How does gardnerella manifest itself in women. Symptoms and treatment regimen for gardnerellosis in women

Gardnerellosis is an acute inflammatory disease of the genitourinary system in men and women associated with vaginal gardnerella. The causative agent is the anaerobic bacterium gardnerella, which is part of the vaginal microflora (less than 1% of the living microorganisms). A change in the composition of the microflora causes the development of candidiasis, gardnerellosis and other non-inflammatory diseases of the female reproductive system.

The bacterium belongs to facultative anaerobes, capable of rapidly multiplying, destroying the normal flora in the vagina. The microorganism is resistant to standard antibiotics, which makes therapy difficult when the disease occurs.

Gardnerellosis is common among women who have multiple sexual partners. The disease is sexually transmitted, as men are carriers of the infection. The contact-household mechanism of distribution is unlikely.

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Symptoms of gardnerellosis

Symptoms in women

In half of the patients who were diagnosed with gardnerellosis, the clinical picture of the disease is absent. However, being carriers, these women become sources of infection for men, and also pose a danger to their own newborns.

Symptoms of the disease:

• copious discharge from the vagina of a white or yellowish color;
• unpleasant smell of discharge and in the vagina (reminiscent of rotten fish);
• subjective sensations in the vagina (itching and burning);
• burning during or immediately after urination.

Unlike thrush (vaginal candidiasis), discharge from gardnerellosis is not similar to cheesy plaque. Also, there are no pronounced discomfort during or after sex.

Symptoms in men

Men infected by women are asymptomatic carriers of the disease and are not even aware that they have gardnerellosis. This is due to the fact that the microorganism infects squamous epithelial cells, which are present in the vagina, but are deficient in men.

Gardnerellosis in men occurs when there is a strong decrease in immunity. The disease manifests itself with typical signs of urethritis:

• discomfort when urinating;
• inflammatory phenomena (swelling and hyperemia);
• discharge from the urethra;
• itching and burning in the urethra.

These signs are weakly expressed and are fully manifested in the presence of concomitant pathologies.

Sometimes men develop prostatitis - inflammation of the prostate gland or balanoposthitis - inflammation of the glans penis and both layers of the foreskin. However, such variants of pathology are characterized by poor and sluggish symptoms.

Treatment of gardnerellosis

The treatment regimen for gardnerellosis includes two stages:

At the first stage, an excessive amount of gardnerella in the genital tract is destroyed. Therefore, the main drugs at the beginning of treatment are the specific antibiotics metronidazole and clindamyci, which are prescribed for topical use in the form of gels, ointments or vaginal tablets for 7-10 days.

Treatment of pregnant women with antibiotics is different: in the first trimester, therapy is carried out with ampicillin, and in the second - with metronidazole. Pregnant women should not be prescribed clindamycin, due to the toxic effect on the fetus. Treatment should not be delayed until the baby is born, as the infection provokes premature birth and complications in the health of the mother and child.

After the destruction of pathogenic bacteria, at the second stage of treatment, the normal microflora of the vagina, which has suffered due to antibiotic therapy, is restored. For this purpose, vaginal suppositories containing lactobacilli are prescribed:

• Acylact;
• Lactonorm;
• Lactobacterin.

Sometimes oral medication is also possible. To achieve the result, it is recommended to follow a diet. During treatment, exclude from the diet:

• spicy and fried foods;
• alcohol;
• sweet.

In addition, more fermented milk products containing lactobacilli are added to the diet: yoghurts and kefirs.

Sometimes, against the background of bacterial vaginosis, women develop intestinal dysbacteriosis. For the purpose of prevention, a course of probiotics is prescribed:

• Linex;
• Enterogermina;
• Bifidumbacterin.

It is also useful to prescribe immunomodulators, since the disease often occurs against a background of weakened immunity. As a rule, natural-based preparations (for example, echinacea) are used.

During treatment, sexual contact is prohibited. The key to effective treatment of gardnerellosis is the examination of the sexual partner to prevent reinfection.

Monitoring the effectiveness of therapy is carried out 10 days after the start, if necessary, the preparations are corrected.

Folk remedies for the treatment of gardnerellosis

At home, gardnerellosis is treated with herbs and plants. Medicines are prepared easily, while the positive results of alternative treatment appear quickly.

Here are six popular recipes for folk remedies for the treatment of gardnerellosis:

• Mix 100 g of chamomile with 100 g of sage and the same amount of calendula. Pour 300 g of the collection with 2 liters of water and boil over low heat for 30 minutes. Cool the prepared liquid and use for douching. For one douching procedure - at least 100 ml of healing liquid.
• Steam 100 g of dry pharmaceutical chamomile in 1 liter of hot water, set aside for 60 minutes, strain and use for irrigation. The tool will help destroy harmful bacteria and strengthen the body.
• After the onset of gardnerellosis, it is advised to douche with the help of oak bark - pour 200 g of raw materials with 1 liter of boiling water, cook over medium heat for half an hour and strain. Each time for douching, use 1 glass of this drug. During the day, do at least 2 such procedures.
• 50 g of elecampane root mixed with the same amount of wormwood herb, licorice roots and raspberry leaves. Steam 100 g of the collection in 1 liter of boiling water and set aside for 9 hours. Use the resulting consistency for douching twice a day.
• In the same amount, mix the crushed bergenia root with clover flowers; eucalyptus leaves; tansy flowers; bearberry leaves; wintergreen grass; coltsfoot leaves; mint herb and lamb herb. Pour 2 tablespoons of the crushed mixture with 1 liter of boiling water and set aside overnight. You need to drink such a remedy for half a glass three times a day before meals.
• Calendula tea is recommended to strengthen the body and saturate it with useful trace elements in bacterial vaginosis. Pour 100 g of calendula with 1 liter of boiling water and wait until the liquid has cooled. You can drink this tea warm throughout the day. Positive results usually appear quickly.

