Sexually transmitted diseases/infections (STDs, STDs, STIs, STIs). Urogenital infections. Venereal diseases. Tests for STDs. Tests after unprotected sex. Oral sex.

Which STDs most often affect the oral mucosa?

Chlamydia, gonorrhea, syphilis, and herpes are mainly transmitted orally. There is also a risk of transmission of diseases such as HIV, hepatitis, and condylomas during oral-genital contact. Infection occurs directly by transmission of the pathogen through saliva and natural secretions from the genitals [2]. Sexually transmitted infections and diseases enter the body not only during vaginal or anal contact. Oral sex, that is, that which involves contact using the mouth, lips or tongue, is also a route of transmission. Not all STDs that develop in the mouth cause any symptoms. Sometimes they can occur without any special signs or with non-obvious symptoms [3].

Common ocular manifestations of sexually transmitted diseases

Director of Development of the specialized center for vision restoration OPTIMED, doctor Alexander Nelin, commented on the article “Common ocular manifestations of sexually transmitted diseases” written by Fahad Alwadani and published in the Journal of Clinical & Experimental Ophthalmology in 2022 (Volume 9 Issue 1):

The article “Common Ocular Manifestations of Sexually Transmitted Diseases” by Fahad Alwadani caught my attention because few patients with sexually transmitted diseases know that these diseases also have a negative impact on the eyes.”

The author writes: “Sexually transmitted infections (STIs) are caused by certain pathogenic microorganisms that can be acquired and transmitted through sexual contact. All major groups of microbes (ie, viruses, bacteria, fungi, and parasites) can be responsible for STIs.

Overall, young people, especially those in the 15-24 age group, bear the greatest burden of STIs and account for about 50% of all patients with STIs. Both women and men are equally susceptible to STIs, although the incidence and complications of untreated infections may be greater in women, especially with some bacterial STIs, such as those caused by chlamydia and gonorrhea.

The eye is a common site of attack, and almost all sexually transmitted diseases (STDs) can cause significant damage to the eye. An eye infection can occur as a direct infection, as with gonorrhea, or as an indirect infection, as with acquired immunodeficiency syndrome.

(AIDS). Therefore, eye examinations should be part of the routine screening of patients seen at STD clinics to ensure prompt treatment of ocular complications of STIs.”

In this review, Fahad Alwadani examines the most significant ocular manifestations of sexually transmitted diseases (STDs) that both ophthalmologists and sexual health physicians encounter during their practice. STDs discussed in this review include syphilis, gonorrhea, AIDS and chlamydiae infection, Herpes simplex, human papillomavirus, Molluscum contagiosum, vaginal trichomoniasis (Trichomonas vaginalis), and pubic lice infestation (Pthirus pubis).

According to doctor Alexander Nelin, this review is very interesting, so he wants to present it in full, and hopes that it will seem interesting not only to his colleagues, ophthalmologists, but also to the general public. Here's what author Fahad Alwadani writes:

Gonorrhea

Gonorrhea is a common STD caused by the gram-negative intracellular diplococcal bacterium Neisseria gonorrhoeae. Gonococcal diseases include: urethritis/cervicitis, epididymitis, salpingitis and pelvic inflammatory disease.

The highest incidence is observed in young, sexually active patients. Many have symptoms of a genitourinary infection and most commonly experience a burning sensation during urination and penile discharge, and about half of women have symptoms of the disease and may have vaginal discharge and pelvic pain.

Gonorrhea ocular infection is often transmitted by autoinoculation or direct transmission from genital secretions from an infected partner, and can occur with or without associated anogenital infection.

The conjunctiva is particularly susceptible to gonorrhea infection. Once an infection is acquired, bacteria can quickly invade the cornea, resulting in keratitis.

Initially, keratitis begins in the peripheral part of the cornea, causing marginal ulcers that coalesce to form a peripheral annular ulcer, which can then perforate and lead to endophthalmitis if not promptly and adequately treated. These sight-threatening complications can occur within 24 hours of infection, requiring urgent identification and treatment of the infection.

