Venereal diseases are infectious, that is, arising from the introduction of various pathogens. They are broadcast from person to person only contact and mainly during sex.
The generally accepted definition does not cause questions for doctors, but for patients it is better to decipher it point by point:
- Pathogens can be bacteria, protozoa, fungi, rickettsiae or viruses. Perhaps mixed infection – infection at once with several types of microorganisms.
- Venereal disease is a local and common manifestation of the effect of infection on humans.
- For infection you need a source of infection (sick or carrier) and the way in which pathogens are transmitted. Infection with venereal disease is possible if present:
- Sexual transmission in the process of any sexual activities (traditional, oral or anal intercourse). Pathogens are transmitted from the skin or mucous genital organs, anus (anus), lips and oral cavity.
- Transmission – infection through the blood – with the transfusion of whole blood, erythrocyte mass; infection from needles or instruments on which the patient’s blood or the carrier of the infection has remained.
- Contact-household way: through clothes or objects that are contaminated with infectious secretions.
The word venereal is associated with the name of Venus, the Roman goddess of love: it emphasizes that diseases are more often sexually transmitted.
What diseases are referred to venereal, their classification
Modern sources provide a list of sexually transmitted infections. The list includes only two dozen diseases. Among them – 5 genuine venereal diseases:
And a number of STDs, which today are conventionally called “venereal”, based on the sexual route of infection with them:
Classify sexually transmitted diseases, very diverse:
On the etiological principle (for reasons of development of diseases) diseases are divided into viral, bacterial, fungal and
By effects on the body there are genital types of venereal diseases (for example, gonorrhea, vaginal trichomoniasis), skin (pubic pediculosis, scabies, condylomas) and affecting other organs and systems of the human body (viral hepatitis B and C, amebiasis, AIDS, giardiasis).
In accordance with the prescription of signs there are classical, well-known before our era, venereal diseases such as syphilis, gonorrhea, donovanosis, soft chancre, and venereal lymphogranuloma (all of them are oral infections), and the so-called new venereal diseases are the rest of the list.
Patient syphilis, French caricature, approx. 1810
The names of some classic STDs have historical roots: the ancient Roman physician became the godfather of gonorrhea Galen, who observed the expiration of the seed and used Greek words to describe this feature. The word syphilis is associated with the myth that the offended gods punished a shepherd named Sifilus with a disease of the genitals. This story even dedicated a poem, which was described in detail the main symptoms. A later name is lues (lues) – translated from Latin means contagious disease, and it appeared after the epidemic of syphilis in Europe, which lasted about 50 years (the end of the XV – the middle of the XVI centuries). The names of new STDs are formed from the names of pathogens (trichomoniasis, chlamydia, etc.) and virus serovariants (viral hepatitis B and C), the main manifestations (scabies, condylomas) or symptom complexes (AIDS).
Prevalence and risk
The top lines of the world ranking, including the most common sexually transmitted diseases, firmly occupied trichomoniasis and chlamydia: up to 250 million cases are diagnosed each year, and the proportion of infected people makes up about 15% of the total population of the Earth. They are followed by gonorrhea (100 million fresh cases of the disease per year) and syphilis (up to 50 million). The graphical depiction of the incidence is reminiscent of a wave, which peaks occur during social change for the worse and in the post-war years.
Causes of an increase in the incidence of STDs:
- Demographic – population growth, the increase in the proportion of young and sexually active people, the tradition of early sexual activity.
- Progress in the socio-economic sphere – labor migration, the development of tourism, more free time and money, the craving of young people to the cities and the availability of sexual contacts.
- Behavioral norms change: more divorces, easy change of sexual partners; women are emancipated, and men are in no hurry to start a family.
- Medical causes are frequent cases of self-medication and the transition of diseases to a latent form; Women and men feel safe using condoms and instant STD prevention.
- The prevalence of drug addiction and alcoholism.
Traditional risk groups include prostitutes, homeless people, illegal migrants, alcoholics, and drug addicts who lead an undervalued lifestyle. However, they are confidently catching up with the growing incidence rate among quite successful people: personnel of companies working abroad; tourist industry and tourists; seamen, pilots and flight attendants are also included in the list of unreliable STDs.
The appearance of visible changes at the site of infection is the result of the reproduction and vital activity of STD pathogens. A small number of infectious agents can be repulsed by the immune system and die, and for the development of signs of the disease it is necessary that the law of the transition of quantity into quality should work. Therefore, any infectious diseases have an incubation period – the length of time required to increase the number of pathogens and the appearance of the first visible symptoms of infection (for STDs, rash, discharge).
Usually, the incubation period figures are given in days, with viral infections – in hours. The incubation time can vary, which is associated with the duration of contact, the number of single doses of pathogens, the transmission and the state of the human recipient’s immune system. The incubation period (PI) is shortened in elderly and debilitated patients, in the transmission mode of transmission of pathogens and in patients with immunodeficiency syndrome.
