These sneaky diseases of sexual behavior

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Whoever you hang out with, that's how you'll gain. This folk wisdom has a direct bearing on the risks of sexual behavior. About the uniqueness of sexually transmitted infections (STIs), their diagnosis and prevention - a conversation with Alexander Navrotsky, associate professor of the department of skin and venereal diseases of the Belarusian State Medical University, secretary of the Belarusian public organization of dermatovenerologists and cosmetologists.

Three dozen options

— Alexander Lyudgerovich, the term “STI” appeared relatively recently. And what is behind it? — For me personally, the term “infections” is more acceptable, since the low-symptomatic, hidden nature of the course is typical. Sometimes there is no disease at all, but there is a carriage of bacteria and viruses. They can cause a variety of pathologies of the genitourinary organs (urethritis, orchiepididymitis, prostatitis, endometritis, adnexitis and much more).

The International Classification of Diseases, 10th revision (ICD-10), approved at the World Health Assembly in Copenhagen in 1989, has a section on “Infections transmitted primarily through sexual contact.” These include 9 STIs: syphilis, gonococcal, chlamydial infections, anogenital herpetic and papillomavirus infections, trichomoniasis, as well as chancroid, inguinal granuloma and chlamydial lymphogranuloma (the last three are not found in our country). Up to two dozen other diseases are also associated with sex, although they are sometimes caused not only by infectious factors, but also by other factors. For example, candidiasis of the vulva and vagina, bacterial vaginosis, pediculosis pubis, molluscum contagiosum, hepatitis, cytomegaly, scabies (every fifth person becomes infected with a mite during sex). Of course, we cannot forget about HIV, for which sexual intercourse is natural.

Young people are more vulnerable. Especially girls

— How relevant is the problem of STIs for Belarus? — The incidence of most infections is decreasing. But in 2012, there was an increase in reported cases of urogenital chlamydia (+11.4%) and gonorrhea (+6%). Syphilis should not be taken off the agenda either. The peak of the epidemic was in 1996 (21,616 cases), in 2012 for the first time there were less than a thousand - 977. However, the best figure - 142 cases (1988) - is still far from being reached.

The “leader” in syphilis is the Gomel region (244 cases). I note that a high incidence rate for a number of STIs may indicate a well-organized process of identifying patients and the introduction of modern diagnostic methods. The largest group of patients by social status are workers. In industrial areas of large cities, the incidence is higher.

About 70% of those infected are between 15 and 29 years old. This feature is very upsetting, since this is the age of optimal reproductive potential. And one of the tragic consequences of STIs is infertility. Among young people, a risk group can be identified—girls aged 15–19 years old are 2–11 times more likely (depending on the pathology) to get sick than boys their peers. From the point of view of sexology, 17–20 years is one of the peaks of a woman’s sexuality, when there is an active search for a future spouse. The vulnerability is greater than that of men due to their anatomy. Another risk group is teenagers registered with the police. Among them, the prevalence of STIs reaches 50%. — Do official statistics differ from the real picture of morbidity? — The numbers mentioned are just the tip of the pyramid. According to the Dermatovenerology Service, 32,039 cases of STIs were registered in Belarus in 2012. It's good that this number is decreasing. In 2006, by comparison, there were 168,363 cases. However, this does not include data on morbidity rates in the police, Armed Forces, and other departments that have their own medical services, as well as information on patients in commercial medical centers.

Although people have ceased to be afraid of doctors and to hide “shameful” illnesses, not all those infected with STIs seek medical help. Only 5% of those infected with syphilis last year came to the doctor themselves after noticing the symptoms. It is not uncommon for this disease to be detected in hospitals when people are being treated for other ailments, during medical examinations, and sometimes during examination of donors. The specificity of some STIs is a minimum of signs or their complete absence. One WHO report stated that every tenth person on the planet gets an STI every year. If you project it onto Belarus, it turns out to be about a million people. It is no coincidence that 10 years ago our epidemiologists stated that sexually transmitted infections are in 3rd place in terms of prevalence after acute respiratory viral infections (during the epidemic) and helminthiases.

Friends and strangers didn't get along

— Why are bacterial vaginosis and candidiasis not classified as STIs in some scientific sources? — Because the microorganisms that cause them are conditionally pathogenic. Thus, diseases can occur in pregnant women or in women who are not sexually active. However, most often the disease appears after a change of sexual partner, although the latter does not require treatment.