The classic presentation includes a painful red eye, severe eyelid swelling and copious mucopurulent discharge, heavy conjunctival injections, thinning of the cornea, and chemosis with white infiltrates involving the cornea. Visual acuity may be affected and depends on the extent of corneal damage.

Gonococcal ophthalmia neonatorum is an eye disease of newborns caused by the acquisition of gonorrhea during vaginal delivery. If left untreated, it can lead to vision loss. The disease usually appears within 2-5 days after birth. The practice of ocular prophylaxis is an important preventive method against gonococcal ophthalmology in newborns.

Surveys

Any acute infection (urethritis, cervicitis, conjunctivitis) caused by gonorrhea is detected by the presence of Gram-negative intracellular diplococci (GNID) on a smear obtained from samples of the urethra, vagina or conjunctiva. Isolation of gonorrhea using various cultures used to be the gold standard test for gonorrheal infection. Cultures using selective media such as chocolate agar, Martin-Lewis or modified Thayer-Martin are used for diagnostic confirmation

Treatment

Gonococcal ophthalmia is a medical emergency, so red eyes in a patient with gonorrhea should raise a high degree of suspicion. For eye infections, topical antibiotics such as gentamicin or bacitracin are used frequently and reach much higher concentrations in the eye than systemic medications.

Treatment given every 6 hours is usually sufficient for conjunctivitis. If there is corneal involvement, dual topical therapy is required hourly, day and night. Systemic treatment is ceftriaxone 1 g intramuscularly (ceftriaxone 1 g intramuscularly - IM). If corneal involvement exists or cannot be ruled out due to chemosis and eyelid swelling, hospitalization is required and the patient receives 1 g of ceftriaxone intravenously (IV) twice daily.

The duration of treatment depends on the patient's clinical response, with one-day treatment being sufficient if only the conjunctiva is damaged. However, if we are talking about corneal damage, longer treatment is required. For patients allergic to penicillin, a single oral dose of ciprofloxacin 500 mg (Ciprofloxacin) or a single oral dose of ofloxacin 400 mg (Ofloxacin) can be used. Contact tracing to treat sexual partners is vital.

Gonococcal ophthalmic prophylaxis in newborns involves applying a 0.5% erythromycin ophthalmic ointment preparation to both eyes of each newborn as soon as possible after birth.

Chlamydia

Chlamydial conjunctivitis is an STD most often found in sexually active young people. Women are more susceptible than men. It is caused by Chlamydia trachomatis serotypes D–K (1,2). WHO epidemiological data reported genital chlamydial infections as the most common bacteria responsible for STDs worldwide. Autoinoculation is considered the main route of transmission; however, inadequately chlorinated swimming pools, insects, and other fomites may be other routes of transmission.

Both sexes can develop urethritis, proctitis, trachoma and infertility. Men may have prostatitis and epididymitis. In women, common complications include cervicitis, pelvic inflammatory disease, and acute or chronic pelvic pain.

Symptoms:

Chlamydial conjunctivitis is often unilateral but can affect both eyes. The patient usually experiences subacute red eyes and mucopurulent discharge, which can become chronic if ignored. Because of the similarity of these symptoms to those of viral and other bacterial conjunctivitis, many of these patients may have previously been misdiagnosed and treated with topical antibiotics without experiencing symptoms of relief.

Signs:

Conjunctival vascular injection, superficial punctate keratitis, corneal pannus, iritis and large follicles, which are more noticeable in the lower conjunctival fornix. Follicular reaction is the hallmark of chlamydial conjunctivitis and usually affects the bulbar conjunctiva and semilunar folds of the conjunctiva. Chlamydia trachomatis is considered the most common cause of chronic follicular conjunctivitis and causes 20% of cases of acute conjunctivitis. A palpable tender preauricular lymph node is almost always observed.

Examinations:

Direct fluorescence microscopy of monoclonal antibodies from conjunctival smears is a fast and cheap diagnostic method. Enzyme-linked immunosorbent assay for chlamydial antigens and polymerase chain reaction (PCR).

