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HE EPEAEC OOBM TEM.

ocoe pae epo 2 POCABCA OCAPCTBEHHA MEHCA AAEM aepa ayepca eoo aye oe aa poeccoao ooo ceaco paooxpae HE EPEAEC OOBM TEM.

ocoe pae epo POCAB 2000 3 A o p :

... M..Oxa, ... M.B.Xpo, .H.eo (aepa ayepca eoo pocaco ocyapceo eco aae - a. a. po. M. . Oxa.

P e e e :

poeccop B.H.aac aey aepo ox eepecx oee MA.

Meoecoe ocoe yepeo Meoeco occe o oceooy opaoa pocaco ocyapceo eco aae.

OABEHE.

Haeoae paea. cp.

I Cpeoo py B 4 II Moa 6 III Xa 9 IV epec 15 V oope 21 VI Cc 24 VII apao ( ap) 30 VIII opayea eepeca IX axoa payea (ooao) X Bpyc ao eoea XI Bpyc eaa XII Cpo popeeoo yoea eoea XIII Tpxooa XIV ao XV poee I XVI poee II XVII poee III XVIII poee IV XIX epaypa HE, EPEAEC OOBM TM.

a ocee 20 e poo cyecee ee eooeco cya ooe : e, oye oopx epeac peyeceo p ooo oae (BO, 1982 .).

oae oo, o axoc paape e ao opo epec poee . O 5 accecx e: oope, cc, apo, opayea venereum, payea inguinale, x co aeo opoco cocae oee 20 (poee 1). Eeoo pe pecppyec oee 250 . ox cyae : oope-25 ., xao e-50 .

Ceye ae oe ocoeoc :

ca pacpocpaeoc ox x eca (cooc aoc yea aoeaeoc) oco e poeae e eo e ypoae ooo (cee - B e) eoope e oy eo e coa pacpocpaeoc e, ea ee pocy, pc ex ocoe (ecoe, eaoa epeeoc, pa e a) opeee x ecoe coaoe aee aoeaeoc ec oaaee oooo oee, oaeo pc B poa, a oye aoea, ocoeoc x ee cococy poa B.

Cyecye p ypo opo :

1. peypeee oaa c oyee - epa poaa.

2. Bee eee eccox e (peypeee pacpocpae)- opa poaa.

3. paoe eee x e peypee ocoe pea poaa.

I. CTPETOO P B . Cpeoo py (C) o 1964 . e paccapac a aoe eoea. B oceye 30 e C pa oco aepa aoea epaax ex, ec ey aoy, a aoee aco cpeac poopa, p aepe ee y oopoex epx 2 ece . B ayepce c poae C ca e oex ye, ao, ocepooe oep, aepe poax oce x, peepeeoe e o peepeee po.

eoo. C c ac opao op aaa oy oapye y 5-35% cex epeex. eccoa ooa aaa cpeaec pepo y 20% e (4,6 - 40%). Haoee co ypoe ooa y e ooe 20 e, ex coy ooy aoc, coyx BMC- opae: aoee aco- xo o aae aeee aco- ea a. Ca a epeeoc e e a ypoe ooa. Haoee aeo C c p cooa ceex aex cpe, ya - Toa - Xea: yo c po oe c oaee acoo co eaa. p cooa eceeo cpe o 50% e, ex C e yy epoa.

Pc epea oopoeoy C p poa aep cocae 42-72%, a p ocyc poa - oo 8%. pepo 2/ poax oopoex o aepe c C yy ecco oce e. Hecop a co ypoe epao epea, peaa acoa eco e C y oopoex epx e cocae 1,3 - 3:1000, poxc , oce 7 e 1-1,7: 1000. Ha ae 100 poax oopoex pxoc oo o cya ec o e. oea coo e ec e oo a peea, ooo 16-47% epcoaa pooo oee c oce C e.

Booa epeaa e o oopoeoo oopoeoy.

Hoooa (o) pc poa oopoex C p ocyc e y aep cocae 13-43%.

aop, pepacoaae ec opa e (cecc oopoex, a C): a acca ea, eooeoc (poc aoeaeoc 7-10-15 pa), ec xopoao, ypaoa e, oee eepayp ea y poe, eo poeyo oee 12-18 aco (pec epo-24 aca), aae e y oopoeoo p peyx poax. ae oe ooo, poopapeee ecape ceee e ca poa oopoex.

Ooo 2 / 3 ae C (acc Ig G) ocyae oy o aep oce ee epeeoc, p o 34 ee o epexo cyeceo ee, e oee oe cpo. Cpe oopoex c cecco cece C paee aao aoea (epe 7 e ) cpeaec 80,7%, a oee- 19,3%. p oox apaax cecca cepoc pepo oaoa: 5,7 - 6%.

ece poe. Cecc c pa aao ae oae epe 48 aco oce poe: y 60% - epe cy (o 56% coaa poec p poe), ocoo y eooex aoecx ee o aepe c aopa pca. aoeae xapaepyec aepee c ec poe cecca: eo (30%) eoe (40%).

Booa oeoca opa aoea c o ceecoo oa, pecpaop cpecco ea cxoo epe ecoo aco.

Cecc c o aao (1 ee-12 ee) poec eo (85%), 20-30% cyae ey peecy co co copo epxx xaex ye, oo ece poe e: o, cyc, o, app, opae o.

C c aco po ocepoox eox aoea y aep: ocepoo oep. T ec peoe oee eepayp ea epe 12 aco oce poo c axape, ooo, oeeoc a oac apaep. Boo poe e co copo oeox ye.

aoca. oo caapo aoce eccoo ooa C oeoox ye eyoo-eoo paa epeex ec yypa eo c cooae ceex cpe, e ao oa poc opao op oox ye pa-opaey ey opy.

oco poax oopoex (99%) e e coo aoea, ooy a ooa C ceye ycaaa yypa eoo. Meca po: yo, opo, apy cyxoo poxo, pa a. Booo opeeee pa- ooex oo A, acpae eya paxe. Bcoo ooc aoc oaae opeeee ceeco H: (yceoc), C(ceoc) (pooceca eoc: ooea opaea) o ooe yypaoy eoy coca, cooeceo-71, 90, 61, 94%.

eee. p eco oyee cpeco opa ec e.

Ho, a a eee ae pooc pec, p a ceao op peoeyec pe ao c oee po cepo ec: a, oyceece e (eo-, epa-, ap), eaocop 1-o 2-o ooe, a ae ppo, a. Oeaec peceoc C epay aooa, o p oopeeo ee ea o yca eo ece (cep).

poaa. E aoc oycoea ec aoea eo cxoa y oopoex, a ae oco eo aoeea cpeoooo e y oopoex: e epao epeae.

opoooe eee aoo y epeex eeo e oo pec, . . p ooo acyae peooa, a e, poe oo, coxpaec po e, e ea opa, poypya ea-aaa, papyae e. ocee 10 e peoeyec eee aoo poax: a 1-2,0 / c oop eee 1,0 epe 4-6 aco.

Aepacoe oeco A (1993-1994.) peaae poo poay e C poax ce poea c aopa pca (10-35% cex epeex, ooo 20%). p o poay e oya 20-30% epeex, oopoax C, o e ex aopo pca.

Aepaca aae eap (1992.) peaae poo cp epeex 26 ee yypa eoo, a ao poax o oo oopoa ea c aopa pca (4-6% cex epeex). p o poay e oya 4-8% poax epeex, oope oopoa C oce 26 ee.

Ceye oe, o ecoe peee aepx cpec (xopec e opoe aaa epe 6 aco) - eeo.

poaecoe eee aoo oopoe epe y (aepe, cepoc) - eeo. oa aoo ee oeea p a C e y ooo peea o, a ae p aaee cpeoooo e oopoeoo p peyx poax.

II. MOAM. pya poopao acea, a pao, cce xaex oox ye. Paa ecoo pax o ae coca o, ax e y eoea: Mycoplasma pneumoniae, ac po ax eo, eae oa: M. fermentans, M. primatum, M. hominis, eao ocaa caea c ocae poecca aoo aa M. genitalium, Ureaplasma urealyticum. M. hominis U. urealyticum, aoee aco cpeaec oox yx poopa, ocee 20 e paccapac a peoaaea pa paoopax aoea:

caopooe aop, aoece e, epopoe, ocepooe e, xopoao, ecoe, ocaee aoea aoo aa. Oao, ae cceoa ocex e ceecy o oee cpoo po x eecyx opao aoeee aoea oox ye.

oeeec M. axoc ey aep pyca. M. c ea ecx cooo yx opao, ox o aep ocyce eoo ce, a o pyco- coepae H poco cpee e eo. M. hominis oaec o Ur. urealyticum opooe oo, eaoo yceoc aoa.

Moaa- aepo poopa, pepaa ap op c ocooee aaa. peaaa- poapo opa, pepaa oey (cycpa eoxo poca) aa.

eoo. Hoopoee oopyc ea oaa o pe poe. ooa aaa ypeaao oeaec y 1/3 - 1/2 oopoex eoe (24%- ocoo, 9% po ). ooa oao cpeaec ecoo pee.

ecx poe y oopoex ooa e ae.

Meo poopapee a acoy ooa e e. p eoo poeye eee 1 aca acoa ooa caec (o 22%). B eee epoo oa poe ooa popecco caec, peyepao epoe cpeaec peo. oce epoa oooo copea ooa apacae ece c acoo oox oao. opox cecyao ax e ypeaaa eec 40-95%, a oaa- 15-72%. epeex eepeex e oa ec c oaoo acoo. Cee ooa caa c ooo aoc (oeco apepo), opaco e (cee oce e), ypoe opaoa oxoo ce, c cee ooee.

ao e ocoa a ee opaa oaa eocpa oe pa ceecx ae. B co yype poopa ceaec pae peo. Ocoo cpeo e opaa ec co yo (oe cepe) c oaee ceeo poo cpaa, oco copo aoo, oax poc aep. Heoe aopaop e oooc ypoa oa. Ho o e ee paecoo ae, . . ece cya, peye oo cceoa, pae pe.

Cepooece ec e cepooecoo oea a pcyce oa a: aa, ca oeea, epy eaa, ec oae eaoa, ELISA. B ece oae eaoa ceec eao (ap M. hominis oea ypeaa) oc cpey, coepay eo pac, aea poopa. Aea py paoee poopao, pecy ee ea aopo pH cpe. Meo ELISA ycaaae ae ceecx ae acco G, M, A. Ec ec, ocoae a oce ae M. hominis cac ocaoo ae, o cepooece ec ooe ypeaa eee o. ae o pa ae oaae a eao e e, o e yaae a e eco.

ece poe.

1. ooeca c oa c caopoo aopa e a oaaa.

2. He oapyeo c oa c xpooco aoa poe ypoca oa.

3. C a oa oox yx c oop aopa paa cyao eyeeo.

4. p cooecx paax xopoaoa p e oooox o po ypeaa e oaaa: ceaeoc po aoeco oc e oaac o opo. Po M. hominis oee oea: p e oooox o oa peo ceaec po (2-5%), ecoo ae A (o 35% po 8% opo), 85% oeaec ae poc pa ae. Oao, o M. hominis A oee, e 80% cyae coeaec c ae a coopyex aep (ooa pa e A).

5. eae oa, acee opa oa o pe poo, e paccapac, a pa cepx e y oopoeoo. M. ocycy po coooo oc p cecce oopoeoo, oe cpeac peo (9-10%). ae ceac xaex yx y yoo eooex (eee 1500,0) oopoex.

6. ooa ypeaao aaa epeex 23-26 ee e caa c o acco oopoex, peepee e o peepee poa. pe ppoa, peapaa paeo ecyeo a ypeaay, e a cxo epeeoc, a acoa ee ypeaa oox ye e eac (84%-79%). p peepeex poax A ypeaaa eea 2,2%, a oaa 1,5% (o py a-11% 7%). Ho, ec A ec oo oa, o p cpae c ea co cep oa e pa oee a oo o pee o poopapee.