PI for some common genital infections (in days):
- Chlamydia: 7-21 days;
- Trichomoniasis: 7-28 days;
- Gonorrhea: 2-10 days;
- Urea and mycoplasmosis: 21-35 days;
- Syphilis: 21-28 days;
- Genital herpes: from 1 to 26, usually 2-10 days.;
- Condyloma (spiky): 30-90 days.
The main manifestations of classic venereal diseases
The symptoms of sexually transmitted diseases are divided into primary signs that appear on the skin or mucous membranes at the site of pathogens, and are common, associated with their toxic effects on the body. For example, bubbles or erosion are local manifestations of sexually transmitted infections, and fever is a common symptom.
Causative agent of syphilis (Treponeva pallidum, spiral bacterium or spirochete) is predominantly sexually transmitted. The risk of infection during unprotected sex reaches 30%. In the external environment, spirochetes are unstable; they need certain values of temperature and humidity to maintain activity. This is the incubator is the mucosa of the genital organs, mouth or rectum. The infection can also be transmitted intrauterinely – to the child from the mother, or through transfusion of infected blood.
Primary A sign of infection with syphilis is hard chancre: it appears in the place of direct introduction of treponema and at first does not cause concern. There is a seal, then in its place there is a rounded ulcer with a hard bottom and raised edges. There is no pain, and chancre can be small in size – from 1 cm in diameter. After a couple of weeks, the lymph nodes are enlarged, which are located closer to the chancre, but they are also painless and do not bother the patient. Chancre heals by itself after 1-1.5 months. after the appearance, however, the infection remains in the body and syphilis passes into the secondary period.
Start secondary syphilis is a symmetrical venereal rash (roseola), which often appears even on the feet and palms. When rashes, the temperature rises, the lymph nodes increase already throughout the body. Characteristic alternation of deterioration and improvement of the general condition – periods of exacerbations and remissions. From skin manifestations, warts (wide warts) that are localized in the perineal region and anus can be attracted to the patient’s attention; also noticeable hair loss on the head.
Tertiary the period of syphilis is associated with severe internal diseases that develop over several years after infection. If untreated, about 1/4 of the patients die.
The causative agent is paired cocci, under a microscope similar to coffee beans, the concave side of which is turned towards each other. The name is sonorous – Neisseria gonorrhoeae, given to microbes in honor of their discoverer, venereologist
on the photo: gonorrheal discharge in men and women
Main the signs infections – purulent inflammation of the mucous membranes. During sexual transmission, both partners almost always develop urethritis (inflammation of the urethra). Gonorrhea is distinguished by pain after and during miccia (urination), during intercourse; even at rest, lower abdomen and lower back can hurt. The discharge in the acute period is abundant and purulent, the color varies from white to yellow. With the transition to the chronic form of discharge a little, they become whitish and thick.
Important: Unlike men, women with gonorrhea are often insignificant, they can be mistaken for a symptom of non-specific urethritis, cystitis or endocervicitis. Be sure to make an appointment with a doctor if discharge occurs more than one cycle and has a putrid odor; if there is bleeding between periods; if no strength and constantly whining waist.
Complications associated with ascending urogenital infection. In women, gonococci infect the uterus, tubes and ovaries, in men – the testicles, epididymis (epididymitis), prostate. The standard result of chronic gonorrhea is spikes internal organs. If adequate treatment is not received or the immune system has failed, then gonococcal disease is possible. sepsis (blood infection) with a fatal outcome or the transition of infection to internal organs (liver, heart, brain) and an unclear prognosis for later life. The sad, though not fatal, result of chronic gonorrhea is 100% male and female infertility.
The causative agent is Bacillus Haemophilus ducreyi. The disease is mainly “tied” to countries where there is a warm and humid climate (Africa, Asia, South America), in European countries is rare. Infection occurs through sexual intercourse, with anal and oral sex. Chances of getting an infection during one-time unprotected sex – 50 to 50.
Differences of soft chancre from hard (syphilitic)
Signs of contamination: primary manifestation is a red spot, denoting the locus of infection. Then a purulent vesicle appears, it turns into an irregular ulcer, soft and painful. The diameter of the ulcer varies from 3-5 mm to 3-10 cm and more. Then the lymphatic vessels are inflamed (lymphangitis), forming a painful subcutaneous strands. In men, they are palpable on the back of the penis, in women – on the skin of the labia majora and pubic. After 7-21 days inflammation goes to the lymph nodes (lymphadenitis); dense buboes appear, which later turn into soft ulcers and open up. Complications – swelling of the foreskin, pinching the glans penis, gangrene of the genitals.
With soft chancre, skin manifestations are numerous and are at different stages of development: blemishes, ulcers and scars are visible at the same time.