Treatment:

Local treatment is tetracycline ointment four times a day for six weeks. Systemic treatment is azithromycin 1 g (Azithromycin) in a single dose or doxycyline 100 mg (Doxycyline) twice a day for 1-2 weeks. Contact tracing to treat patients' sexual partners is vital.

Syphilis

Syphilis is a multistage, chronic and progressive disease caused by a bacterial spirochete called Treponema pallidum, which is often transmitted sexually and can also be transmitted transplacentally in the womb from an infected pregnant woman to the fetus, and through blood transfusion. Based on the progression of the disease, acquired syphilis is classified as early, late and neurosyphilis.

The eye is not a common site of syphilitic infection. The pathogen usually spreads into the eyes through the bloodstream. Ocular syphilis can be caused either by direct invasion of a spirochete or by an allergic reaction in tissues sensitized by the pathogen.

Syphilis can damage almost any part of the eye, including the sclera, cornea, lens, uveal tract, retina, retinal vasculature, optic nerve, pupillary tract, and cranial nerves.

Ocular syphilis can be similar to various eye inflammatory diseases. Therefore, a high index of clinical suspicion is critical for correct diagnosis.

Ocular involvement is rare in the initial stage of syphilis, but can affect the eyes in the secondary stage, and more often in the late, latent and tertiary stages.

Clinical manifestations

Corneal inflammation caused by syphilis is called interstitial keratitis and is an immune-mediated, non-ulcerative, non-suppurative inflammation of the corneal stroma. It may be localized or diffuse, affecting one or both eyes, and associated iritis, with or without keratinous discharge, may also be present. It may appear as white infiltrates around the cornea and last a long time without responding to conventional treatment.

Syphilitic iridocyclitis occurs in approximately 4% of patients with secondary syphilis. About half of these cases are bilateral. Although it most often occurs in secondary syphilis, iridocyclitis may rarely occur in primary and tertiary syphilis. This condition should be suspected in STD patients with intraocular inflammation refractory to conventional treatment.

Syphilitic scleritis manifests itself in the same way as any other scleritis, but it lasts a long time and is often resistant to traditional treatment.

The Argyll Robertson pupil is a classic pupillary change seen in syphilis and most often occurs in the later stages of the disease, although it can be seen in the early stages of neurosyphilis.

The optic nerve and the 3rd, 4th and 6th cranial nerves may be involved during early neurosyphilis. Optic neuropathy is commonly seen in patients with secondary syphilis.

Progressive loss of vision as a consequence of optic nerve atrophy can be considered a manifestation of tertiary syphilis. Syphilis can also manifest as necrotizing retinitis, affecting the mid-periphery and peripheral retina.

Surveys

The diagnosis of this disease largely depends on clinical manifestations, but the following tests can be used to confirm:

Dark field microscopy.

Dark-field microscopic examination is the definitive method for diagnosing early syphilis. The characteristic thin, corkscrew-like rod-shaped appearance of the bacterium T. pallidum is clearly visible on dark-field microscopic examination of exudates or lesion samples from patients with primary or secondary syphilis.

Serological tests:

Serological tests remain the mainstay for diagnosing syphilis; Available serological tests for syphilis are of two types: quantitative nontreponemal tests (eg, Venereal Disease Research Laboratory - VDRL; and Rapid Plasma Reagin - RPR) and specific treponemal tests (eg, fluorescent treponemal antibody absorption test - FTA -Abs); T. pallidum passive particle agglutination assay (TP-PA) and various enzyme immunoassays.

Treatment of ocular syphilis

Parenterally administered penicillin G is the drug of choice for the treatment of all stages of syphilis. Treatment regimens can be selected from several options: (A) intravenous aqueous penicillin G 12–24 MU (mega units - MU) daily for two weeks or (B) intramuscular. Procaine penicillin 2.4 MU daily for two weeks, taken with probenicid 2 g (Probenicid) once daily or (C) oral amoxicillin 3 g (Amoxicillin) twice daily for a month.

