RU2185861C1 - Method for treating chronic trichomonadic endocervicitis - Google Patents

Abstract

FIELD: medicine, dermatovenerology, gynecology. SUBSTANCE: the method deals with endocervical vacuum aspiration and instillation of 20 ml 3%-hydrogen peroxide solution, 3-5 times per each procedure. Then electrophoresis of chymotrypsin solution is conducted at 5 mg/100 ml physiological solution and 1 ml dimexide. EFFECT: higher efficiency of therapy. 2 ex

Description

 The invention relates to medicine, namely to dermatovenereology, and can be used in dermatovenereological, gynecological, physiotherapeutic departments and offices of hospitals and clinics.

 Chronic trichomonas endocervicitis (CTE) is one of the most commonly diagnosed diseases in dermatovenereological practice. Currently, complex therapy is used for the treatment of CTE, including the following drugs and methods: etiotropic (metronidazole, tinidazole, tiberal, atrican, nutxojin, macmiror), immunocorrective (pyrogenal, polyoxidonium, cycloferon, methyluracil, etc.), enzymatic (chymotrypsin , lidase, wobenzym), local treatment (vaginal baths, tampons, endocervical instillations with drugs), physiotherapy (drug electrophoresis, magnetic laser therapy, etc.). [1, 2, 3, 4].

 But at the same time, these methods have significant drawbacks, since with CHE, accompanied by endocervical cysts, which can serve as a reservoir of latent infection [5], they are ineffective because of the impossibility of draining and sanitizing these cavities with drugs administered as transvaginally (-cervical) and applied systemically (orally, parenterally) and physiotherapy.

 Ultrasound examinations of the cervix using transvaginal access (TBI) made it possible to establish that cystic microcavities are found in 60% of patients with CTE, and in 27% they are localized in the upper third of endocervix.

 The authors first developed a method of treating CTE, including etiotropic therapy, instillation of a medicinal substance and drug electrophoresis, characterized in that before electrophoresis, vibration massage with vacuum aspiration of endocervix and instillation with a sterile disinfectant solution 3-5 times each procedure are performed.

 For the implementation of vibration massage and transcervical vacuum aspiration, we have developed the Vibroaspirator device, for which an application for a utility model has been submitted.

 The method is as follows.

 The position of the patient is lying on the gynecological chair. The external genitalia and the cervix, removed using a Cuzco mirror, are treated with a sterile swab moistened with a disinfectant solution.

After the sterile cervical tip is inserted into the cervical canal, the diameter of which is selected according to the size of the external pharynx, the VP-1 electric massager (vibration frequency 30-50 Hz) and the ALP-02 vacuum pump are turned on. The amount of vacuum in the cervical tip is regulated according to the testimony of the vacuum gauge of the pump and should not exceed 0.4 kg / cm ² .

 Vibro massage and vacuum aspiration of the cervical canal are performed alternately with transcervical instillation with a 3% hydrogen peroxide solution in a 20 ml disposable syringe through the cervical tip 3-5 times each procedure.

 The duration of the procedure is 7-10 minutes.

 The next step is the drug electrophoresis of a solution of chymotrypsin 5 ml (5 mg per 100 ml of physiological saline) and 1 ml of dimexide using a combined vaginal cervical electrode.

 Side effects and complications were not noted.

 The method is characterized by non-invasiveness, ease of implementation and is fully compatible with other methods and treatment methods. It complements traditional therapy.

 The above-described technology for the pathogenetic treatment of CTE is carried out before and in combination with etiotropic therapy.

Contraindications:
- pregnancy;
- menstruation;
- metrarrhagia;
- Genitourinary tumors.

 We observed 82 patients with CTE, accompanied by endocervix cysts aged 18 to 46 years with a disease duration of 6 months to 5 years. 40 of them (49%) had VZOMT, 41 people. (50%) - cervical pseudo-erosion, 42 patients (51%) were unsuccessfully treated 2 or more times with various antiprotozoal agents and antibiotics.

 Examination of patients included general clinical methods, including colposcopy (KS colposcope) and TVUZI (Pie Medical 200 apparatus with a sectoral multiplanar sensor), cytomorphological, microbiological and molecular genetic (PCR) studies of the contents of the cervical canal.

 Observed were divided into 2 groups of 41 people.

 Before the combined vaginal-cervical electrophoresis for drainage and sanitation of the endocervix, the patients of group I (main) group at the first stage of treatment (before prescribing antiprotozoal drugs) were given a vibration massage and vacuum aspiration of the cervical canal through the developed cervical aspirator cervical (VAC) alternating 3% hydrogen peroxide solution 3-5 times.

 Patients of the II (control) group used only endocervical instillation with a 3% hydrogen peroxide solution and combined vaginal-cervical electrophoresis of a solution of chymotrypsin and dimexide.

 At the 2nd stage of treatment (on days 7-10), patients of both groups were prescribed antiprotozoal drugs, taking into account the sensitivity of Trichomonas to them in vitro.

