Method for treatment of urogenital infections that are sexually transmitted and caused by chlamydiae and/or micoplasma

FIELD: medicine.

SUBSTANCE: invention is referred to the field of medicine, namely to dermatovenerology and immunology and can be used for treatment of patients with sexually transmitted urogenital infections caused by chlamydiae and/or micoplasma. It includes the infusion of antibiotics of macrolides group or immunotropic drug that is selected individually, for which purpose the sensitivity of patient to immunotropic drugs is determined. That is done by in vitro definition of interferons in the samples of peripheral blood and urogenital scrapings before and after addition of each studies drug. As the result the immunotropic drug selected for treatment is the one that induces the increase of interferon activity in studied material by no less than 4 U/ml compared to the baseline level in the samples of peripheral blood and urogenital scrapings.

EFFECT: method provides for etiologic recovery, prevention of disease relapses, particularly due to effective interferons production on systemic and local level.

1 dwg, 4 tbl, 5 ex

 

The invention relates to medicine, namely to dermatology and immunology, and can be used for treatment of urogenital infections, sexually transmitted and caused by chlamydia and/or mycoplasmas.

Modern studies have confirmed the significant role of immune mechanisms in the development of the urogenital infectious diseases [Rakovsky IV // Mycoplasma person and mycoplasmal infections (Lecture. Part 1 and II) // Clinically. lab. diag-ka. - 2005. No. 2. No. 3. - C-32].

Clinical observations have shown that the treatment of urogenital diseases is complicated by the persistent nature of current infections and relapses approximately 10-15% of cases. This fact has served as justification for the imposition of immunotropic drugs in the treatment of chlamydial infections of the urogenital tract [Gomberg M.A., Chernousov A.D., Soloviev A.M. // the Use of immunotherapy in the management of patients with infection caused by Chlamydia trachomatis. // STIs. - 2001. No. 5. - P.48. Kamaganova IV, S. Khromov, Cooks J.F. ñ // is the Complex treatment of complicated chlamydia // Consilium medicum. - 2005. - P.9-10].

There is a method of treatment of urogenital chlamydial infections with the use of adjuvant therapy, including immunotropic drug superlymph and antibiotic setrole the macrolides, we adopted for the prototype [kamaganova I. Khromov the S., Cooks J.F. ñ //is the Complex treatment of complicated chlamydia // Consilium medicum. - 2005. However, the lack of individual approach to the choice of immunotropic drugs leads in some cases to the recurrence of diseases of the urogenital tract. The disadvantages of existing methods of treatment can be attributed to the lack of assessment of individual sensitivity to immunotropic drugs peripheral blood cells and scrapings of the urogenital tract of the patient.

The objective of the invention is the development of effective treatment of urogenital infectious diseases caused by chlamydia and/or mycoplasmas.

The technical result is to achieve etiological recovery and relapse prevention by determining individual sensitivity to the immunotropic drugs and accounting for the production of interferon in systemic and local levels.

The essence of the invention is that in the treatment of urogenital infectious diseases, sexually transmitted and caused by chlamydia and/or mycoplasmas, appoint immunotropic drug and an antibiotic of the macrolide group. Pre-determine sensitivity to immunotropic drugs. With this purpose in samples of peripheral blood and the scrapings of the urogenital tract determine the activity of interferon before and after adding each of the CSOs of the study drug. In the choose the immunotropic a drug that induces increased activity of interferons in the studied material not less than 4 IU/ml compared with baseline levels.

The method is as follows.

1. The clinical examination of the patient samples are scraping the urogenital tract, as well as samples of peripheral blood collected from the cubital vein with a solution of an anticoagulant. One of the samples of scraping the urogenital tract and sent to the molecular-genetic analysis (the polymerase chain reaction, PCR) to establish an etiologic diagnosis. Another sample of scraping, as well as a sample of peripheral blood of the patient is examined for sensitivity to immunotropic drugs for their effect on the production of interferons.

To do this, in 96-well tablets make cells peripheral blood or cell scrapings of the urogenital tract, diluted with medium RPMI-1640, at a concentration of 2×106/ml.

2. In a sample of cells add one of the tested immunotropic drugs: immunal, neovir, superlymph in different concentrations of 1:10, 1:100 and doses of 1 or 10 μg/ml

3. In accordance with the scheme of the experiment, the wells included the following reagents: 1) cells in peripheral blood (control, raw data); 2) cells scraping (control, raw data); 3) cell accessories the historical blood + test drug; 4) cells swab + test drug.

