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"description": "Невенерический сифилис – инфекционное заболевание, которое характеризуется поражением кожи, слизистых оболочек, костей и суставов, но без патологии внутренних органов и нервной системы.",
"etiology": "<p>Возбудитель невенерического сифилиса – один из подвидов грамотрицательной спирохеты вида Бледная трепонема, а именно – Treponema pallidum endemicum. Спирохеты имеют штопорообразную извитую форму. Спор, капсул, жгутиков не образуют. Спирохеты обладают активной подвижностью вследствие выраженной гибкости их тела.</p>\r\n<p>Источником инфекции является больной человек. Инфицирование происходит при неполовых контактах с больным, а также через бытовые вещи. Распространению болезни способствует низкий санитарно-гигиенический уровень культуры. Чаще болеют дети.</p>",
"pathogenesis": "<p>В месте внедрения возбудителя появляется первичный аффект (беджелоидный шанкр), который проявляется незначительными воспалительными явлениями на едва гиперемированном отечном основании. Воспалительные явления в лимфатических сосудах и узлах при этом отсутствуют. В результате слабой местной тканевой реакции и анергичного состояния регионарных лимфатических узлов происходит более активное проникновение спирохет в кровь (спирохетемия), распространяясь в кожу и слизистые оболочки. В короткие сроки образуются вторичные беджелиды. Они диссеминированные, множественные, симметричные и полиморфные: розеолезно-папулезные, пустулезные и кондиломатозные.</p>",
"diagnostics": "<p>Диагностика беджеля основывается на типичной клинической картине, учете возраста, эпидемиологической обстановки и нахождении Т. pallidum в материале из свежих высыпаний кожи и слизистых оболочек в темном поле зрения. Большое значение для диагностики могут иметь результаты серологических исследований крови. При беджеле реакция Вассермана, осадочные реакции, а также РИБТ, РИФ дают положительный результат. </p>",
"treatment": "<p>Лечение больных эндемическим сифилисом, а также контактировавших с ними лиц проводится препаратами пенициллина пролонгированного действия. При противопоказаниях к применению пенициллина лечение проводится эритромицином или тетрациклином.</p>\r\n<p>Если болезнь перешла в третичную стадию, могут понадобиться восстанавливающие хирургические операции.</p>",
"prevention": "<p>Профилактика эндемического сифилиса включает:</p>\r\n<ul>\r\n<li>Своевременное выявление больных детей, изоляция их от здоровых и проведение соответствующего лечения.</li>\r\n<li>Клинико-серологическое обследование всех членов семей и лиц, находившихся в тесном контакте с больным, для выявления активных и латентных форм заболевания.</li>\r\n<li>Превентивное лечение всех контактировавших лиц с больными беджелем.</li>\r\n<li>Улучшение жилищно-бытовых условий, повышение санитарной культуры населения.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Течение невенерического сифилиса включает в себя отдельные стадии.</p>\r\n<p>В раннюю стадию входят инкубационный период (от 1-2 недель до 3 месяцев), а также первичные и вторичные высыпания. Поздняя (третичная) стадия включает гуммы (характерные узлы в тканях, где происходит их разрушение; язвы, после которых остаются заметные рубцы).</p>\r\n<p>Сначала в том месте, через которое возбудитель проник в организм, появляется беджелоидный шанкр (язвочка). Затем образуются высыпания на слизистой оболочке рта, а также в районе гениталий и заднего прохода. Они имеют склонность к мацерации (мокнут).</p>\r\n<p>Далее проявления болезни распространяются на кожу туловища и конечностей. Это буро-красные высыпания, которые шелушатся и сильно зудят. Подобные высыпания при отсутствии лечения держатся от полугода до года.</p>\r\n<p>После этого обычно следует третичная стадия: часть высыпаний преобразуется в гуммозные (узловатые или язвенные) высыпания. На этой стадии заражение уже менее вероятно, однако третичные беджелиды очень болезненны и несут опасность для самого больного. На этой стадии болезнь глубоко поражает подкожную основу, кости, суставы, сухожилия. Образуются обширные язвы со свищевыми ходами и гнойными выделениями. При локализации в области конечностей возникают беджелоидные остеомиелиты, разрешающиеся инвалидизирующими рубцами. Часто в связи с провоцирующим травматизирующим действием недоброкачественной пищи гуммозно-язвенные очаги локализуются в области рта, глотки, проникая в ткани неба, носа.</p>",