Bacterial vaginosis was previously called gardnerellosis, mistakenly believing that the pathology was caused by the microorganism Gardnerella vaginalis. However, the basis is polymicrobial syndrome. Back in 1984, at an international congress in Sweden, they decided to use a new term - “bacterial vaginosis”. Lactobacilli predominate in the normal vaginal microflora. With bacterial vaginosis, a qualitative and quantitative change in its composition occurs. During sexual intercourse, a woman receives new microorganisms from her partner. In a certain situation, they begin to “squeeze” the main inhabitants and are able to “overthrow” them. Bacteroides, peptostreptococci, mobiluncus, prevotella, hemophilus, mycoplasma, corynebacteria, gardnerella, ureaplasma, Candida fungi and other microorganisms are found in increased quantities in the smear. The cells of the desquamated vaginal epithelium are covered on all sides with microbes (these are the so-called key cells - Amsel’s main confirmatory criteria). But there is no inflammatory process. The diagnosis is established taking into account other laboratory criteria - homogeneous creamy grayish-white discharge, evenly distributed on the vaginal mucosa, a positive amine test, a vaginal discharge pH of more than 4.5.

Three positive criteria present means bacterial vaginosis.

Mycoplasma is different from mycoplasma

— Mycoplasmas and ureaplasmas also belong to opportunistic microorganisms. If they are found, do I need to take antibiotics? — Scientists have clarified the role of mycoplasmas and classified urogenital pathology caused by mycoplasma genitalium as an STI. With the rest, not everything is so clear.

Ureaplasma urealiticum and mycoplasma hominis are today classified as conditionally pathogenic urogenital flora. Ureaplasma is present in the genital area of 5–10% of healthy men and 20% (according to some authors - up to 40%) of women.

And imagine the situation: he and she met, there was intimacy. After some time, the man complained of discharge. The urologist diagnosed ureaplasmosis. The patient made a claim against the woman. And the gynecologist said that she was healthy. Which doctor is right? Both! Ureaplasma, which existed harmlessly in the female body, got into a new place for it - the male urethra, and made a “revolution” there. The change in microflora caused a sharp reaction of the body - an inflammatory process. There is no reason to blame your partner. Treatment is necessary when inflammation is caused by mycoplasma genitalium. If ureaplasma urealyticum or mycoplasma hominis are detected and quantitative analysis shows that the pathogen content is more than 104 CFU (colony-forming units), then these microorganisms are “responsible” for the inflammatory process. If there is less pathogen, it has nothing to do with it. We need to look for another culprit.

Whatever the outcome of the search, the inflammatory process must be eliminated. If not, the doctor will decide what to do next. Sometimes therapy is indicated for rehabilitation for a healthy person when his sexual partner falls ill.

Each pathogen has its own diagnostic method

— Today they are actively advertising PCR diagnostics. Is this really the best solution for identifying STIs? — For chlamydia, the role of this molecular biological method is immutable. The alternatives - RIF and ELISA - are significantly inferior in sensitivity. The first detects the pathogen in 40-60% of cases, the second - in 60-70%. And PCR is 90%. But an even more reliable method (the so-called gold standard) is bacteriological. However, it is very expensive and is used in scientific institutions. To establish a diagnosis, it is recommended to combine two methods. And when monitoring cure (carried out no earlier than 4 weeks after the end of therapy), ELISA should not be used to detect antibodies. It is more suitable for epidemiological studies.

There is no universal, 100% effective diagnostic option for all STIs. For syphilis, for example, serological methods come first (they have recently been significantly improved). Today, enzyme immunoassay and a modified passive hemagglutination reaction are widely used. In men with acute gonorrhea, a routine Gram-stained smear (sensitivity 90%) is sufficient. In women, gonococcus is detected in cervical samples only in 45–64% of cases, in urethral samples - in 16%. For patients, the main method is cultural examination. But PCR testing to confirm these two infections is not recommended. The range of examinations and methods will be determined by the doctor, based on the clinical picture, anamnesis and other circumstances. — Which STIs are more likely to be asymptomatic? — A clear clinical picture usually occurs with gonorrhea in men. Other infections have a long incubation period (2–3 weeks) and a more gradual course. Viral infections may generally show no signs for years.

In women, STIs are less common. True, with trichomoniasis, acute vulvitis can develop with itching, burning, pain when walking, and sexual intercourse. The severity of the course is not yet a criterion for making a diagnosis. There are about 330 laboratories in our country that study these infections. The diagnosis must always be confirmed by laboratory testing.