7. ocepooa e. eae oa aco ceac po po c xopao (12,8%), M. hominis ypeaaa ceac c oaoo acoo. Beee oa copooaec oo pa ceecx ae. B o e pe o eepayp eco, c ceo 1-2 , ece poe a ecceo poxo ae e pee ceeco aooepa.

ca acoa oepo, ax M. hominis, eeca, a po oa pa ocepooo e, ocoeo cpae c py poopaa, eca.

8. Bocaee aoea aoo aa. Ocoac a poooecx cepooecx cceoax peooey po M. hominis BMT oo oe 10-30% cyae. Ta a ycaoea eca c M. hominis aepaoo aoa (B), o eee oa oox ye e c BMT, ooo, yaae a po o aoea poopao, ax B.

peaaa e pae ao po oo BMT.

9. ecoe. c ecoe e eo ypeaa ec c oaoo acoo. p cceoa cyae eocoo eco e eo c ey ae oa co, ooc cepaooo (ocoa ec), aeco eeo c, acoo oceye epeeoc. eyceoe eee ecox ap epao oepae ocyce aeo po oa poee eco.

eee. A ooe oa c peapa, oae ce ea. Tepa oaoo e po a M. hominis, a ypeaa. M. hominis ycea oy, o ycoa ppoy. peaaa, aoopo, ycea ppoy, o ycoa oy. a ee coy aoc ooe M. hominis, cpe ooe ypeaa.

Heoopy aoc ooe oa e aoo.

Ceye oe, o ya ypeaay oox ye oe pyo, ..

ca cpea aaa apye ae ao, a ppo.

By eoaaoc po po oa aoeax oox ye ayepce eoo pe oaa ee, apaeoo po oa, oa pae peo. p oopx aopax, peepeex poax, eco ecoo eea eee ooe oa paccapaec, a ec cepe. B cyax, e M. hominis, ooo, ec po aoea:

oep ocepooa xopaa, e oooox o, xopo ec e oo ocaec p cooa aoo, e oaax oec a oa.

III. XAM. Chlamydia trachomatis - aoee pacpocpae poopao, epeaxc oo y. C aaa 1980-x aeo opoco ae xa, a pe ocaex aoea oox ye, ocec x aoea pepoyo y opo oopoeoo (ae op BMT, o oopoex, eo).

Po xa coca p a. C. psittaci ae cao aoeae x eoax, y eoea cpeaec peo. C.

pneumoniae ae ocpe ocaee aoea xaex ye y eoea. C. trachomatis ee 15 cepoo. Tp x (L1, L2, L3) a eepecy opayy (B), cepo A, B, Ba C c po paxo, ocae cepo a ocaee aoea oox ye epaae e.

O cex pyx poopao xa oac coepeo oco e o, oop aaec c poa ycex eo xoa ocpeco ceoo xa poecca aooa.

epa cye eooo poecca- ppeee eaoec eaoo, o eooo eeapoo ea (T) ee xoa.

Oo o epeca pec yec e (oa, ypepa, oepc, oep, aoe py). oce ppee ceye aoo T e ypye. Byp e T cyecye oaaeco ayo - aocoe, e xa ocac ec poca, a oepxoce ae poa py paca c aoco. Booo, o oa p xpoa e. aee T peopayec ceaoe ee (CT), ye eaoec aoe cocooe ee. CT eeoo e oe e e. CT ec 8-24 aca, oecpyc pepaac oe T. epe 48- aca ea papyaec T ec o e cpey. aaec o paoe xa, oop c ooo 48 aco.

Xa aoae pyc e, o ec ooc ypeoo aepe: ac o aex eec ep e-xoa, e cepye AT, c epeec apao. Ho, a ce aep, coep H PH, paoaec eee, ee epy oooy aooe paopaex aep, oopa coep cxo oocaxap.

eoo. y epea e ocoo ooo. epeaa oee pya, e y oooa. ocao, o pc apae e o poaoo appa cocae ooo 40-45% p xao, ooo 80% p ooooo e. B 1/2-1/3 cyae xa c po eoooooo ypepa y y, pepo ooe cyae cpoa Peepa. Beca aca ceaa, xao-ooooa e: p a oope xa oapye y 30-50% e 20 40% y. B ecx oox yx aoee aco opaaec ea a (oepc). aoeae e ee ceecx coo, oe cya ec e poc. Cco-o ep (ec aaoo eoooooo ypepa y y) oae pc OBMT, ec peepyapo ooo epea eoaao e.

Moe cecyao ae e eee e o xao e. Aea xa oapye y 20-40% ecoo acee. oco x e a oe oceoa e e e. acoa cepooepc apacae 30 oa, aee poca e aaec. e a xa ec y 3-5% e. Bae xapaep oceyeoo oea: xa ec 15-33% y aeo eepecx oee, 29-68% y appo y c eoooo ypepo, 67-74% p oaao xao ypepe appa, 28-63% y e co cco-o epo.

aop pca xao e: oepo, ooo opac, coao-ooec cayc, oeco oox appo, pe O (c co coepae cpoea-50). e oa pc xaoa. epeex aopa pca c: epeeoc e paa, opac eee 20 e, pye , o a, ypep y oooo appa, cco-o ep, yp p ocyc aep oe.

ece poe. eoe aoea oox ye e, ae xa, aoa poe oope. Ho xaa e 5 pa ae ae eccoo, poae a coxpa poopa eoe pe, yao epo p apae C. trachomatis (6-14 e) aeo oe, e p apae N. gonorrhoeae. ooy cpe acee cyecye oo peepyap e, oa pc ocxoe e, ypoae pepoyoy opo e.

oep. ea a-ac oox opao, aoee aco opaaea xa, oope c ceec apaa pecoo (yecoo) e, opaa epexoy oy oepc. oep a e ca c xao ee.

e pe e c xao ee e e e coo aoea. opaea ea oe e opao oo, c eppoeco poe oo-cc ee aaa. aco aaec apa oypoo epa. pao xaoo epa ec ae p epcoo poco 10 oee oopoepx eoo oe pe ae eeo c, opaeo o pay. ca e e a ae cpeaec y c xao ee.

Ocp ypepa cpo xapaepyec ype, ac oecycae, ype p ocyc aepyp (co poopao eee 100 c./). peoaa, o 25-50% cyae po cpoa oe C. trachomatis. o aoee epoo y e, pax O, p coax e y oooo appa eo cyecoa coo aoea (o 14 e) ocyc aaea oopx e oeox ye. e c ocp co aepype co c ooo 4 e eec aae e oeox ye. c yaa cpoo aaepaa epa eea.

oep. 50% aeo co cco-o epo ec cooece pa oepa: aaece e pa M eoa, o copooaec oapyee C.

trachomatis yypa coyooec eoa. cex aeo c xa cao oapye cooece pa oepa. Cyec, epccpy xa oep oe coxpac y aeo, oyax aaepay epa o ooy OBMT, c a peepyapo xao e, poeyoo cye e pacpocpae e aaa aoe py. Coycy oep, epoo, ec po aox pooee, aco copooax OBMT.

Ocp ca ec ca cep ocoee xaao e. p cceoa e e a aox py, p poee cepooecx po c caa c C.

trachomatis ea 30-50-67%. B acoee pe caec, o e eee e y 20-40% aeo c OBMT x po ec xaa e.

o eoop a ec e cya xao e coca eee 50%, ocax cyax aoeae poeae ao, p ocyc aaea, o c opooec ee, pecppye p aapoco (pocac).

Cpo -X-ypca (1930-1934.)-ocp epea, po accoy caeoy poeccy ey epee oepxoc ee po apa, o ae o pao epxe apae oa, aco paee a pa ocpoo xoeca. Cpo caec cece ocpoo caa oopeo oo. B ocee o o a paax cepooece cceoa oaa ooecy c cpoa c xao ee.

epeeoc oopoee. C. trachomatis eec e a y 5% epeex (2-37%). 60-70% oopoex, poex ea, ec cepooece pa xao e.

pepo y 30% (20-50%) oopoex epe 2 ee paaec o, a y 10-20% oopoex peeax 3-4 ece eo. ecapeo ceee, poeoe p ex ox oooax, oe peopa apaee oopoeoo xa. Paep poe poa oopoex opeec pacpocpaoc xao e ee a.

o oopoex, ae xa, epe oca 1910 oaooa, oope caa peooee o a ceecoo eooo aea oox yx aep. aoeae aaec epe 5-14 e oce poo, aoee aco- ep ec . B oce cyae aoeae ae e ee papeaec caocoeo, epe ec . p eo ee ooo opaoae ayca, pyo o. p pae ee ., a pao, aaaec e ocec. aoca ocoaa a opaa cocoa o o e (e oe ea), yypao eoe, opeee aea xa (oooae opecpye aea, ELISA). Cepooeca aoca e coyec y a y oopoeoo ae xa, oyex o aep.

poaa ooeope pao cepepa cyao ap eea peypee xao e. Meoo poa a oopeo, a xao e ec peee ax ae, coepax ppo epa. py apaee poa aoea oopoex ec ee eee epeex, poax xa.

eo. o 1975 . po xa oo eo oopoex e paaac. o ce cya pecppyc epe ee , p o ae peyeo oa e ec oae (cpeaec 50%). aoeae aaec c coo co copo epxx xaex ye, aco e oe eepayp ea.

Oeaec aoeoc oca (e ee), ooe cyae - yxae apaao epeo. Co co copo x xaex ye poc e axo, a a caao, oo pcy ao. Xapaep pepye xp a oxe, xp a oxe peoc. Ha peeopae x pecppyec x pacpee (ye) ycopoe cepe epcae pa. B aae po:

oeco eoo ope, oeco ooo-oeo. OC po y ox ee yaae a yepey oc. B ae po oe p ceecx Ig G Ig M.

ao oepaec co po Ig M (oee 1:32), a ae yypa eoo, oop ec oco. Meo, apaee a opeeee aea xa, oaa o yceoc ceoc. eee: ppo per os oe 50 //cy, paeo a 4 pa, eee 10-14 e. eoc ee cocae 80%, ooo poeee oopoo ypca.

Xaa e y epeex. aeoe oeco cceoa, poex 1980-1990 ., e oep c xao e oepca ocepoox aoea.

oep oce aopa paaec y 10-35% e c xa epo. a ae, ceye paccope eecoopaoc oceoa a ae xa ee a e, apyx pepae epeeoc, c oceye poao OBMT epao o pe oepa aopa.

B epopoe: ecop a oee cooe, oco cceoa opa c x ocoe epeeoc c xao ee.

Heoaae, a acca p poe, peepeeoe e o.

Cee o c x ocoe epeeoc c xao ee y epeex poope: ecop a oee cooe, oco cceoaee pax cpaax pa y c e oepa.

aoca. poe eco ap aoea ooo cceoae cocoa eooo aepaa oepca ypep (c o eoxoo ya aoo): opaae o pay c oco oopoyeapo o o yeee (oee 30 oe pe).

ooec eo ocoa a e ceecx ypeox e eoo aepae cocoo c eax opoo, opaex o aaoay, peec peo, ..

oe eoe (yceoc 20%). Eo oo peoeoa oo aoc ox oo y oopoex.

ae cepooecoo cceoa o cyecy ecoe: y a ae xa y cecyao aoo acee (o 40%) aoca eopea, a ooee ae ooo cceoa ceecy o epeeceo poo e. Cya cee e oepa p Ig M, o ceecoo Ig G 4 paa.

Tp ceecx ae e a oooc cy o eco ope, oaa ee e. B o e pe, ocyce ae xa cae ae e, a cepooece ec oy pec a eo cpa pyax acee c o acoo xao e. p ooex ecax eoxoo oepee a poa ee ceecoo aea, yypa eoo. Booo pecoe eee, o, oao, e peoeyec y pooo pacpocpae C. pneumoniae, cepooec e oo o C. trachomatis.

yypa eo ec caapo. p eoxooc pacoppo peec ceaa cpea (cypoocya), coepaa ao: ea, ao, ca. Cpea c poo coxpaec oxao (a y), oy cpey ypoa ceye poec peeax cyo, ae poy ceye aopo p 70 C0. yypa eo (Mao) c poo epaec 24-72 aca, ae pooc opaae (oo, o e, ee yopeco oooae aea) poco. yceoc eoa ocae 70-80%, p oopo accae epe cpey ypoa oo e 10-20% cyae poa.

