| DIAGNOSING INTRACELLULAR INFECTIONS BY COLPOSCOPY. DORAMYCIN – DRUG OF CHOICE |
M. JUGELI, MD, Obstetrics & Gynecology
B. TKESHELASHVILI, MD, Obstetrics & Gynecology
L. ZAQARIA, Obstetrics & Gynecology
Sexually transmitted infections (STIs) are one of the most common disorders wide spread among every age group and gender. Prevalence remains high in every continent of the world. STIs negatively influence each organ and system, damage genital system and in addition to infertility cause various reproductive problems and systemic pathologic reactive processes.
Among STIs intracellular pathogens take significant place. In addition to Chlamydia, Mycoplasma and Ureaplasma are common genital pathogens. They damage epithelium of genital tract, cause its intensive denudation, sub-epithelial edema, leukocyte and then lymphocyte infiltration, these changes lead to inflammatory diseases and various perinatal complications (stillbirth, chorioamnionitis, postpartum endometritis, fetal and neonatal infections).
According to statistics of various authors, each year about 90 million people become infected with sexually transmitted intracellular pathogens, bringing enormous economic burden annually. Diagnosing sexually transmitted infections requires highly qualified clinical and laboratory studies. Quite fairly cervical screening has been given special importance , as an integral marker of STI for diagnosing infections caused by intracellular organisms in pregnant and non-pregnant women. There are a lot of diagnostic methods with high clinical values , as a gold standard: bacteriology studies, DNA study with direct immunofluorescent methods and express tests that are also useful in practice.
Each method has its good and bad sides, linked to the time of the procedures, sensitivity and specificity of the tests. According to the modern trends made by researchers nowadays it is recommended to use whole complex of tests in order to properly diagnose STIs.
It is known that via colposcopy it is possible to suspect probable presence of Trichomonal, Candida, herpes HSV and human papiloma viral HPV infections.
In our prospective study, conducted in special colposcopy clinic we found out that among screened women: frequency of Chlamydial infection was 37,5% of cases, Mycoplasma- 30,3%, and Ureaplasma infection – 40%. Colposcopy has high diagnostic values for establishing Chlamydial, Mycoplasma and Ureaplasma infections- Sensitivity 0,96 (SE) and specificity - 0,79 (SP) and diagnostic efficiency - 0,93 (DE).
Specific cervical lesions likeheighten lymphoid follicles and/or spider angiomas on ectocervix are pathognomic for infections caused by intracellular pathogens.
Picture №1 - Heighten lymphoid follicles on ectocervix
Picture №2 - spider angiomas in 10% of the cases
Picture №3 - Both signs in 4,0 % of the cases
Despite emergence of dozens of new medications , treatment of sexually transmitted infections is still actual.
We will make a brief survey about major antibiotic groups used against intracellular bacteria with reviewing their effectiveness, sensitivity and resistance.
The longest history of use has antichlamidial medications- Tetracyclines and Macrolides. These agent are also actively used against Mycoplasmal infections, nowadays.
In 1979 it was revealed in a double-blind placebo controlled clinical trial, that Doxycicline was highly effective against Mycoplasma infection.
According to the latest published data, decreased efficiency of Tetracyclines against Mycoplasmal infections was noted. This fact is explained by emergence of resistant Mycoplasma strains against Tetracyclines and Erythromycin and its increased sensitivity toward other medications.
It is obvious that , evaluating antibiotic resistance in each individual case is crucial for proper treatment. But wide based clinical studies allover Georgia is important to make statistical data about resistance peculiarities in our region.
In developed countries, highly controlled medical service system and even antibiotic prescribtions, determine bacterial sensitivity and resistance trends, because chaotic use of antibiotic prescribtions cause emergence of new resistant strains. That’s why in addition to detecting causative organism we decided to conduct resistance-sensitivity studies of the causative intracellular bacteria. Unfortunately such studies were possible only for certain strains of Mycoplasma/Ureaplasma.
Bacterial culture studies have no alternative in sensitivity studies, but PCR for detecting resistant genes is also valuable. These studies are easily done for Mycoplasma/Ureaplasma , but Chlamydial resistance and sensitivity studies are quite difficult from technical point of view.
According to our study results , it was found out that new generation Macrolides Doramycin (Spiramycin) had significant results.
Doramycin is 16-cyclic natural antibiotic of Macrolide group. It is broad spectrum antibiotic effective against gram(+) and gram(-) organisms, aerobic and anaerobic bacteria, against atypical bacteria (Mycoplasma, Ureaplasma, Chlamydia) and Toxoplasma (unicellular parasite). Doramycin well penetrates Chlamydia and Mycoplasma and create much higher concentration than other medications do.
Doramycin has marked post-antibiotic effect- lowering microbial virulence and increasing phagocytic activity of neutrophils.
In our study we found out high sensitivity of Mycoplasma/Ureaplasma toward Doramycin (92,1%).
Based on our studies we state that: colposcopy screening has superiority in diagnosing Mycoplasmal and Ureaplasmal cervicitis, also microbiology and drug sensitivity studies and finally from treatment point of view Doramycin as a drug of choice.
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