No need to be afraid of saunas

— Is there a danger of catching an STI in public places - saunas, steam baths, swimming pools? - For men - definitely not. In women this is theoretically possible, but in real life it is unlikely. For infection, it is necessary that the patient’s wet secretions, in which the pathogen persists for some time, reach the genitals of a healthy person.

A more dangerous option is to use a washcloth or towel from an infected person, which is what happens to little girls who have the same personal hygiene items as the infected mother. Syphilis and herpes can be transmitted through saliva. And if you drink from the same bottle, mug, use someone else’s toothbrush, lipstick, razor, or smoke a cigarette (while having inflammation of the gums or microcracks on the lips), infection is likely.

Yet this is rarely recorded. People are sanitary informed. But syphilis is an insidious disease. Today, compared to the mid-1990s, it has changed its “face”; for example, in 2012, 49% of cases were asymptomatic (early latent syphilis). Therefore, the main thing is to actively identify patients by testing various categories of the population.

Barrier for pathogen - latex

— How reliable is a condom as a means of preventing STIs? — I asked this question to Jean-Paul Coulet, a WHO expert. I received the answer: “It is very difficult to conduct such large-scale studies. I think about 82%.” Why not 100%? Because people make mistakes when using a condom or it is of poor quality. If these factors are excluded, we can talk about a complete guarantee of reliability. — How is safe sexual behavior interpreted today? — Rule one is not to begin sexual activity until adulthood. Very often, an early debut ends in a sad “venereological” experience. The average age of onset of intimate life among affected adolescents is 14.5 years. The connection between STIs and premature sexual activity is obvious.

The second rule is the correct choice of a sexual partner. Third, loyalty to one person. Fourth is the exclusion of accidental contacts. Well, if the latter happens, use barrier contraception (condom) correctly. - Remind me exactly how... - It is advisable to buy a condom at a pharmacy. It should be made of a highly elastic material - latex, lubricated with lubricant. Before use, it should be checked for leaks: lightly squeeze the unopened package (it should not wrinkle, retaining air). Shelf life - no more than 5 years. The contraceptive should be put on immediately upon the onset of an erection, and never inside out. You need to remove it immediately after ejaculation, before the seminal fluid begins to flow out of it. Do not store condoms in places where the sun's rays penetrate, or carry them in the back pocket of your trousers (the integrity may be damaged). If after opening the condom is sticky, it means it is old and no longer suitable.

Syphilis and gonorrhea. Separate conversation

— When should you be tested for STIs? — If there is a change of partner, it is necessary. With each new “love”, infections can accumulate, making it more difficult for a doctor to figure out and cure completely. It is very important to get tested for STIs before having children to prevent pregnancy complications and ensure normal fetal development. In our country, all pregnant women undergo such screening.

Those who have close contact with children, work in public catering, and some other specialists should also be tested for certain types of STIs during medical examinations. — Who and where is the best place to get treatment? - For syphilis and gonorrhea - only see a dermatovenerologist. Only state dermatovenerological institutions have the right to establish these two diagnoses. In the Minsk City Clinical Internal Affairs Department, for example, up to 3 thousand tests per day are carried out for syphilis alone, and clinical laboratory diagnostic specialists have been working in this area for many years. If those with little experience begin to work, an incorrect laboratory response is possible, and undetected patients will continue to spread the dangerous disease.

Commercial centers may provide screening tests for syphilis. But if the result is positive, they are required to refer them to a dermatovenerologist to confirm the diagnosis and treatment. It is no coincidence that Syphilis is called the monkey of all diseases. He knows how to disguise himself as neurological, skin, eye, proctological ailments, ENT pathology and many others. If the doctor notices an atypical course, you should immediately remember about the “monkey” and test the patient for syphilis.

Is the devil as scary as he is painted?

— What is the danger of STIs? - Most are fraught with infertility, pregnancy complications, and in men - erectile dysfunction, impotence. Often one has to observe the so-called. mixed infections - several at the same time. For example, gonorrhea is combined with other STIs in 70% of cases. That is why you cannot treat “on the advice of friends”: an effective drug “according to their experience” can kill one pathogen and only slow down the reproduction of others. As a result, a sluggish chronic process develops, which is even more difficult to cope with.

The most severe infection is, of course, syphilis. If it is not treated, then the ending is clear - disability. The main target of this disease is the nervous system. The human papillomavirus (HPV) is also very dangerous. In women, it can lead to cervical cancer. The most carcinogenic types of HPV are 16, 18, 45 and 56. — Have approaches to the treatment of STIs changed recently? - Undoubtedly. The first feature is that therapy has become shorter. For example, today you can get rid of gonorrhea with one injection. To treat syphilis, there are long-acting drugs that last up to 7 days. This is very convenient, because previously you had to go to the hospital.