Oapyee ceecoo aea ec oee cp e eoo aoc xaoa. B acoee pe cyecy a ocyx eoa opeee aea xa. Bo-epx, poe opaae yopecpy oooa aea eeapx ee aax c yceoc oee 90% ceoc ooo 95% ( cpae c eoo yyp). Bo-opx, eo ELISA c yceoc ceoc cooeceo 90% 90%. oo ooee peya oox eoo coca 2-3%. p oceoa py acee c o acoo xao e (2-3%) ooea pooceca eoc eoa (coaee peyaa eca c ae aoea), ecop a coy . C., cocae ooo 50%.

coa, ooe peya eca oaaec pa ooe cyae.

oepaa ea pea (P) ooe yea co ceecx yaco H 100 000 oee pa, ea x ocy ea. Meo ec y o ooc aoc xaoa cpe py acee c ypoe poa, a eo ., C., pac 100%.

Oceoae a ae poa xa oaao ce ea, y ooo , o, coae, oa eoco.

Peao oceoa a xao oox ye yac e c coo epooc e: cco-o ep, oep, OBMT, ypep ( ypep y oooo appa). p oceoa py acee c o acoo poa ceye cooa yypa eo P. p coo acoe poa (oee 8%) ooo peee eoo poo opaa yopecpy aea ELISA.

eee. ep ao poa aoea ec ocyecee popa cpa a poaoc xae oox ye e, oopa ec oao epao opoao epea e, cyeceo oae pc apye poecco pepoy aoea oopoeoo, p, epy oepe a acya epeee.

Cyecy p ocox apae ope c ee:

1. Mep, apaee a yeee peepyapa e: a) pooe cooae epaa ee oope ycpa cyecyy oopeeo xay e, ) eee cyae eoooooo ypepa oox appo epao ppoo, ) ao e oxo ee cco-ooo epa.

2. peypeee epaao e: aea paa cepepa cyaa ap, pee poa ooeope a ae a, coepae ppo epa, ae ooe xa.

Ceye oe, o a oxo e ycpae oacoc pecpaopo e y oopoex, aeo ycyae o eoc epa, apae a ycpaee e oox yx e.

3. peypeee oaa oopoeoo c ee poecce poo:

ee eee epeex c poa oepco.

Oceoae cex epeex opoocoee epope p acoe poa oy eee 5% oee oo c (ooeco o pe) oceoae eee oopoex. p acoe e oee 6% caoc ooec o oceoae eee epeex.

eee epeex 37 ee ppoo eee 1 ee cae ypoe poa oopoeoo c 50% o 7%. eee aoco ycpae e y 98% epeex, a 95% oopoex ocac opo. Booo peee aa c ypoe eoc 92,7%.

Peoeye pe ee e epeeoc oc per os 100 2 paa cy eee 7 e (opo eeoc e peyec) Apo (cyae) per os oa oa 1, 0 pa (opo eeoc e peyec) pye pe:

Ooca per os 300 2 paa cy eee 7 e (opo eeoc epe 3 ee). pooca eee.

ppo per os 500 4 paa cy eee 7 e (opo eeoc epe 3 ee) A per os 2,0 cy eee 10 e (opo eeoc).

Booo peee paa aa, peee oceeo ocoeo ao p ee OBMT oe 600 4 paa cy ypeo.

Peoeye pe ee p epeeoc ppo (ocoae) per os 500 4 paa cy eee ee oe 250 4 paa cy eee 14 e.

Aoc per os 500 3 paa cy eee 7-10 e eee oopoex. eee oa oopoex pacopa epaa ppoa ax pao eocaoo a. ooy e poe xao e y oopoex c oaa cceo epa ppoo, ycpae ocoooy ooa peypeae pae eo. ppo aaaec oe 40 / / cy eee 2 ee.

IV, EPEC. Boye-herpes simplex virus, oocc ceecy pyco epeca, ya ae xo pyc oea, epo oc pye.

aoeae epeac oo y aec y a pyca: 1 2. Bpyc coep H, opyy oooo opoeo. Oac ea ocoo opaaec B-2, o 15% cyae cpeaec B- (o 20-40% p opoeao oae). Aea oo a pyca e epepcy peaoc oco aopaop e paec.

Paa epoe apaee opay opy aoea (pe).

Bpyc poae epoe ooae, aee, epe aco epo e, - a (ycee eeae) aeo opea coo oa, e cyecye oeo. ae, ee aea B-1 oy poac B-2. B o cyae e poeae opoe, e p epo poa B-2, ooy e epe o eep ea epec.

epeeca e ae poec e peo, a x acoa 3-4 paa e p poa B-2. p o 25% cex peo e poea e ec eccooo ee pyca.

pepo 5% acee ee aae eao epeeco e, e 15-30% e ceece aea B-2 e aaea. epeex aea B-2 cpeac 16-29%. B-2 oo e e a 80-86% p epo e, 65% p epe oe eepo epece, oo 12% p opao ope aoea.

Ceye oe, o po B oo paa e a oepya, a p aopo caec pyc ao eoea.

ece poe e. Be p pax cpoa:

1. ep o epoo eaoo epeca paaec y , e ex ae B. p ao ee pyca apaac ooo 75% appo. Xapaep paee ece co c oece oee opae, popeccpy o e, a ae axoa aeoa, oe poe: xopaa, eooae, a, ooa o, ooa. c opao yo cceo oe poxo caocoeo e ocec, o pepo y 4% ep o epeca copooaec eo.

2. ep o eepoo epeca, oop cpeaec y c aea pyoy, eepoooy y pyca. aoeae poeae e, aoa opay opy, o eee eo eca apaeo.

ooy acoee pe pac, o ocaoo ao paa yaae op oo o a ae copoe po ocp epo aoea.

3. Bopa epec (ae cpeaec p poa B-2). oee x opae peapec ec popoa coa:

o, y, apece. popo pooaec 2 . aee poec a eca coaa, eoc oopo cocae 1/2 o oo eoc oa epoo epeca. co opae eooe, a oe co ocycy. epo ee pyca opoe, oo 3-5 e, a epooc eo ee e a ae ee.

aoca. y eo aoc B- eee pyca yype, o peye 48-72 aca. epa oa ee pyca a 5-30% oo - opaex peyao. ooe peya eca oee epoe p epo apae eee-p pee aoea, a ae epe ecoo cyo o oea apae (o 72 aco) cpae c oee o ocea. Cee ca ae a ooe peya p ypoa pyca cpae c ocox . Oao, p cooa oo ecx pao yypaoo eoa aoc oe cya aoea ocac epacoa. aeoe co , c oaa cepooec ae e, e e coo aoea co e: pe, ypyy, copa, pea.

cooae ceecx oooax ae a , C cooeceo 78%, 98%, 93% 92%. Coaee c peyaa yyp cocae 75%, o oe ao ocaooe oeco eo ae: e eee 20. B o e pe o ec e aee e oee yypa eo, a a p o acoe aoea pye acee aoceca eoc eca caec, eo yyp ye oppepye c eoo aoc pyca, a p eccoo ee pyca e a yceoc eca c cooae oooax ae oe e, e yypaoo eoa.

epe aa c yocope (ELISA). p ao pacpocpaoc pyca pye acee (eee 10%) p eccoo eo ee aocece peya eoa eco, o p ec o epece o aeo ye: , C coca, cooeceo, 84-97%, 99%, 89%. B o e pe pae cce a pae peya, p ao eoe opeeec ae, o e a pyc.

oepaa ea pea. o peape a ooc aoc aoea epeco paec acoo (100%).

Cepooece ec e e paecoo ae, a a e oy oep ae ao e. O oy oe p eco aaee ooe aoea epeco. Ocyce ae opae aoeae poo, o 80 - 90% cex pocx e aea ooy oo a pyca.

oopoeoo p oope a poae B ece a eco ec eo yyp.

eee. B aae 1980-x ooc epoe eoe cpeco ee epeca - aop (opac). peapa, aaaec opaex pyco eax, paeo aoecye c pyco ao, ocoppye peapa ooocaa eo aoe poooe aop poca, oop, c oype opo pyco H-oepa, ocaaae ce pyco H. Ta opao oeceaec paeoc (e aaaec opox eax) eoacoc ec peapaa. Aop cyecye ope 5% a, acy cyce epopaoo pee, opoa pooe pacopa ooo /.

Ceye o, o p aece a eaeo aa oy py epaa, a ecoea p ee pea aoea eo poa, e oa aocc a ccy aaa, a a e ocoa oeo, oaae papaaee ece.

Bypeoe eee A. peoeyec p x cyax epoo oa aoea, o copaae pe o opoe, cae co aoea yopaae pe ee pyca. oa: 5 / epe 8 aco eee 5 e.

B e acy peapa oc p:

1) epo eao epece oe 200 5 pa cy eee e, 2) p ex poex opao op aoea o e oe eee 5 e (eaeo aa eee p epx paax aoea) 3) poae acx x peo (ooo 6 pa o) oe 400 a cy epepo o 6 e (oee ea poaa e pooac). Boo apa opoa: o 200 a cy o 200 5 pa cy. oaae yea aea a oe ee e ec. p pepae pa peapaa y 86% ox ceye pe aoea.

Ceye o, o ae p yceo peypee ecx op aoea, a oe ee ooo eccooe eee ooa epeaa pyca.

Ba peypee aoea oa e cyecye. Oao, oe oe c opa pea aoea e pey ceecoo ee, a oo coaecoo.

B acoee pe A. ee epeca eae, ecop a oee ox peapao. Baaop (apec) - L-ao p A., oepac poy ee, peyao oopoo ec A. eaea aocoa L-a. peapa ee oee coy oocyoc cpae c A peec eeo oe 1000 a cy ee 10 e. poaeca oa-500 pa cy.

aop (ap) oe ocac eax opaa (7-20 aco po 1 aca y A.), o eee ee ooe pyco H-oepa.

peec eeo oe 125-250-500 a cy o eoc pae A. ocape oaae poe ece a H oepay. peapa oce oe pec oo eco. op apyec e yac B, cae epeay pyca. Cyecye e e 3% pea ecoo pee (Tpae).

ea epec epeeoc.

eoo. acoa eccoo epeeco e oox ye y epeex cocae 0,1-4%. Cpe epeex c ooeo yypo B oox ye acoa eccooo ee e cocae 13-66%. epeeoc e e a acoy ec epeeco e. Bopaa opa aoea e e a cxo epeeoc (aop, eoaae), o e epo op oe ooo. epeaa pyca oy epe aey pocxo ceo peo (ee cya), o copooaec ocec: 1/3 oopoex poaec p, ce e-c epooec ocoe.

epec oopoex cpeaec c acoo 1/5 000-1/20 000 poo.

epeaa pyca ooa p aax poax, ecapeo cee cyae peepeeoo o, oooao. Hao pc epea B oopoeoy cyecye p epo e: 50% (20-80 %), a cepoc ocae 50%, p o e oeaec opae ox ccx opoo. p opao ope aoea pc poa oopoeoo e peae 4%, coca peao pepo 1%. By peoaa eccox op aoea ooo 70% cex cyae epeca oopoex, cpeaec p ocyc coo pyco e ea y aep. Maepce aea B e c ao ao oopoeoo.

epa e y aep I o II pecpe pepo 20% cyae po eoaa. epa e III pecpe ee cae cepe ocec: eoaae, P, epopoee, aoeae oopoeoo. pepo 10-11% epeex pooa e pyc oce epoo oa aoea. Pee op aoea eepe o eee oac (eee pyca yype oox ye 0,5%). B o e pe ceye o, o ecco oce B oe coo e oopoeoo. p aaee opao op epeca eccooe eee pyca a oe poopapee cpeaec y 1% (0,75-3%) epeex. Pc aoea oopoeoo x cyax cocae eee 1:1000. He ce e, y oopx eea yypa eaoo epeca e aae eo ecx poe. ooy, p ocyc coo y aep pecaa peopa oa oopoeoo c B paec eooo.