Patients allergic to penicillin can be treated with oral erythromycin or tetracycline 500 mg four times daily for one month. Topical, periocular, and systemic steroids play an important role in the treatment of ocular complications of syphilis. Contact tracing is also vital.

HIV

HIV/AIDS is a multisystem disease that affects the eyes in 70% of cases. All parts of the visual system can potentially be affected in patients with HIV.

Ocular complications of HIV infection are mainly a consequence of secondary possible infections, and not a consequence of complications from antiretroviral drugs.

Herpes zoster ophthalmicus (HZO) affects about 5-15% of patients with HIV. Kaposi sarcoma is a highly vascular tumor caused by human herpes virus type 8, which usually affects the skin and mucous membranes. This occurs in approximately 25% of patients with HIV.

More than 50% of HIV-infected patients have anterior segment complications such as dry eye, keratitis, and iridocyclitis. Varicella zoster virus (VZV) and herpes simplex virus (HSV) are the most common causes of infectious keratitis in HIV-infected patients. Iridocyclitis in HIV-positive patients is usually mild and is often associated with retinitis due to Cytomegalovirus (CMV) or VZV.

Cytomegalovirus

(Cytomegalovirus - CMV) is the most common cause of intraocular infections in people with AIDS, and cytomegalovirus retinitis is the most common infectious eye complication, which can affect 30-40% of people with severe immunodeficiency. An ophthalmologic examination, including dilated indirect ophthalmoscopy, should be performed to examine the entire periphery of the retina. The diagnosis of cytomegalovirus retinitis is made clinically, noting the appearance of poorly defined white retinal lesions that may be associated with hemorrhages. Patients may have one or more lesions in one or both eyes.

HIV retinopathy is the most common retinal lesion seen in patients with HIV, often presenting as white patches. This occurs in 50-70% of patients.

Infectious choroiditis is found in 1% of eye disorders in HIV-infected patients, with Pneumocystis carinii being the most common organism identified.

Pneumocystis carinii pneumonia (PCP) is the most common possible systemic infection in people with AIDS. Pneumocystis choroiditis is usually a feature of disseminated systemic pneumocystosis in patients with severe immunodeficiency. Choroidal infection is classically bilateral and multifocal. Clinically, the lesions are multiple, yellowish, well demarcated, and characteristically visible at the posterior pole of the eye.

Treatment of eye complications

Most possible ophthalmic pathogens cannot be completely eradicated; therefore, their treatment requires lifelong suppressive therapy.

Treatment of cytomegalovirus retinitis depends on both the site of active retinitis and the patient's immune status. It involves an initial induction phase of 2–4 weeks to inactivate the retinal infection using high-dose anti-cytomegalovirus drugs, followed by low-dose maintenance therapy to prevent progression of retinitis. Systemic therapy includes intravenous drugs (Ganciclovir sodium, Foscarnet sodium and Cidofovir) and oral drugs (Ganciclovir and Valganciclovir). Topical treatments include Ganciclovir and Fomivirsen sodium implants.

Oral Valganciclovir is the newest drug approved for the treatment of cytomegalovirus retinitis. Its proven efficacy has made it a convenient and effective replacement for intravenous Ganciclovir for induction and maintenance therapy.

Herpes

Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), also known as human herpes viruses 1 and 2 (HHV-1 and HHV-2), are members of the herpes virus family, Herpesviridae. HSV-1 is usually acquired orally during childhood, but can also be transmitted sexually. HSV-2 is an STD.

It is now clear that both types HHV-1 and HHV-2 can infect any area (eye and genitals). The primary infection may consist of relatively nonspecific conjunctivitis; however, subsequent episodes of reactivation may involve the cornea. Disease of the corneal epithelium manifests itself as characteristic dendritic ulcers. Clinically, wet eyes, redness, blurred vision and ocular discomfort are the most common presenting symptoms.