Venereal lymphogranuloma (inguinal lymphogranulomatosis)
The causative agent of venereal lymphogranulomas – some serotypes Chlamydia trachomatis. Disease in Europe is quite rare, mainly recorded imported infection and cases associated with the port cities. The possibility of contracting a household route exists, but most of the transmission occurs through sexual contact.
On the photo: signs of venereal lymphogranulomatosis – inflamed inguinal lymph nodes in women and men
Main manifestations: 1-3 weeks after infection, a bubble appears at the site of chlamydia infiltration, which disappears without treatment and may go unnoticed. Then regional lymph nodes grow, merging with each other; skin over inflammation purple-violet, palpation pain. Further suppuration occurs, the formations are opened with the expiration of yellowish pus.
Complications inguinal lymphogranulomatosis – fistula anal, scrotum, urethra, recto-vaginal, between the rectum and bladder. Later development is possible. elephantiness genitalia due to local lymphostasis, strictures (narrowing) of the rectum and urethra.
on the photo: manifestations of donovanosis in the genitals
Donovanosis (venereal (inguinal) granuloma)
Donovanosis is an exotic disease originally from the tropics. Pathogens – callimatobacterium or calf Donovan, they are infected by sexual and domestic means. Symptoms develop slowly. It begins with the formation of a red nodule on the skin or mucous membranes of the genitals, mouth, anus. Then the nodule turns into an ulcer with a velvety bottom and raised edges, the size of the defect increases with time. Strictures urethra, vagina and anus, elephantiasis – The main complications of donovanosis.
Signs of infection with new STDs
photo: typical discharge for chlamydia
Primary signs of infection at the men – Urethritis with characteristic morning discharge in the form of a transparent drop. Have of women – urethritis, colpitis, inflammation of the cervix with scanty and muddy secretion, associated pain and acyclic bleeding. Transmission of infection is possible only through sexual contact, oral – it is unlikely. Is impossible to become infected through the household contact method (through the pool water, toilet seats, baths or bed linen.). Newborns can get chlamydial conjunctivitis or pneumonia if they become infected during labor from the mother.
The infection is transmitted sexually or household way (only of venereal diseases! although such cases are extremely rare), oral and anal infections are rare. In men, the symptoms of urethritis and prostatitis prevail, in women – colpitis. For trichomoniasis, yellowish, copious, frothy discharges with an unpleasant odor, itching in the perineum, pain during intercourse and urination are typical.
“Sex” types of mycoplasmas
Mycoplasmas are intermediate between bacteria and viruses, can live in humans, animals, and even in plants. Able to multiply in the mucous membranes of the mouth and pharynx, organs of the urogenital tract. Often determined in healthy people, up to 50% of women are carriers of mycoplasmas. Mycoplasma hominis and M. genitalium cause urethritis in men, in women – bacterial vaginosis (gardnerella), inflammation of the fallopian tubes and ovaries. Mycoplasmal pyelonephritis may also develop. Infection occurs through sexual contact, in everyday contacts the transmission of infection is unlikely.
Pathogens – Ureaplasma parvum and U. urealyticum, causing urethritis in men and inflammation of the uterus and ovaries in women. As a complication of urolithiasis develops, spontaneous abortion or early labor is possible during pregnancy. Many healthy people become carriers of the infection; more often it is women.
The causative agent – herpes simplex virus (Herpes simplex); sexually transmitted infections occur through oral, anal and genital contacts. The home distribution of this virus is unlikely. The first symptom of the disease is a painful, mottled blistering rash at the site of the virus introduction; the patient feels a sharp pain and a burning sensation, the local edema is growing. At the same time, the general condition worsens, the temperature rises and a headache begins. Bubbles transform into erosion, from which a yellowish liquid is released. After 5-7 days erosion heal, leaving pigmentation. Relapse or re-infection is always possible.
HPV (Human Papillomavirus)
HPV causes a range of different skin lesions, in particular genital papillomas or spiky condyloma. The reason is a sexually transmitted infection, including orally, HPV serotypes 6 and 11. On the genitals, epithelial outgrowths resembling cocks combs are formed. Formations can merge, increase in size. In women, genital warts are more often found in the locus of the vulva and vagina, in men, on the penis and inner leaflet. preputium (foreskin). Possible warty growths in the corners of the lips, on the tongue.
skin manifestations of human papillomavirus infection – papillomas
Candidiasis – the result of rapid reproduction of fungi (genus Candida), which are normally always present in healthy people on the oral mucosa, urogenital and intestinal tracts. It refers to sexually transmitted diseases due to possible sexual transmission and skin manifestations, which are often observed in the genital area. Candidiasis can develop after treatment with antibiotics and corticosteroids (prednisone, dexamethasone), diabetes, AIDS, after prolonged stress, in the third trimester of pregnancy. Symptoms genital candidiasis in women – cheesy, with a sour odor vaginal discharge, perineal itching, pain during urination and during sexual intercourse. In men, a whitish plaque is visible on the head of the penis, pain is present during miccation and after intercourse.