Pc aoeaeoc oopoex p eao epeeco aep e 10 pa e, e p pex opax aoea y epeex. a ep, a eep ep o aoea po aoeaeoc oopoex 30-40% cyae. pcyce B ee a, a opee o oo, oa pc aoea oopoeoo. Maepce aea B-2, o e B-1, oaa aoe ece a oopoeoo. p poopoa aoeaeoc oopoex eoxoo ya eooe co B: opaee ae, y y ooo epcoaa poee, yxaax a peo.

poaa aoeaeoc oopoex. a ocee 30 e e coao aoo eoa peypee epeeco e y oopoex. eoc ecapea cee p a B oox yx p eoo poeye oee 4 aco ec coeo.

Aoee epe C opeee ypypooo poa acoee pe poo e peoeyec, .. pc eo ocoe peae acoy pacaeapo epea. poe oo, epeo ec cya, oa p ee ooeo yyp pyca e a A, oopoe oce aax poo e ee ecx, cepooecx pao aoea. Peoeoaac o 1988 oa aa ee, aaac eeeeo opeee yyp pyca oox yx pooa oooo poa oopoeoo poax, ceo paa opoocoe eeo.

epo ee pyca oox ye coca 3-5 e aco ocac epacoa.

Beee epeeoc p aaee aoea ea epeco y epeeo ( appa):

p ocyc ca a oox opaax poo po epe aae poec oceoae aep oopoeoo eoo yyp a oe poo o aep e peyec p ao oxoe pc eoaao e oe a: 1:1000 poo.

p oe epeecx ca a oox opaax poax p peepeeo oooox o:

poeee C cae pc aoeaeoc oopoeoo oepa poec o peeax 4 aco o oea oooox o p eoo poeye oee 4 aco poeee C ae ec eecoopa y epeex c opa opa aoea epooc poa oopoeoo oe a, a oa C coea:

opoo, oo ocoe aep.

p oe ca epe poa:

peoeyec yypaoe cceoae P c epao 3-5 e.

p ocyc pyca oox yx ec po epe aae.

p epo oe epeca, oa pe oee ac, a ocoe oopoeoo oee epo, opaa oxoo ec eeeeoe opeeee yyp pyca oox yx ocee ee epeeoc.

p aax poax oaao epeeco e oox ye:

oao poee c ooo coao aoea p epo oe aoea eee pyca y oopoeoo eoo yyp P (aa, oa, coooa oc, cy, oa) ec oae. o ooe ec y oopoeoo cape 48 aco, ocoeo coooo oc, ec oaae / ee A.

p poex epeeco e y epeeo cpoe eee ee aa ee ec aeo, a poopapeee C e peoeyec.

p epeecx cax e oox opao pc oe B ee a o: 1-2%, o cpao c ao p opax opax aoea. Peoeyec ec po epe aae, pp opae eca caea. He aa o ae py epcoaa.

eee p epeeoc ooo p x opax aoea, ypoax aep. Ha ceo e poeee ee A. p epeeoc peypee peo aoea e peoeyec. B o e pe, poex cceoax, e epeee c o e oya A., oeeo cee aco oapye B oox yx, , a cece, aco C. poe ococ peapaa, ocoe epeeoc, opaex ocec oa e eo.

cpy aep c ec poe epeca:

ea oaa c oao opae (oee e, py) pa oopoeoo e apeaec pyoe capae e poooaao epcoa c poe epeca ye ya ayepcoo ecoo oee.

V. OHOPE. Baec pa-opae ooo Heccepa. B ppoe cyecye oo o xo oooa-eoe. Mpoopa oe cyecoa a ccx oooax, opx pec, yec oc eopooea ee. ae ceo opaac ooo oeoooo paa. Opa oe ycee yco ee cpe. Oa pa poopaa c ceye yco: pH=7,4, eepaypa 35,50C, coepae CO2 opyae cpee 2-10%.

eoo. oope poo pacpocpaoe aoeae: eeoo pe pecppyec oee 25 . ox cyae, p o eco, o oee oo cex cyae aoea ocac epacoa. eca.

aco poeae eccoo, opaa oepc. e aoee coa aoeaeoc oeaec opace 15-24-29 e, oopo pecppyec 75-80% cex cyae aoeaeoc. aoeaeoc y y e cpe pocoo acee cooocc 1,5:1, o y opoco coooee opaoe c peoaae aoeaeoc cpe e.

cecyao ax e 15-19 e oa 2 paa e, e opace 20-24 oa. oope pecppyec y 1-2% e, ocopex ayaopo, y 5% e, axoxc a caoapo ee, y 0,5-7% epeex.

epeaa H pocxo o ceo epe ooe oa.

ae ceo opaaec oepc ypepa (70-90% p poa oepca). Pc apae y e e, e y y. p oo ooo oae c o appo pc apae y y cocae 20-25%, y e - 50-90%. p o yao epo copaaec o 3-5 e. B 1976 oy epe oapye ycoe ey a H, oaae ceec B-aaaa. B oceye o oee poc ca ax ao: 1988 .-4%, 1991 .-13% cex cceoa. C 1983 . pecppyc a c e eeec oo, ycoe e oo ey, o eaocopa, aooa, epaa.

ece poe aoea. Xo oco poax e e ee coo aoea, o aea x ac: o 40-60%,oea ae ee aaa, yp, eecpyae poce ee, eoppa, yco coopa oac aoo aa. 15-20% poax e ocec paac OBMT, oo oe cpay oce ooa ecpya.

eca apa epa, aoo H, e oaec o epa pyo oo, oe copooac e ypepa, opaee e Cee apo.

Beooe op aoea a opaee po , o, o, epea (cpo -X-ypca).

ooea yypa H po e ec y 30-50% e c eeo oopee, p y 5% poax o eceoe eco pcyc H. Cpe e c pcyce H oox yx y 10-20% o ceaec o, eee e y 5% poax o eceoe eco eo pcyc.

Pacpocpae op aoea poc cpaea eo poe cece aepe. x acoa cocae 0,1-0,3% o cex cyae aoea, p y e 4 paa ae, e y y. ae aoeae poec III pecpe epeeoc peeax ee o aaa ecpya. Meee e ooe cyae yac oaa ceecy oo aoea y ee yyp oye ypex cpe opaa (po, cyca). oo caec epoo, ec yac oy ooey yypy H oox ye ooo eo oooo appa. oo caec ooo, ec p ocyc ooeo yyp eee oaaec e.

Ca aepe oe copooac ooo, xopao, appo, epao a pe poe aoea, a oap (c opaee aopaoo aaa) e. epa poec opaee ce ae, a oopx oc ey, pepaaec ycy , aee, ecceo ceae. Ceec ceec app poec opaee oee, c, oeocox cycao. po, a pao, cepa. Coaa oc popeae o xapaep coep yypy H.

Oa oopoex eca c 1881 ., o ee poa cpeaac y 10% cex oopoex. p poa aep o 30 35% oopoex p aax poax pyc H. aoeae oo poec epe 4 , o ooe yao epo o 21 . ece poe paac ycopoe oo oe, oop p ocyc ee cpo popeccpye o e poo c ocey pyeae ceoo.

epeeoc. p a H ee a oo oocee ocoe epeeoc: ypaoaa e, peepeeoe e o (21-75%), peepeee po, aop (11-35%), poee eooex ee (17-67%), a ae P, cecc oopoex po. epaaa cepoc ocae 8-11%. a, o o ce poae epeee e e coo aoea, peoeyec oceoae cex epeex eoo yyp p epo e, oopoe oceoae epeex py pca aae peeo pecpa.

aoca. He oo epeee, o oco eepeex c oopee e e coo aoea. p epo apae aoee aco opaaec oepc. Opaae o pay ccyaa oeaoo oaa e (paopaee oo yp oopoepx eoo) ooe aocpoa aoeae y 95% y, o oo y 60% e. oepe aoea y e eoxoo eee poopaa yype. B o cceoa yac ce cecyao ae e. Ho oee peao poeee oo cceoa pyax pca: aoeae y oooo appa, pa aoea oox opao, OBMT, ae pyx , oocee ooe c. Bce epeee p epo e o po cceoae a ae oope eoo yyp, y epeex py pca cceoae oopec III pecpe. ee H coyc ceee Cpe a Taepa-Mapa c aoo, oco, cao.

yypa eo p eceo ocee ooe oo aoeae 80-90% cyae. ye cooa a oceoaex aopa aepaa e a oa aepaa e a po . Cepooece eo cceoa ee y a ae oce peyx oo aoea. oc aea H eoo ELISA (oo) ee coy C y y c coa aoea, o ooe aoc oope ee a C eoa , o cae cooae eoa cpa aoea p eo pacpocpae oy eee 1%.

eee. a y, a eepeee e c eocoo oopee e e pa peax ee. H ycee o o apo aea, xo ocee o oc a, ycoe aaepa cpeca. Aaepae cpeca, peee ceo, a poe eeoc, pea 95%. Cpe ox oopee aco aaec oe, a 15-25% y 30-50% e oopeeo c H apae C. trachomatis. ooy ce ae, poxoe eee o ooy oope, o oya eee po xa. Oopeeo peoeyec cepooec cp a cc.

eee eocoo ooooo e Peoeyee pe:

epaco (poe) / oopao 125 * eee eo po cca yaoo epoe ec per os oopao 400 pooca per os oopao 500 Ooca per os oopao 400 * opxoo e peoeyec pa epee op aep * epeee o oya eee eaocopa , p x eepeococ, ceoo oe 2,0 /.

Peoeyec ooeoe eee xao oe oco oe 100 a e eee ee. epeex - ppo 500 (250 ) epe paa e eee 7 (14) e.

Aepae pe:

Ceo (apo) 2,0 / oopao eoc-500 /, eoac (aopa)-500 /, eoea-1, /, eoc-2,0 / oopao.

eypoc ace 1,0 eooc poc 200 per os oopao.

oca 400 Hopoca 800 per os oopao.

oce ee eocoo oope cooec c peoeye pea ec a eeoc e peyec (peoea epa o opo aoeaeoc, CA). p coxpaxc coax aoea eoxoo oopoe yypaoe cceoae c opeeee yceoc H aoa. p ee aeo py pca, ex coy epooc pee, peoeyec oopoe cceoae a ae H epe 1-2 eca. ooe app ox H yac oceoa eoo yyp ee o oye peyao oceoa.

eee ocoo oope.

Peoeye pe:

epaco 1,0 / / pa cy Aepae pe:

eoac eoc 1,0 / epe 8 aco p eepeococ B-aax aoo - Ceo 2,0 / epe 12 aco eee pooc o pao ecoo yye 24-48 aco oce oo, aee, o cee oo ee c aaa ee, oo ceye pe: ec 400 pooca 500 per os a e.

* Ceece e oap pey / ee cox o epacoa: 1-2,0 epe 12 aco. eee ea pooaec 10- e, oapa - o 4 ee.

apeaa H ec o cxee eocoo H. epe 4-7 e pooc opo eeoc eoo yyp.

Oa oopoex peye o ooo pea a 24 aca o aaa ee, oopoe pooc epacoo oe 25-50 //cy / / oo oe eee 7 e ( pocx-1,0 / oopao).

Heoxoo eeacoe poae a ooec pacopo o pepae ee.