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"code": "A60",
"name": "Аногенитальная герпетическая вирусная инфекция [herpes simplex]",
"icd_name": "Аногенитальная герпетическая вирусная инфекция [herpes simplex]",
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"cause": [
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"slug": "a60_anogenitalnaya_gerpeticheskaya_virusnaya_infekciya_herpes_simplex",
"lead": "Нарушение здоровья, относящееся к группе инфекции, передающиеся преимущественно половым путем",
"description": "Аногенитальная герпетическая инфекция представляет собой хроническое рецидивирующее вирусное заболевание, передаваемое преимущественно половым путем, характеризующееся поражением кожи и слизистых оболочек половых органов и мочеполового тракта.",
"etiology": "<p>Возбудитель генитального герпеса является разновидностью вируса простого герпеса (ВПГ 2 типа). Генитальный герпес имеет половой путь передачи, при различных формах половых контактов легко проникает через поврежденную кожу и эпителий слизистой оболочки от больного генитальным герпесом. </p>\r\n<p>Также передача ВПГ возможна:</p>\r\n<ul>\r\n<li>воздушно – капельным путем;</li>\r\n<li>вертикальным путем от больной матери плоду (во время родов при контакте с родовыми путями матери, трансплацентарно, восходящим путем с наружных половых органов матери через цервикальный канал в полость матки);</li>\r\n<li>при самозаражении - аутоинокуляции (больной человек сам переносит инфекцию с зараженных участков тела на незараженные – с лица на половые органы);</li>\r\n<li>бытовым путем - редко (через влажные предметы гигиены).</li>\r\n</ul>\r\n<p>Факторами, способствующими проявлению и/или рецидивированию генитального герпеса, являются: снижение иммунологической реактивности, переохлаждение и перегрев организма, интеркуррентные заболевания, медицинские манипуляции, в том числе аборты и введение внутриматочной спирали, а также некоторые психические и физиологические состояния.</p>",
"pathogenesis": "<p>ВПГ передается при тесном контакте с больным или вирусоносителем. Вирус проникает через слизистые оболочки половых органов, уретры, прямой кишки или микротрещины кожи.</p>\r\n<p>После проникновения в организм через слизистую или кожные покровы, вирус сразу же взаимодействует с сенсорными нервными окончаниями, используя особые рецепторы. После попадания в нервный аксон, вирус оказывается в нервных ганглиях, в которых он может оставаться в пассивном состоянии, зачастую, навсегда.</p>",
"diagnostics": "<p>Диагностика типичных случаев генитального герпеса, как правило, не затруднена и основана на клинических проявлениях.</p>\r\n<p>Лабораторные методы диагностики генитального герпеса включают:</p>\r\n<p> </p>\r\n<ul>\r\n<li>Методы обнаружения ВПГ в материале пораженных органов (соскобахиз влагалища и шейки матки, мазке из уретры, гистологическом материале маточных труб и т. д.). С этой целью применяется метод выращивания ВПГ на культуре тканей и последующего изучения его свойств, используется метод распознавания вируса под электронным микроскопом;</li>\r\n<li>Методы обнаружения антител к ВПГ в сыворотке крови (иммуноглобулины М и G). Позволяют выявить генитальный герпес даже при бессимптомном течении и определить антитела к ВПГ 1 или 2 типа. К ним относится ИФА- метод иммуноферментного анализа.</li>\r\n</ul>\r\n<p>Обнаружение генетического материала вируса методом ПЦР.</p>",
"treatment": "<p>Существуют три основных подхода в лечении генитального герпеса: противовирусная химиотерапия, иммунотерапия и комбинация этих методов.</p>\r\n<p>Этиопатогенетическая противовирусная терапия с использованием аналогов нуклеозидов (препараты ацикловира) основана на способности последних угнетать ВПГ на стадиях синтеза вирусной ДНК и сборки вирусных частиц, торможении их размножения. Именно поэтому всем больным с диагнозом генитальный герпес следует назначать эпизодическую или превентивную (супрессивную) терапию.</p>\r\n<p>Эпизодическую терапию используют в момент обострения у пациентов с редкими симптоматическими высыпаниями, во время которого необходимо начать приём препарата.</p>\r\n<p>Превентивная (супрессивная) терапия направлена на подавление возможной реактивации латентного ВПГ. Её назначают в следующих случаях:</p>\r\n<ul>\r\n<li>пациентам с тяжёлыми и частыми рецидивами генитального герпеса (более 6 обострений в год);</li>\r\n<li>с целью профилактики передачи ВПГ в парах, где один из партнёров не инфицирован генитального герпеса (не имеет АТ к нему в крови);</li>\r\n<li>при наличии выраженных психосексуальных реакций на рецидивы герпеса;</li>\r\n<li>при значительном влиянии инфекции на качество жизни пациента.