;
• elongation of the cervix;
• endocervicitis;
• violation of the functions of the genital organs;
• burning;
• increased urination;
• sensation of the presence of a foreign object in the vestibule of the vagina;
• with complete prolapse, part of the uterus and the walls of the vagina are visible.

Herpes

A viral disease characterized by a rash on the skin and mucous membranes in the form of grouped vesicles. Herpes is a common ailment, its causative agent is the herpes simplex virus. Most often, the disease manifests itself on the skin, eyes and the outer part of the genital organs.

The reason for the development is a decrease in immunity, hypothermia, overheating.

Symptoms:

• burning skin;
• malaise;
• chills (rare);
• eruption in the form of crowded vesicles.

Gonorrhea

A sexually transmitted disease transmitted through sexual intercourse. The development of the disease is often manifested by damage to the organs of the urinary system.

The cause of the disease is infection with gonococcus.

The main signs of the disease in women:

• pain when urinating;
• itching in the genital area and urethra;
• increased frequency of urination;
• burning and cutting;
• excretion of urine in small portions;
• feeling of incomplete emptying of the bladder;
• purulent discharge.

Dyspareunia

This is a condition in which there is a feeling of soreness or discomfort in the outer part of the genital organs, discomfort occurs before, after or during intimacy.

The disease has a mental nature and is more often manifested among the weaker sex. The cause of the development of the disease can be defects in the development of the vulva or vagina, infectious diseases, for example, bartholinitis, vulvitis, vulvovaginitis, colpitis.

The main symptom of the disease can be called pain, which varies from aching to cutting. Its degree is different, some note slight discomfort, others - unbearable pain, and often it is localized in one place, it all depends on the posture and situation.

Dysfunctional uterine bleeding

A pathological condition caused by a malfunction of the endocrine glands that produce sex hormones, this leads to abnormal acyclic bleeding.

The causes of the development of the disease are inflammation of the pelvic organs, frequent stressful conditions, physical or mental overwork, difficult pregnancy or abortion, malnutrition, genetic diseases of the reproductive and endocrine systems.

The main symptoms are:

• bleeding that occurs between regular periods;
• violation of the cycle;
• profuse bleeding lasting more than a week;
• signs of anemia;
• puffiness;
• weight gain;
• dyspnea.

Ovarian dysfunction

A disease of the genital area in women, when the production of hormones is disturbed due to a disorder in the hormonal function of the ovaries.

The cause of this condition can be inflammation in the uterus, appendages and ovaries, various diseases, endocrine disorders, abortion, exhaustion of the body due to frequent stress, mechanical damage to the uterine cavity (intrauterine device).

Signs of the presence of the disease:

• irregular menstruation;
• infertility or miscarriage;
• cramping or pulling pains in the lumbar region and lower abdomen;
• severe premenstrual syndrome;
• dysfunctional uterine bleeding;
• amenorrhea.

breast cyst

Multiple or single pathology that forms in the cavity of the mammary gland, its contents are liquid-like, a cystic cavity is formed in the ducts.

The cause of the disease is the accumulation of secretion, an increase in the milk duct or the formation of a fibrous capsule.

Often the disease is asymptomatic for a long time, and after a certain amount of time it can be manifested by burning and unpleasant (painful) sensations inside the mammary gland. Symptoms usually increase on critical days. When the cyst becomes inflamed, fever, swollen lymph nodes, and reddening of the skin appear.

Ovarian cyst

A benign tumor-like formation that has a liquid content and can increase in size. Cyst formation can occur in many organs and tissues. These neoplasms are distinguished by structure, causes of occurrence.

Among the causes of the development of the disease are ovarian inflammation, endocrine diseases, hormonal dysfunction, abortion.

Often the disease is asymptomatic, but with a complicated course, these neoplasms manifest themselves with the following symptoms:

• pain in the lower abdomen;
• an increase in the size of the abdomen and its asymmetry;
• violation of the menstrual cycle;
• compression of blood vessels and organs.

lactostasis

A disease when a nursing woman has stagnation of milk in the mammary glands. The manifestation of the disease is a thickening of the breast tissue, this process is accompanied by pain.

The cause of the occurrence may be a violation of the outflow of milk due to narrow milk ducts or increased milk production. The aggravation of the disease occurs due to rare feeding or refusal to feed the baby, improper breast capture by the baby, irregular nipples, the presence of cracks, hard physical labor or stress.

The symptoms of the disease are as follows:

• pain during palpation or feeding;
• puffiness;
• tightness in a certain part of the chest;
• tuberosity of the affected area;
• redness of the breast or part of it.

Breast lipoma

A benign tumor formed from fat cells may have a different shape (round, oval, flat), soft, but when connective tissue appears in them, it becomes dense.