Stromal keratitis occurs in almost 25% of cases of ocular herpes. This condition involves deeper parts of the cornea, possibly due to an abnormal immune response to the initial infection. In these rare cases, scarring and thinning of the cornea develops, which can lead to rupture of the eyeball and blindness. Other ocular manifestations of herpes are iridocyclitis and secondary glaucoma, which may be associated with trabecular block or trabeculitis.

Human papillomavirus

Human papilloma virus (HPV) is a member of the papilloma virus family that is more common in sexually active patients between the ages of 20 and 30. More than 30–40 types of HPV are commonly sexually transmitted and infect the anogenital area.

Human papillomavirus often affects the surface of the eye. Corneal and/or conjunctival squamous cell neoplasms have been associated with HPV 16 or with HPV 18. In addition, conjunctival papilloma caused by HPV infection is a common benign epithelial tumor.

Molluscum contagiosum (Molluscum contagiosum)

Molluscum contagiosum is a virus that affects the skin and mucous membranes. It is caused by a DNA poxvirus called Molluscum contagiosum virus (MCV). There are four types of MCVs: MCV-1 to MCV-4. MCV-1 is the most common, and MCV-2 is usually seen in adults and is often sexually transmitted.

The skin of the eyelids can be infected with this virus. The lesions are often 1-5 mm in diameter, with dimples in the center. They are usually painless, but may become itchy or irritated. If they are on the eyelid margin, they may be associated with secondary keratitis and follicular conjunctivitis.

Pubic lice (Phthiriasis pubis)

It is a disease caused by Pthirus pubis, a parasitic insect (pubic louse) that infests human pubic hair. These diseases affect approximately 2% of the population worldwide. These parasitic insects can also live on other types of hair, such as eyelashes and eyebrows, causing phthiriasis or lice pubis. Pubic lice are usually acquired through close contact between people, including sexual transmission, sharing towels, clothing, beds or closets. Adults become infected more often than children.

Performance

Manifestations of pubic lice on the eyelids are rare in the general population. Patients may have itchy eyelids. A magnifying glass or stereo microscope can be used to accurately identify nits, nymphs, and adult lice; Magnification reveals lice and their nits attached to the roots of the eyelashes. The specialist should then look for manifestations of pubic lice in other parts of the body, especially the genital area, and the partner's partners, if possible. The diagnosis is clinical.

Treatment

Lice or their nits can be removed manually using tweezers. Eyelash infection can be treated with petroleum jelly applied twice daily for 10 days or 1% permethrin lotion, phenothrin and carbaryl, keeping the eyes closed for 10 minutes of application. To completely eliminate this problem, further treatment will be required in other affected parts of the body.

Vaginal trichomoniasis (Trichomonas vaginalis)

Urogenital trichomoniasis can be transmitted sexually. Direct physical contact promotes parasite adhesion and penetration into mucosal surfaces, which consequently triggers an inflammatory response in the host. Similarly, direct and physical contact is most likely necessary for transmission of the parasite to extragenital sites, such as the pharynx, respiratory tract and eyes.

Exposure of healthy conjunctiva to vaginal secretions containing T. vaginalis parasites results in conjunctival infection, represented by inflammation of the conjunctiva and yellowish purulent discharge from both eyes.

Indeed, the paucity of publications in the literature may not reflect the true incidence of ocular infections caused by T. vaginalis.”

Director of development of the specialized center for vision restoration OPTIMED, doctor Alexander Nelin, recommends that all patients with sexually transmitted diseases undergo examination by an ophthalmologist, since almost all sexually transmitted diseases can cause significant eye damage.

Risk factors for oral lesions due to STDs

There are several conditions in which the risk of contracting sexually transmitted diseases through the oral route is significantly increased. These include:

• Sexual intercourse during menstruation.
• Oral-genital contact in the presence of dental diseases with damage or inflammation on the mucous membranes of the oral cavity, gums, tonsils, and throat.
• Ingestion of infected body fluid.

It is not necessary to have a pathological process in the mouth to become infected with an STD [3].

