Sexually Transmitted Diseases - I. I. Mavrov 2005

Public Prevention
Individual Prevention of Contagious Sexually Transmitted Diseases

Epidemiological data indicate that the rising incidence of reinfections resulting from sexual contact is driven by shifts in the population's age Structure, the increased availability of modern contraceptives, and social changes caused by urbanization, industrialization, greater mobility, and evolving contemporary family and gender relationships.

While changing the demographic and social conditions that determine disease frequency is hardly feasible, measures must be taken to ensure that sexual activity does not pose a risk to health. In this regard, personal (individual) prophylaxis plays a critical role.

Casual and extramarital sexual encounters always carry risks, especially when intercourse occurs under METABOLISM/18.html">The Influence of alcohol (as is frequently the case), since alcohol enhances sexual arousal while simultaneously lowering vigilance. Therefore, following sexual contact with a casual partner, consulting a physician for advice and a preventive medical examination is strongly recommended.

There are several precautionary measures that everyone can and should practice. First, the genitals should be thoroughly washed before intercourse, and sexual contact should be avoided if any abrasions, scratches, or fissures are noticeable. In addition to regular washing of the external genitalia, women should douche the Vagina with warm Water or a weak boric acid solution (1–2 teaspoons per 3 cups of water). Before intercourse, the Penis and Scrotum should be greased with any fat-containing substance, preferably petrolatum (to which calomel - mercury monochloride, a small amount of grey mercurial ointment, or quinine may be added). It is essential to urinate immediately before intercourse. Immediately after sexual contact, one should urinate again, striving for a strong urine stream, and carefully wash the genitals (women should also douche).

Effective personal prophylaxis requires specific information, notably regarding the correct use of condoms.

Condoms must be stored in a cool, dark place and protected from direct sunlight. A condom should be put on before any genital contact begins to prevent exposure to infectious secretions. Only water-based lubricants should be used with condoms. The condom must be applied carefully (to avoid tearing) by holding the tip and rolling it down the erect penis, leaving space at the end for semen while ensuring minimal trapped air.

The Use of spermicide-containing condoms provides better protection against infection, an effect that is further enhanced by introducing Spermicides directly into the vagina. After ejaculation, caution must be exercised to prevent the condom from slipping off before withdrawing the penis from the vagina. The penis should be withdrawn while still erect, holding the condom firmly at its base. It is advisable to use latex condoms, which, unlike standard rubber ones, offer superior protection against HIV and other viral urogenital infections.

Individual prophylaxis is most effective when performed within the first few hours following sexual contact. It can be carried out either at specialized individual prophylaxis clinics (which operate around the clock) or independently by individuals exposed to the risk of a sexually transmitted infection through a casual encounter. In the latter case, autoprophylaxis is performed using portable (pocket-sized) individual prophylactic kits in accordance with the enclosed instructions.

Prophylactic care at designated clinics should be provided on a round-the-clock and unhindered basis. Preventive measures against Sexually Transmitted Infections can also be administered universally and continuously at inpatient dermatovenereology dispensaries by nursing staff.

Procedure for Providing Prophylactic Care to Men

1. The visitor urinates and washes their hands with soap and water.

2. The penis, scrotum, pubic area, thighs, and Perineum are thoroughly washed with warm water and soap.

3. After drying with a napkin, these same areas are meticulously wiped with a cotton swab soaked in a 1 : 1000 mercuric chloride (corrosive sublimate) solution or a 0.05% chlorhexidine bigluconate (hibitane) solution.

4. The anterior Urethra is irrigated with a 1 : 6000 potassium permanganate solution or a 0.05% hibitane solution, using at least 0.5 L of flushing fluid.

5. Using an eye dropper, 6–8 drops of a 2–3% aqueous protargol solution or 1–2 mL of 0.05% hibitane are instilled into the urethra, and the external urethral meatus is compressed for 2–3 minutes. After releasing the solution, patients are advised not to urinate for 2–3 hours.

6. The visitor is provided with a gauze napkin to protect the genitals from soiled underwear, which should be changed at the earliest opportunity.

For male autoprophylaxis, hibitane is used in accordance with steps 1, 2, 3, and 5.

Procedure for Providing Prophylactic Care to Women

1. The visitor urinates and washes their hands with soap and water.

2. The genitals, pubic area, perineum, and thighs are thoroughly washed with warm water and soap.

3. After drying with a napkin, these same areas are meticulously wiped with a cotton swab soaked in a 1 : 1000 mercuric chloride (corrosive sublimate) solution or a 0.05% chlorhexidine bigluconate (hibitane) solution.

4. Vaginal douching is performed using a 1 : 6000 potassium permanganate solution or a 0.05% hibitane solution, utilizing 150–200 mL of fluid.

5. Upon completion of douching, 8–10 drops of a 1–2% silver nitrate solution are instilled into the urethra using an eye dropper. Using a Cusco speculum, the vagina and the vaginal portion of the cervix are wiped with the same solution; once the speculum is removed, the vaginal vestibule is wiped, paying special attention to the crypts and paraurethral ducts.

6. The visitor is provided with a gauze napkin to protect the genitals from soiled underwear, which is subsequently recommended to be changed.

Women perform autoprophylaxis in accordance with steps 1–4 using hibitane, followed by the instillation of 1–5 mL of a 0.05% hibitane solution into the urethra.

While the aforementioned measures to prevent urogenital contact infections are not always fully effective, this by no means implies they should be neglected. On the contrary, they must be followed strictly, as in most cases they can prove highly beneficial.

A typical specific form of individual Prevention is the prevention of Pregnancy, where Methods aimed at averting conception are used at the couple's own discretion. At certain stages of life, for various reasons, Pregnancy and Childbirth may be undesirable. A married couple should be free to decide how many children to have and when. The right to have or not have children at any given time should be granted to everyone. There is no universal method of Contraception suitable for all. Family planning is understood as planning by the couple themselves. Interference in family affairs by government agencies or medical institutions is unacceptable.

Important factors in primary health care aimed at preserving the family include not only addressing contraception, but also treating Infertility, managing recurrent Miscarriage, preventing abortions, and so forth.

Contraceptives are used both to prevent unwanted pregnancy and to regulate its timing, taking into account the woman's age, the couple's health status, the number of children, and the intervals between births.

Medical professionals face the urgent challenge of reducing the number of abortions. Unfortunately, modern contraceptive methods are used by only 5 to 6 out of 100 women of reproductive age. The use of highly effective and safe methods of contraception can eliminate abortion, following which the incidence of gynecological disorders rises (according to clinical observations, post-abortion rates of miscarriage, perinatal morbidity, and mortality increase by 2 to 3 times). Systematic and consistent efforts to promote the rational use of contraceptive methods are essential not only in antenatal clinics, but also in dermatovenerological dispensaries, medical sanitary units, and other healthcare facilities.