Inflammatory diseases of the genital organs (VSPO) in women occupy the 1st place in the structure of gynecological pathology and account for 60-65% of the number of women seeking admission. It is possible that the number of cases is higher, as patients with often erased forms do not consult a doctor. The increase in the number of VZPO in all countries of the world is the result of changes in the sexual behavior of young people, disruption of the environment and reduced immunity.
Classification. According to the localization of the pathological process, inflammatory diseases of the lower (vulvitis, bartholinitis, colpit, endochervicitis, cervicitis) and upper (endomyometritis, salpingoophoritis, pelviperitonitis, parametritis) divisions of the genital organs, the boundary of which is the internal uterine pharynx, are distinguished.
According to the clinical course, inflammatory processes are divided into:
with severe clinical symptoms;
subacute with erased manifestations;
chronic (with an unspecified duration of the disease or prescription
more than 2 months) in remission or exacerbation.
Etiology. VSPO can occur under the action of mechanical,> thermal,
“Chemical factors, but most significant — infectious. Depending on the type of pathogen VPO are divided into non-specific and ‘specific (gonorrhea, tuberculosis, diphtheria). Streptococci / staphylococcus, – enterococci, · Candida mushrooms, · chlamydia, · mycoplasmas, · ureaplasmas, – E. coli, · Klebsiella, · proteas / viruses, actinomycetes, otrichomonads, etc. can be the cause of nonspecific inflammatory diseases. , chlamydia, trichomonids, Mycoplasma genitalium) in the occurrence of VSPO an important role is played by conditionally pathogenic microorganisms living in certain parts of the genital tract, as well as associations of microorganisms. Currently, inflammatory diseases in the genital tract are caused by mixed microflora with a predominance of anaerobic non-spore-forming microorganisms. Pathogenic pathogens of VSPO are transmitted sexually, less frequently with everyday life (mainly in girls when using common hygiene items). The sexually transmitted diseases include gonorrhea, · chlamydia, · trichomoniasis, herpetic and chapillomavirus infection, acquired immunodeficiency syndrome (AIDS), · syphilis, anogenital warts, – contagious mollusc / Conditionally pathogenic microorganisms become causative agents, OOP, ZDV / PPI / OS-PPV activators. their virulence, on the one hand, and reducing the immunobiological properties of the microorganism, on the other.
Factors that prevent the ingress and spread of infection in the body. In the genital tract there are many levels of biological protection against the occurrence of infectious diseases. The first is the closed state of the genital slit.
Activation of conditionally pathogenic microorganisms and the spread of infection are hampered by the properties of the vaginal microflora – the creation of an acidic environment, the production of peroxides and other antimicrobial substances, the suppression of adhesion for other microorganisms, · the activation of phagocytosis and the stimulation of immune reactions.
Normally, the vaginal microflora is very diverse. It is represented by gram-positive and gram-negative aerobes, facultative and obligate anaerobic microorganisms. A large role in the microbiocenosis belongs to lacto-and bifidobacteria (Dederlein rods), which create a natural barrier to pathogen infection (Fig. 12.1). They make up 90-95% of the vaginal microflora in the reproductive period. Breaking down the glycogen contained in the surface cells of the vaginal epithelium to lactic acid, lactobacteria create an acidic environment (pH 3.8-4.5), which is detrimental to many microorganisms. The number of lactobacilli and, accordingly, the formation of lactic acid decrease with a decrease in the level of estrogen in the body (in girls in the neutral period, postmenopausal). Lactobacillus death occurs as a result of the use of antibiotics, vaginal douching with solutions of antiseptic and antibacterial drugs. Vaginal rod-shaped bacteria also include actinomycetes, corynebacteria, bacteroids, fuzobakterii.
The second place in the frequency of detection of bacteria in the vagina belongs to cocci – epidermal staphylococcus, hemolytic and non-hemolytic streptococci, enterococci. Enterobacteria, E. coli, Klebsiella, Mycoplasma and Ureaplasma, as well as yeast-like fungi of the genus Candida, are found in small quantities and less frequently. Anaerobic flora prevails over aerobic and facultatively anaerobic. Vaginal flora is a dynamic, self-regulating ecosystem.
General infectious diseases, accompanied by a decrease in immunity, endocrine disorders, the use of hormonal and intra-uterine contraceptives, the use of cytostatics violate the qualitative and quantitative composition of the vaginal microflora, which facilitates the invasion of pathogenic microorganisms and can lead to the development of inflammatory processes caused by conditionally pathogenic bacteria.
The cervical canal serves as a barrier between the lower and upper portions of the reproductive tract, and the border is the internal opening of the uterus. Cervical mucus contains biologically active substances in high concentration. Cervical mucus provides activation of non-specific protection factors (phagocytosis, synthesis of opsonins, lysozyme, transferrin, harmful for many bacteria) and immune mechanisms (complement system, immunoglobulins, T-lymphocytes, interferons). Hormonal contraceptives cause thickening of the cervical mucus, which becomes difficult for infectious agents.
The spread of infection is also prevented by the rejection of the functional layer of the endometrium during menstruation, along with microorganisms that have got there. When an infection penetrates the abdominal cavity, the plastic properties of the pelvic peritoneum contribute to the delimitation of the inflammatory process by the pelvic area.
Ways to spread the infection. The spread of infection from the lower genital tract to the upper can be passive and active. Passive propagation through the cervical canal into the uterine cavity, into the tubes and into the abdominal cavity, as well as the hematogenous or lymphogenous pathway are referred to. Microorganisms can also be actively transported on the surface of moving sperm and trichomonads.
The spread of infection in the genital tract is promoted by: various intrauterine manipulations in which infection is carried from the external environment or from the vagina into the uterine cavity, and then the infection passes through the fallopian tubes into the abdominal cavity;
menstruation, during which microorganisms easily penetrate from the vagina into the uterus, causing an upward inflammatory process; childbirth; surgery on the abdominal organs and the small pelvis; foci of chronic infection, metabolic and endocrine disorders, nutritional deficiencies or imbalances, hypothermia, stress, etc.
Pathogenesis. After penetration of the infection, destructive changes occur in the lesion focus, with the occurrence of an inflammatory reaction. Biologically active mediators of inflammation are released, causing microcirculation disorders with exudation and at the same time stimulation of proliferative processes. Along with local manifestations of the inflammatory reaction, characterized by five cardinal signs (redness, swelling, fever, soreness and impaired function) may cause general reactions, the severity of which depends on the intensity and extent of the process. Common manifestations of inflammation include fever, hematopoietic tissue reactions with the development of leukocytosis, increased ESR, accelerated metabolism, and intoxication of the organism. The activity of the nervous, hormonal and cardiovascular systems, the indicators of the immunological reactivity of the hemostasiogram change, the microcirculation is disturbed in the focus of inflammation. Inflammation is among the most common pathological processes. With the help of inflammation, localization and then elimination of the infectious agent together with the tissue damaged under its influence are provided.
Inflammation is among the most common pathological processes. With the help of inflammation, localization and then elimination of the infectious agent together with the tissue damaged under its influence are provided.