The disease can develop due to hormonal changes, stress, metabolic disturbances, or a genetic predisposition.

The disease has no obvious symptoms, often the tumor is detected during self-palpation, it does not cause pain, with the exception of a large lipoma, which compresses the nerve endings.

Mammalgia

A disease in which a painful unpleasant sensation appears in the area of ​​\u200b\u200bthe mammary gland may be accompanied by increased sensitivity, swelling and a feeling of heaviness.

The following causes of the development of the disease are distinguished:

• hormonal fluctuations;
• inflammation of the mammary gland;
• injuries, operations;
• neurosis and stress;
• gland tumors (malignant and benign);
• premenstrual syndrome;
• artificial childbirth, abortion;
• taking ovulation stimulants or oral contraceptives.

Symptoms of the disease can appear individually, or all at once. Main:

• dull, aching pain in the breast;
• sensation of seals on palpation;
• constipation;
• bloating;
• discharge from the nipples;
• headache;
• an increase in the size of the breast.

Mastopathy

Breast disease in which benign tumors are formed. With mastopathy, regressive and proliferative changes occur in the tissues of the mammary gland. There are such types of the disease:

• nodal;
• diffuse with dominance of different components (cystic, glandular, fibrous or mixed).

Cystic mastopathy is nodular formations in the form of sacs or chambers, inside of which there is liquid.

Fibrous resembles a scar, because it forms a connective tissue.

Mastopathy with a glandular component is a nodular formation, based on glandular tissue, which is characteristic of the mammary gland.

The most common is mixed mastopathy, the tumor formations of which usually include cells of various tissues.

The main symptom of the disease is dense formations in the mammary glands of a nodular or diffuse nature. Usually, before menstruation, they begin to ache a little, and soon the pain subsides, but often unpleasant sensations are always present.

Other symptoms of mastopathy:

• pain on palpation;
• swollen lymph nodes;
• puffiness;
• skin rash;
• liquid protrudes from the nipples (rarely).

Mycoplasmosis

A gynecological infectious disease leading to inflammation of the urinary tract. This pathology develops when conditionally pathogenic bacteria of the mycoplasma family enter the woman's body.

Often, urogenital mycoplasmosis develops for the following reasons:

• constant stressful situations;
• decreased immune defensive function;
• strong physical and emotional stress;
• pregnancy;
• hypothermia.

There are several forms of the disease: acute, fresh, sluggish, subacute and chronic.

This ailment can be asymptomatic for a month, but after that it develops quite quickly and has violent symptoms.

Signs of an acute form:

• itching when urinating;
• redness of the external opening of the urethra;
• discharge from the genitals of gray or yellow color;
• discomfort with intimacy;
• burning and itching in the genitals;
• the presence of constant pain in the lower abdomen;
• lower back pain;
• the threat of miscarriage or premature birth.

Symptoms of the chronic form are similar to diseases such as cystitis, vaginitis or pyelonephritis.

uterine fibroids

A common disease among women, which is characterized by a neoplasm of a benign nature, it is localized in the myometrium (the muscular membrane of the uterus). The tumor is a plexus of smooth muscle fibers, fibroids can be either multiple or single.

The main factors due to which the disease often develops include:

• not regular sex life;
• hormonal disorders;
• chronic infections in the genitals;
• gynecological surgeries and manipulations;
• infertility;
• hypodynamia;
• endometriosis;
• decreased immunity;
• frequent stress.

Signs of the disease are:

• constipation;
• prolonged menstrual flow, often with blood clots;
• uterine discharge;
• aching pain in the lumbar region and lower abdomen;
• pain when urinating;
• sharp cramping pains in the lower abdomen;
• signs of anemic syndrome;
• pain during intimacy;
• an increase in the abdomen;
• miscarriages and infertility.

Thrush or candidiasis

The disease is provoked by a high concentration of fungal microflora on the vaginal mucosa.

The cause of the development of the disease may be a decrease in immunity due to the use of antibiotics or the transfer of an infectious disease, disruption of sleep, nutrition, rest, constant stress.

Symptoms:

• burning in the area of ​​the outer part of the genital organs;
• feeling of itching;
• pain when touching the labia;
• discomfort or pain during intimacy;
• painful urination;
• cheesy white discharge.

Fallopian tube obstruction

A condition in which the egg is unable to travel from the ovary to the uterine cavity.

The main cause of this pathology is the inflammatory processes taking place in the fallopian tubes. Also, the disease can be provoked by adhesions formed as a result of surgical intervention, an ectopic pregnancy, congenital developmental defects, endometriosis, polyps, and various tumors.

Obstruction of the fallopian tubes does not affect the woman's condition in any way, it can be detected in the presence of inflammation, which is accompanied by fever and pain in the lower abdomen. The main symptom that indicates the disease is the absence of pregnancy with regular intimacy without the use of contraceptives.