</li>\r\n</ul>\r\n<p>Противовирусные препараты при супрессивной терапии назначают ежедневно, в непрерывном режиме, длительное время.</p>\r\n<p>Возможно использование супрессивной терапии короткими курсами для предотвращения развития клинических симптомов на определённый период (экзамены, отпуск и т.п.). Супрессивная терапия приводит к снижению частоты рецидивов, уменьшению асимптоматического выделения вируса, снижая риск его передачи.</p>\r\n<p>У больных с генитального герпеса в стадии ремиссии возможна стимуляция неспецифической резистентности иммуномодуляторами под контролем иммунограммы. </p>",
"prevention": "<p>Способом профилактики первичного заражения генитальным герпесом служит использование презервативов при случайных половых контактах. Однако, даже в этом случае вероятность инфицирования ВПГ через микротрещины и повреждения на слизистых оболочках и коже, не прикрываемых презервативом, остается высокой. Возможно применение антисептических средств (мирамистин и др.) для обработки участков, на которые может произойти попадание вируса.</p>\r\n<p>Рецидивирующее течение генитального герпеса отмечается при снижении защитных реакций организма: болезнях, перегревании, переохлаждении, приходе менструации, беременности, приеме гормональных препаратов, стрессах. Поэтому для предотвращения рецидивов генитального герпеса имеет значение здоровый образ жизни, полноценное питание и отдых, прием витаминных препаратов. Мерами профилактики генитального герпеса служат также соблюдение интимной гигиены и гигиены половой жизни, своевременное выявление и лечение венерических болезней.</p>\r\n<p>Для профилактики самозаражения, когда вирус генитального герпеса переносится грязными руками с губ на половые органы, необходимо выполнение элементарных гигиенических требований: тщательное и частое мытье рук (особенно при наличии лихорадки на губах), использование отдельных полотенец для рук, лица и тела, а также для каждого члена семьи.</p>\r\n<p> </p>",
"clinical_picture": "<p>Инкубационный период может составлять до недели после полового контакта с вирусоносителем. Характерным признаком является появление герпетических пузырьков в месте, где было соприкосновение с половым партнером - в области наружных и внутренних половых органов, половых губ. Пузырьки вскрываются и на их месте образуются болезненные язвочки, которые покрываются корками. Затем корки сходят. В течение десяти дней могут появляться новое высыпание. Более чем в половине случаев герпес протекает без клинических симптомов, но вирусоносители также могут инфицировать своих половых партнеров. Наибольшую опасность бессимптомные вирусоносители представляют для новорожденных, поскольку у них герпес может вызывать тяжелые неврологические изменения и слепоту.</p>",
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"description": "Трихомониаз – это инфекционное заболевание мочеполовой системы, которое вызывается влагалищной трихомонадой. ",
"etiology": "<p>Возбудителем урогенитального трихомониаза является влагалищная трихомонада, которая относится к простейшим одноклеточным организмам. Трихомонады не устойчивы во внешней среде и при высушивании быстро погибают, но возможно сохранение их активности во влажной сфере (белье, мочалки, полотенца). </p>\r\n<p>Передается трихомониаз половым путем, хотя и не исключено и внеполовое заражение: вертикальный путь передачи возбудителя во время родов, при прохождении плода через инфицированные родовые пути. Бытовой путь передачи влагалищной трихомонады в настоящее время подвергается сомнениям. Многие авторы утверждают, что возможно заражение через полотенца, купальники и прочее. </p>\r\n<p>Факторы, способствующие развитию урогенитального трихомониаза: </p>\r\n<ul>\r\n<li>расстройства эндокринной системы; </li>\r\n<li>нарушения обмена веществ; </li>\r\n<li>гиповитаминоз; </li>\r\n<li>бактериальное загрязнение влагалища, сопровождающееся изменением его кислотности; </li>\r\n<li>менструация и послеменструальный период. </li>\r\n</ul>",
