Sexually transmitted diseases (STDs) are among the most significant diseases of a social nature. This is explained not only by their wide spread, but also by the severe consequences for the patient’s body and for society as a whole. What are the current ideas about the therapy of sexually transmitted infections?
Complications of STDs in case of untimely diagnosis and ineffective treatment lead to a violation of reproductive health in women and men, to severe congenital diseases in children, as well as to damage to the internal organs and systems of the patient with his subsequent disability. Therefore, special requirements are imposed on the treatment of this group of infectious diseases, the main of which are high therapeutic efficacy, low cost and ease of use for the patient.
According to WHO, 333 million new cases of STDs are registered annually in the world, which are distributed as follows:
- 12 million new cases of syphilis;
- 62 million new cases of gonorrhea;
- 89 million new cases of chlamydia;
- 170 million new cases of trichomoniasis;
- 30 million genital papillomavirus infection;
- 20 million genital herpes;
- 7 million chancroids.
The high prevalence of STDs leads to large economic losses. Experts of the National Council for Science and Technology of the USA believe that the US Department of Health spends $ 5 billion annually (without AIDS) to combat sexually transmitted diseases.
Currently, STD therapy, regardless of the localization of the process, is based on three main directions: etiotropic therapy, pathogenetic therapy, symptomatic therapy and spa treatment.
The main component of etiotropic therapy of STDs are antibiotics and chemotherapy drugs. Taking into account the characteristics of individual microorganisms (for example, chlamydia are intracellular parasites), these drugs should have good penetration into the cells affected by pathogens. According to the recommendations of WHO experts, antibacterial agents intended for the treatment of patients with STDs should have the following properties:
- high efficiency (at least 95%);
- good tolerance and low toxicity;
- accessibility for the general population;
- the ability to provide maximum effect with a single application;
- ease of use (oral administration);
- absence of resistance of pathogens.
It is generally accepted that patients with acute and chronic genitourinary infections need antibacterial therapy (therapy of sexually transmitted infections). At the same time, most clinicians note significant difficulties in the treatment of this category of patients, which is explained by:
- features of the development of pathogens, for example, ET chlamydia are phagocytized by a sensitive cell > transformation of ET into transitional corpuscles > transformation of transitional corpuscles into RT > RT produce new ET and then the cycle repeats. This cycle of chlamydia development lasts 2-3 days, after which most of the infected cells are destroyed, and many newly formed ET and RT enter the intercellular spaces. As a result, new cells are infected and the pathological process continues. Therefore, when treating chlamydia infection, it is important to take into account both the type of pathogen and the spectrum of its sensitivity to antibacterial drugs, as well as the phase of its development. The most sensitive to antibacterial agents are only RT in the period of their active life. ET is a significantly less metabolically active form of extracellular existence of chlamydia and is significantly more resistant to the effects of antibacterial drugs;
- immune disorders that often contribute to the manifestation of infection. Complications of urogenital infections, including chronic prostatitis, also significantly contribute to an increase in the frequency of failures in antibacterial therapy of patients. An important factor aggravating the effectiveness of treatment are infiltrates in the affected tissues (especially in the prostate gland), as well as micro and macrocalcinates. The above, in the end, contributes to the creation of a depot of “reserved” pathogens that are difficult to access for antibiotics and chemotherapy drugs;
- the presence of a mixed infection in many patients. Most publications on this problem indicate that in 30-40% of cases microorganisms are found in associations with representatives of conditionally pathogenic microflora isolated in etiologically insignificant concentrations. According to Adaskevich (2004), in patients with systemic manifestations of chlamydial genitourinary infection, associations of pathogens (chlamydia) with trichomonas occur in 84.5% of cases, and with anaerobic microorganisms – in 53.6% of cases. Therefore, at present there is an opinion that the associative nature of infections probably contributes to the formation of resistance of microorganisms to antibiotics;
- a limited list of antibacterial drugs with pronounced antimicrobial and antiviral effects, as well as an increase in the number of strains of microorganisms resistant to them.
The problem of antibacterial therapy of STDs
Analysis of literature data on the problem of antibacterial therapy of STDs indicates that, despite the large selection of antibiotics and chemotherapy drugs recommended for the treatment of this group of infections, the question of rational etiotropic therapy regimens remains unresolved. Despite the use of modern drugs, it is not possible to achieve 100% rehabilitation of the patient’s body in all clinical cases.
One of the most difficult problems remains the treatment of a persistent form of STDs, as well as infections occurring with systemic manifestations. In addition, prolonged and repeated use of etiotropic therapy courses using various antibiotics and chemotherapy drugs often leads to allergic reactions, intestinal dysbiosis, toxic effects on the liver and contributes to the suppression of various parts of the immune system. The “immunological insufficiency syndrome” developing in these conditions can lead to the formation of persistent forms of infection, which ultimately leads to a recurrent course of the disease.
Recently, along with etiotropic treatment of STD patients, more and more attention is being paid to pathogenetic therapy of patients in this category. The main importance in this direction is given to immuno-oriented therapy, since the development of immune status disorders in 75-80% of patients with STDs has been proven. Cholinolytics and antispasmodics are used to normalize autonomic dysfunctions in patients with STDs.
Therapy of sexually transmitted infections in the postinfectious stage of treatment of a chronic infectious process, physiotherapy, instrumental and spa treatment are often used to improve hemodynamics, anti-inflammatory, resorbing, analgesic effects, as well as to facilitate the transport of drugs into the pancreatic tissue.