Acute mastitis

An acute inflammatory process that affects the breast tissue. Most often, the disease develops in lactating primiparous women.

The cause of the disease is pathogenic microorganisms that penetrate the nipple area through cracks and microtraumas, as a result, there is a violation of the outflow of milk.

Among the main symptoms are the following:

• breast engorgement;
• an increase in the size of the gland;
• pain when expressing milk;
• redness of the skin;
• poor general health;
• the presence of seals in the thickness of the gland.

Papilloma

Benign formation on the mucous membranes and skin of a tumor-like nature. Outwardly similar to the nipple, but its base is narrow (stalk), usually has a dense or soft texture, brown color. The localization of the disease on the skin is a cosmetic defect, in the larynx it can manifest itself as respiratory failure, bleeding and ulceration.

Infection with the papillomavirus occurs through direct contact with an infected person.

When it enters the body, the virus manifests itself in various formations on the skin and mucous membranes. These formations can be multiple and single, the growth process is usually accompanied by itching and burning. Also, symptoms of the active phase of the disease are swollen lymph nodes, fever and chills.

Polyp of the body of the uterus and cervical canal

A pathological condition in which cells of the glandular epithelium of the endocervix or endometrium grow, their division provokes chronic inflammation of these areas.

Basically, the disease is asymptomatic and is detected quite by accident, with the exception of damage to polyps or ulceration, inflammation.

Then pulling pains in the lower abdomen, minor bleeding and menorrhagia may appear.

Habitual miscarriage

A condition in which more than two pregnancies in a row end in spontaneous abortion without outside interference. Usually, abortion occurs in the first trimester, sometimes a woman does not even know that she was pregnant.

Among the causes of the disease are the following:

• underdevelopment of the fetal egg;
• intoxication and chronic infections;
• defects in the structure of the uterus;
• uterine tumors;
• inflammation in the uterine cavity;
• hypovitaminosis;
• the use of contraceptive and hormonal drugs;
• endocrine diseases;
• viral diseases transferred at the beginning of pregnancy;
• genetic determination.

Main features:

• cramping pains in the lumbar region and lower abdomen;
• bleeding;
• bloody issues.

ovarian hyperstimulation syndrome

The condition of the female body when the ovaries show an excessive reaction to ovulation-stimulating drugs. Usually, ovarian stimulation is used in case of infertility treatment and anovulatory cycles. The purpose of this process is to achieve normal ovulation in a woman.

The main cause of the disease is an imbalance of hormones, and among the factors contributing to the development of the syndrome are the following:

• age up to 35 years;
• inadequate dosage of drugs;
• low body weight;
• a history of polycystic ovary syndrome;
• the body's response to drugs does not meet expectations;
• history of ovarian hyperstimulation syndrome.

With the development of the disease, symptoms appear that may differ depending on the severity of the course:

Leaks easily

• discomfort or slight pain in the lower abdomen;
• slight swelling of the legs;
• occasional bloating and feeling of heaviness;
• sometimes feeling worse.

• palpable pain in the groin;
• pain in the sacrum and lower abdomen;
• vomiting, nausea, diarrhea;
• decrease in the amount of urine and acts of urination;
• dizziness, weakness, flickering in the eyes;
• bloating and heaviness in the abdomen;
• swelling of the external genital organs and legs;
• weight gain.

• severe arching pain in the sacrum, inguinal region, abdomen and coccyx, aggravated by any movement of the body;
• severe swelling of the body;
• hypotension;
• violation of acts of urination;
• difficulty breathing, shortness of breath;
• accumulation of fluid in the peritoneum, an increase in the size of the abdomen;
• repeated vomiting and nausea;
• violation of the heart rhythm;
• temperature rise;
• dizziness, weakness.

polycystic ovary syndrome

A disease in which cystic growths with liquid contents form in the ovarian cavity.

The unambiguous causes of the development of the disease have not yet been determined, but most often the disease is provoked precisely by a genetic predisposition.

The main symptoms of the disease:

• disruption of the menstrual cycle;
• polycystic ovaries;
• excessive production of male hormones;
• difficulty conceiving or inability to get pregnant;
• type 2 diabetes;
• darkening of the skin on the inside of the thighs, back of the head, or armpits.

Premenstrual tension syndrome

The disease is a set of symptoms (signs) that precede menstruation, which explains the pathological course of the second phase of the cycle.

The syndrome occurs for the following reasons:

• disruption of the thyroid gland;
• imbalance of progesterone and estrogen during the second phase;
• conflict situations and frequent stress;
• hypovitaminosis;
• increase in prolactin production;
• genetic determination;
• violation of water and electrolyte balance.

