RBM. Med. CHASOPIS, 5 (61) - IX / X 2007
LI Padalko SG Bondarenko, AD Popov GF Boyko
City Maternity Hospital № 2, Center for Family Planning and Human Reproduction, Dnepropetrovsk
Summary. In the genesis of spontaneous abortions, premature births and fetal pathologies leading role played by inflammation of the genitourinary system, women, caused by pathogenic and opportunistic bacterial and viral associations, Trichomonas vaginalis revealed by this pathology in 40-65% of women. They perform reservoir and transport function for drugihmikroorganizmov, preventing the action of antibiotics and contributing to rising infection of the genitourinary system. Therefore, their detection and eradication are the key to successful treatment of other sexually transmitted infections. In order to increase the effectiveness of treatment of urogenital trichomoniasis and getting rid of opportunistic microorganisms in the scheme of treatment of trichomoniasis should include Solkotrihovak. The article is the experience of special moves for pregnancy loss for the year 2006 Chronic trichomoniasis was detected in 64 out of 134obsledovannyh patients, all were treated with optimal use of drugs and antitrihomonadnyh Solkotrihovaka. Efficacy of treatment was 90%.
Keywords: miscarriage, urogenital trichomoniasis, infection, sexually transmitted protivotrihomonadnye drugs Solkotrihovak.
INTRODUCTION
Miscarriage stable at approximately 20% of all pregnancies. According to leading experts in this field, there is no miscarriage of noninfectious origin, despite the poly etiology of each case of premature termination of pregnancy (Ministry of Health of Ukraine, 2003). Besides miscarriage, infection of feto-placental complex in the first trimester of pregnancy can lead to congenital malformations in the fetus, and later - to violations of hemostasis, causing a delay of intrauterine growth retardation, its perinatal hypoxic-injury, premature detachment of normally situated placenta, causes the development of preeclampsia and eclampsia, postpartum complications (Moors G.I. that spivavt., 2004).
In the complex of rehabilitation measures before a planned pregnancy, and even more so in the case of the burdened history a priority is a survey of spouses to infection, sexually transmitted infections, followed by treatment of both partners in accordance with the results of the survey (Ministry of Health of Ukraine, 2003, 2004).
Urogenital trichomoniasis (OGC) - the most common disease transmitted through sexual contact. Every year in the world recorded more than 200 million cases of infection. The incidence in the general population of women is 5-10% in pregnant women - 14%, inflammation of genitals and miscarriage - 40-65% (Moors G.I. spivavt that., 2004). Furthermore, Trichomonas vaginalis detect with human papillomavirus (Human papillomavirus) in 40-60% of cases of intraepithelial neoplasia and cervical cancer, 15% - when tsistopielonefritah facilitating the formation of endometrial hyperplastic processes (including adenomatosis), uterine leiomyoma, activating herpes infection. Babies born from mothers with trichomoniasis, in 12-18% of cases developed early postnatal pneumonia, and in 5-7% - cystitis (Butcombe EA, Ryumin DV, 2002).
The incubation period of urogenital trichomoniasis with an average of 10 days, at times ranging from 2 - 3 days to 1 month. In 10-20% of urogenital trichomoniasis occurs in the form of asymptomatic bacteria in 40-50% - as the primary-chronic process with minimal clinical manifestations, which is the cause of late referral to a doctor. Often acute trichomoniasis patients treated independently of inadequate volume, leading to chronic process. In view of the transport function of Trichomonas vaginalis to other sexually transmitted infections (STIs), chronic ATM leads to the formation of structural and functional abnormalities in the cervix, the uterus, fallopian tubes, which could then lead to miscarriage and infertility. Chronization trichomoniasis increases the resistance of trichomonads to protistotsidnym drugs.
SUBJECTS AND METHODS
In 2006, the Center for Family Planning and Human Reproduction surveyed 134 married couples with habitual fetal loss in history.
Survey of patients of the Center of family planning was presented to smear studies urogenital swabs with the color of methylene blue and Gram, crops on the microflora with the definition of sensitivity to antibiotics, sowing for gonorrhea. To detect Trichomonas vaginalis, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Herpes simplex virus, Cytomegalovirus and Neisseria gonorrhoeae using immunofluorescent method of diagnosis, as well as for ELISA detection of antibodies in the blood. Microscopy of smears on the flora reveals only typical forms of Trichomonas vaginalis; in cases of atypical, modified forms or gardnerelleze reliability of the method is significantly reduced. This method has the lowest sensitivity. Immunofluorencent swabs using monoclonal antibodies to Trichomonas vaginalis is a highly sensitive and specific (Romankova O.I., celebrity, VG, 2004). Serological tests identify antibodies to Trichomonas vaginalis are not sufficiently informative due to the weak immunogenicity of Trichomonas and can be used as additional (Romashchenko OV Rudenko, AV, 2003, the Ministry of Health of Ukraine, 2004).
RESULTS AND DISCUSSION
Chlamydia trachomatis detected in 47 (35%) women, Mycoplasma hominis - in 29 (20%), opportunistic flora - in 83 (62%). Trichomonas vaginalis as a component of mixed infections were detected in 64 (48%) women and in 24 (18%) men. According to the literature identifying trichomonads in the ratio of 4:1 in women and men explain features of course trichomoniasis in males (Moors G. I. that spivavt., 2004). According to history in 34 patients with diagnosed trichomoniasis already were treated to terminate the pregnancy, 16 of them more than once. In 20 women conducted therapy drugs imidazolovogo number of post-abortion period. The high frequency of recurrences of urogenital trichomoniasis in this group of patients is associated with rising resistance to all drugs trichomonads imidazolovogo series (from 80% to metronidazole is 20-30% for ornidazole) (Zakharkin YF, et al., 2004) and inadequate dosing, inferior treatment of sexual partner (30% of cases the husband is treated under the scheme wife appointed gynecologist). None of the patients in the treatment scheme in the previous course was not included regulated by the Order № 582 Solkotrihovak (Ministry of Health of Ukraine, 2003), which increases the sensitivity of Trichomonas to protistotsidnym drugs normalizes vaginal biocenosis significantly reduced the incidence of recurrence of trichomoniasis.
