Some aspects of sexually transmitted diseases therapy

Abstract

U Poliklinici NADA u Požegi rađena je dijagnostička obrada, liječenje, te kontrola rezultata ispitanica s ranim simptomima infekcije donjeg genitalnog sustava. Vodeći simptomi su opetovano peckanje, ili svrbež, te pojačani vaginalni iscjedak dulje vremena. Detekcija Chlamydiae trachomatis vršena je pomoću »Human« testa baziranog na interakciji monoklonalnih anti LPS antigena s LPS antitijelom. Detekcija mikoplazmi vršena je pomoću seta »Mycoplasma duo«, firme »Bio-Rad«. Aerobne bakterije izdvojene su uzgojem u aerobnim uvjetima na standardnim podlogama. Putem PAPAtesta vršena je detekcija Trichomonas vaginalis, funga i Gardnerella vaginalis. Rezultati su pokazali da su četiri najčešćaa uzročnika infekcije: C. trachomatis, a potom Mycoplasma hominis i Ureaplasma urealyticum, te Trichomonas vaginalis. Primjena lijeka je provedena prema preporuci o liječenju genitalnih infekcija uzrokovanih s klamidijom trahomatis i mikoplazmama [1], s doksiciklinom u količini od 2×100 mg/21 dan u oba partnera. Potom prema našim smjernicama objavljenim 2003. god. [2] s azitromicinom 3×500 mg tjedno/3 tjedna, roksitromicinom 2×300 mg/tri tjedna [3]. Terapija vaginalnog trihomonasa provedena je s metronidazolom 2×400 mg/7–10 dana oba partnera. Kontrolni bris uziman je nakon provedene stanke od liječenja u trajanju od 4 tjedna. Rezultati su pokazali da je oko 70 % ispitanica s infekcijom mikoplazmama i vaginalnim trihomonasom izliječena u prvom pokušaju, te je kontrola bila negativna. Preostalih 30 % izliječeno je ponovljenim drugim postupkom. Nažalost liječenje klamidije trahomatis nije se pokazalo tako uspješnim. Praćeni su klinički parametri poput crvenila vulve, rodnice, te cervikalne sluznice, pojačanog iscjetka, te karakterističnog opetovanog peckanja. Tijekom ponavljanih kontrola klinički znakovi upale prestajali su uglavnom do/nakon četvrte kontrole, osim u manjeg broja izuzetaka. Također je rađena kontrola cervikalnog brisa na C. trachomatis. Tijekom ponavljanih kontrola, ukupno 9 postupaka, do negativizacije cervikalnog brisa došlo je samo u 36,8 % bolesnica. Kontroverzno je pitanje opravdanosti tako dugotrajnog i iscrpljujućeg liječenja s naizgled lošim rezultatom. S druge strane ispitanice kod kojih je došlo do prestanka kliničkih simptoma bolesti, samo su u manjem broju imale recidiv kliničke simptomatologije, ali spriječene su eventualne komplikacije koje mogu nastati. Mišljenja smo da dijagnostiku i liječenje treba provoditi.Diagnostic analysis, treatment and control were made in examinees with early symptoms of lower genital tract infections. The main symptoms were repeated itching around vulva as well as intensified prolonged secrete – discharge. The detection of C. trachomatis was done by the »Human« test based on monoclonal LPS antigens in reaction with LPS antibodies. Mycoplasmas were detected by »Mycoplasma duo« set produced by »Bio-Rad«. Aerobic bacteria were cultivated in aerobic conditions on standard media. Fungi, Trichomonas vaginalis and Gardnerella vaginalis infections were detected by PAPA test. The results showed that the four most frequent agents were C. trachomatis, then M. hominis and U. urealyticum and finally Trichomonas vaginalis.Therapy was administered according to treatment guidelines, with doxycycline in doses of 2×100 mg/21 days for both partners [1], azithromycin 3×500 mg per week [2] and roxithromycin 2×300 mg for three weeks [3]. T. vaginalis infections were treated with metronidazole 2×400 mg/7–10 days for both partners. The control cervical swab was taken after the four-week interval without any therapy. The results showed that examinees were cured in about 70 % cases after the first treatment against T. vaginalis and mycoplasma. The rest of 30 % were cured in the second therapy treatment. Unfortunately, the therapy of C. trachomatis wasn\u27t so successful. We were monitoring clinical characteristics of the inflammation such as redness of vulva, vagina and cervicitis manifestation, intensified secrete and characteristic repeated discharge. Clinical symptoms of the inflammation disappeared mostly till the fourth control, except in a lesser number of cases. Also we made control cervical swabs for C. trachomatis. We repeated swab controls as long as the patient arrived to control because of disturbances, or the swab was positive in some cases nine times. Swabs tested for C. trachomatis became negative in only 36,8 % cases. The validity of such long treatment with apparently unfavorable results is controversal. On the other hand, examinees in whom clinical symptoms of illness ceased, experienced disease relapse in only a small number of cases. Complications were prevented, therefore it is our opinion that diagnostics and therapy have to be continued