Unfortunately, viral diseases are much more difficult to combat. Genital herpes and HIV infection are incurable. Human papillomavirus infection (anogenital warts) takes a chronic course in some patients. But there is already a preventive vaccine against it. Girls aged 12–13 years should be vaccinated before sexual activity begins. This can be done in government and commercial medical organizations. - What about chlamydia? People say that it is impossible to get rid of it... - He will be cured. The effectiveness of therapy largely depends on the quality of laboratory diagnostics. One of the conditions for its reliability is that for analysis one should take not the discharge (mucus, pus), but the epithelium (scraping from the urethra or cervical canal).

Chlamydia parasitizes intracellularly and is not easy to detect. In the early 2000s, the RIF method (immunofluorescence reaction) was actively introduced. In commercial centers offering such diagnostics, chlamydial bodies were determined visually in a smear. Laboratory doctors who lacked experience found not chlamydia, but something resembling it. But the patient still received treatment. Control tests showed a false positive result. They prescribed a different course... This continued until the disappointed patient, who had spent a lot of money and did not receive proper therapy, came to the dermatovenous dispensary. And it turned out that he did not have chlamydia, and perhaps never had it. The complexity of diagnosis often led to false negative results. Therefore, testing for chlamydia must be carried out using two or more laboratory methods. And if there is PCR, then they definitely need it. In addition, a control study should be performed at least a month, and preferably one and a half months after the end of the course of therapy. If you do it earlier, you may get a false positive result. Fortunately, such situations are mostly a thing of the past. There are enough effective drugs for the treatment of chlamydia - josamycin, clarithrimycin, ofloxacin, etc. A significant role is played by determining the resistance of the STI pathogen to the prescribed antibiotic and the discipline of the patient. You should not skip taking the drug or have sexual intercourse, even using a condom, to prevent re-infection. - For some STIs, treatment is forced, there is criminal liability... - This applies to syphilis and gonorrhea. The country's Criminal Code contains Article 158. The patient who has been diagnosed with this is warned about the possibility of infecting another person, the rules of treatment, and personally signs the corresponding document. For those who ignore doctor's recommendations and infect a sexual partner, punishment is provided - imprisonment for up to several years or correctional labor. The measure is fair. In all civilized countries, the state protects the health of its citizens through the law.

The current organization of treatment of sexually transmitted diseases (now this term is used less and less) is fundamentally different from the Soviet one, which was largely repressive in nature. Every year, about a thousand people in the Union were sent to jail simply for evading examination. If you didn’t show up when called to see a doctor, you’ll be put on trial! At that time, dermatovenous dispensaries had special closed departments where patients who evaded examination or violated the treatment regimen were placed. There were policemen on duty, there were locks on the doors, bars on the windows, and even the most obedient patient had to show a pass to go out for a walk. It's hard to believe now. That is why people were afraid of skin and vein dispensaries. However, such strict measures made it possible to keep the incidence of STIs to a low level. Nowadays, a patient with any STI can be treated on an outpatient basis. The most convenient option is a day hospital. I arrived in the morning, took the injection, and went to work. After starting treatment, a person is no longer dangerous in terms of household transmission of infection.

The convenience of venereological care also includes the organization of anonymous treatment rooms. There are three of them in the capital alone. The patient will be asked to identify himself only if syphilis is detected. This is too serious a disease, it can be passed on to offspring. It is necessary to examine everyone who had sexual and domestic contact with the infected person. — What issues of prevention and diagnosis of STIs should health workers be taught? — First of all, the correct attitude towards patients. I am against discrimination against such patients. Echoes of the time when these illnesses were considered shameful and they tried to hide them still remain. There are examples of misunderstanding and disrespectful attitude towards people with STIs. And a person, seeing the doctor’s disgust and disgust, will never talk about his problems. Young people show great interest in issues of sex life and sexuality. Practice shows that young people have sex, but they have little knowledge of how to protect themselves. Education requires sensitivity and an individual approach. In my opinion, it is impossible to give indiscriminate lectures “about this” in schools. It is necessary to give information selectively, to someone who is already ripe for its correct perception. In my opinion, a gynecologist, urologist, therapist, pediatrician who communicate with teenagers and young adults could unobtrusively advise how to behave, how to protect themselves from diseases and unwanted pregnancy. But the prevention of AIDS and STIs needs to be given more attention and activity. So that later there will be no excruciating pain for the fatal mistakes of youth and their consequences! Elena Kleshchenok Medical Bulletin , April 4, 2013

Causes of multiple myeloma

In myeloma, the DNA of plasma cells is damaged. Because of this, an excessive number of altered and useless plasma cells (they are also called myelocytes) accumulate in the body. Such cells accumulate in the bones, causing tumors, destroying bones and producing defective proteins (also called Bence Jones proteins, monoclonal). Such proteins, unlike normal antibodies, cannot fight foreign cells; they are excreted from the body by the kidneys.