When treating all 64 patients due to chronic process administered Solkotrihovak company ("Valeant Pharmaceuticals Switzerland", Switzerland) intramuscularly at a dose of 0.5 ml (1 vial) for 1 week prior to the appointment imidazolovyh drugs, then 2 more times at intervals of 2 weeks. Revaccination with the introduction of 1 mg was planned 1 year after treatment (Ministry of Health of Ukraine, 2003; Moors GI, et al., 2002, 2004).
Before appointment imidazole conducted biochemical research on liver blood center. In its normal parameters, and in the absence of a history of treatment with metronidazole used metronidazole 0.5 g per os 2-3 times a day (depending on body weight) for 10 days. In acute inflammation in the genitourinary system used metronidazole 0.5% 100.0 ml 2-3 times a day intravenously for 5 days, then metronidazole 0.5 g 2-3 times a day, 5 days. In these cases, vaccination Solkotrihovakom started 2 days after starting treatment imidasoles. If you are using a previous course of treatment of metronidazole or liver pathology used ornidazole 0.5 g of 2 - 3 times per day for 10 days. In any treatment plan also received hepatoprotectors, eubiotics, conducted topical treatment. After receiving imidazole appointed adaptogens, vitamins, antifungal drugs (Ukrainian Ministry of Health, 2003; Moors G.I. that spivavt. 2004; Solsky SY spivavt that., 2006). For negative controls were carried out further examination for STIs (indication) to further treat diagnosed infections, as trichomoniasis as monoifektsii was not identified in any of the cases. When identifying viral infection (Herpes simplex virus, Cytomegalovirus) were carried out according to immunological immunocorrection.
Spouses of patients treated by a dermatologist or andrologist (sexopathologist). In the case of negative results of the survey to her husband were treated as a contact to trichomoniasis (Moors G.I. that spivavt., 2004; Ministry of Health of Ukraine, 2004).
Before treatment with each pair conducted health education talk on the use of barrier contraceptive methods, good personal hygiene and the need for examination of other family members because of the possibility of household transmission of urogenital trichomoniasis.
Control cured performed after 10-14 days, repeat the test samples were carried out after 1 and 3 months (Ukrainian Ministry of Health, 2004). At the first follow-up examination trichomonads have been identified in 60 patients (93%) at 2-3, in 58 (90%). According to the literature izlechivaemost when applying metronidazole only 20-40%, Ornidazole - 60-75% (Dyudyun AD, et al., 2005).
CONCLUSIONS
Thus, the use Solkotrihovaka the treatment of chronic urogenital trichomoniasis significantly improves the effectiveness of treatment and increases the chances of rehabilitation fertility by optimizing the health of women in many ways.
REFERENCES
1. Butcombe EA, Ryumin DV (2002) urogenital trichomoniasis. Attending Physician, 2: 64-70.
2. Dyudyun AD, Polion NN, Yuschishin NI, Polion JN, Dyudyun SD (2005) Rational approaches to the treatment of urogenital trichomoniasis. Women's reproductive health, 3: 11-12.
3. Zakharkin YF, Nikitin AF, Belugina EE, Streltsov, KG (2,004) Sensitivity of different strains T. vaginalis to protivoprotozoynym drugs used to treat inflammatory diseases of the urogenital tract. Venereology, 11: 30-32 (see also http://www.Wectology.ru/publik/STAT1.aspx).
4. Moors GI, Kletina AG, Nagorno-AE (In 2002) Treatment of patients with trichomoniasis imidazole group of drugs in high doses and lyophilisates "Solkotrihovak. Dermatologiya that kosmetologiya, 1: 53-54.
5. Moors, GI, ranks GP, Nikitenko IN (2004) Treatment of resistant forms of trichomoniasis high doses Tiburan in combination with the vaccine and Solkotrihovak tsinkteralom. Dermatologiya that kosmetologiya, 2: 1-5.
6. Moors G.I., Stepanenko V.I., Chinov GP, Nikitenko I.M., Romankova O.I. (2004) Urogenitalny trihomoniaz. Metodichni rekomendatsii. Kyiv, 19 pp.
7. Ministry of Health of Ukraine (2003) Nakae vid 15.12.2003 p. № 582 "About zatverdzhennya klinichnih protokoliv r akusherskoi that ginekologichnoi dopomogi.
8. Ministry of Health of Ukraine (2004) Nakae vid 07.06.2004 № 286 "About udoskonalennya dermatovenerologichnoi dopomogi population of Ukraine.
9. Romankova O.I., celebrity VG (2004) Kombinovana terapiya sechostatevogo trihomoniazu have zhinok. Ukrainian Journal dermatologii, venerologii, kosmetologii, 1: 35-36.
10. Romashchenko OV Rudenko, AV (2003) Suchasni pihodi to diagnostiki that likuvannya urogenitalnogo trihomoniazu. Pediatriya, obstetrics is the ginekologiya, 5: 86-90.
11. Solsky SY, Gnatko OP, Curly AG (2006) Suchasni pihodi up likuvannya urogenitalnogo trihomoniazu. Zhinochy likar, 1: 22-24.