What STDs are transmitted through oral sex and what is their insidiousness?

It is important to understand that the risk of contracting an STD through oral sex is very high - the probability is 98%. The transmission of pathogens of sexually transmitted pathologies is facilitated by:

• the presence of damage to the oral mucosa;
• decreased immunity;
• presence of other diseases.

The tricky part is that there may be no symptoms of infection. And the incubation period may be prolonged. How long it takes for the disease to manifest depends on many factors, especially immunity and medication use. For example, when antibiotics are used to treat a previously identified infectious disease, syphilis occurs without symptoms for several months, or even six months. The patient is infected, but has no idea about it. And the disease becomes chronic, which is difficult to treat.

STDs transmitted orally include:

• syphilis;
• cytomegalovirus;
• gonorrhea (popularly known as gonorrhea);
• HPV;
• trichomoniasis;
• chlamydia;
• hepatitis;
• AIDS virus;
• herpes virus.

All these ailments negatively affect health. Men and women experience different consequences, from infertility to cancer and death.

Possible symptoms of oral STDs

These infectious processes do not always have obvious signs. The most studied in this regard are gonorrhea, in which the pharynx is most often affected, and syphilis with its typical course and appearance of symptoms - chancre, enlarged local lymph nodes, rash.

You should pay attention to manifestations that arose some time after unprotected oral contact.

1. Mouth ulcers, one or more.
2. Manifestations of stomatitis, which can be very painful, or can proceed almost unnoticed.
3. Herpes-like rashes on the lips and the inside of the mucous membrane around the mouth.
4. Difficulty swallowing, especially if it is not associated with other symptoms of a cold.
5. Redness of the back of the throat.
6. Angina-like symptoms.
7. A plaque like a sore throat or diphtheria on the surface of the tonsils.
8. The formation of tonsilloliths in large quantities (unpleasant-smelling, dense, yellowish-gray formations that fly out of the mouth when coughing).
9. Saliva takes on a different color, such as yellowish or streaky [2, 3].

Gonococcal infection

It is caused by the bacterium Neisseria gonorrhoeae and is one of the most common STDs [4]. When infected through the oral route, it occurs as gonococcal pharyngitis with subtle symptoms: a feeling of dryness in the mouth and throat, difficulty and pain when swallowing, slight hoarseness. There may be redness and areas of swelling with whitish films on the mucous membranes of the mouth and pharynx. Diagnosed by culture (culture), treatment is carried out with specially selected antibiotics. If necessary, symptomatic therapy is prescribed - pain relief for sore throat, rinsing for dry mouth, etc. [5].

Is it possible to get tooth decay by kissing?

Dental caries is caused by bacteria called Streptococcus mutans. And so many people think that if you French kiss a person who already has tooth decay, you can get infected from it and put your own teeth at risk.

But in reality, everything is not so terrible at all. The fact is that “caries bacteria” (let’s call them that for simplicity) cannot do much harm if a favorable environment for their harmful activities is not created in the oral cavity. For bacteria to start harming teeth, they need a large amount of carbohydrates - they take it from sugar that enters the oral cavity, that is, simply from the remains of sweet foods. They “digest” sugar (more precisely, sucrose) into organic lactic acid - and then this acid begins to literally eat away tooth enamel.

In addition, it is easier for acid to damage enamel if it lacks calcium, fluorine and phosphorus - the less of them, the faster the tooth will decay. And if there is no sucrose (or it was removed from the oral cavity in time by brushing teeth and other standard hygiene procedures), then the bacteria simply “sleep” and stop actively multiplying.

But still, what happens if two adults kiss and one passes on a certain amount of carious bacteria to the other? Dentists assure: nothing special, because the vast majority of the adult population of the planet already has these bacteria, and only proper eating behavior and compliance with hygiene rules can regulate their number.