Causes of gardnerellosis

Gardnerellosis occurs when the composition of the vaginal microflora changes. The number of beneficial microorganisms (lactobacilli) inhabiting this organ decreases, and the number of conditionally pathogenic, pathogenic bacteria increases. This imbalance can be caused by both internal and external causes.

Internal causes

• hormonal changes in the body;
• reduced immunity;
• chronic fatigue, overwork, stress;
• inflammatory processes of the genitourinary sphere;
• intestinal dysbiosis.

External causes

• malnutrition;
• taking antibiotics and hormonal drugs;
• the use of flavored hygiene products;
• wearing tight synthetic underwear;
• frequent change of sexual partners;
• unprotected intercourse;
• venereal diseases.

The disease is transmitted from a sick mother to her child, usually a girl at the time of birth, but newborn children are not diagnosed like this. To prevent the onset of symptoms of the disease, the infant is prescribed drug therapy.

The likelihood of infection with gardnerellosis increases in women who are sexually active, often change partners and ignore barrier types of contraception. The natural balance of microflora is also disturbed due to the frequent use of vaginal products and birth control pills.

Complications of gardnerellosis

In most patients, gardnerellosis does not lead to complications, and quickly disappears after a course of antibiotic treatment. But, sometimes the disease gives dangerous consequences. Undertreated or chronic gardnerellosis causes:

• endometritis;
• salpingitis;
• inflammatory diseases of the pelvic organs.

Gardnerellosis causes complications during pregnancy, including:

• premature rupture of membranes;
• premature birth;
• chorioamnionitis;
• postpartum endometritis.

In addition, gardnerellosis increases the risk of contracting HIV and other sexually transmitted diseases.

Diagnosis of gardnerellosis

For the diagnosis of gardnerellosis in women, laboratory studies of secretions and desquamated cells of the vaginal mucosa are used. The presence of the disease is indicated by an increase in the acidity of the vaginal environment above 4.5 pH, a positive amine test confirming an increased number of anaerobic bacteria, as well as the detection of Gardnerella vaginalis microorganisms in the desquamated cells of the vaginal epithelium.

In itself, the presence of a pathogenic bacterium is not yet a symptom of gardnerellosis, since small amounts of a pathogenic microorganism are also allowed in a healthy person.

An informative method for the quantitative determination of gardnerellosis in women is the PCR technology (polymer chain reaction), which is also used in the diagnosis of gardnerellosis in men for the analysis of urine, semen, scraping of the urogenital tract and prostate secretion. PCR sensitivity up to 100%.

Differential Diagnosis

I differentiate Gardnerellosis with other diseases of the genitourinary system, with similar symptoms:

• fungal infection of the genital tract;
• trichomoniasis;
• gonorrhea;
• nonspecific inflammatory process.

Forecast and prevention of gardnerellosis

If the treatment of gardnerellosis is started on time, the vaginal microflora is restored after 2-4 weeks. If gardnerellosis is not treated, the risk increases:

• inflammation of the appendages;
• infertility;
• premature birth;
• complications during pregnancy.

Prevention of gardnerellosis implies the absence of stress, hypothermia, douching, as well as healthy sleep, proper nutrition, walking in the air, wearing cotton underwear, using a condom during casual sex. It should be periodically examined by a gynecologist for the condition of the vaginal microflora, and if a violation occurs, correct it with a course of treatment.

Preventive measures against gardnerellosis include:

• having one sexual partner;
• refusal to use intrauterine devices;
• prevention of inflammatory processes in the genital tract;
• the use of antibiotics according to strict indications, followed by correction of dysbacteriosis;
• exclusion of too early onset of sexual activity.

Questions and answers on the topic "Gardnerellosis"

Hello. By PCR, my husband was found to have gardnerella and ureaplasma parvum. The doctor said Gardnerell did not need to be treated, but ureaplasma is possible (although it is parvum that is not dangerous), but if we are planning children, it is better to treat it. They prescribed the antibiotic Unidox Solutab for 10 days to him and me and Linex according to the scheme. Question: Do I need to be tested for gardnerella? As I understand it, women must treat her. I haven't started taking antibiotics yet.

This is necessary to prevent reinfection, and when planning a pregnancy, it is mandatory.

Hello. I was diagnosed with gardrenellez, but no treatment was prescribed. Can I treat myself and with what drugs should I start?

Hello! Self-medication is dangerous to health. Medicines can only be prescribed by the attending physician. Why didn't you receive treatment? Ask this question to your doctor or change it.

Good afternoon He underwent a course of treatment for Gardnerellosis (drank metrodinazole 2 * 2 times a day for 10 days, installations in the canal, injections with transfusion into the buttocks). The course ended on Monday 14 August. The next day there was a PCR analysis, done just in case for all STDs. Gardnerellosis showed a positive result, all the rest - negative. The doctor said to take control after 2 weeks. Today is Friday and I feel the symptoms that appeared before and during the treatment (discomfort in the head area, sometimes a little redness, and most importantly - frequent urge to urinate. The question is - should I wait for a control analysis in 2 weeks and hope that the symptoms will pass? Or insist on continuing treatment only with other drugs, given that another week has not passed since taking metrodinazole.Thanks in advance!

Hello! Treatment of gardnerellosis is considered complete when symptoms disappear and laboratory criteria normalize. You need to draw the attention of the attending physician to the preservation (return) of complaints.

Hello! If the infection is not detected in time, what complications can there be?

Hello! Read about the consequences of untreated gardnerellosis in the section.