VI.CC. Boyee ec cpoxea Treponema pallidum. B oceee ecee C. o p opy e co ae poco aoeaeoc epeex cyae pooo C. Be ep C. c oppoae oaa epoo opae (ap), pecaeo coo eco pooe oye. ep oa papeaec e ee epe 3-6 ee aoeae epexo o opy ca. Bop C.-cceoe aoeae (oe poe, A, aepe) eec 2-6 ee. epe e ca aoea c epoo paoe cpoxe, oa aoee epoa epeaa oe pyoy y.

aee aoeae epexo aey ay, e ey ecx poe. aea aa caec pae p eoc aoea o 1 oa. Tpe C. paaec y pe ox p ocyc ee xapaepyec popeccpy opeee HC, oco-eo cce, apexaox opao (opaoae y xapaepo oeo opoaeceoo peoo C.). Treponema pallidum ec ceo aapo opao, in vitro e pac, o paoaec opae ox, ocoeo poo (oooc px ao cepooeco aoc).

eoo. Caec, o a 1 e cya aoea C.

pxoc 3 eaocpoax cya. B aeo ae C. oo y e epeac, o ooa pacaeapa epeaa oy. 25% ox e ecx poe C. oo epoece oocpe aoea c oee eox oao e opae ccx o. B Poccco eepa coac pae eaopa eooeca cya o aoeaeoc C., oopa c 1989 . o 1997 .

opoca 64 paa cocae 277,3 cya a 100 000 acee. p o oee oo ox - e. Poc eo aoeaeoc cpe ee opoco peae aoe cpe pocx. B 1997 . co ee opoco, oex cco, cocao oee 28 c, a ec x - peo o 14 e. p o 2/3 ee apac oo y, a y aoo epoo pea e po cc. aoeaeoc C.

cpe opoco opace 15-17 e a ocee 5 e opoca 47,4 paa.

a. yao epo C. c o 10 o 90 e. ep oa, ap pecae coo eoeey y c o ocoae. e cyecy cooc c ee apa, oop oe axoc o aae, o py, oe, a ee a, cocax ayce.

Booa A e e axox oyo. opoo C.

xapaepo ae ayoayo eepaoao c (70%), opae aoe, oo (50%), oee poo cce (21%), eepaoaa A (85%), poe oo. p peo C.

ooo oppoae aep aop eocaooc aopaoo aaa, opeee HC: ape, ca cyxoa, apo peoo epa, eoacyp C., pao Ap-Poepcoa, e peapy a ce, o coxpa oooc aooa. Oo pe C.

paaec epe ecoo e aoea, o eo pae c epooec paccpoca ooo aoo pae, ocoeo y ox c yoeo.

Bpo C. Cpoxe poa oy ye 8 ee epeeoc, o ece poe y oa oo oo oce 16 ee, oa oec pea yo cce. p epo opo C. y aoeo oeca cpoxe po aep eec aca pc epea aoea oy ( cpae c aeo ao). poae oa acyae 100% cyae, pa pooo cca oeac 50%, eaope cxo epeeoc: epopoee, eoaae, eoaaa cepoc- 50% cyae. p pae aeo C. po C. cpeaec 40%, epaaa cepoc - 20%, eoaae- 20% cyae. p oe aeo C. po C. cpeaec 10%, epaaa cepoc- 11%, eoaae- 9% cyae.

Cyecy ae o oee coo aoeaeoc cepoc.

p pae oe aeo C. cyax epao epea oopoee e e coo aoea, oope oc epe 10-14 e oce poo. ap e oppyec, a cee cyae, oa apaee pooo poax. Xapaepe poe paeo pooo C. (aao aoea opace eee 2 e) a: ayoayy c (ooa ya opa), aoeoc oca c ee, oee poo ccy pooo, eaoceoea, eyxa, A, oceoxop c ceoapao appo, xopope, p. opae o ccx oooe coepa cpoxe, e p cceoa o oe. Hee eee pa po C.

popeccpye o accecx poe oeo pooo C. : y Xacoa, op e oo eo, epca epa, yxoa (opaee 8 .-o. epa), ceo oc, caee oe, epooece poe (ycea ocaoc, poea, eepaoae ape, apo peoo epa).

aoca. Haoee ce yce eoo aoc cca ec eocpa peoe cex poax, oyex oaa opae. cceoae o oe pa poa c yopecpy aea c ocoep eoa aoc paeo cca pooc oo cyax epoo opoo C. po cceoa epyc oo oaa opae, oyeo apo poee opoo C.

Oao, oco y o ce e, oop cac ao C. oo e e coo axoc aeo ae aoea. ooy ae ceo ao ocoaec a cepooecx ecax, oope opaec a a a: eceece ae pea- a ceece ae po peoe. epoy y oocc pea Baccepaa, coyea cpa aoea.

Tp eceecx eco oo ca c aoc aoea, ooy x peya o oeac oeceo. eee pa 4 paa yaae a aee ee. Hecop a o, o pea Baccepaa e ec cooyce ce eco, co p ae (oee 1:16) oo yaae a a C.

Ceece ec coyc oepe aoa C.

y aeo c ooe eceec eca. oocc:

ec oa peoe, ec acop ceecx yopecpyx ae, ec poeaa. p oe epoo oaa (ap) a eceece, a ceece cepooece ec opae. aocecoe aee ee oapyee cpoxe p cceoa o oe oeeoo oaa.

epe 4-6 ee y cex ox c ep C. ce cepooece ec caoc ooe yy ao a poe opo aeo a aoea. Bce epee c ooe eceec eca a C. oa pooc x oecea oea, a ae ceece ec a C. oo-ooe peyaa eceecx eco oy pec: pyca e, ayoye aoea (oaa, peao app), yopeee apoo caa epeeoc. Oao, oo-ooea pea ae, ae ceo, cao. pepo 2% cyae epoo opoo C. o ae po ocyc ooeo pea y eoooc oppoa oeca ae-aeo. ooy y cex epeex c co pco aoea C. eoxoo pao copoy, occaaa eoxoy ooeo pea oepa ae.

aoca eccooo epocca. p pae (o 1 oa) C., ya oe peya ee ae p eex coooo oc, coooa y e pooc. p eoc aoea C. oee 1 oa coooa y oea: eoo, yeee oepa ea, ooea pea Baccepaa yaa a a epocc. aoca epocca eooa c oo aoo-o ooo eca, ao cac a ocoa oa cepooecx eco ax cceoa coooo oc, acoc, oeco eoo 3, peaee 5, yaae a a epocc.

ao pee epccpyeo aoo C. oe ocae y aea c aaeo aoea o ae pa ae. p yceo ee RW p caec ceae epe 6-12 ece p pax opax C., epe 12-18 ece p eoc aoea oee 1 oa. Poc pa yaae a eoxooc ooex aocecx epop (y) cooecyeo ee.

Bpo C. epyo aocpoa y oopoeoo c coa aoea: eyxa, o ea, oa oa aea, oep ae peoe cceoae o oe. Oao oco poax oopoex e e coo aoea p poe, o x po yo a ooey pea a C. o a eceecx eco. a pea oe cece a ceecx ae y oa, epeex ey o aep (Ig G), xc cece eo poa (Ig M). Paeee x o ae pecae oe pyoc. Ec cepoooc oopoeoo ec cece accoo epexoa Ig G o aep, p ae p pea Baccepaa eyoo cac cea peeax 3 ece . o oopoe, e ooey pea Baccepaa p ocyc ecx poe C., oe oee c cooae oo eca eeeco eee 9 ece. o pa ae yaae a a C. eoxooc ee. poae oopoee oy e e e oo ecx, o cepooecx pao aoea, ec poae eep pooo oe cpo epeeoc.

oco co ca ooee eceece ec (RW), oepe peoece eca po yo oaaeco aoea C., pcya ee oopoeoo.

ec ycee o aoc pooo cca y cceoa A: opeeee cpoxe p poco o oe apaee poo. p ypayoo cceoa oa oope a C. c eaoceoea, oa aea, eocoa epoxooc ea, pa eyo o oa.

eee. oea oaeoy ee:

cyae ooo oa c o, e oep ao C.

a c ooe a poco o oe a c ooe peyaa cepooecx peoeceecx eco a, y oopx ao C. e oe oepy c oo opeeoc a, eec o ooy C., o ee pa pee: oa opae, oopx aea peoea p cceoa o oe, 4-x pa o pa ae p eceecx ecax.

y eoo ee C., o oaao oyeo ec cepeo, ec apeepaoe eee ea. opa peapaa, oa eoc ee ac o ca C. eo ecx poe (poee 2). p epocce epeeoc apeepaoe eee ea ec ece o ee c oaao eoc. Bce ae, poxoe eee o C. o poepe a ae B. p coo epooc B-e a c ep C. o oceoa a B oopo epe 3 eca. p a y aea coo, yaax a oooc opae HC a eoxoo poec oceoae c peee, cooeceo, coooo y eeo a.

p epo opo C oea eoc ee ocoaa a cepooecx ecax ecx ax. B cyae epoo opoo C. ae oceyec ec cepooec epe 3 ece oce ee. Tp ae p RW oe cc 4 paa epe eca oce ee. Ec oo e pocxo, o ooo eee o ee, a aea ceye oceoa a ae B-e.

ooe ae yac aeco cepooeco eco oceoa. Ec o eooo ceye oop ypc ee.

a c coxpac pepy coa aoea 4-x pa oo pa ae p RW o oce oe a B po oopoe eee y eeoc peyeo ypca pee. oop ypc ee coco 3 eeeex ypex e ea ea oe 2,4 . e., ec peya coooo y e yaa a ae epocca.

eee aeoo C. apaeo a peypeee peoo C.

ae, ee C. eycaoeo pooeoc, eyc a oe c o ae C. c eoc aoea oee 1 oa.

c ae C., e aep ey, eee py aoa ooo oo oce ce epocca p cceoa coooo oc. pec peapa oca epaa. p pae aeo C. eee pooc 2 ee, p oe- 4 ee. epeee o poee eo oce ececa.

acoa e epocca o a cceoa coooo oc y c ae C. a, ooy pyoe poeee coooo y e peoeyec. Oao oa eecoopaa:

p a pao opae epo cce a p a pyx poe aoo C.: aop, p, y eeoc ee ae B-e p RW pa oee 1:32 p eoc aoea oee 1 oa p apyeo epa e cooa ea p eoc aoea oee 1 oa.

eoc ee aeo c ae C. peye oeceo oe eceecx cepooecx eco epe 6 12 ece.

cceoae a epocc oopoe eee eoxoo, ec p ae opaca 4 paa pa ae epe eee pa pea 1:32 a 12-24 eca oce ee e cac 4 paa y aea pcycy ece co aoea.

ae c paa oeo (peoo) C p aep ey eac o cxee, peoeoao oeo aeoo C. eee epeex pooc oo eo, p eoxooc-oce ececa.

pa opae HC oy oc p o ca oe.

ooy ce ae c C., y oopx ec pa opae a, cyxa, apa epeo-oox epo o po cceoae coooo oc.

epeex eee eo eo a peypee epea aoea oy, a ee e, paec y oa.

Ceye ae, o coe p ae p RW a oe ycaoe aoa eycaoea eoc aoea yaa a ae pc poe pea c po C., ecop a eee aep. p ee C. oce 20 ee epeeoc cyecye pc peepeeoo poopapee cpecca oa, ec eee copooaec peae p-Xeceepa. Haee a peyaa ee p epeeoc pooc eeeco c cooae po eceecx cepooecx eco. Hoopoee o cepoox aepe o oceoa a ae pooo cca, ec eee C. y aep e poooc poeeo oo ppoo eee C. y aep aoeo eee, e a ec o poo eee poeeo aea oa ea, o p ae p eceeco cepooeco ece cc eee e 4 paa eee C. p epeeoc e oepeo oyeao o opao eee C. poeeo pao o epeeoc, o e cooecye cepooeco oe peyao ee.

Ec a oya aeaoe eee eo pax cpoax epeeoc, po C. cpeaec pae peo. Hoopoe eee aaaec, ec eee aep o epa, ec o eo eeco, ec oo poeeo e peee ea aee a oopoe aee eooo. oo oopoeoo c oopee a po C. epe eee eoxoo poec cceoae coooo oc. p opax peyaax cceoa ceye oopao ec ypeo ea e oe 50 c. e./ acc oopoeoo. Ec peya aooece cceoae e poooc oopoeoy ceye aa o pacop pcaecoo ea oe 50 c. e./ acc eeeo eee 10 e.

p oopeeo poa B y ox C. c eoc aoea eee 1 oa eec oe pc opae HC, ae cpeac eya ee. Oao, pc x ocoe e ec co, ooy peoeyeoe eee p epo opo C.

ocac ee. p aeo C. y c B-ee coooa y ec oaeo o aaa ee. p ocyc pao epocca pooc eee ea eo px eeeex ex o oe o 7,2 . e. p ee x ca C. y B-poax coyc oo peapa ea, p eoxooc-oce ececa.