Laboratory examination using various techniques is the basis for the diagnosis of sexually transmitted diseases. Previously, preference was given visual determination of pathogens, performing seeding of secretions (cervix, vagina, urethra, rectum, pharynx), followed by microscopy. The technique is quite accurate, but the result comes at least a week later, and the loss of time is a serious problem for the attending physician and patient.
A smear on the microflora is done quickly, the method is inexpensive and simple. Sterile swab take discharge: for men – from the urethra, for women – from three standard points (urethra, vestibule, cervix). The material is then applied to a glass slide, stained and examined under a microscope. You can determine the degree of inflammation by the number of leukocytes, assess the qualitative composition of microflora. Viruses with light microscopy can not be seen.
Modern diagnostic options in venereology – UIF analyzes (straight immunofluorescence), ELISA (immunoassay). Material – discharge, the result of the examination the doctor receives in a few hours. Methods are cheap and widely available, but accuracy is down to only 70%. Therefore, these tests are used for preliminary diagnosis.
The final diagnosis is set by the PCR results, which means “polymerase chain reactionOr a test for the DNA of the pathogen. Material – excretions and urine, time for obtaining the result of the analysis – up to 2 days, accuracy up to 95% Preferably PCR is used to detect hidden or chronic infections. In case of acute purulent inflammation, it is recommended to do a mutual fund, ELISA, and seeding.
The definition of specific antibodies (material – venous blood) indicates that there is an immune response to the presence of this pathogen,
Treatment of bacterial STDs is performed. antibiotics, additionally including in the scheme of local procedures (instillation of the urethra), immuno-and physiotherapy. When combined infections (gonorrhea and chlamydia, syphilis and gonorrhea) use drugs that act simultaneously on several pathogens. Viral infections (HIV, hepatitis B or C virus, herpes simplex virus) are treated with special means, and antibiotics are prescribed only for accompanying complications caused by bacteria. It should be remembered that antibiotics do not act on viruses!
- Treatment acuteuncomplicatedgonorrhea: tablets cefixime, ofloxacin (0.4 g once) or ciprofloxacin (0.5 g once).
- Chlamydia: doxycycline tablets 0.1 g x 1, or azithromycin 0.1 x 2, course 1 week.
- Softchancre: once – azithromycin tab. 1.0 g, or ciprofloxacin tab. 0.5 g x 2 course 3 days or erythromycin tab. 0.5 g x 4 – 1 week course.
- Venereallymphogranulomatosis: tab doxycycline (0.1 g x 2, course 3 weeks) or erythromycin (tab. 0.5 g x 4, course 1 week).
- Donovan: trimethoprim (0.16 g x 2) or doxycycline (0.1 g x 2), a course of up to 3 months.
- Ureaplasmosis: azithromycin tab. 1.0 g once or doxycycline (tab. 0.1 g x 2, 1 week course).
- Candidiasis: on skin lesions – clotrimazole cream, twice a day, a course of 5-7 days. Inside – tablets fluconazole, 50-100 mg per day, a course of 5-7 days. For women – vaginal suppositories (clotrimazole, isoconazole). Candles betadine, polzhinaks, terzhinan are considered ineffective for candidiasis, in addition, can cause vaginal dysbacteriosis and as a result – the development of gardnerellosis.
- Herpetic eruptions in the genital area: antivirals (acyclovir, valtrex, pharmaciclovir). Ingestion and intravenous administration of the solution is more effective than local use in the form of ointments or creams. It is impossible to get rid of the herpes simplex virus completely, the symptoms reappear with problems with the immune system (stress, acute respiratory infections and SARS, AIDS).
- Genital warts remove (laser cryotherapy, electrocoagulation), appoint interferon injections at the base of each wart. Antivirus farm. funds are ineffective. Approximately one third of patients recovering without treatment within 1–3 months, relapse is observed in 25% after therapy or removal of genital warts.
- Prevention atcondom care, male or female, reduces the risk of contracting sexually transmitted diseases, but none of the manufacturers promises a 100% guarantee. Attempting to defend oneself by wearing two condoms at the same time is doomed to failure: latex is broken, and infection is possible in 50% of cases, as with unprotected sex.
- Pharmaceuticalfacilities: Betadine, gibitan, miramistin are effective against gonococci, trichomonads, pale treponem, herpes simplex viruses, but only if the drugs were used no later than 2 hours after sexual intercourse.
Spermicidal drugs (contraceptive, pharmatex) have not passed clinical trials in relation to protection against STDs, so using them as a means of prevention is not recommended.
The only and guaranteed way to not get sexually transmitted infections is the traditional monogamous relationship, a happy life with one partner.