Hello! I am 50 years old and I was diagnosed with Gardnerellosis, the doctor prescribed me Lavomax tablets and Viferon rectal suppositories. I have been taking the drugs for 10 days, but the symptoms do not disappear. I don’t know what to do.

Hello! The treatment regimen for gardnerellosis includes two stages: at the first stage, an excessive amount of gardnerella in the genital tract is destroyed. Therefore, the main drugs at the beginning of treatment are the specific antibiotics metronidazole and clindamycin, which are prescribed for topical use in the form of gels, ointments or vaginal tablets for 7-10 days. After the destruction of pathogenic bacteria, at the second stage of treatment, the normal microflora of the vagina is restored. Vaginal suppositories with lactobacilli are prescribed. Report treatment failure to your doctor.

Hello! For the first time, gardnerella was discovered at the 20th week of pregnancy, after childbirth they began to treat it. No other diseases were detected, my husband was checked, he is clean! During these six months, I was prescribed from the drugs: metronidazole, polygynex, dalacin, vaginorm-s, polyoxidonium, salvagin. I was told not to use panty liners as they can also cause gardnerella. I have no smell, and the discharge is not particularly disturbing. Just according to the analyzes, there are more of them now, already 11.6. Now metronidazole was prescribed again, only once for 2 years. How long should I take the test to see if there is a result? Can this crap be cured?

Hello! You probably already know everything about gardnerella. This is a symptom of bacterial vaginosis. They do not apply to sexually transmitted infections. The cause of gardnerella is a change in the microbiocenosis of the vagina against the background of diseases of the gastrointestinal tract, unreasonable use of antibiotics, douching. Bacvaginosis is based on a decrease in immunity. You were on a standard treatment regimen. The examination of the husband is not relevant. I advise you to check the condition of the intestines, pay attention to digestion. Donate blood for glucose, and if necessary, you will have to exclude the presence of helminths. That is, everything that can provoke bacterial vaginosis. During the examination, local intimate hygiene products (tantum rose, epigen intim), interferon preparations with antioxidants C, E (viferon), as well as probiotics (bion-3) can be prescribed.

Hello! My girlfriend was diagnosed with gardnerellosis. As a result, I was prescribed the following treatment: clarithromycin 500 once a day (10 days), metronidazole twice a day (10 days), bifiform 2 capsules twice a day. I didn't get tested. There are doubts about the correctness of the prescribed tablets. Are there too many antibiotics for the male body, if they write everywhere that this infection in men does not linger and is washed out in a natural way?

Hello! That's right, you don't need treatment.

Gardnerellosis and bacterial vaginosis are synonymous words.

They say about gardnerellosis when the number of normal bacteria (lactobacilli) in the vagina decreases and the growth of conditionally pathogenic flora, which includes gardnerella, increases. However, gardnerella are not the only representatives of conditionally pathogenic microorganisms, but with their increased content in the vaginal secretion, gardnerellosis is diagnosed.

Gardnerella vaginalis is part of the normal microflora of the vagina, but in very small quantities. About 96-98% of the normal microflora is occupied by lactic acid bacteria, which produce lactic acid, which makes the pH of the vaginal secretion acidic. Gardnerellosis is characterized by a shift in the acid-base balance to the alkaline side, which allows pathogenic microorganisms to attack the vagina, cervix, uterus and appendages and cause the development of inflammatory diseases. In addition, a characteristic feature of gardnerella is their ability to exist without air, that is, in an anaerobic environment.

Causes

Factors that contribute to a decrease in the growth and reproduction of lactic acid bacteria (Doderlein sticks), which provokes the growth of gardnerella and other opportunistic microbes, can be divided into two groups:

External preconditions:

• promiscuous sex life;
• violation of the rules of intimate hygiene;
• tight and squeezing underwear and synthetic trousers (prevent the access of oxygen to the genitals);
• the use of panty liners and the abuse of vaginal tampons;
• disturbed ecology;
• malnutrition, diets (lack of lactic acid products, vitamins);
• abuse of douching and local contraception (candles, spermicides);
• intensive antibiotic treatment.

Internal preconditions:

• the presence of endocrine diseases;
• weakened immunity;
• chronic stress, lack of sleep;
• pregnancy;

Symptoms of gardnerellosis

The incubation period of the disease lasts 5-10 days, but can be extended up to 3-5 weeks. Vaginal discharge is a pathognomic symptom of gardnerellosis. As a rule, they have a grayish-white or yellowish color.

If the disease continues for a long time, then the discharge becomes green. It is difficult to confuse gardnerellosis with other inflammatory diseases of the vagina, since the discharge has a characteristic smell of rotten fish. Also, a distinctive feature of the disease is the absence of external signs of inflammation (redness, swelling).

In about 30% of cases, patients may experience itching and burning in the vagina and urethra, especially during sexual intercourse and urination.

Gardnerellosis in men

Some doctors believe that gardnerellosis can also occur in male partners. However, there is no consensus on this issue, since not all men at risk have symptoms of the disease.

In men, gardnerellez proceeds more erased. Only a small proportion experience discomfort during urination, which indicates the development of urethritis. From the urethra there is a grayish discharge with a specific smell of rotten fish.

Diagnostics

To establish the diagnosis of gardnerellosis, it is enough to determine 3 of the four possible signs:

• complaints of increased whiteness from the vagina;
• identification of key cells in vaginal smears;
• increase in pH (normally 4.5);
• positive discharge amniotest.

In vaginal Gram smears, key cells are determined, which are nothing more than desquamated epithelial cells with Gram-negative rods attached to them.

The environment of the vaginal secretion in patients with gardnerellosis is in the range of 5.0-7.5. Amniotest positive, it is based on the appearance or intensification of the smell of rotten fish when mixing vaginal secretions with a 10% potassium hydroxide solution.