VII. apo ( ap) - aec opao, epeac oo y, ae e a oox opaax, aco coeayc c axoo aeoae (yo). Boye - Haemophilus ducreyi-aep e aeo eoo paopaeo ao, opaye, p opace o pay, xapaepe eo e ca po, aya aapo, yco poca oopoo aoa aoe H:

coa aoc, oeoe coepae CO2, eepaypa 33-350C.

aoeaeoc apoo pe e, e C., o cpeaec ocoo cpaax peeo pa, oex paoax cpeaec ae, oope.

oe ae ooe eopeae y c CC. pepo 10% ox . oy apae C. B. oy e o aoeae ec oaopo eepocecyao epea B.

yao epo c 3-10 e, ae 4-7 e. pcyce oao opae opaaec oo opaa (ooe y, op, co aaa). B ece epe oye opayec aea aya, opya oo pe. epe 2-3 aya pepaaec ycyy , ae, oeey y c o, op epoec ccyao, pac ooo ocae. oo ox epe 7-10 e oce oe epoo oaa paaec ae oocopo ( 2/3 cyae) oeea axoa aeoa (yo), oopa oe ec.

ao cac ae ceo a ocoa ecx poe, o peyaa opac o pay yooo aepaa yoa (yceoc 50%), o a yypaoo cceoa. Bcea eoxoo o o oooc pcyc pyx .

eee pooc oox appo apoo 1,0 per os oopao, epacoo / 0,25 oopao, aoco-0, c ayaoo coo-0,125 (a) per os p e eee 7 e, poocao per os o 0,5 a e eee 3 e. epeex peoeyec eee ppoo o 500 4 paa e eee ee.

VIII. opaya eepeca. Pacpocpaea peyeceo poecx cpaax. Boye - Chlamidia trachomatis, cepo L 1-3.

yao epo cocae 3-21 e. epu oa oayec a ye, ee a, coax aaa, ooy oo e aeaec aeo. O pecae coo eoeee ey ay, oope oe c. epe 1-4 oce oe epoo oaa acyae mopua cmau, ocaea a axo cpo:

oocopo oee ae c oppoae yoa, oop papaec y pe ox, a aopea cpo: co poa, o ae cpeaec y e y-oocecyao. Boo oe co: xopaa, ooa o, a. Tpea ca aoea xapaepyec poecca papye pyea ae aopeao o, cpypa, coooc.

ao cac a ocoa ecx poe, yypaoo eoa cceoa (yceoc 50%), pea ca oeea:

p ae cooecy cepoa xa pae peae 1:64.

eee pooc oox appo oco per os o 100 a e eee 21 . epeex peoeyec eee ppoo per os o 500 4 paa e eee 21 .

IX. axoa paya (ooao) pacpocpaea poecx cpaax aec Callymmatobacterium granulomatis: paopaeo, eoo, ecpoopaye aoo, oocec pye Enterobacteriaceae. epeac a oo, a eoo y: epe e. ece poe pecae eoee aya aoeao oac, oope ae c, e axoo aeoa. Booo opaee ooc pa. ao cac a ocoa ecx poe oapye ee ooaa apoaax ao ocoo aepaa oaa opae (opaca o e).

Cepooecx eoo aoc e papaoao. yypa eo peec peo pecae coo ypoae aepaa oaa opae a eox eax ypx poo c oceye cooeco eae oye.

eee pooc o ceoe opae epao per os o 500 4 paa e eee 3-4 ee. peapaa peepa c:

xopaeo (eoe), per os o 500 p e, ea / oe 1 / a e.

X. Bpyc ao eoea, H-coepa pyc, aca oee 60 o, oocc ceecy aopyco, xapaepyec cocooc poa e e e. T pyca 6, 11,16,18, 31, 33, 35, 39 a opaoae oo (opoao) a oox opaax. Haoee aco ocpooee oo (condyloma acuminatum) ac a 6 11. T 16 18 ca c ooopaoa oox opao: 16 B ee p ca e a III cee 47%, p pae e- 47% cyae. T 18 B ee, cooeceo, 5% 27% cyae. H pyca oapyea y 10 11% e ee a p opax peyaax ooecoo cceoa (opaca o aaoay), 91-92% cyae p aooecx ax ooecoo cceoa.

eoo. epeac oo y, epooc apae appa cocae 65-70%, y e pyc pao cee, yao epo cocae 2-3 eca. e y epeex oe c po pecpaopoo aoaoa y oopoex, aeoo a pyca 6 11. Booe y epea:

pacaeap, oa c a poooo aaa, poae oce poo. Oe eoa ac ee, pox poa aep aoea pecpaop aoaoo. Pc epea B o poao aep oopoeoy cocae pepo 1:1000. Bpe aaa ecx poe aoea eca apaeo: oo 25% cyae oo paaec peeax oa oce poe, 50% cyae- opace o 3 e, o peoaae poae B oce poo.

pocx aopa pca poa B c: co oox appo, ypee, eoe peee opax opaeo. He cyecye ooo ecoo aopaopoo eoa cceoa, oo yaaeo a poae B.

Ocycy ocye cepooece ec, eoa ypoa pyca e papaoaa. ooy caec, o oco cyae poa B e copooaec ec poe. Xo, o eoop a, poae B cpeaec 2 paa ae, e B, oo, a cece B-e, c pe o acoe oce oope eoooooo ypepa, acoee pe pac, o oco cyae poa B poea cyec oy pacoaac oo p ooco, ooeco cceoa, eoo oc c peee ex H-pa. p o, o co poax B oo eeco, oo cpeac pepo y 1% poax, e 2% cyae c cyeco ee oy e p ooco.

Copeee ae yaa a acoy oo acoc o ocoeoce yaeo py acee o 0,5% o 3%. Hae ca e a yeae ee oo a ye ee a o 3 7%. Caec, o e 6-12% cex e e aey e B, x oo y 10% oc oo, paaec ca pa e a. yocypecce coco oa acoy ecx op e, ycop pae ca e a. oocc:

ae oce epeca opao, epeee, poae B.

ec poe aoea c ocpooee oo aopeao ypoeao o: ypepa, poeoc, ayc, pa a, ya, aae, ea a (oce oo).

oo, a pao, ce e po, o, yy o, oy pooo. e . ae pacoaac a apyx oox opaax poeoc. Ho o 50% e c opaee y e oo a ee a, oope p ooco ee p opaoe 5% ycyco coo.

ao cac a ocoa: a) ecx poe, ) cooecoo cceoa, ) ax ooco (apa ecea), ) opeee H pyca eoo pa (cpye ayoo cceoa).

eee. ooe yoee pyca eooo, ooy eee ee ocoo oceecy e. Oo ocaoo yoeo aea, oeeo, opoo aco eeo. 20-30% ox oo cea peeax 3 ece oce oe e ee. aee oo ooo 22-94% cyae acoc o eoa ee, o peeax 3 ece oce ee acoa pea oo peae 25%.

eee c peee oo aoa eo 63-88%, acoa pea cocae 21-39%. oooc (ooc)- aoee ooec aa cocaa ooa, peec eco e 0,5% pacopa, aooce, eo e ao ca oce aa. eoc ee cocae 45-88%, acoa pea epe 3 eca - 33-60%.

peee p epeeoc e yeo. He peoeyec pee p ooax ypep, po aaa.

oo e 10-25% pacopa peec eco, oaeo epaoo, o 6 aa eeeo, caec epe 1-4 aca oce aa. eoc ee cocae 22-32-79%, acoa pea 11-27-65%. By ooo ococ epaoeoc p epeeoc poooaa. Tpxopycyca coa ecx aa e opoa oe cooac p epeeoc eeeo o 6 poeyp.

eoc ee paa aoo y ooa: 35-94%, a acoa pea 11-22-36%. y eoa yae oo p epeeoc c xpypec, poecpy, epoayepa, a ae aepoepa, xo eo opo, a eo eoc cocae 23-40%.

Mecoe cceoe peee epepoa pae opoo, a peya ee e ye, e p pyx eoax.

aeo c cyec opa o a oo, ooco, oc, e oppoa oo, ye oca e ee. p a ca e a eee ac o e ca.

Oceoae oox appo e c ooa cyec opa e e peoeyec, a a o cac ye poa. peee peepaa yeae epooc poa B. paec aoo eca cpa e e cyecye. Hae oo a oox opaax cyece op e e c oaae oepa ecapea cee, y o aoeaeoc oopoeoo, a ae oooc ypypooo ocaaoo eo poa.

Oepaoe poopapeee oe eoxo p ox paepax oo, oyppyx pooe y ypoax pooeee.

XI. Bpyc eaa. Bpyc eaa A ec PH-coepa opapyco, oocc epopyca. a y epea opao-ea, o ooa eo epeaa epe ooo oa.

ooy, p ocpo eae y oooo appa, aoo BA, peoeyec poaecoe ypeoe eee peeax 2 ee o oaa yooya (aaoya) oe 0,02 / acc (1,5-2 ). Boooc epaao epea pyca e oaaa.

o ox e peyec, xo yo o, o x ea c coo apae.

Bpyc eaa coep H. Ce B c p aea: HBsAg, HBcAg HBeAg. pcyce oceeo yaae a coy eooc co pc epea B, a y epeex c ae oo aea aeo ae (o 90%) pocxo poae oa. poae B pocxo o ceo p oae c a ooo: po, cepa, eeo aa cepe, oa pyc poae epe ee eax opoax. B pax cpaax aoee a y epea pyca c ooe oa, paaxc cpaax peeo pa epaa epeaa epaa epo. Haoee a cpyeo aoc ec opeeee HBsAg copoe po.

Ae, xapaep , pcycye y acee pax cpa c acoo 1:1000, o paaxc cpaax oe cpeac c acoo 2-25%. Haoee aco cpeaac opa e- eccooe pcyce HBsAg ae po p opax oaaex y ee. o 70% e eopooo opaca yce e B, a acoa ocpoo xpoecoo eaa cpe epeex cocae, cooeceo, 1-2 / 100 5-15 / 1000.

epeaa B oy oe ocyecc: 1) pacaeapo, 2) poax (ocoo y epea), 3) oce poo, 4) epe pyoe ooo ooo. pepo 80-90% oopoex o aepe, aoex III pecpe, e ceec ae copoe po, p aoea aep pax cpoax epeeoc epeaa pyca oopoeoy pocxo 10% cyae. eoe pcyce HBsAg copoe po cao c ae xpoecoo eaa ppoa ee. B pax cpaax p xpoeco ocece HBsAg pyc o 10% oopoex, paaxc cpaax A - o 30-40%. B o e pe o ce e, poe aep, e HBeAg, pyc ee epoo oa , 85% x caoc xpoec oce HBsAg.

epeex c ocp eao co aopo 1 pecpe peepeex poo yeaec, o e peae ypoe eaa p pyx xopaox cocox. Hae xpoecoo oceca HBsAg e e a epaae cxo.

Xo pacaeap epexo pyca oaa, eo pcyce y oa e ae aoa pa.

aoca. ece poe ocpoo ae e, a p A.

yao epo cocae 60-180 e. ao ocpoo eaa oepaec cepooec: pcyce ae po HBsAg cooecyeo Ig M. Ae oec po yao epo, pcycye epo ecx poe aoea ceae oce opoe. pepo 5-10% ox ocac xpoec oce pyca. poax oopoex ece poe aoea pe, ae oo poeae e eccooo xpoecoo eaa c ae HBsAg po, oee coepa o ee, cooec paa eaa. p eccoo ee aoea pepo y 10% ee a 3-4 ece oe oc eyxa.

eee. Ceecoo ee e cyecye. Peoeyc:

oce pe, ooaa eo ea, ea eaeo c eaooc ece p ocyc ceecoo ee ooa poaa aoea, oopa coco acco ya ceec yooyo ao ya ao. e p ycaoeo oae c B o ecpoa a ae ceecx ae. p x ocyc a oo copee oc yooy oo e oe 0,06 /. oce ee yooya ceye poec aa. ooa aa peypeae poae oopoeoo 85-95% cyae.