4. Tablets incubated in CO2-incubator at 37°C for 24 h Then separated from the supernatant and tested for the presence of activity of interferons (IFN).

5. Titration for determining the activity is carried out in 96-well flat-bottomed tablets, for example, the culture of diploid human fibroblasts grown in the growth medium prior to the formation of monolayer. As an indicator of test virus using virus encephalomyocarditis mice (vamc).

6. When considering the results choose the immunotropic a drug that induces increased activity of interferon is not less than 4 IU/ml compared with baseline levels.

For evidence of a possible implementation of the stated purpose and achievement of the technical result here is the following data.

Example 1

Patient P, 24 years old, came with the purpose of investigating the presence of sexually transmitted infections. At the time of inspection subjective feelings are absent, discharge from the urethra in appearance and the volume does not differ from the physiological norm. The use of PCR has allowed to detect the presence of Chlamydia trachomatis + Ureaplasma.urealyticum. Thus, the patient was diagnosed with urogenital chlamydial Ureaplasma infection.

Diagnostic survey activity interf the Ronov in samples of clinical material and the scrapings were not found.

Before therapy was determined by the sensitivity of peripheral blood cells and scrapings UHT to immunotropic drugs to immunolo, Nibiru, superlymph. For this selection of immunotropic drugs for their effect on the production of interferon. Revealed the sensitivity of blood cells (4 U/ml) and scrapings UHT (8 U/ml) to superlymph. Sensitivity to immunolo was detected only when the action on blood cells (4 U/ml) (table 1). Negative results were obtained by testing the sensitivity of blood cells and scrapings UHT to Nibiru (table 1). This was the basis for inclusion superlymph in the complex therapy. The patient was prescribed superlymph, suppositorie scheme: 25 ED 1 candle 25 UNITS at night, the course of 10 days.

After applying superlymph the PCR results showed the absence of U.urealyticum, however, were identified .trachomatis. Subsequent appointment jozamitina at a dose of 500 mg to 1 t × 3 times/day course of 10 days.

Application jozamitina to the lack of C.trachomatis in the scraping of the urogenital tract. Thus, in the complex therapy superlymph and dzhozamitsin were not detected by the method of Poland chlamydia and Ureaplasma. Etiological recovery, confirmed by PCR, was maintained for 3 months, and then in the course of the year. Thus, during the year the patient had not been marked by relapses and what Ecodom PCR not detected chlamydia and Ureaplasma.

Example 2

Patient F., 28 years old, came to survey for the presence of sexually transmitted infections. He reported that the sexual partner identified chlamydial infection. Previously, the patient was examined and was not treated. At the time of inspection subjective feelings are absent, discharge from the urethra in appearance and the volume does not differ from the physiological norm. Application of PCR method allowed to detect the presence of Chlamydia trachomatis + Mycoplasma genitalium and to establish the diagnosis of chlamydial and Mycoplasma infection. The results of the evaluation of interferon status showed that the patient's production of interferon in systemic and local levels were not found.

The patient revealed sensitivity to immunotropic drugs: superlymph (blood samples and scrapings), immunolo (blood sample), Nibiru (scrape)that was the basis of the inclusion superlymph in the complex therapy (table 2). The patient was prescribed superlymph, suppositorie at a dose of 25 UNITS on 1 suppository for the night, the course of 10 days. At the beginning of therapy superlymph the patient noted some redness, swelling in the area of the urethra that was associated with antimicrobial action superlymph - suppress the excessive growth of the bacterial flora of the urogenital tract, (staphylococci, enterococci, yeast-like fungi, and others). On okonchan and application superlymph these phenomena were completely resolved. However, after therapy superlymph in the scraping of the patient were again detected chlamydia and Mycoplasma. Along with this, the patient had increased activity interferoninducible cells.

The patient was scheduled therapy roxithromycin at a dose of 500 mg 1 tab. 3 times/day course of 10 days. The application jozamitina C.trachomatis and Mycoplasma genitalium were not detected in the scraping of the urogenital tract using PCR method.

Etiological recovery, confirmed by PCR, was maintained for 3 months, and then during the year of observation.

Thus, during the year the patient had no recurrence and PCR were not detected chlamydia and Mycoplasma.

Example 3

The Patient Br., 22 years old, came about vaginal discharge observed during 1.5 years. Diagnostic examination by PCR detected Mycoplasma genitalium, Ureaplasma urealyticum, and Gardnerella vaginalis. The original level of activity of interferon was reduced. The patient without selection immunotropic drug was prescribed therapy with superlymph suppositories dose of 25 UNITS on 1 suppository for the night, the course of 10 days. After the end of therapy superlymph PCR were again detected Mycoplasma, Ureaplasma and gardnerelly against the background of significant vaginal dysbiosis. The patient had survived the initial reduced level is aktivnosti interferon in the blood samples and scrapings UHT. Along with this, the identified violations of the composition of the microflora UHT.