Signs of PMS are divided into physical and psychological, the first include:

• swelling of the mammary gland;
• vomiting, nausea;
• increased sensitivity and pain in the mammary glands;
• diarrhea, obstipation;
• headache, migraine;
• pain in the lumbar region, joints, muscles;
• hyperemia of the face;
• tachycardia;
• pastosity of the lower extremities;
• increased urination.

Psychological symptoms include:

• a state of depression;
• alternation of mood;
• insomnia or prolonged sleep;
• aggressive behavior;
• irritability;
• panic state;
• mnemonic disorders;
• suicidal thoughts.

Syphilis

Venereal disease, which affects all human organs, proceeds for a long time in an undulating pattern of development.

The causative agent of the disease is a pale spirochete, you can become infected through contact with the fluids of the affected body.

The first symptom of infection with an ailment is the formation of multiple or single sores, which is called a hard chancre. Gradually, other signs appear:

• swollen lymph nodes (mainly inguinal);
• weakness;
• joint and muscle pain;
• subfebrile temperature;
• headache;
• the formation of a syphilitic rash (spots, pustules, nodules);

With a long course of the disease without treatment (more than 5 years), the destruction of the affected organs begins.

Adhesive process in the pelvis

Adhesions are strands that lead to displacement and fusion of internal organs.

The causes of adhesions can be injuries, inflammatory processes occurring in the uterine cavity, on its mucous membrane, appendages, and muscular membranes. Often, adhesions are provoked by foreign objects that can enter the abdominal cavity during surgery.

Depending on the severity of the course of the disease, symptoms may be absent or expressed quite clearly. The main features are:

• diarrhea or constipation;
• dull, sharp or aching pain in the lower back, groin, lower abdomen;
• pain during defecation, intimacy, menstruation;
• vomiting and nausea;
• bloating;
• dry mouth.

Fibroadenoma of the breast

A benign formation of connective and glandular tissues, which looks like a seal and is mainly localized on one side. Fibroadenoma is not attached to the skin, therefore it is mobile, smooth and elastic to the touch, usually does not cause pain when touched.

Causes of the disease:

• hormonal disbalance;
• endocrine diseases;
• obesity;
• diabetes;
• disruption of the pituitary gland;
• pathology of the adrenal glands and ovaries;
• liver disease;
• depletion of the body;
• frequent stress;
• breast injury.

The disease is almost asymptomatic, usually seals are found by chance, with the exception of large formations. But, if the fibroadenoma is localized near the nipple, the following symptoms appear:

• pain when touched;
• the formation of cracks, sores on the nipple and the approximate area;
• secretion of a liquid that is odorless.

Chlamydia

Infectious disease, its causative agent is chlamydia.

The disease can affect the musculoskeletal, cardiovascular, respiratory, genitourinary systems. The danger of chlamydial infections is that they can give a lot of different complications. Basically, infection occurs sexually, quite rarely the disease is transmitted by household means.

In half of the cases, the disease does not manifest itself with any symptoms, so in such cases there is a risk of developing complications. Signs of infection are as follows:

• mucopurulent discharge;
• burning;
• abdominal pain;
• temperature.

Chronic endometritis

Inflammation, in which the mucous and submucosal layers of the uterus are affected.

The chronic form of the disease develops as a result of an untreated acute form, which can occur after an abortion, childbirth, intrauterine manipulation, or the presence of foreign bodies.

Among the main symptoms are the following:

• violation of the menstrual cycle;
• uterine bleeding;
• bloody or serous-purulent discharge;
• pain in the lower abdomen of a aching nature;
• pain during intimacy.

endometriosis

With this disease, cells similar in structure to the cells of the uterine cavity spread outside its borders, as a result, monthly changes occur in the endometrioid foci that are inherent in the endometrium (uterine cavity), and this is what leads to the disease.

The following factors lead to the development of the disease:

• decreased immunity;
• genetics;
• damage to the uterus (abortion, etc.);
• hormonal disorders;
• late childbirth and the onset of sexual activity;
• allergic diseases;
• chronic diseases of the genitourinary system;
• endocrinological diseases.

In the initial stage, the disease is mostly asymptomatic. For a severe stage, the following symptoms are characteristic:

• menstrual dysfunction;
• menorrhagia (cycle disorder);
• blood clots during menstruation;
• symptoms of general anemia;
• algomenorrhea;
• infertility.

Cervical erosion

A disease due to which an ulcer is formed on the mucous membrane of the cervix. This process is pathological, it is characterized by a change in the area of ​​the normal mucous epithelium to a cylindrical epithelium.

The most common causes of the disease: late or early onset of sexual activity, inflammatory processes, genital infections, mechanical damage, hormonal disorders.

Often the disease does not manifest itself, but the main signs of erosion are:

• pain during intimacy;
• mucopurulent discharge;
• bleeding after intercourse.