Treatment of gardnerellosis

Therapy of gardnerellosis in women is handled by a gynecologist. Treatment of the disease is carried out in two stages. At the first stage, metronidazole and clindamycin preparations are used, which are effective against anaerobic bacteria.

Treatment is carried out both locally (in suppositories and creams) and internally (in tablets). Tampons with metronidazole or clindamycin are prescribed 2 times a day for 7-10 days. Metronidazole is administered orally in tablets of 0.25 g. (2 tablets twice a day). The course of tablets and tampons is 7-10 days. In parallel, it is necessary to take multivitamins and herbal immunostimulants (echinacea, eleutherococcus, magnolia vine).

The second stage of therapy pursues the restoration of normal microflora in the vagina. To do this, locally prescribed biological products (lactobacterin, apilak, bifidumbacterin, bifidin). Tampons are introduced at 2.5-3 doses intravaginally twice a day, the course of treatment is 7-10 days.

To treat or not to treat a sexual partner - doctors have not yet come to a consensus. However, during the treatment of gardnerellosis, sexual rest should be observed. Also, during the period of treatment of the disease, it is necessary to follow a diet with a high content of sour-milk products and limiting sweets, spicy and salty foods.

Complications and prognosis

Gardnerellosis itself is not a dangerous disease, but a violation of the normal microflora of the vagina with the activation of opportunistic microorganisms contributes to the penetration of pathogenic microbes into the internal genital organs, which leads to the development of inflammatory diseases:

• inflammation of the uterus and appendages;
• urethritis and prostatitis in men;
• male and female infertility;
• abortion and miscarriage;
• inflammation of the cervix.

The prognosis for timely and complete treatment of gardnerellosis is favorable.

Gardnerellosis is widespread among gynecological diseases in women. It received its second name "bacterial vaginosis" due to the development of Gardnerella vaginalis bacteria in the vagina.

In a normal state, the microflora of a healthy woman always contains these bacteria in small quantities.

But an increase in the concentration of gardnerella and their imbalance with lactobacilli leads to the appearance of pronounced symptoms of gardnerellosis. Treatment of this disease with the help of drugs should begin when the first signs are detected.

Causes

Where does gardnerella come from in women, and what is it? This bacterium is present in the vagina of every woman. A stage may simply come when its quantity increases and it becomes pathogenic.

Factors contributing to development gardnerellosis:

1. Taking antibiotics, hormones and other drugs that affect the normal microflora of the body.
2. Very frequent change of sexual partner. This leads to the fact that infection with one of the sexually transmitted diseases can occur, and only then a violation of the microflora and the growth of gardnerella bacteria.
3. Overwork, hypothermia, stress.
4. . In women, hormonal disruptions occur quite often, and they are the cause of the development of a disease, as well as the cause of an increase in the number of bacteria.
5. General systemic diseases.
6. Sexual infections and venereal diseases in women.
7. Local procedures that upset the balance in the vagina: douching, the use of suppositories, tampons and vaginal capsules with active substances.

Under the influence of these factors, vaginal dysbiosis, gardnerellosis, candidiasis and other nonspecific inflammatory diseases occur.

Symptoms of gardnerellosis in women

Symptoms indicating the development of gardnerellosis in women are very few and similar to signs of other gynecological diseases.

The main, and in most cases, the only symptom of gardnerellosis is mild, homogeneous, gray-white or yellowish vaginal discharge, which has an unpleasant odor (the smell of "rotten fish").

The appearance of such symptoms, discomfort and pain during intercourse, indicates the development of inflammatory processes in the vagina and other organs of the small pelvis in women.

Risk of disease during pregnancy

The presence of this disease can lead to:

1. Fetal infection.
2. Endometritis.
3. Small weight in a child who has just given birth.
4. The development of complications after a caesarean section.
5. Inflammation of the lungs in a newborn.
6. The development of uterine bleeding, which is of great danger.
7. Rupture of the amniotic membrane, and at a very early stage.

That is why you should not ignore the symptoms of gardnerellosis and start treatment, especially if the woman is in an "interesting" position, as this can lead to unpleasant consequences.

More about douching

When douching, the normal microflora of the vagina is washed out, which is replaced by opportunistic bacteria (for example, Gardnerella vaginalis).

Often, when symptoms of gardnerellosis (unpleasant smell of vaginal discharge) occur, women resort to douching on their own, linking the unpleasant odor with poor hygiene. In this case, douching causes an even greater exacerbation of gardnerellosis.

According to modern concepts, douching has neither hygienic, nor preventive, nor therapeutic effect. Moreover, it is a risk factor for gardnerellosis, inflammation of the appendages, ectopic pregnancy.

Treatment of gardnerellosis in women

When the first symptoms of gardnerellosis are detected in women, treatment should be started as soon as possible. Therapy for the disease includes several drugs used in the form of vaginal gels and creams, as well as oral tablets. Usually the duration of treatment is 7 days and includes the medicines described below.

The treatment regimen for gardnerella is complex, and consists of two parts:

1. Reducing the number of gardnerella living on the vaginal mucosa. This is achieved by ingestion of systemic antibiotics (in the form of tablets): clindamycin and metronidazole. In combination with them, local forms are used - clindamycin cream and metronidazole gel.
2. Restoration of the normal microflora of the vagina. It is achieved by ingestion of probiotics containing lactobacilli (Lactobacterin, Laktonorm), as well as local treatment in the form of suppositories (Acilact, Laktonorm).

For successful treatment, it is also important to follow dietary recommendations, which include avoiding fatty, fried, spicy foods, and drinking alcohol. It will be useful to take fermented milk products and yogurts containing lactic acid bacteria.

All actions in the treatment of gardnerellosis in women are aimed at restoring a healthy vaginal microflora. The effectiveness of treatment can be judged by the disappearance of symptoms of gardnerellosis (reduction of burning sensation, pain, dryness; no discharge and unpleasant odor from the vagina).

The control bacterioscopy is prescribed a week after the completion of the course of treatment, repeated - after 1-1.5 months.

Prevention

First of all, it is necessary to limit promiscuous sexual relations that contribute to the spread of STIs, timely approach the treatment of various diseases of the body, primarily related to its hormonal levels and the sexual sphere, eat right, pay great attention to rest, and avoid stress that affects the state of immunity.

Bacterial vaginosis is an infectious non-inflammatory process of polymicrobial etiology, caused by dysbacteriosis of the vaginal microbiota. The disease is characterized by the appearance of specific, abundant discharge associated with a significant decrease in the number of normal vaginal lactobacilli and an increase in the activity of opportunistic microorganisms.

With bacterial vaginosis, fungi, gonococci and Trichomonas are not found in the secretions. The disease is also not accompanied by an inflammatory lesion of the mucous membranes of the vagina (this is its difference from vaginitis). Bacterial vaginosis is not an infection in the direct sense of the word and is classified as a condition of severe vaginal dysbacteriosis.

The cause of bacterial vaginosis is a polymicrobial bacterial microflora: gardnerella, bacteroids, veillonella, prevotella, etc. In the vast majority of cases, bacterial vaginosis is caused by gardnerella, so the term gardnerellosis can be considered a synonym for bacterial vaginosis.

Gardnerellosis is a nonspecific bacterial vaginosis caused by gardnerella. In the ICD10 classification, gardnerellosis and bacterial vaginosis do not have their own code, since these terms appeared later than the classification.

In this regard, bacterial vaginosis or urogenital gardnerellosis can be classified according to ICD 10 as:

• B96.8 - diseases described elsewhere and caused by specified bacterial agents;
• T76.8 - as other specified inflammatory diseases affecting the vagina and vulva.

According to statistics, gardnerellosis in women is the most common infectious disease of the female genital area. Previously, gardnerellosis was included in the group of sexually transmitted diseases (STDs or STIs). It is now proven that bacterial vaginosis is not sexually transmitted, because:

• gardnerellosis is caused by opportunistic bacteria, normally - in the minimum amount that is part of the vaginal microflora;
• gardnerellosis in men is practically not found. In men, gardnerella can be detected only transiently, while their temporary carriage is asymptomatic and only in isolated cases is accompanied by the development of inflammatory complications.

However, in women who have a large number of sexual partners, this disease is more common, since in the presence of vaginal dysbacteriosis with unprotected sexual contact with a carrier of bacterial vaginosis, the risk of developing bacterial vaginosis is higher.

Gardnerellosis in women does not pose a direct threat to life, but it can cause:

• development of infertility;
• habitual miscarriage;
• postpartum or post-abortion inflammatory complications;
• complicated course of pregnancy.

Gardnerellosis during pregnancy poses the greatest danger, as it can cause:

• spontaneous abortion;
• premature discharge of amniotic fluid;
• early childbirth;
• the birth of small children.

In the postpartum period, gardnerellosis in women significantly increases the risk of developing:

• endometritis (especially during delivery by caesarean section);
• pelvioperitonitis;
• abscesses;
• sepsis, etc.

It should also be noted that, if left untreated, often recurrent bacterial vaginosis is a risk factor for the development of neoplastic processes in the cervix, increases susceptibility to various infectious agents (including, in particular, herpesvirus type 2 (genital herpes)).

How is gardnerellosis transmitted?

The disease does not apply to STDs, however, uncontrolled unprotected sex increases the risk of developing gardnerellosis. Normally, gardnerella are present in the normal microflora of the vagina, however, with the development of dysbacteriosis, they begin to actively multiply, suppressing the activity of lactobacilli.

Causes of gardnerellosis in women

The cause of gardnerellosis is vaginal dysbacteriosis. Risk factors contributing to the development of gardnerellosis are:

• hormonal imbalances (including during menopause);
• age-related or inflammatory hypotrophic or atrophic processes in the vaginal mucosa;
• frequent change of sexual partners;
• vaginal cysts or polyps;
• pathology of the vaginal epithelium;
• the presence of malformations or anomalies in the development of the genital organs;
• reduction in the number of lactobacilli producing hydrogen peroxide;
• change in the pH of the vagina to the alkaline side;
• frequent douching;
• the use of aggressive sulfate soaps or gels for personal hygiene;
• frequent use of spermicides;
• decreased immunity;
• the presence of immunodeficiency states;
• long-term treatment with antibacterial agents, antifungal drugs, immunosuppressants, glucocorticosteroids, etc.;
• radiation or chemotherapy;
• the presence of chronic inflammatory processes in the OMT (pelvic organs);
• hypovitaminosis, exhaustion;
• anorexia nervosa;
• carrying out endoscopic or surgical gynecological manipulations;
• alcoholism;
• the presence of diabetes.

Symptoms and treatment of gardnerellosis in women

The main symptoms of gardnerellosis in women are:

• the appearance of abundant thick whitish-gray (sometimes frothy) discharge with a specific "fishy" smell. The appearance of a large amount of leucorrhoea (about twenty milliliters per day) is the main and obligatory symptom of gardnerellosis in women;
• pain or discomfort during intercourse;
• increased discharge of secretions after intercourse or during menstruation;
• the appearance of itching, burning, discomfort in the genital area or burning during urination (these symptoms are noted quite rarely);

In some cases, the discharge may be odorless. There are no streaks of blood and pus in gardnerella secretions. Their microscopy does not reveal signs of an inflammatory reaction - leukocytes. When conducting an examination in the mirrors, the vagina is not inflamed and not swollen.

In chronic gardnerellosis (long-term, more than 2 years for bacterial vaginosis), leucorrhea may have a yellowish tint and a sticky, viscous, foamy and viscous consistency.

Gardnerellosis in men, as a rule, does not occur or is asymptomatic, in the form of transient carriage. In rare cases, signs of gardnerellosis in men can be balanoposthitis and urethritis.

Diagnosis of gardnerellosis

To confirm or refute the diagnosis, smear microscopy, examination in mirrors and anamnesis are performed.

The diagnosis can be made based on the Amsel criteria:

• the presence of specific secretions;
• a positive amino test (a sharp increase or the appearance of a smell of rotten fish when 10% KOH is added to the secretions);
• increase in vaginal pH above 4.5;
• determination of "key" cells during smear microscopy.

Microscopy with an assessment of vaginal biocenosis in points from 0 to 10 (Nugent points) can also be used. The diagnosis of bacterial vaginosis is made with a score of more than 6 points. Nugent is currently considered the gold standard for diagnosing gardnerellosis.

The Hay-Ison scale can also be used, in which the results of smear microscopy are recorded as five levels of dysbacteriosis of the vaginal microflora.

Treatment of gardnerellosis in women

Treatment of gardnerellosis with folk remedies is not carried out. Bacterial vaginosis is treated with antibiotic therapy and drugs that restore the normal balance of lactobacilli in the vaginal microflora.

At the time of treatment, it is recommended to refuse to take alcoholic beverages, fatty, fried and spicy foods. It is recommended to increase the drinking regime, as well as to consume more fresh fruits, vegetables, kefir, yogurt, etc. Additionally, multivitamin complexes can be prescribed.

Douching with gardnerellosis is contraindicated, as it increases the risk of developing an ascending infection (bringing bacteria into the uterine cavity).

Antibiotics for gardnerellosis should be prescribed exclusively by a gynecologist based on tests. Systemic antibiotic therapy is indicated in the absence of the effect of local treatment (suppositories from gardnerellosis).

Treatment regimen for gardnerellosis in women

Metronidazole and clindamycin are the drugs of choice for gardnerellosis. Local use (intravaginal) gels or suppositories with metronidazole (1-2 times a day) or clindamycin (once a day) is recommended as a starting therapy for a course of five to seven days.

According to indications, Terzhinan can be used for gardnerellosis (the drug contains ternidazole, which is highly effective against gardnerella).

Polygynax is not used for gardnerellosis, due to the lack of effectiveness against gardnerella in its constituent components (polymyxin B, neomycin and nystatin).

It is also possible to use Hexicon for gardnerellosis, however, it is preferable to use the agent not as monotherapy, but as an addition to systemic antibiotic therapy in the presence of a mixed infection.

In the absence of the effect of local therapy, the use of metronidazole tablets (500 mg twice a day) or clindamycin for seven days is indicated. Ornidazole for gardnerellosis in women is prescribed for severe bacterial vaginosis, as well as for a combination of gardnerellosis with other gynecological inflammatory diseases.

In the future, patients are prescribed drugs that restore the normal balance of lactobacilli. It is recommended to take drugs of acidophilic lactobacilli, bifidobacteria (Linex, Bifidumbacterin, etc.). Highly effective local use of lyophilized cultures of lactobacilli (vaginal capsules Laktozhinal).

Treatment of gardnerellosis in men

Article prepared
infectious disease doctor Chernenko A.L.

Bacterial vaginosis is a disease that often occurs in sexually active women. In the vast majority of cases, pathology appears under the influence of bacteria Gardnerella vaginalis (Gardnerella vaginalis). Strictly speaking, gardnerellosis is not classified as a sexually transmitted infection, however, sexually transmitted diseases provoke the development and aggravate the course of bacterial vaginosis of a similar etiology.

Gardnerella is a conditionally pathogenic microorganism, that is, it is present in small quantities on the mucous epithelium of the vagina. Taxonomically, these pathogens are classified as facultative anaerobic flora. In other words, their life cycle proceeds without access to oxygen, however, unlike other anaerobes, gardnerella can also tolerate aerobic conditions.

Outwardly, gardnerella are similar to small sticks with oval ends, their size rarely exceeds 1.5 microns. Previously, pathogenic microorganisms Gardnerella were considered representatives of the genus Haemophilus (they were called Haemophilus vaginalis).

However, in the mid-1980s, they were proven to belong to the Bifidobacteriaceae family. The vast majority of cases of Gardnerella are Gram-negative, although a Gram-positive stain is occasionally possible.

"Inhabiting" the mucous epithelium of the vagina, lactobacilli, as a result of the destruction of glycogen, produce lactic acid. It determines the pH value in the range of 3.8 - 4.5, which prevents the reproduction of various microorganisms. In addition, lactobacilli have an enzymatic effect, so their level serves as a kind of indicator of the state of the female genital organs. Bacvaginosis develops against the background of the replacement of microorganisms of the genus Lactobacillus by an association of pathogenic or conditionally pathogenic bacteria.

Gardnerella vaginalis produces specific catabolites that inhibit the functional activity of local immunity and leukocytes. As a result, bacteria penetrate deep into the vaginal mucosa, affect the overlying sections of the genital tract, and spread to the urinary tract. In addition, the development of gardnerella contributes to the reproduction of other flora (staphylococci, streptococci, klebsiella, E. coli, klebsiella, etc.).

Bacterial vaginosis provoked by gardnerella is the most common infectious disease among sexually active women aged 18-45 years. According to different authors, the incidence of such an infection ranges from 30 to 80% in the structure of inflammatory diseases of the genital organs in the fairer sex. Such inaccuracy in the numbers is due to the fact that in a third of women gardnerellosis is asymptomatic.

Gardnerella vaginalis: transmission routes, factors provoking the development of pathology

Some doctors are inclined to believe that gardnerellosis is sexually transmitted. However, in this case, the question of the presence of these bacteria in a small amount in the vagina of girls and virgin girls remains open. Therefore, experts believe that this disease can be safely attributed to polyetiological.

The following factors contribute to the appearance of pathological concentrations of gardnerella vaginalis:

• promiscuity, especially without the use of proper protective measures (condoms);
• concomitant sexually transmitted diseases (trichomoniasis, chlamydia, gonorrhea, etc.);
• a variety of therapeutic and diagnostic intravaginal manipulations (douching, especially if it is therapeutically unreasonable, colposcopy, etc.);
• abortions;
• taking drugs that impair the functioning of local immunity (corticosteroids, antibiotics and fungicides, including local action in the form of ointments and suppositories, cytostatics, chemotherapy);
• extragenital diseases that negatively affect the state of the immune system;
• improper diet with a predominance of too sweet foods and a deficiency of sour-milk products;
• use of topical spermicides;
• the use for hygiene purposes of pads, tampons, intimate products with too high a content of synthetic perfumes and allergens;
• wearing tight underwear with a synthetic gusset;
• hormonal disorders caused by both natural causes (pregnancy, childbirth, breastfeeding period), diseases or taking appropriate medications;
• chronic fatigue, emotional overstrain and exhaustion;
• diseases and conditions accompanied by a violation of the microflora of the digestive and genitourinary tract;
• malformations and anatomical features of the structure of the vagina;
• insufficient personal hygiene;
• foreign bodies in the vagina and uterus (spirals, caps, etc.).

Infection with gardnerella vaginalis does not occur through sexual contact. However, the development of this disease is closely related to the characteristics of sexual relationships. The risk of bacterial vaginosis increases with an early onset of sexual activity, the presence of a large number of sexual partners, a high frequency of urogenital, rectogenital sexual contacts, etc.

Gardnerella infection: symptoms in women, diagnostic methods, possible complications

Symptoms of bacterial vaginosis provoked by Gardnerella are nonspecific. Many sexually transmitted diseases (for example, chlamydia, trichomoniasis) can occur under the guise of gardnerellosis. The incubation period of infection is from 3 to 10 days, but on average - a week.

Symptoms characteristic of the pathology are:

• quite abundant, sometimes foamy discharge from the vagina, at the initial stages of the disease they are homogeneous, gray-white in color, but later acquire a thicker consistency and a yellowish tint;

• the characteristic unpleasant smell of stale fish, it intensifies after sex, during menstruation, after washing with soap, such a sign is due to the breakdown of amino acids produced by anaerobic gardnerella;
• itching and burning, but only a third of women with bacterial vaginosis complain of these symptoms.

The occurrence of an unpleasant "fishy" odor from the vagina, combined with abundant discharge, is the reason for contacting a gynecologist.

Diagnostic criteria for gardnerellosis are:

• plaque, evenly covering the mucous membrane of the vagina and external genital organs, while pathophysiological signs of the inflammatory process occur extremely rarely;
• pH values ​​above 4.5 after carrying out pH-metry separated by the vaginal epithelium;
• a positive result of the amino test, this is one of the express diagnostic methods, which is carried out by mixing a vaginal smear with a 10% potassium hydroxide solution on a glass slide, in the presence of gardnerella, a strong smell of rotten fish appears;
• detection of cells characteristic of bacterial vaginosis after microscopy of a Gram-stained smear from the vagina.

Instrumental methods for detecting the disease supplement the data of the anamnesis and complaints of the patient. Gardnerella infection requires differential diagnosis with other urogenital pathologies caused by gonococcus, trichomonas, chlamydia, opportunistic microorganisms. For this, PCR tests are prescribed to detect the DNA of bacteria.

Without appropriate treatment (and sometimes against the background of drug therapy), gardnerellosis is prone to a chronic relapsing course. So, six months after the first episode, the symptoms of bacterial vaginosis reappear in a third of patients, and within a year - in 50 - 70% of women. Such violations of the composition of the physiological microflora of the vagina often leads to persistent recurrent candidiasis and other lesions of the urogenital tract. Sometimes gardnerella is also found in the bladder in the process of identifying the causes of cystitis.

In recent years, information has appeared that anaerobic pathogens of bacterial vaginosis secrete nitrosamines. They serve as coenzymes of carcinogenesis and can cause dysplastic and dystrophic processes in the cervix. They, in turn, can cause a variety of pathologies, including malignant cell transformations.

Gardnerellosis in women: features of the course and therapy during pregnancy, manifestations of the disease in men

Often, bacterial vaginosis, provoked by bacteria of the genus Gardnerella, occurs during pregnancy. As a rule, this is due to concomitant changes in hormonal balance. For early detection of pathology, regular gynecological examination is mandatory, especially in women at risk (with previous or concomitant sexually transmitted infections, chronic inflammatory lesions of the genitourinary system, etc.)

But to date, a clear connection has been established between the development of such a disease and infertility, an unfavorable outcome of pregnancy, the threat of miscarriage, and premature birth. In addition, in the absence of therapy, gardnerellosis is dangerous for early rupture of amniotic fluid, intrauterine infection of the fetus, and various inflammatory lesions of the uterus in the postpartum period.

Therefore, with the appearance of secretions of a characteristic consistency and with a specific odor, it is necessary to urgently begin therapy. Most medications for bacterial vaginosis are contraindicated in the first trimester. Therefore, at this stage, even doctors recommend using folk remedies.

Starting from the second trimester, gardnerellosis in women is treated with:

• Clindamycin (Dalacin, Clindamycin) in the form of a cream or suppositories of 5 g or one piece, respectively, at night for 3 to 5 days;
• Metronidazole (Metrogil, Metrovagin, Trichopolum, Trihosept, Flagyl) cream (0.75%), suppositories - 2 times a day intravaginally or tablets of 0.5 g twice a day, the course of therapy is 5 - 7 days.

In men, gardnerellosis is usually asymptomatic. As a rule, representatives of the stronger sex are carriers of the infection. However, if immunity is weakened as a result of any diseases or taking medications, there is a risk of developing bacterial urethritis (inflammation of the urinary canal) or balanoposthitis (damage to the head of the penis, foreskin).

Similar pathologies are manifested in the form of burning during urination, discharge with an unpleasant odor from the urethra. Often note the appearance of a grayish-white sticky coating on the glans penis, redness and slight swelling of the skin in the area of ​​the foreskin.

How to treat gardnerella: drug and alternative therapy, restoration of local immunity, methods of prevention

Anaerobic pathogens of bacterial vaginosis are highly sensitive to various antibacterial drugs from the group of fluoroquinolones, penicillins (but only in combination with clavulanic acid), macrolides. Tetracycline antibiotics (for example, Minocycline) are less active against Gardnerella. However, most experts believe that the use of potent antimicrobial agents for the treatment of uncomplicated vaginosis is unjustified.

Therefore, first-line drugs are:

• Nitroimidazoles(Metronidazole, Ornidazole, Tinidazole). They are used orally, intravaginally in women and topically in men. Dosage and duration of treatment is determined individually. As a rule, take Metronidazole (or its analogues under other trade names) 2.0 g once or 0.5 g twice a day for a week. Ornidazole drink 0.5 g twice a day for 5 days, Tinidazole - 2.0 g once. Preparations of this group in the form of suppositories or ointments are used twice a day for 5 days.
• Lincosamides. Of the drugs in this class, clindamycin is the most effective. It is applied topically (applied to the glans penis or inserted into the vagina) once a day at night for 6 days. Oral administration of 0.3 g twice a day for a week is possible.

Additionally, doctors emphasize that metronidazole is absolutely incompatible with alcohol. Therefore, it is necessary to refrain from taking alcoholic beverages for the entire duration of treatment and for 24 hours after its completion. Clindamycin creams and suppositories can damage the latex used in condoms and vaginal diaphragms. Therefore, during therapy with this drug, it is better to give up sexual life (sexual contacts with gardnerellosis without a condom can aggravate the course of the disease).

Some patients prefer to treat bacterial vaginosis and urethritis with alternative medicine methods.

• Pour 3 tbsp. dry herb celandine with a liter of boiling water, squeeze a few cloves of garlic, insist for 3-4 hours, strain and use for douching.
• Pass pine and juniper needles through a meat grinder (take in a ratio of 1: 1), squeeze out the juice from the resulting slurry, moisten a regular swab in it and insert it into the vagina overnight. To increase the effectiveness of treatment, alternate with gauze or cotton swabs soaked in a mixture of onion and horseradish juice. The course of therapy lasts 12 days.
• Mix 10 g of lavender herb, bird cherry flowers and Chernobyl, 20 g of calendula herb, sage and cudweed, oak bark, birch leaves, 30 g of chamomile flowers. Pour two tablespoons of the mixture with a liter of hot water, wrap the dishes with a towel, leave for 2-3 hours, strain and douche at night for 2 weeks.
• Buy yarrow and eucalyptus tinctures at the pharmacy, mix and drink 25 drops in 50 ml of water three times a day on an empty stomach.
• Mix equal proportions of mistletoe and yarrow herb. Brew a couple of spoons with half a liter of boiling water, insist overnight and strain. Can be used for douching or taken orally 1 tbsp. three times a day.
• Grind a tablet of Trichopolum into powder, add a teaspoon of honey and the same amount of onion gruel. Apply the resulting mass to a swab and insert into the vagina at night. Alternate with tampons with calendula ointment (available at the pharmacy).
• A tablespoon of tansy baskets is poured with a glass of boiling water, simmer in a water bath for 15 minutes, cool to room temperature and strain. The solution is used for douching.
• Mix in equal proportions black poplar buds, calendula and chamomile flowers, eucalyptus and bird cherry leaves. Take 2 - 3 tablespoons, pour a liter of boiling water, insist overnight and strain. First, douche with this solution, then insert a swab with lanolin-based propolis ointment into the vagina (if it is not in the pharmacy, you need to mix 10 g of crushed propolis and melted lanolin). The duration of treatment is 2 weeks. In parallel, you can drink a decoction of wormwood.
• Pour a tablespoon of bird cherry fruits with 300 ml of boiling water, boil over low heat for 20 minutes, cool and strain. Drink 1/3 three times a day half an hour before meals. Also, this solution can be used for douching.
• For men, for the hygiene of the penis, the following composition is recommended: half a liter of chamomile decoction, 1 tbsp. soda, 5 drops of potassium permanganate and 2 drops of iodine.

However, treatment does not guarantee re-infection. Its likelihood increases if provoking risk factors are not excluded. You can increase the activity of local immunity with the help of drugs designed to restore the normal composition of the vaginal microflora. They are used both in the form of suppositories and in the form of tablets.

In order not to face the problem of how to treat gardnerella, it is better to engage in the prevention of infection in a timely manner. It is necessary to minimize the wearing of tight synthetic underwear and clothing, especially in the hot season. Panty liners and sanitary pads should be changed at least every three hours. Too frequent and unnecessary douching should also be avoided. In addition, you must adhere to the rules of safe sex and use condoms.