Bce epeee o po oceoae a oceco HBsAg.

p ooeo peyae ce oopoe x e oe e yooy oe 0,5 / c oceye aae peeax 12 aco . ooeoe eee a pooc opace 1 6 ece. Ec oceoae aep a ae HBsAg e poooc, oa paccapaec a poaa, a oopoeoy oc yooy pooc aa. Heoxooc ee a aee ac o ax oceoa aep. p ycaoeo oae c B ya aa ecoo epcoaa ae ec oaeo.

Bce e a ea ocee HBsAg ceye paccapa a co apae. epcoaa peoeyec oee aco, epao, oo.

o oopoex o aepe, ocee HBsAg e peyec, papeaec opee py, o p peax coco pyoe capae eecoopao pepa.

Bpyc eaa C epeac apeepao o pe pacy.

yao epo cocae 30-60 e. acoa epao epea cocae eee 10%. B ocoo: 75%, poeae eccoo, o y oo ox aoeae caoc xpoec. x, pepo y 20-25% oo aaaec pae ppoa paa ee. acoa y epeex aa e a oe oy: 1,5-2%. epeeoc e e a eee eaa, a o - a cocoe aep oa. p xpoecx opax ooo oee aco P eoaa.

aoca oe pooc eoo ELISA, o e ooe paa Ig M Ig G, xapaepe ocpoo eo eyeo eaa.

Booo peee eoa P, ycaaaeo ae pe.

Ceecoo ee aa e cyecye. peee epepoa pocaaae pae e 40-50% cyae, o acoa pea epe 6-12 ece cocae 44-80%. Oceoae epeex, a cee cyae oeoo pca, e pooc.

XII.CHPOM POPETEHHOO MMHOETA EOBEA Boye aoea - pyc, ee 1983 . (ceeco pepopyco), c 1986 . aaec pyco yoea eoea (B). Ocao a eo a B-1, e o ee epe 10 eeecx cyo, B-2, epe ee y aeo aao Ap, o acoee pe eec y ox C o ce pe. Eo pacccoc e, e y B-1, a eee aoea oee eeoe. Booo poae ooo oo a pyca oopeeo.

Ceo C xo a eye o pe, a pa cep.

B 2000 . co aoex o ce pe peco 40 ., pe oco coca e e. Cpe poax B e 85% axoc pepoyo opace, a 90% cyae aoea ee pocxo cece epea pyca epaa epo o poao aep.

B Poccco eepa a aao 1999 . o a M P eo 11 095 B-poax, x-24,6% e 4,1% ee. o a BO a 1998 . P cpe paa opace 15-49 e apecppoao 40 c ox B-poax, o cocae 0,05% o oe ceoc pocoo acee.

ece poe B e C - eaa oea ca pooo cepa aoea, ax B, epxya acepa, pecae eco poax B. B aeop C oaa ce a c co C 4 (+) T-oo eee 200 eee 14% o x oeo ca (poee 3). epe oee, yaax a C (eca aeop C), 1993 .

oae p aoea: a pa e a (eee 1%), opaa eo (1%), yepye ex (9%). eooo ye ao o, o aeop B e: ao y aaa (yop, ac), ca eeoo e (yepea ea), ocaee aoea aoo aa, ocoeo, ocoee yooapa acecco. e aoee xapaep ceye aoea, yaae a C: eoca eo, ao eoa, cpo ycaoc, pooo e, pox, a pyco epeca ( eo, oa, e, e ceae oee 1 ec.), oeaopyca e, yepye, ocoao HC, oa.

oo aoee. e pyca aaec co ca c eo xoa. pyc e, ee C 4 ae oec- peyeceo T-o (xeep), a ae B-o, poeo, e ea, acpo oa, oe apo, oo/apoa. Moy opaac C 4 (-) epe e. oce c epa eo pooe pyco ac yp e xoa pocxo opaa pacp eoa pyca, eo H-o poae po e eppyec xpooco. oce oo a ce pecypco poao e aaec ce pyco H, eo ooo pyca, eo copeae eee e xoa. oy C 4 poax oo yaaec ae 15 e.

B ec e eo: ae- y 30% poax, o x pax (10-50 ac pyca 1 ). p B 1 po axoc o p. ac pyca, o eae pc apae p yoe o aoo e, e p B e. B coooo oc oeco pycx ac B aeo e-1000 1 . C pyo copo, aae, eee cepe, ce coepa ac B aeo ee, e po.

To e oocc cea ce: 1/10-1/100 o oeca ac pyca po.

epeaa aoea pocxo e epe oc, e ao coooo B, o epe poae e, oopx oo cee, cepeax aaa e a, oope aa pyc o yo cce xoa, o oe coaa poe c eee. epexoy e o aeoo coco aoy oy peooeo cococoa pyc oea, epeca, eaa , ea-appa, eece aop, coepaec cee po. C aao paoe B poaa ea e, pocxo ce epa opaoae acx ooepx eo.

oeco C 4 (+) eo yeaec a 25-40 / o. oa ypoe C 4 (+) eo cc eee 300 /, pe o opacae, a y ooo oc co aoea, o ce cae c papyee cce yea oopycece e oaecee aoea, opeee ao: C. ooy ocaec o cep, ae p poopyco ee, ooo 2 e.

oeee pyca oaec o epx e e: o caoc oee apecc, cpee paoaec, yco ee. oeco apycx eo C 8 (+): oo-epo - caec.

eca aeop A xapaepyec pooo aoea, oope oy e ca c B ee, pacpocpaex eecx paoax pyax pca. yao epo B e cocae o 3 e o 3 ece (3-6 ee). ae oec oec coo, aoax ooyeo: xopaa, o, cooc, eooae, a, appa, ooe o, ooc, aa, A (oaeoa), ayoayea c a ee. Haao aoea eaoe, o e xapaepo ooyeoa. Boo ae epooece co, aooece yoae po ee.

ao cac o ay cepooepc: oc aea B.

aee acyae eccooe cocoe eec 7-11 e, oce eo acyae yoe (y oo ox epe 5-6 e). aco ece coo aoea oe ya poooeeca ypypa (c, eex), A (oee 3 ece), oa- oe co: xopaa, oe o. Ec yaao coae pcoeec ao ooc pa, eoa y, o epe 6-14 ece ceye oa paepyoo cpoa C. eco aeop A pae oco B poax.

ece aeop B C pecae coo ee.

Hepooeca coaa, xapaepa aeop C, cpeaec eca aco , ooo, ec cece poo oec B a epy ccey eoea: 40-80% yepx o C e cooece pa aoo HC. H o eo cceoa e oe pecaa pe epexoa B e o eccooo cooy ee (C). Ho ce e ceye opaa ae a:

cee eaopa, ca T-oo (xeepo), oee ca T-cypeccopo, ypoe ae B, oee pa ae MB, aae popeccpyeo C y oooo apepa.

AHOCTA B HE Bao B e o pa C:

oaae pae eco oo poaa ocoe aeee popeccpoa aoea p eo ee c epooc epea B pyoy y y epeex eee e cae epooc epao epea B Meo yoyopece coyec peo: opoo, oo, peyec oo o cceoae. To e oocc paoyopeea.

yypa eo: opoo (peyc ep ooeco a), oo (oee 1 eca), yceoc- eeca. B eco pae e peec.

Haoee pacpocpae ec oc ae B eoo yocop (ELISA). Meo oaae coo yceoc ceoc, oao a pax aax e aea ocycy (eoe oa). pooceca eoc eoa ac o pacpocpaeoc B cceyeo pye caec oe oy, e acoa e ecoa. p ooeo peyae eca peoeyec poo poepoe cceoa, apep, Western blot-eo xpoaopa a ee, opy ae B: e cepe ooo pyca. Booe oc aeo pyca c cooae oooax ae. eo oee o, . . B oe paoac ocyce ae ey. o oo cyecye oo ecoo ee, o oex cyax-o 6-14 ece epe cepooepce.

Meo oepao eo pea (P) ae oooc pacoaa ax oec H B: 1 o a 100 000 eo.

B oe eco pae eo peec oa peo: ocoo y oopoex, opo a eee B e paeo e B y e, oepaxc cecyaoy ac.

B acoee pe aoee ae poocec apepo e ca ypoe PH B. oaao, o pc pa ecx poe (C) cep po ca c cxo ypoe PH B po. o oaae oaac y poocec eco, e co C oo. Opeeee ypoe PH B ooo oe eay aeoc ox: p ypoe eee 5 000 o/ poopyea pooeoc peaa 10 e;

p ypoe 5-13 c. o/ cpe pooeoc cocaa 9,5 e;

p ypoe 13-36 c.

o/ - 7,4 oa;

a p ypoe oee 36 c. o/ - 5,1 e.

Ceo cooc ceyee pecaee o eee B e.

Cpay oce apae pyc aae ypo paoac po, o copooaec ao yo peae. oce aoo epoa oye, pooaeoc ooo 6 ece, coepae pyca capyec a coo o ypoe. Bcoe p ceecy o oxo pooe, a e - o oee eeo popeccpoa aoea.

eoo y e. Haoee pacpocpaea pa B poa cpe y ocac oocecyaa c. B o e pe y e aoee aco po poa B ec / yopeee apoo-48%, aee ceoa eepocecyae oa 36-38% ( y - 3%), eopacy - 5% ( y-1%). e c aoee cpopacye pyo B poax.. B pe pocxo c o eooo y epea pyca eepocecyaoy. Bcece eepocecyax oao apo aaco peoe coooee B poax y e cocae 1:1. o a BO 1989 . pe acaoc ooo 3 .

e c B ee, 2000 . x co opoco o 13 .

Tpacccoc. Pc epea B p oox oaax oo eece. Ho eco, o B epeaec oooy apepy c ee acoo cpae c py : oope, xao, cc. poe cepoooc cpe ocox oox apepo , poax B, cocae 7-68%. e ee aee oeco oox oao (oee 100- o 31% poa), aa cec (38%), cooae ooa (10% po 80 - 90%).

oca pc apae B a 1 ooo a e cooa ooa:

1:1000, o p a C y apepa-5:1000, a p eccoo ee aoea-0,7:1000. aopa pca apae B p ooo c: ae pae o, oa c pocya, ocyce eee y apepa (oo oae pc epea pyca). B ae epeaec epe po e cocae: e, aa, aop cepa, o e epe peapa eo (ay) yooy.

Cp a B eoa opaoa peapao po ca pc epea pyca epe po.

apeepa y apae B (yo o) o: 0,25-0, 4%. Pc apae epe cce ooo oe o: 0,09% (9:100 000). poe oo: epeaa B ocpeco p, apooe, epe ee o, eopeey oy eooa, a cepeax ea (ce, ca, oa) oepa B oe a eo epeaa ae paec eooa.

He ax, yaax a po aceox epeae B. oa c o, cae c yxoo a , oee oae pyy e ey poa B.

EEHE PEPEEHE HE ep cpeco, apecppoa ee B e OBH (ao). O oae aoc epea B:

opao pacpa, e ca ca copoc pea pyca, o, co oepe, cae acoy ec oopycecx e pa cepoc ox. eee pocx ee cape 3 ece co C yocypecce poo ce oeca aea B (p24) copoe paopeeoy (ooo 2 ece) apaca oeca C 4 (+) eo. o appoa o 500-600 o 1500 .

ooe ec a: ae, epoe, ooy, ooy o.

oee o . e poo yee eo ea.

Aepao . p eo eepeococ eeoc oy ao, ay aa. ax o x eoacoc eoc p epeeoc, x a epay epeay e eec. B ocee o ecy pay epe oe eapcee peapa-op poea: caap, poap, ap (pca), eap, a ae eyeoe op opao pacpa: epa ep. Ceo e ee ec ooe oaee pea pyca, o peopaae popeccpoae e, cae oooc ya, oecex a pae ycooc pyca eapce peapaa eeoc ee. aay 1997 oa oco ceaco aa peea oee ao ae ee: poo epa peapaa pax py (poee 4). eocaa x peoea oocc cooc cxe ee (o pxoc pa eeeo o 20 aeo oee), eo coa cooc (10-12 c. o. CA o), ace ooe e.