It’s another matter if an adult kisses a baby: young children may not have “caries bacteria” in their bodies at all, and the enamel of teeth at such a tender age is not yet as strong as in adults. That is, even a “social kiss” with pursed lips can pose a danger to a child: after all, both mature people and tiny children have the habit of licking their own lips - and this is how infection occurs. However, this is how most people get cariogenic bacteria into their bodies - and this usually happens before the age of three. And not all children’s teeth begin to decay immediately after infection - this most often does not happen if the child is taught to brush his teeth, rinse his mouth, etc. And an adult, especially one who has had caries before, has nothing to fear at all - no fundamental he cannot get new cariogenic microflora or microfauna, no matter how you kiss!

In general, the VivaDent clinic advises not to be afraid of kisses on Valentine's Day, but of too many cakes at a romantic dinner. At the same time, don’t forget about brushing your teeth - this will protect your teeth, make your breath fresh, and kisses more pleasant!

Syphilis

Syphilis is caused by Treponema pallidum. Despite the certain “familiarity” of the name of this disease, it is not the most common. The pathogen penetrates the skin and mucous membranes, causing a cascade of manifestations. When infected through oral contact, it affects the mucous membranes of the mouth, throat, and lips [4]. Symptoms of syphilis develop in stages. In the first stage, one or more ulcers form in the mouth and throat - chancre. They are round, slightly recessed, the edges are smooth, the bottom is shiny, pink, sometimes with a grayish coating and the release of a translucent liquid. As a rule, the lymph nodes become inflamed at the same time, in this case the cervical ones. If the infection is not treated, it progresses to the stage of secondary syphilis, during which a skin rash appears. In this case, the lymph nodes swell strongly and painfully, not only regionally, but also distantly. Sometimes this stage occurs latently, without manifestations, and then, over time, syphilis spreads and affects other organs and systems of the body [6].

In the presence of erosions or ulcers, repeated studies should be carried out in a dark field of view of a microscope to separate them for treponema pallidum.
Its detection is decisive in the diagnosis of primary syphilis, since specific serologies become positive only 2–3 weeks after the onset of primary syphiloma. Dyadkin Yu. V., Ph.D., Associate Professor of the Department of Dermatovenereology KSMU [6]

To detect syphilis, various laboratory diagnostic methods are used: PCR, RPGA, ELISA, RIF, RMP and others. Blood or scrapings from the chancre may be used for testing. Antibiotics are selected for treatment depending on the stage and location of the process and manifestations. During treatment, complications may develop, including the Jarisch-Herxheimer reaction - a sharp and severe exacerbation of the disease due to the rapid disintegration of treponemes and severe intoxication [6].

Herpes simplex virus, HSV-1

Herpes simplex virus type 1 causes the disease popularly known as the “cold.” Its causative agent is the herpes virus HSV-1 (herpes simplex). It is similar to HSV-2, or genital herpes, but they are different forms of the disease.

A “cold” on the lips (although herpes can develop on the gums, and on the mucous membranes of the cheeks, etc.) during sexual intercourse infects the mucous membrane and causes a typical herpes rash. It may appear as a spot, vesicle, or focal erosion. Depending on the course of such elements, there may be one or several; they can form in one place, or they can disperse throughout the mucous membranes of the mouth and oropharynx. The temperature often rises and regional lymph nodes become enlarged. Various methods are used for diagnosis (virological, cytological, serological), but more often the PCR method is used to detect HSV.

The causative agent of herpes remains in the cells of the body forever, and so far there is no way to completely cure this infection. But there are methods that can be used to reduce or prevent the appearance of herpetic rashes. In the acute period, local treatment is prescribed - treatment with antiviral drugs, drying of crusts, anesthesia of ulcers on the mucous membranes. Special antiviral antiherpetic drugs are prescribed internally, which inhibit the development of the virus in the cells, preventing it from “getting out” and causing an acute process [7].

STDs localized in the oral cavity can occur almost unnoticed and masquerade as other diseases. Because of this, diagnosis can be delayed and the impact on health can be devastating. Therefore, during oral-genital contacts, prevention plays a huge role. The only method that can reduce the risk of developing an oral form of STDs is a condom and a latex napkin.