When bones are destroyed, the level of calcium in the patient's blood increases: this is evidenced by frequent constipation, nausea and thirst. If the amount of protein and calcium in the body is increased, it leads to kidney damage. Moreover, normal hematopoiesis in the body is disrupted, due to which the number of normal leukocytes and red blood cells decreases. As a result, a person develops anemia, and the body's resistance to infections decreases.

Although the exact cause of the onset of pathological changes in plasma cells is still unknown, there are certain factors that can increase the likelihood of developing multiple myeloma.

Who is at risk for multiple myeloma?

People over 60 years of age;
People suffering from obesity;
People who have been exposed to radiation;
People who worked with pesticides, insecticides, petroleum products, and other toxic substances;
People whose relatives suffered from multiple myeloma;
Patients suffering from HIV infection;
Patients suffering from monoclonal gammopathy (a group of diseases in which the human body begins to produce
abnormal antibodies);
Patients suffering from autoimmune diseases (for example, systemic lupus erythematosus or rheumatoid arthritis).

Temporary blindness

Another rare disease was reported in Australian Natalie Adler, who lives in Melbourne. A young girl suffers from temporary blindness. It is expressed in the fact that the patient periodically cannot open her eyes due to severe spasms of the eye muscles. Interesting fact: the girl’s phenomenon is observed cyclically and repeats once every three days. Natalie says that the first time this happened to her was after she suffered severe sinusitis with complications of staphylococcal nature. Since doctors cannot yet help her heal, she plans all her affairs in such a way as to get everything most important done before the next spasm.

THE TRUTH IS SOMEWHERE IN THE MIDDLE

There are many versions and guesses as to where this scourge came from. Some researchers argue that the reason lies in genetically modified agricultural products. After all, it is known that to create it, animal genes are inserted into plant genes. Others blame bacteria characteristic of plants: supposedly a person becomes infected from the soil or through ticks. Some people adhere to the version that these are textile fibers that got into sores from clothing and somehow miraculously came back to life.

Daniel Elkan in the journal New Science described one patient who for years discovered “fibers like flexible plastic, some writhing in a zigzag pattern. They are thin, like the silk of spider webs, but strong enough to even break the skin if you pull on them.” And some claim that Morgellons disease is a new type of biological weapon.

One way or another, there is no exact answer, and meanwhile patients take radical measures: they burn furniture, clothes, etc., move to other houses, but the strange illness does not recede.

Diagnosis of multiple myeloma

In many cases, multiple myeloma is detected even before its main symptoms appear, during a standard preventive examination. Changes observed in the results of laboratory tests allow specialists to suspect this disease in a patient at an early stage. Further examination directly depends on the manifestations of the disease.

Laboratory tests necessary to diagnose multiple myeloma:

Clinical blood test. As a rule, with multiple myeloma, the level of white blood cells in the body is reduced. Similarly, the level of hemoglobin, platelets and red blood cells may be reduced;
Proteinuria (excretion of Bence Jones protein in the urine);
Total whey protein: due to the large amount of monoclonal proteins, its level increases;
Serum albumin. Albumin is a protein synthesized in the liver that is responsible for the transport of various substances - for example, certain hormones, fatty acids and bilirubin. Its level can decrease even with high total protein, since normal protein increases precisely due to the presence of pathological components - monoclonal proteins similar in structure to albumin;
Serum creatinine is a metabolic byproduct that is excreted through the kidneys. In multiple myeloma, the kidneys are damaged, which can cause creatinine to be elevated.

Symptoms of multiple myeloma

Symptoms of myeloma directly depend on the activity of the process; often in the initial stages of the disease they are completely absent. The signs themselves are nonspecific - that is, the appearance of certain symptoms can be provoked by a completely different disease. That is why only a doctor can determine the exact cause of their appearance.

The main symptoms of myeloma are: