Military medical commission gynecologist. All questions about VVK when applying for service in the Ministry of Emergency Situations or the Ministry of Internal Affairs of Russia. Can a soldier be fired without passing the VVK, upon reaching the age limit

hello! when I was dismissed from the bodies of the Ministry of Internal Affairs, I didn’t pass the military specialization, I have a group 3 shell shock, I don’t hear in my right ear, I received documents during the service, I quit 6 years ago, can I now go through the military professional experience of 18 years

Dismissal at the end of the contract VS correctly

Artur is an active serviceman, more than 20 years of service (cal.), recognized as in need of housing, l / case is under calculation, I have not passed the VVK yet, I want to quit at the end of the contract in June 2018 after passing prof. retraining (report on...

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What is due to a police officer upon dismissal on the conclusion of the VVK?

Hello! VVK declared unfit (D- unsuitable). I have been serving in the authorities since 2001. Injured while on study leave. What payments are due? Can I retire if the length of service is 17 years, and how to do this? Please tell me!

Am I entitled to payments and VVK upon dismissal from military service at the end of the contract?

When leaving military service at the end of the contract, are there any payments and do I have the right to undergo VVK? In service for 7 years.

Can a soldier be fired without passing the VVK, upon reaching the age limit?

Hello! Can a contract serviceman be fired upon reaching the age limit without passing the IHC. The contract ends on 07/19/2017. They sent me to the polyclinic for an IHC, then I sent documents to the hospital IHC,...

June 13, 2017, 22:34, question #1666211 Sergey Nikolaevich, Orel

Do I need to pass VVK upon dismissal from the federal fire service

Hello. I work as an inspector ONDiPR (State Fire Supervision) I wrote a letter of resignation on 05/10/2017 of my own free will. In May 2017, I wanted to get a job at the Ministry of Internal Affairs. In the personnel department of the Ministry of Internal Affairs, I was given a referral for group 2. At...

Passing the VVK upon dismissal from the Armed Forces of the Russian Federation

Hello. What are the terms for passing the military medical commission upon dismissal, and what order regulates this?

11 April 2017, 10:20, question #1604498 Konstantin, Stavropol

Due payments upon dismissal of a serviceman for health reasons

My husband has been on contract since 2010. according to the decision of the VVK in 2016, the health group B is limited fit. The disease was received during the service. contract until 2018. What payments are due to him?

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Re-passing VVK

I am a contract serviceman, after passing the VVK - "D" I am unfit for military service, released from military service duties until I am excluded from the lists of the unit. I'm waiting for a housing subsidy, so I'm not fired. Soon it will be like a year. Should I re...

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Dismissal from the penitentiary system

I serve in the penitentiary system. During the period of being on sick leave, he was placed at the disposal of the state with subsequent dismissal due to age. Sick leave for more than 120 days, then another vacation. Was sent to the VVK (forecast ...

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Dismissal for health reasons

According to the conclusion of the VVK, he is not fit for military service "D". I am on electronic registration for housing - a subsidy. Service 25 years of calendars. According to the Federal Law, they cannot be fired without housing. Before being excluded from the lists, the part must be released from execution ...

09 July 2015, 13:04, question #899418 Anatoly Palamarchuk, St. Petersburg

sick leave

Hello, I am a major of the medical service, in March 2013, during the passage of the VVK to conclude a new contract, a disease was detected - aseptic necrosis of the head of the left femur, according to article 65 of the schedule of diseases and TDT (at that time PPRF ...

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Sick leave compensation

My husband was fired for non-compliance with the contract, but before that he was in the hospital and after passing the VVK he was assigned category B. Is it possible to make a dismissal due to illness and how much compensation will be paid for dismissal due to illness. Thank you in advance. Husband...

Russia regarded Israel's actions as hostile and stated that it reserves the right to adequate response.

TALKING ON EQUALS

IN Moscow after Russian spy plane tragedy Il-20 over the Mediterranean Commander of the Israeli Air Force arrived General Amikam Norkin. For negotiations in Ministry of Defense RF he was accompanied by a retinue of military and civilian specialists. Even before Norkin's arrival in the capital Russia the Israeli press "leaked out" that he allegedly intended to meet with Russian Defense Minister Sergei Shoigu, and then with President Vladimir Putin. However, presidential spokesman Dmitry Peskov said that "the meeting with Norkin is not on the Russian leader's schedule." There was no such meeting in the schedule of Shoigu. And this, from the point of view of “diplomatic politeness”, is a fairly clear sign that the Israeli general was prepared for the appropriate “level of reception”. There was clearly a discussion on equal terms. Therefore, from the Russian side, the Commander-in-Chief of the Aerospace Forces (VKS) of Russia, Colonel General Sergey Surovikin.

The meeting of the delegations (and from our side about 15 people sat down at the table) took place in one of the halls of the Ministry of Defense. A source told the KP military observer how the negotiations went, and (for obvious reasons) asked not to reveal his names and positions. Here is a recording of our conversation.

OUR FACES WERE SERIOUS

- How did the negotiations begin?

From the fact that Surovikin and Norkin greeted each other, shook hands and, together with the accompanying persons, sat opposite each other at long tables. I noticed that all of our people had very stern faces, and the Israelis did not make diplomatic smiles. Everyone understood that the situation was not the same - the conversation would be very difficult.

Norkin first expressed condolences to the families and friends of the deceased crew of the Il-20, and then said that the Israeli side was ready to provide the Russians with all the necessary data on the situation with our aircraft. In front of him lay a plump folder of documents. These were the findings of an investigation conducted by the Defense Army Israel after the incident. Including pre-flight information about the four IsraeliF-16, which appears in this tragedy. I figured that there would be fifty pages.

- And how did Surovikin react to this?

He spoke in the sense that, they say, thanks for the documents, but we need to look into them very thoroughly. Because we are also conducting our own investigation, that we have our own documents of objective control. There are Syrian...

"WHAT DOES ASAD DO HERE?"

And then Norkin outlined the vision of the tragic situation with our Il-20 from the Israeli side. He spoke for a long time, I can only tell you some of the main points. And I’ll immediately notice that we didn’t hear anything fundamentally new.

There was a set of arguments already heard from Tel Aviv, from the Israeli Defense Ministry ...

- And which ones?

Well, for example, Israel lays full responsibility on the Assad regime for the downing of the Il-20. When our people heard this, many wanted to exclaim: “And what does Assad have to do with it?” This is typical demagoguery! Yes Yes! The Israelis, in all seriousness, blamed the Bashar al-Assad regime for the tragedy, emphasizing that it was the Syrian air defense hit the plane.

Someone from our side immediately cut off the Israeli with an iron counterargument: “If yourF-16 did not break into airspace Syria, did not provoke the Syrian air defense to open fire, then no tragedy would have happened.

- And how did the Israeli delegation react to this?

Again suffered the same demagogic blizzard. Say, Israeli The Air Force attacked the objects of the Syrian army, which (with a reservation - allegedly!) Produced weapons for Hezbollah, which (and here again - allegedly!) Was intended to be used against Israel, escalating the threat ...

"WE HAVE OTHER DATA"

- And what did Surovikin say to that?

He said that all this needed serious factual evidence, not speculation. Because that's how far you can go. Military people operate with facts, not versions. In response, the Israelis showed our satellite images of those areas whereF-16 struck. And they sang again: they say, from these pictures it can be concluded that these are military plants for the production of high-precision missiles, and not aluminum plants, as the Assad regime claims. One of our guys cut them off again: they say, different conclusions can be drawn... Including far-fetched ones... Let's get down to business. But again they heard: “Israel believes that Iran and Hezbollah are responsible for this tragic incident.”

Here Surovikin, with his questions to Norkin, returned the negotiations to the right track. And again he made it clear to the other side that it was the actions of Israeli aviation that day that provoked the tragedy. And again he reminded the guests of the words of Shoigu: "The blame for the downed Russian plane and the death of the crew lies entirely on the Israeli side." This is our principled position.

- And what did Norkin say to that?

The Israelis got out here too: “When the Syrian army fired missiles that hit the Russian plane, Israeli Air Force planes were already on Israeli territory.” And that, they say, during the attack by the Israeli Air Force, the Russian aircraft that was hit was not in their zone of action.

And what was our response to that?

And from our side it immediately sounded that we have other data. Other Documents. The Syrian air defense command also has them. Here you need to thoroughly check the data. Literally minutes and seconds.

ALMOST FROM THE CHAIRS DID NOT FALL

- And the question of why the Israelis informed us only a minute before the moment when their fighters broke into the Syrian sky was raised?

Certainly! It was evident from the expression on the faces of the Israeli delegation that this was a very, very unpleasant question for them. Moreover, both Surovikin and our other officers reminded them of our long-standing, back in 2015, agreements on the "rules of the game."

- And how did the Israelis react to this question?

Verbose and dull. Even the translator had difficulty choosing words. And when they said that “the Syrian anti-aircraft batteries fired indiscriminately,” and then “we (the Israelis, - ed.), unfortunately, also did not bother to make sure that there were no Russian aircraft in the air,” then our officers almost fell off their chair! Is it with the vaunted super-modern Israeli radar stations “not to see” under your nose such a colossus as the Il-20 ?! Even an Israeli schoolboy would not believe this. We had to firmly repeat our position again: the Israeli pilots set up the Il-20 under the fire of the Syrian S-200.

ADJUSTMENTS WILL BE

In general, the impression was that Norkin and those accompanying him at the peak moments of the negotiations tried to evade specific military-technical issues related to our Il-20, but pressed on something completely different. The fact that Iran, for example, wants to strengthen its military presence in Syria and transfer weapons to Hezbollah.

But what does this have to do with it, if we are primarily interested in the main thing - do the Israelis recognize that it is the actions of their fightersF-16 provoked the tragedy?

- And how did the negotiations end?

Surovikin once again reminded the Israeli delegation of the point of view of the Russian Ministry of Defense, which was expressed by Shoigu. Well, agree to continue contacts. They also talked about the need to make serious adjustments to the Russian-Israeli agreements that were established three years ago after such a tragedy.

- Russia regarded Israel's actions as hostile and stated that it reserves the right to adequate response. Was this discussed in the negotiations?

No.

- But such actions will be?

We are military people. We have a Supreme Commander, we have a Minister of Defense.Whatever order we receive from them, we will carry it out.

In order to get a job in the fire department (namely, in the service, in a certified position) - you need to pass the VVK and not everyone succeeds. Perhaps this is the main authority for weeding out potential firefighters.

What is VVK

This is a military medical commission, the main task of which is to determine the suitability of a candidate (employee) for service (further service) in the specified position.

Let's try to make the process a little easier and to acquaint you in advance with what is necessary for passing the VVK.

Documents for passing

• First, it is necessary pattern direction , which you need to obtain from the personnel department of the organization where you are going to get a job. The referral is valid for three months from the date of issue;
• Passport of a citizen of the Russian Federation;
• Military ID

Applicants, that is, candidates for study who have not completed military service in the Armed Forces, must have registration certificate , in which there is a mark A - fit for service.

Candidates in whose registration certificate the mark B-3, B-4 are not allowed to pass the VVK, even minor restrictions on the service are grounds for refusing to pass the VVK.

This requirement applies to boys, girls do not have a registration certificate.

Analyzes

1. clinical blood test (with extended leukoformula);
2. general urine analysis;
3. blood test for syphilis, HIV, hepatitis B and C;
4. a certificate of vaccination against diphtheria (or a corresponding mark in the vaccination certificate);
5. fluorography of the chest organs (in two projections). Please note that not only the conclusion is necessary, but also the pictures themselves;
6. ECG with interpretation at rest and with exercise;
7. study of vestibular function (for positions of the first and second groups of assignment);
8. chemical-toxicological examination for narcotic substances;

The results of examinations are valid for three months, fluorography - 6 months.

References

1. Outpatient card or detailed extract from the outpatient card for the last 5 years. If the place of residence has changed over the past five years, then extracts are needed from all the clinics where you were observed;
2. Certificates indicating the existing (if any) diseases and dispensary records;

Information about dispensary observation from psycho-neurological, narcological, dermatovenerological and tuberculosis dispensaries. As a rule, these certificates are paid, of the established form, and are issued in the relevant dispensaries.

Doctors who will need to go directly to the commission:

• dentist;
• surgeon;
• otolaryngologist;
• neurologist;
• psychiatrist;
• dermatologist;
• ophthalmologist;
• therapist;
• female candidates additionally visit a gynecologist.

Note that each doctor examines very meticulously, if there is the slightest doubt, as a rule, referring to additional examinations.

When extending the service life

(The list is attached to the entry by clicking the download button)

1. Referral of the personnel department for a medical examination.
2. Service certificate.
3. Service characteristic.
4. Outpatient card.

Certificates indicating the existing diseases and the terms of dispensary observation for them:

All certificates must be certified by the personal seal of the doctor and the seal of the relevant medical institution.

Preparation for passing the commission

Preliminary training is optional, but if a candidate is serious about serving in the Russian Emergencies Ministry and wants to have the best chance of passing the VVK, a serious approach is needed.

The document that used to be guided by the VVK when determining fitness for service is the order of the Ministry of Internal Affairs of the Russian Federation dated July 14, 2010 No. 523 ( is currently invalid).

• "On the requirements for the state of health of citizens entering the service in the internal affairs bodies of the Russian Federation and employees of the internal affairs bodies of the Russian Federation, lists of additional mandatory diagnostic tests carried out before the start of a medical examination, forms of documentation necessary for the activities of military medical commissions, the procedure for conducting a control examination and re-examination and on recognizing some regulatory legal acts as invalid";
• (expired, instead: Order of the Ministry of Emergency Situations of Russia dated August 30, 2018 N 356 ) "On the requirements for the state of health of citizens entering the service in the federal fire service of the State Fire Service, and employees of the federal fire service of the State Fire Service, lists of additional mandatory diagnostic tests carried out before the start of a medical examination of citizens entering the federal fire service of the State Fire Service, and employees of the federal fire service of the State Fire Service, the procedure for conducting a control examination and re-examination based on the results of an independent military medical examination and the forms of documentation necessary for the activities of military medical commissions in the system of the Russian Emergencies Ministry.

Pay attention to the section: additional requirements for citizens who did not serve and enter the service and (or) in educational organizations.

Now you can preliminarily assess the state of your health and its compliance with the requirements. It is clear that this will only be a rough estimate, but in some ways it is possible to be ahead of the curve and take action. There are health disorders that are an obstacle to service, but can be corrected. Therefore, it would be more expedient to come to the passage of the commission, having treated and corrected everything that can be corrected and treated.

What needs to be done before passing the commission? It is worth estimating the ratio of your height and weight and the compliance of your parameters with the norm (Table No. 2 to the annex to the Requirements of Order No. 190), it is quite possible to lose extra or missing kilograms in advance or, conversely, eat up. It is worth contacting a dentist in advance to sanitize the oral cavity, caries can play a cruel joke. In general, it is worth treating in advance everything that can be treated and corrected, so that the doctors do not have unnecessary reasons to focus their attention. But pay attention - if the correction requires surgical intervention, you need to undergo a commission no earlier than 6 months after the operation, if you come before the expiration of six months - the verdict will be "temporarily unfit".

Is it possible to hide any health problems and go against the existing rules? Of course, nothing is possible. Now, with the active development of paid medical institutions, many people prefer them to budgetary clinics at the place of residence, preferring comfort, lack of queues, records. At the same time, the outpatient card at the place of residence, respectively, will be clean, without records of treatment.

It is also possible not to answer the whole truth to the standard questions of specialists about the presence of complaints in their profile - not all diseases can be determined by the doctor without additional examinations, therefore, when determining the need for these examinations, he will still be guided by your words and map data.

Therefore, if you set a goal, it is, of course, possible to hide (or try to do this) the presence of problems, but you should think carefully - and who will you ultimately deceive? It would not work that himself. The commission's requirements for health are extremely high, but this is due to the serious stress on the body in the performance of duties in this position. And some minor feature that does not interfere in everyday life and does not cause absolutely no trouble, in extreme conditions can play a fatal role and turn into a disaster not only for the employee himself, but also for those for whose lives he is responsible.

How to pass the CPD

When hiring, not only physiological health is important, but also psychological. That is why special attention is paid to psychodiagnostics, which is carried out by the specialists of the CPD. The abbreviation TsPD means nothing more than a center for psychodiagnostics, where candidates for service undergo a psychological examination.

You can also prepare for the passage of the CPD. First, you need to carefully analyze your appearance. Yes, and in such serious organizations they are met by clothes, so it should be clean, tidy, and remember that you still go to a reputable institution with a very specific goal, so you should not shock others. Resist the temptation to come in shorts and flip-flops, no matter how hot it is.

If you have tattoos, piercings, be prepared to answer additional questions. If there are scars, get ready to answer questions about their origin.

Try to look at yourself from the outside. Psychologists draw conclusions not only on the basis of testing, they evaluate the candidate in a comprehensive manner. Believe me, nothing will go unnoticed. Bitten nails, dirty shoes, the smell of a freshly smoked cigarette - all these are the "hooks" that a specialist can "hook" on, so you should not give him an extra reason.

Immediately before the day for which the examination is scheduled, it is necessary:

• Get enough sleep. Lack of sleep will definitely affect your psychophysiological state;
• Don't be hungry. Provide in advance the opportunity to satisfy hunger and thirst;
• Tune in to the fact that the examination will take a lot of time. Do not plan anything else for this day, in order not to be nervous and not in a hurry.

Well, it would be useful to recall that it is completely unacceptable to appear for examination in a state of residual alcohol intoxication (with a smell). Even if you have a good reason in the form of your own wedding or the anniversary of your beloved mother-in-law, refrain.

How is the examination carried out? First, you will be tested. The standard tests used on the JPC are easy to find, they are all available, and you can even take them in advance.

What do you need to pay attention to?

• Read the questions carefully, emphasizing the words always, sometimes, never, often, occasionally.
• Don't try to be perfect. All tests contain questions that determine the so-called scale of sincerity, on the basis of which the degree of your truthfulness is assessed. You will not pay for carrying luggage on an empty bus in the absence of a conductor? So don't be afraid to admit that you won't.
• Memorize your answers. There are a lot of questions, often they are repeated, with a slight change in the wording. Don't get confused.

Testing to determine the coefficient of intelligence. These tests can also be found and familiarized with them in advance, with the correct answers, respectively, too. But still, do not rewrite the answers, but first solve the problem so that you can demonstrate the course of your thoughts, if necessary.

There will be many tests, with a lot of questions, please be patient. After testing, you will have a mandatory conversation with a psychologist. And here try to remember that you are talking with a psychologist and he evaluates you for the degree of suitability for service. Do not relax, be on the alert, although the task of a psychologist is just the opposite.

You should not take a “closed” position during a conversation - cross your arms and legs, hide your eyes, often touch your face with your hands. Based on the results of the conversation, the specialist may send you for an additional examination.

The results are not handed over to the candidate, they are taken by the personnel department employee.

In what other cases is it necessary to undergo VVC and CPD

When transfer to a position, whose destination group is higher than the one for which you passed the commission.

It is worth noting that the requirements for the health status of existing employees in this case are somewhat different from those that apply to candidates.

Passing the transfer commission is somewhat easier than initially for the position. So in some cases, if a candidate did not pass through the first group of destination, but passed, for example, through the third, it makes sense to still get a job in the group for which he passed. And later, already being an employee, try to go again to the position for which it was originally planned.

In the case of an employee being transferred to a position with an increase in the assignment group, he also needs to pass the CPD.

In the event of an insured event. Employees of the Ministry of Emergency Situations of Russia are insured on a mandatory basis, that is, in the event of an insured event, the employee is paid a certain amount. The amount of the sum insured depends on the severity of the injury. And just the severity of the injury is determined by the military medical commission. You can read more about it in our article.

It is necessary to collect all the certificates, all the conclusions of doctors, all the pictures - all this will come in handy at the commission.

Full list of required documents:

1. Referral for medical examination. The personnel department issues a referral, it must be indicated that an employee is sent to determine the severity of the injury. Valid referral for three months from the date of issue;
2. The conclusion of the internal investigation, (certificate of injury), is signed by the head of the unit. It indicates the circumstances of the injury and must necessarily be a conclusion in the following wording - "the injury was received in the line of duty" or "the injury is not related to the performance of official duties."
3. Medical characteristics (it is drawn up by the attending physician).
4. Outpatient card.
5. A copy of the sick leave.
6. A copy of the certificate of the passage of the VVK for fitness for service from the personal file.

If, upon receiving an injury, you did not go to the polyclinic of the Ministry of Internal Affairs, but to another medical institution, then you must additionally provide:

1. certificate of initial appeal to a state or municipal health care institution (original);
2. an extract from the medical history of an outpatient (inpatient) patient;
3. discharge epicrises and other medical documentation (certified copies).

All medical documents must be certified with a corner stamp and the seal of the healthcare institution you applied to.

IMPORTANT! Do not delay with registration, the period from the moment of injury to the moment of insurance payment should not exceed three years.

When extending the service life

(reaching the age limit)

Upon reaching the age limit (currently it is 45 years for employees whose rank is not higher than lieutenant colonel) and extending the term of service, the employee needs a commission opinion on the possibility of continuing to serve.

Upon dismissal

Upon dismissal, an employee is invited to undergo an IHC, from which he has the right to refuse. If the VVK recognizes an employee as unfit for further service or fit with restrictions, then the basis for dismissal may change. You can read about in our article.

Also, an employee should be sent to the VVK if the total duration of days of disability is 4 months a year or more.

This is a relative innovation, please note that earlier they were sent to the IHC with a continuous sick leave of 4 months, now all sick days during the year are considered.

The psychologist of the unit directs the employee to undergo the JPC based on the recommendations of the previous conclusion and the results of the examinations.

Vulvovaginal candidiasis (VVC)- this is an inflammation of the mucous membrane of the vulva, vagina, urethra, perineum by fungi of the genus Candida.

SYNONYMS FOR CANDIDIOSIS

Urogenital candidiasis, vulvovaginal mycosis, urogenital mycosis, thrush, genital fungus.

ICD-10 CODE B37 Candidiasis. B37.3 Candidiasis of the vulva and vagina. B37.4 Candidiasis of other urogenital sites.

EPIDEMIOLOGY OF VULVOVAGINAL CANDIDIOSIS

Vulvovaginal candidiasis- one of the most frequent urogenital infections. The prevalence of thrush among women of reproductive age is 25-40%. Vulvovaginal candidiasis is second only to BV. More than 2/3 of the female population of the planet once in a lifetime suffered vulvovaginal candidiasis. The most common recurrent vaginal candidiasis. As early as 3–6 weeks after the cure of candidiasis, 10–33% of patients in vaginal smear studies note the presence of a culture of Candida albicans.

PREVENTION OF CANDIDIOSIS

Rational antibiotic therapy, timely correction of the immune system, regulation of carbohydrate metabolism, the correct choice of hormonal contraception, personal hygiene are important and effective preventive measures.

SCREENING

Patients with complaints of curdled vaginal discharge, itching, burning, dyspareunia, all pregnant women at registration and during the period of dynamic observation are subject to examination.

CLASSIFICATION OF VULVOVAGINAL CANDIDIOSIS

Allocate:

• acute vulvovaginal candidiasis;
• recurrent (chronic) vulvovaginal candidiasis;

Candidiasis is not a generally recognized pathology due to the presence of fungi in healthy women.

ETIOLOGY OF VULVOVAGINAL CANDIDIOSIS

The most common causative agent of vulvovaginal candidiasis is fungi of the genus Candida, which includes C. albicans, C. pseudotropicalis, C. glabrata, C. krusei, C. parapsilosis, and others. In addition, the frequency of fungal infections caused by fungi of other species is increasing: Torulopsis glabrata, Saccharomyces cerevisae, etc. Fungi most often affect the vagina, vulva, and perioral skin. anal region, urethra. The disease - urogenital candidiasis, proceeds according to the type of vulvovaginitis or dermatitis of the vulva.

PATHOGENESIS OF VULVOVAGINAL CANDIDIOSIS

Risk factors:

• wearing synthetic, tight-fitting underwear;
• sanitary napkin;
• oral sex;
• diabetes;
• pregnancy;
• taking broad-spectrum antibiotics;
• high-dose oral contraceptives;
• treatment with steroid drugs;
• diaphragms, IUDs, spermicides.

Along with known risk factors such as pregnancy, high-dose hormonal contraceptives, and antibiotics, the main cause of vulvovaginal candidiasis is a weakened immune defense. Women suffering from acute or chronic vaginal candidiasis, on average, have fewer T-lymphocytes, T-helpers and B-lymphocytes, as well as a smaller number of T-killers, compared with healthy women.

CLINICAL PICTURE OF VULVOVAGINAL CANDIDIOSIS

The clinical picture is characterized by:

• heavy or moderate cheesy vaginal discharge;
• itching and burning in the vulva;
• increased itching in the afternoon, during sleep, after water procedures, sexual intercourse, long walking, during menstruation;
• dyspareunia;
• dysuric symptoms.

In non-pregnant women, complaints prevail over the clinical symptoms of the disease. Patients complain of itching and burning in the vulva, gray-white "curdled" discharge from the genital tract and urethra, urination disorder. During a gynecological examination, edema of the vulva, hyperemia and bleeding of the mucous membranes are noted, on the skin there are areas of hyperemia and maceration. A characteristic symptom of the disease is gray-white deposits on the mucous membranes, which are difficult to separate with a spatula, areas of pronounced hyperemia under the plaque.

Complications of vulvovaginal candidiasis:

• vaginal stenosis;
• increased risk of pelvic infections;
• recurrent infections of the urinary system;
• miscarriage;
• the birth of small children;
• chorioamnionitis;
• premature rupture of membranes;
• premature birth.

DIAGNOSIS OF VULVOVAGINAL CANDIDIOSIS

The diagnosis is made by evaluating the history, complaints, clinical manifestations and laboratory results. In addition to express methods (light microscopy of native preparations, Gram smear microscopy stained with accredino orange, luminescent microscopy), culture methods with selective media (Saburo) and immunofluorescent methods are used. To suspect a candidal infection, a combination of three of these symptoms is necessary:

• curdled discharge;
• local signs of inflammation;
• the presence of spores or mycelium in smears.

Criteria for the diagnosis of vulvovaginal candidiasis:

• vaginal pH 4.0–4.5;
• no smell (in the smell test in the mirror and aminotest);
• detection of yeast-like fungi or pseudohyphae in a wet preparation (positive result 40–60%);
• detection of yeast-like fungi or pseudohyphae in a Gram smear (positive result up to 65%);
• detection of yeast-like fungi during the cultural study of the material (if symptoms from the vulva prevail, then the material must be taken with a swab in this area).

The procedure for diagnosing urogenital candidiasis

1. Smear microscopy.
2. Cultural method.
3. Serological reactions of RA, RSK, RP.
4. Enzyme immunoassay (ELISA).
5. Polymerase chain reaction (PCR).

PHYSICAL EXAMINATION

A gynecological examination reveals a large amount of white curdled discharge, hyperemia and swelling of the mucous membranes.

LABORATORY RESEARCH

• Microbiological diagnostics: ♦ smear microscopy of vaginal discharge (native and Gram-stained preparations); ♦ cultural method (determines the amount, genus and species sensitivity to antifungal drugs, as well as the nature and degree of colonization by other microorganisms).
• Serological methods (RSK).
• Immunofluorescent diagnostics (CandidaSure).
• Express methods (do not allow to identify the accompanying flora).
• Immunological research.

It has been established that mycoses are not sexually transmitted, however, it has been confirmed that this disease is associated with the nature of sexual contacts (anal-vaginal, orogenital, etc.). Candidiasis vulvovaginitis is not sexually transmitted, even though identical strains of fungi are isolated from partners. Treatment of sexual partners is necessary only in case of development of candidal balanoposthitis.

TREATMENT OF VULVOVAGINAL CANDIDIOSIS

Conditions for effective treatment of vulvovaginal candidiasis:

• the abolition of estrogen-progestogen drugs;
• withdrawal of glucocorticoids;
• cancellation of antibiotics;
• rejection of bad habits;
• carbohydrate restriction, diet;
• local therapy in uncomplicated cases;
• combined local and systemic therapy for recurrent VVC.

Primary cases of treatment of acute vulvovaginal candidiasis, as a rule, do not cause difficulties. The use of antifungal agents, mainly azoles, is effective. It is much more difficult to treat recurrent vulvovaginal candidiasis. Treatment requires the use of not only antifungal drugs, but also a complex of auxiliary therapy. Very often, treatment is unsuccessful, despite the use of many antifungal drugs. The HIV epidemic makes this problem even more urgent. Another urgent problem is the combination of infection with gastrointestinal lesions.

Treatment of acute vulvovaginal candidiasis.

• Butoconazole: 2% vaginal cream 5 g once.
• Ketoconazole: vaginal suppositories 400 mg (1 suppository) 3-5 days.
• Fluconazole: 150 mg orally as a single dose.
• Itraconazole: 200 mg orally twice a day for 3 days.
• Sertaconazole 300 mg (1 vaginal suppository) once.
• Clotrimazole: 100 mg (1 vaginal tablet) for 7 days or 200 mg (2 vaginal tablets) for 3 days or 500 mg (1 vaginal tablet) once or 1% cream 5 g intravaginally for 7-14 days.
• Miconazole: vaginal suppositories 100 mg (1 suppository) at night for 7 days or 200 mg (1 suppository) for 3 days.
• Nystatin: vaginal tablets 100,000 IU (1 suppository) daily for 14 days.
• Thioconazole 6.5% ointment 5 g intravaginally once

Despite the high efficiency of traditional local therapy, many patients experience relapses after 1–3 months. Many factors contribute to this. For example, broad-spectrum antibiotics, especially with prolonged use, change the normal vaginal microflora, resulting in the development of BV. Oral contraceptives increase the risk of candidiasis in the same way as pregnancy: high estrogen levels cause high levels of glycogen, favorable for the growth of fungi of the genus Candida. In addition, estrogens enhance adhesion to the vaginal epithelium and its colonization by fungi. In patients with diabetes, the risk of vaginal candidiasis is higher due to increased levels of glycogen in the vaginal epithelium and reduced immunity. An increase in the number of Candida species such as C. pseudotropicalis, C. glabrata, C. parapsilosis is another reason for the increase in the number of relapses.