 TWSI monitoring was carried out every 7 days of therapy. Assessment of the clinical condition and control of the cure of trichomoniasis was carried out for 2 menstrual cycles after the end of the course of treatment (bacterioscopy, culture method, PCR).

 Our complex therapy using the developed method for the treatment of CTE allowed achieving in patients of the 1st group of etiological cure - 37 people. (90%), clinical -39 people. (95%), disappearance of endocervix cysts - 37 people. (90%). In patients of group 2, etiological cure occurred in 20 people. (50%), clinical - in 31 people (75%), in 39 (95%) endocervix cysts were preserved.

 Thus, the use of the treatment method developed by us at one of the stages of the complex therapy of CTE allows to significantly increase the therapeutic effect, contributes to the rehabilitation of patients with PID.

 Example 1

 Patient L.K., 26 years old, turned to the Medical practice center with complaints of drawing pains in the lower abdomen, yellow discharge from the vagina.

 During the year she underwent 3 courses of protistocidal and antibacterial therapy in various hospitals of the city due to urogenital trichomoniasis and chlamydia.

 Unmarried, unprotected sex during the year denies.

With an objective study:
- on the mirrors: on the neck pseudo-erosion with a diameter of 1.5 cm, pus discharge from the cervical canal;
- bimanual examination determined edematous, moderately painful appendages on the left.

 With colposcopy: glandular pseudo-erosion of the cervix, diffuse colpitis.

 When TVUSI: the body of the uterus is of normal size 4.8 • 3.0 • 4.3 cm. The contour is even, the structure is uniform. The cavity is linear in shape. Endometrium 1 cm corresponds to phase 2 of the cycle (26 day cycle). In the thickness of the cervix, at the level of the internal pharynx, anechogenic masses with a diameter of 5.0 and 6.0 mm (echoes of endocervix cysts). The right ovary is 3.4 • 2.0 cm, the left ovary is 3.3 • 2.0 cm. The structure of the ovaries is not changed. Volumetric formations in the field of appendages were not identified.

 Bacterioscopy: scraping from the cervical canal: trichomonads, gonococci, gardnerella, fungi of the genus Candida not found; the number of leukocytes 20-40-60; epithelium - a significant amount; mucus - a significant amount; found sticks, cocci.

 In sowing on tvaginalis: trichomonads were found that were sensitive to the combination of deflamon with macmirror, moderately resistant to the combination of tiberal with macmirror.

 In a scraping of their cervical canal, C.trachomatis DNA was detected by PCR.

 Based on complaints, anamnesis and clinical and laboratory examination, the diagnosis was established: genitourinary trichomoniasis, chlamydia with complications, chronic left-sided salpingoophoritis, endocervicitis, glandular-cystic pseudo-erosion of the cervix, endocervix cysts.

The following therapy was performed:
- Polyoxidonium 0.006 i / m every other day 10.

 - Vibro massage with vacuum aspiration of endocervix, alternating with endocervical instillation of a 3% solution of hydrogen peroxide 3-5 times, 1 time per day for 14 days.

 - Vaginal cervical electrophoresis of a solution of chymotrypsin with dimexide 1 time per day for 20 minutes 14 days.

 On the 7th and 14th day of therapy, TWSI monitoring was performed.

 TVUSI on the 7th day: endometrium 1 cm corresponds to phase 2 of the cycle (18 day cycle). In the thickness of the cervix, one anechogenic formation with a diameter of 4 mm is visualized.

 TWUSI on the 14th day: the structure of the cervix is homogeneous. Echo-signs of endocervix cysts were not noted.

Then they proceeded to the second stage - etiotropic therapy:
- Deflamon 0.5% 100 ml 3 times a day in / drip 5 days.

 - Macmirror 2 tablets 2 times inside 10 days.

 - Rovamycin 3 million 3 times inside 10 days.

 - Ginalgin 1 tab. 1 time vaginally 10 days.

 - At the end of deflamon - tiberal 1 tab. 2 times inside 5 days.

 - Twice treatment of pseudo-erosion with solkovagin.

 For two menstrual cycles (on the 6th day), control clinical and laboratory studies were performed.

 At the same time, the observed complaints did not show, during a gynecological examination, a complete resolution of the inflammatory process in the uterine appendages was ascertained, the cervix was epithelized, which was confirmed by control colposcopy, the structure of the cervix was homogeneous in TBI, in smears and cultures from the cervical canal and vagina t.vaginalis were not found, C. Trachomatis DNA was not detected by PCR by cervical scraping.

Example 2
Patient T.A., 34 years old, turned to the Medical Center "Medical Practice" with complaints of periodic pulling pains in the lower abdomen, mainly in the right iliac region for 6 months.

 In the anamnesis: diathermo-electrocoagulation of pseudo-erosion of the cervix, chronic salpingo-oophoritis. Married. Menstrual function is not impaired. The husband suffers from genitourinary trichomoniasis, chronic urethroprostatitis. He is undergoing treatment.