Oopycece e. B oece C aoee aco cpeaec eoca e, oopa xapaepyec coo cepoc (5-20%) co ypoe pea (e cooecye poa). eee: ceo (cyaeocao peop), o oe a eppye c epo eyxo y oopoex. Ho pc e opo epeeo aeo peocxo aoo oa.

p epeeco e peoeyec aop 0,2 5 pa/cy per os, p pooooo aao aoe-eooao (0,2/cy c opoe y ee) yoao (0,1/cy). Tocoao poec y epeex epepe coa co copo HC, ooo epopoee ypoca y oa (o, aa, cyx).

Peoeyec poeee cepooecoo cpa. p cepooepc oe pa ae (ocp T.) eoxoo eee: cyaa (1,0 4 paa per os) pea ooa (pea ooa epa eyxa) o 25-50 /cy 1 pa per os. oeaopyca e y epeex oe poc peo, po ceoe, a ae oo, oao, eoo, eao, peye ee aopo oe 5 / 2 paa cy / (a 1 ac) eee 2 ee.

Bao oopyceco ee ec yepye, ae pey ee (oa, pa, ayo).

Pc epea B-e ecoy epcoay o: cpe c. epaoo, ex ec oa c B poa aea (1000 x c apeepao oye) pc ypoo epea coca 0,1% o. p apeepao oy pc apae oaac eee 1% (4 cya a 1000). Pc xpypa cocae 1:4500-1:130 000. cpae: pc apae pyco eaa oce yoa o cocae 10-35%. oaao, o ae pc apae cyecye p yoo pae ae, p pae peeo co cea po poaoo aea, p oae c po o pe y o apep e aea c B, p oae c po aea, yepeo o B e oceye eca. a p paoe c poa cepea ea peoeyec oee epao, aco, ax oo, xaao, acoe e py. Oxo appyc. Booo oceoae eepcoaa a B e poeee poa .

eooece ace B e.

e c B ee ca (paeaa eoa) e a cpeaec 5 pa ae, a ec ca cooecye cee yocypecc (oecy C 4 eo). p e opae e y B poax e ao c opaco o aaoay ec oee o eoo aoc cpae c oocoe. B poax ae aaec popeccpoae ca e a e pe oce xpypecoo ee, o ae ac o cee yocypecc.

Hapye yo a a ypoe oep po oe aco ocaex aoea opao aoo aa y e c B ee. aoex ae pxoc pea xpypecoy eoy ee. B pye e c BMT eecoopae cp a B. ac aoeae (o 24%) p B poa ec aa ao. c eo yocypecce o aco ep coo popeccpoa aoea, eo epexoa ca C.

opae. oo aeca ec ae eoo peypee B poa, o e epeeoc. Haoee ee eo opae y B poax e cepoe opo cepa. BMC e peoeyc y coo epooc eox ocoe. By eaeoc ae e peoeyc pee pepaoe oooe coee eo epoecoo oepa.

XIII. TPXOMOHA. poceee T. vaginalis, aee o aoeae, epe ocao 1836 . Tpxooa cocae pepo eep o cex ec x e aaa, a T. vaginalis oe pcycoa y e e coo aa. B eo aoeae cpeaec c acoo 3-5%. pepo ooa e c T. vaginalis e ee coo aoea, o y 30% o oo eee 6 ece oc co aoea. Bee ooeo yyp aao pxooa ee ocoepy c c oeco oox appo ae aepaoo aoa (B), o e caa c opaco, ecpyaoo a, eoo opae, po aoo, acoo oox ao.

Coa aoea c ee aaa cepoo (46%), eoo (36%) o-eoo ea (10%), ee ooe oc (12-34%) ceaoopa xapaep, ypo aax pH oee 4,5. aco p ooco oo e oee poo ccy e a, .. ya yyc ox.

Co aoea apae e c a ocoae ocao aoa. ae ceo ec ao oe oep p poco aoo aa, pooeoo y cea a peeo cee a ee aaa c eco a pacopa. ocoy pxooaa oe a aey oopoepy pa, oopa acpye e pcyce, eoxoo ya oac aa c eo oeco eoo. B cex aax pxooaa oo xopoo aea, aoap oe a e cox yo. yceoc eoa aoo aa oeec o 42% o 92%. ooo ceaca yceoc eoa cocae 80% cpae c yypo, o ec o poeypy acex, o yceoc e peae 50%.

ypoae pxooa e ec co, o peyc ceae cpe, ae a aaoa yepepa. a ee (oo cooa ocao o, o peoeo y y) oeaec ae yo, oop ypyec. Eeeo eee 5 e a cpe cceyec o pocoo o oe ox pxoa. Hecop a ocyoc, eco pae eo yyp coyec peo. aoca pxooaa ooa p poco aa, opaeoo o aaoay ( o pay), o yceoc eoa ecoa: 52-67%.

B ocee o oc oe eo aoc aoea:

oooae aea, yocop (ELISA), aec aa.

Oao, eooe cooae e e a oooc ooaeo caac o x aoc.

Ece e eee pxooaa ec peee epoaoa (pxoo, a, o) poox 5-poaoa:

ao(a), opao(epa). B ax opx cceoa oyoax 1993 oy yaaec, o p epoaoa p epeeoc e po pocy pox ypoc y ooca. Bceo, o eee oopao oo 2,0 co e eo, a caap 7-e ypc (250 p e). poe eeoc p ao pee oao cocae 86-97%. Peoeyec eee oooo appa e, oo pxooao. eee pooc p a pxooa oox yx ae p ocyc coo.

ooa o pe ee e peoeyec.

p ee epoaoo oa oeac: ooa o, eaec op pyc, ooa poa. epe poeee oopoo ypca peoeyec oc eoo po. Ha epo ee o e oce eo yopeee aoo ceye c. By o eoc ecx op ee e c epoaoo, coyc ee B, pe e ceye. p ocyc oce ee coo aoea oopoe cceoae a ae pxooa e pooc. Bce eapca, oae aoc pocoax epeo ee (eo, eoapa), ycop eee epoaoa.

He ceye aaa epoao ep pecp epeeoc. peeoo oee coo o epo ooo ecoe peee opaoa (100 o aae), xo ypoe eeoc p eo pee ooceo o: 48-66%. p cpoe epeeoc oee 12 ee peoeyec eee epoaoo oe 2,0 oopao.

p eeoc ee caapx oax epoao aaaec o 500 a e eee 7 e. p eeoc o cxe ee peapa aaaec oe 2,0 oopao eee 3-5 e. p ocyc ea o o o peyec aaee peapaa o 500-750 4 paa cy eee 7-10 e. p oopo aae cox o eoxoo oe eo coca po. o ce 3 /cy ca c co pco cepx oox ec peapaa: eopae epooece ee. ooeoe / eee peapaa e yyae peya ee.

Trichomonas vaginalis, caa o cee, e caa co oaece aoea oox opao, ecoe, aopa oepo.

Oao, c aoeae, epeac oo y, oa yaae a epooc a pyx oox aoea. Tpxooa ca c ae B, oop coeaec c eoop aoea ayepce eoo. Oao, ca pxooa c a ocoe epeeoc, a peepeeoe e oooox o peepeee po ocac ec, coe eee peopa ocoe epeeoc - eeco.

eo aepa ee pxooaa epoaoo e cyecye. Oao, ocee o oc peapa, o eoc cpae c epoaoo. Tao: a) 0,5 epe 15 y eee 1 aca (ceo 2,0), ) 0,5 a e eee ee, ) 2, oopao a (4,0). Opao: a) Oopao 1,5, ) 0,5 a e 5 e (5,0). Hopao: a) 0,5 a e 6 e, ) Oopao 2,0.

B Pocc cacepa ox pxooao ocyecec a ocoa paa M P N286 o 07.12.93.

XIV. AHO. p - c oo opo x oox ye e. O pcycy y 22% e e coo aoea, y 39% c coa yoaa. ocao, o 75% e eee yy e xo o o pooo yoaa, a 40-45% a oee oo. Haoee aco oox ye eec Candida albicans (81%-95%) pye a (Candida globrata). aopa, pepacoaa pocy a o aae, c oyp, caxap ae, epeeoc, opee, eee aoa, cepoa yoepeccaa. epeeoc caa c poco oceca, oeo yceoc e o eoc ee. Ao (a, epa, eaocop), yea opay aepay opy, cococy oopyceco ooa aaa pa. opoae opae c co oa opoo oa pc ooa aaa pa, o acoa ecx op e e eec. Hoee eco oeaeo eo e, oa eepaypy aoc y oepxoc ea, cococye pa pox aoea.

ooa epeaa e ocac o opoco. Xo oee poa oooo appa ( 4 paa) e c poo ee e a o aco oox oao oepa o peooee, o ec ae ece opapye: a) e po c ey poo ee py , ) e pa acoe aoea y aeo c e x, ) e ax o o, o eee y e a eee aoea y e. B acoee pe caec, o eee oooo appa e c poo ee aaa e ec oae. eee peyec oo ya c ec poe e: e aaa c ec yo papaee. Hecop a poo pacpocpae e, popae ayca oce eea apae ca-ep, cooae eecx poao, a, ea, cpecc e a acoy pooo yoaa.

Te poe aaoo aoa: opacee ae y aaa, eyee, o, copa cyae a oepxoc e ee e, c pyo caec a, oee oo y 38-60% e c ooe peyaa yyp C. albicans. Moo oep ao, aa e ceoe p po poco oce opao peapaa 10% OH, ey aco pecye ae eooo epa, oy e eo e e oee pe e c ae po oox yx o a yyp. Hecoo ye peya a opaae peapaa o pay, o ooo oo e c ooeo yypo e oy e eoo. Meo yyp e pye a (C. globrata, C. tropicalis), oope oapyac 10-23-35% cex cyae poo e, pyee oac ee ae pepy.

eee ocpx pox e po ycpae coo aoea ceoe po oox ye 80-90% cyae, o pe e ocac poeo. opao ee oaoy eey eoc c cao, o oe pec oee opo ypca.

Peoeyee pe ee pooo yoaa yooao 2% pe 5,0 o aae eee 3 e opao 1% pe 5,0 o aae 7-14 e opao ( oao) 100 aae ae eee 7 e o 2 ae (200 ) eee 3 e opao 500 aae ae oopao Moao 2% pe 5,0 o aae eee 7 e Tooao (Baca) 6,5% a 5,0 o aae oopao Tepoao (Tepao) 0,4% pe 5,0 o aae eee 7 e 0,8% pe eee 3 e Tepoao 80 ce o aae eee 3 e eooao epe po 200 a e eee 5 e 200 p paa e eee 3 e (ycpaee eoo peepyapa e) yoao (ea) epe po 150 oopao 50 3 yoao e ee x peyec epe eco epae p ee eocox pox yoao, ooy paccapaec a peapa peepa cyae, ycox ee.

B cyax ec oo aoa oo cooa 1% pacop eaoea, oop a cpoe ecoe yyee, o p ocoo pee oe a aey cyxoc ae y.

Heopo ocaoo e eoo ecoo ee ec aaee opo co e opoa eaox acyax: 600 eee 14 e. o eee e co pe y epeex. cpa aa p epeeoc pyee, ooy peoeyec ecoe aaee aoo (op-, o-, yoo-, epoao) eee 7 e.

p acx peax aoea (4 paa o) peoeyec eee eooaoo oe 400 eee 14 e c ocey e peee opaoa (eco pa ee) eooaoa (100 e o 6 ece o 400 5 e eeeco). eecoopao paccope oooc B e. eee oooo appa e c po yoao cao e p ocyc ecx poe aoea e peyec.

aepa ao. B 1955 . apep oca ec cpo aa c xapaep (85% cyae) cep ooe ee c aaxo, co pH aaa (5-5.5) e pcyc po pxooa. p cceoa aoo aa ae xapaepe eae e, aae e. eep e aa cepe ec. oeco eoo o opa. aax ee ee poopa, aae eep Gardnerella vaginalis. B oceye 20 e a oepea c oo xapaepoo cpoa c ae G. vaginalis, xo yaaoc, o aco o poopa oe pcycoa oox yx e, e ex coo aoea.

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