These species are less sensitive to traditional topical treatments than C. albicans. An increase in their clinical significance is facilitated by the completion of local treatment by patients before the onset of a cure. The insufficiency of traditional therapy for the eradication of such pathogens, the widespread use of short courses of topical imidazoles increases the risk of developing resistance. If in acute forms only local therapy is possible, then in chronic forms a combination of local, systemic and anti-relapse therapy is mandatory.

Therapy for chronic vulvovaginal candidiasis:

• a systemic antimycotic (itraconazole 200 mg orally twice a day for 3 days or fluconazole 150 mg for 3 days) and
• local therapy with azole drugs (on average, for 14 days).

Prevention of recurrence of vulvovaginal candidiasis:

• systemic antimycotic (itraconazole 200 mg orally or fluconazole 150 mg on the first day of menstruation for 6 months);
• therapy with local preparations once a week for 6 months.

Medicines used to treat genital candidiasis*

Imidazole preparations:
♦ ketoconazole (nizoral) - inhibits ergosterol biosynthesis in the fungus cell. Apply 400 mg / day, for 5 days;
♦ clotrimazole (kanesten) - inhibits the synthesis of nucleic acids, lipids, polysaccharides in the fungal cell. Apply in the form of vaginal tablets, 200-500 mg or 1-2% cream for 6 days;
♦ miconazole - 250 mg, 4 times / day, 10-14 days. Vaginal cream or vaginal suppositories (400 mg) daily for 3-6 days;
♦ bifonazole - 1% cream, 1 time / day. at night, 2-4 weeks;
♦ ginezol 100 or 400 mg: 1 suppository per vaginum;
♦ ginalgin - 1 vaginal suppository at night, 10 days;
♦ isoconazole (travogen) - vaginal balls, 3-5 days;
♦ econazole - vaginal cream, 0.15 g, 3 days;
♦ batrafen - vaginal cream 5 g at night, 10 days. Triazole preparations:
♦ fluconazole - 0.05 -0.15 g 1 time / day, 7-14 days;
♦ itraconazole (orungal) - 200 mg 1 time / day, 7 days. N-methylnaphthalene derivatives:
♦ lamisil - 0.25 g 1 time / day. (regardless of food intake), 2-4 weeks.

Antifungal antibiotics:
♦ nystatin - 500 thousand units 4-5 times / day, 10-14 days. To increase the effect, oral administration of nystatin is combined with intravaginal suppositories of 100 thousand units for 7-14 days;
♦ levorin - 500 thousand units 2-4 times / day, 10-12 days;
♦ amphoglucamine - 200 thousand units 2 times / day, 10-14 days.

Topical preparations:
♦ imidazoya derivatives (clotrimazole, miconazole, bifonazole, ginezol, ginalgin, isoconazole) - 1 vaginal suppository or 1 portion of vaginal cream at night for 10 days;
♦ dekamin - 1% ointment vaginally 1-2 times / day, 2-3 weeks;
♦ polygynax complex (neomycin, polymyxin, nystatin) at night, 1 suppository for 12 days;
♦ macmiror complex (nifuratel, nystatin) - vaginal suppositories for the night;
♦ terzhinan (neomycin, nystatin, ternidazole) - 1 vaginal suppository at night, 10 days;
♦ pimafucort (amycin, neomycin, hydrocortisone). It is used as a cream or ointment 2-4 times / day, 14 days;
♦ meratin combi (ornidazole, neomycin, nystatin) 1 vaginal suppository at night, 10 days;
♦ betadine - 1 vaginal suppository (0.2 g), 14 days.

CONTROL OF THE TREATMENT OF VULVOVAGINAL CANDIDIOSIS

• In the acute form, control of treatment is carried out 7 days after the end of treatment.
• In chronic VVC, the evaluation of the effectiveness of treatment is performed within 3 menstrual cycles on the 1st day after the end of menstruation.

Microscopy of smears of vaginal discharge is performed (native and Gram-stained preparations). Sowing of the discharge is necessary when the pathogen is not detected by microscopy, as well as in chronic recurrent VVC (in the latter case, species identification of the pathogen and sensitivity to antifungal drugs are required).