An objective examination:
- on mirrors: multiple Ovuli Nabothi;
- bimanual examination revealed a deviation of the cervix to the right, heaviness and pain in the region of the right appendages,
When TVUSI: the body of the uterus is of normal size 5.7 • 3.8 • 5.2 cm. The contour is even, the structure is homogeneous. The cavity is linear in shape. The endometrium of 1 cm corresponds to phase 2 of the cycle (day 16 of the cycle). Single anechogenic formations are visualized in the thickness of the cervix: in the upper third of 4 mm, in the middle third of 3 mm, in the lower third of 5 mm (echoes of endocervix cysts). The right ovary is 3.4 • 2.0 cm. The left ovary is not sighted.

 Bacterioscopy: scraping from the cervical canal: trichomonads, gonococci, gardnerella, fungi of the genus Candida not found; white blood cell count 60-70; epithelium - a moderate amount; mucus - a significant amount; found sticks, cocci.

 In sowing on t.vaginalis: trichomonads were found that were sensitive to the combination of makmiror with naxojin, tiberal, tinidazole, deflamon; moderately resistant to the combination of macmirror with atrik.

 Based on complaints, medical history and clinical and laboratory examination, the diagnosis was established: urogenital trichomoniasis with complications, chronic salpingoophoritis on the right, cystic pseudo-erosion of the cervix.

The following therapy was performed:
- Pyrogenal with 15 mcg / m every other day according to scheme 5.

 - Vibro massage with vacuum aspiration of endocervix, alternating with endocervical instillation of a 3% solution of hydrogen peroxide 3-5 times, 1 time per day for 10 days.

 - Vaginal-cervical electrophoresis of a solution of chymotrypsin with dimexide according to the above procedure 1 time per day for 20 minutes 10 days.

 On the 7th day of therapy, TVUZI monitoring was performed: the structure of the cervix is homogeneous.

Then they proceeded to the second stage - etiotropic therapy:
- Tinidazole 2 tablets 2 times a day inside 4 days.

 - Macmirror 2 tablets 2 times a day inside 10 days.

 - Ginalgin 1 tab. 1 time a day vaginally for 10 days.

 - Kanamycin 1.0 g / m 2 times a day for 5 days.

 - After the end of tinidazole, tiberal 1 tab. 2 times a day inside 5 days.

 - Vaginal tampons with levomecol, dimexide, metrogil 10 days.

 - Diathermopuncture of superficial nabot cysts was performed.

 For two menstrual cycles (on the 6th day), control clinical and laboratory studies were performed.

 At the same time, the observed complaints did not show, during a gynecological examination, a complete resolution of the inflammatory process in the uterine appendages was ascertained, the structure of the cervix was homogeneous in a TBI ultrasound, and no t.vaginalis were found in smears and cultures from the cervical canal and vagina.

Thus, this method of treatment allows you to:
1) drain and sanitize the cervical canal, eliminate non-operatively endocervix cysts, which are often reservoirs of latent chronic STIs, that is, they contribute to the elimination of "uncontrolled depot"infections;
2) improve microcirculation and lymphatic drainage, eliminate lymphostasis and venous hyperemia, which positively affects trophic tissue and regenerative processes in the cervix;
3) promotes the resorption of osmotic foci, the penetration of drugs into them, administered both transcervically and systemically (orally, parenterally);
4) to free the cervical glands from the products of inflammation and pathogenic microflora;
5) remove aspirate with pathological contents from the cervical canal without passing through the vaginal mucosa, thereby preventing contamination.

Sources of information
1. Skripkin Yu. K., Mordovtsev V.N. Skin and sexually transmitted diseases. A guide for doctors. M., Medicine, 1999, v. 1; 652-653.

 2. Borisenko KK. Diagnosis, treatment and prevention of sexually transmitted diseases. Methodical materials, M., Sanam, 1998; 99-100.

 3. Adaskevich VP. Sexually transmitted infections. A guide for doctors. Nizhny Novgorod, NGMA, M., Medical Book, 1999; 184-187.

 4. Malevich K. N., Rusakevich P. S. .. Treatment and rehabilitation for gynecological diseases. Reference manual. Mn .: Vysh. Shk., 1994, 128-129, 208-218.

 5. Khachkuruzov SG. Ultrasound in gynecology. Symptoms Diagnostic difficulties and errors. SPb., "ELBI", 1999, 411.

Claims (1)

 A method of treating trichomonas endocervicitis, including etiotropic therapy, instillation of a medicinal substance and drug electrophoresis, characterized in that 3-5 times each procedure is carried out alternately vibromassage with vacuum aspiration of endocervix and instillation of 20 ml of a 3% hydrogen peroxide solution, then electrophoresis a solution of chymotrypsin 5 mg per 100 ml of physiological saline and 1 ml of dimexide.