The patient was scheduled therapy roxithromycin at a dose of 500 mg 1 tab. 3 times/day course of 10 days. The application jozamitina PCR were found out gardnerelly. At the same time, bacteriological examination showed a reduction in the levels of lactobacilli. After 3 months of observations by PCR newly discovered gardnerelly, the purpose of therapy without selection immunotropic drug did not lead to an etiological recovery. PCR were found gardnerelly. Marked characteristic vaginal dysbiosis within the next 3 months.

Example 4

Patient C., 30 years old, came with the purpose of investigating the presence of urogenital infections, sexually transmitted diseases. At the time of the survey subjective feelings are absent. Application of PCR method allowed to detect the presence of Mycoplasma.hominis + U.urealyticum. Evaluation of interferon status of the patient showed that the initial activity of interferons in the studied cells in peripheral blood and scrapes UHT were not found.

Before therapy in blood samples and scrapings revealed the sensitivity of cells to superlymph, immunolo and Nibiru (table 3). The patient was prescribed therapy with neovia - one of the drugs of choice. Neovir was administered in a dose of 250 mg with 2 ml of 0.5% solution of novocaine is, every 48 h, a course of 10 injections.

After therapy neovia in the scraping of the urogenital tract PCR detected Mycoplasma, was reduced level of production of interferon by peripheral blood cells and scrapings UHT.

The patient was scheduled therapy roxithromycin at a dose of 500 mg 1 tab. 3 times/day course of 10 days. The application jozamitina were not detected by PCR Mycoplasma and Ureaplasma. In addition, the sensitivity to immunotropic drugs persisted.

Etiological recovery, confirmed by PCR, was maintained for 3 months, and then in the course of the year. In a patient after therapy neovia and roxithromycin during the year is not marked by relapses and PCR not detected M.hominis and U.urealyticum.

Example 5

Patient B., 31, filed in connection with the fact that the sexual partner during the examination in female consultations identified Mycoplasma infection. At the time of inspection subjective feelings are absent, discharge from the urethra in appearance and the volume does not differ from the physiological norm. Application of PCR method allowed to detect the presence of M.hominis and Gardnerella vaginalis.

When evaluating interferon status before therapy decreased activity production of IFN in blood samples and scrapings UHT.

Before terap is in her blood samples and scrapings UHT revealed the sensitivity of cells to superlymph (table 4). The patient was prescribed therapy with concomitant administration of superlymph and jozamitina. Schema therapy: superlymph suppositories dose of 25 ED no 1 candle on the night, jozamitsin at a dose of 500 mg 1 tab. 3 times/day, a course of 10 days. In therapy superlymph + jozamitsin PCR were not detected Mycoplasma and gardnerelly. However, the patient noted a decrease of the production of interferons on the system and local levels. Etiological recovery, confirmed by PCR, was maintained for 3 months, and then in the course of the year.

Thus, the use of the proposed method in 52 patients, 25 men and 27 women with urogenital infectious diseases, sexually transmitted diseases and activated chlamydia and/or mycoplasmas, was made the selection of immunotropic drug effect on secretion of interferons in samples of peripheral blood and scrapes UHT. In all cases (32 patients received first therapy superlymph, then roxithromycin; 20 patients received simultaneously superlymph + jozamitsin) achieved etiological recovery during the year there was no recurrence. Sensitivity to immunotropic drugs was associated with suppression of the high level of growth associated microflora and restore nor the social composition of microflora of UHT, and with the increased activity of interferons detected in samples of peripheral blood and the scrapings of the urogenital tract on the system and local levels. The method improves the efficiency of treatment, relapse prevention and lengthening the time of remission.

A method of treating urogenital infectious diseases, sexually transmitted and caused by chlamydia and/or mycoplasmas, including the appointment of immunotropic drug, antibiotic groups, macrolide, wherein the pre-determined sensitivity to immunotropic drugs, which determine the in vitro activity of interferons in samples of peripheral blood and the scrapings of the urogenital tract before and after adding each of the studied drugs and choose the immunotropic a drug that induces increased activity of interferon is not less than 4 IU/ml compared to baseline levels in a sample of peripheral blood and the scraping of the urogenital tract.



 

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