"pathogenesis": "<p>Трихомонады закрепляются в клетках слизистой оболочки мочеполового тракта и вызывают там воспалительный процесс. Продукты жизнедеятельности трихомонад отравляют организм человека, снижают его иммунитет. </p>\r\n<p>Трихомонады могут обитать в половых органах и даже в кровяном русле, куда проникают через лимфатические пути, межклеточные пространства с помощью фермента - гиалуронидазы. Трихомонады чрезвычайно приспособлены к существованию в организме человека: могут менять форму, маскироваться под клетки плазмы крови (тромбоциты, лимфоциты) - что затрудняет диагностику трихомониаза; «цеплять» на себя других микробов и этим способом уклоняться от иммунной атаки организма. </p>\r\n<p>Попав на слизистую оболочку влагалища, трихомонады выделяют специальные вещества, позволяющие прочно прикрепиться к её стенкам. Кроме того вагинальная трихомонада обладает свойством вырабатывать специальные ферменты, расщепляющие поверхностно расположенные клетки слизистой оболочки влагалища. В ответ на агрессивное воздействие трихомонад, в слизистой влагалища возникают воспалительные процессы, которые выражаются следующими изменениями: </p>\r\n<ul>\r\n<li>Резкое покраснение и отек слизистой </li>\r\n<li>Отслоение поверхностного слоя клеток </li>\r\n<li>Мелкоточечные кровоизлияния </li>\r\n<li>Повышение местной температуры </li>\r\n</ul>",
"diagnostics": "<p>На основании жалоб больных и осмотра можно заподозрить наличие трихомонад. При осмотре у больных трихомониазом женщин наблюдаются признаки воспаления — отек и гиперемия вульвы и влагалища. При проведении кольпоскопии может наблюдаться симптом «земляничного цервикса»: покраснение слизистой с точечными и очаговыми кровоизлияниями на шейке матки. Отмечается дисплазия эпителия, иногда возможно появление атипичных эпителиальных клеток. </p>\r\n<p>Из лабораторных методов диагностики применяют: </p>\r\n<ul>\r\n<li>микроскопическое исследование нативных мазков из влагалища, уретры и шейки матки (достоверен только при быстрой микроскопии свежевзятых мазков); </li>\r\n<li>микроскопическое исследование окрашенных мазков по Грамму; </li>\r\n<li>культуральный метод (посев слизи и содержимого уретры на питательные среды, занимает от 4 до 7 дней); </li>\r\n<li>ПЦР (полимеразная цепная реакция) – выделение ДНК трихомонад из отделяемого уретры или влагалища. </li>\r\n</ul>",
"treatment": "<p>Современные методы лечения больных трихомониазом основаны на использовании специфических противотрихомонадных средств. Лечению подлежат все больные, у которых обнаружены влагалищные трихомонады, независимо от наличия или отсутствия у них воспалительных явлений в половом аппарате, а также больные с воспалительными процессами, у которых при обследовании трихомонады не обнаружены, но простейшие обнаружены у половых контактов или источников заражения. </p>\r\n<p>При лечении трихомониаза назначают антипаразитарную терапию: используют препараты группы 5-нитроимидазолов. К ним относятся тинидазол, метронидазол, орнидазол, ниморазол, тернидазол. </p>\r\n<p>Параллельно с лечением соблюдают гигиенические правила по уходу за мочеполовыми органами: </p>\r\n<ul>\r\n<li>Ежедневное подмывание половых органов с использованием антисептических средств (слабый раствор перманганата калия, раствор фурацилина) или детергентов, то есть обычного туалетного мыла. </li>\r\n<li>Индивидуальное использование туалетных принадлежностей (мыла, мочалок, полотенец). </li>\r\n<li>Ежедневная смена нижнего белья.</li>\r\n</ul>",
"prevention": "<p>Основной мерой профилактики трихомониаза является отказ от беспорядочной половой жизни и наличие только одного сексуального партнера, в котором есть полная уверенность. Также к мерам профилактики можно отнести следующее: </p>\r\n<ul>\r\n<li>Обязательное использование презервативов во время половых отношений. </li>\r\n<li>Строгое соблюдение норм личной гигиены. </li>\r\n<li>Регулярная сдача анализов и обследование у врача. </li>\r\n</ul>",
"clinical_picture": "<p>Симптомы заболевания у женщин: </p>\r\n<ul>\r\n<li>обильные пенистые или жидкие выделения желтоватого, зеленоватого оттенка с неприятным «рыбным» запахом; </li>\r\n<li>зуд, жжение и гиперемия наружных половых органов; </li>\r\n<li>боль при мочеиспускании; </li>\r\n<li>боль при половых контактах. </li>\r\n<li>слизистая оболочка влагалища резко гиперемирована, легко кровоточит, покрыта гнойными выделениями </li>\r\n</ul>\r\n<p>Симптомы заболевания у мужчин: </p>\r\n<ul>\r\n<li>выделения из мочеиспускательного канала; </li>\r\n<li>боль при мочеиспускании; </li>\r\n<li>при поражении предстательной железы — симптомы простатита; </li>\r\n<li>в редких случаях возможно выделение крови из мочеиспускательного канала. </li>\r\n</ul>",
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