Gardnerella and Gardnerella
- Pathogen of Gardnerella
- Prevalence of the disease
- Risk factors, sources of infection and ways of transmission of gardnerellosis
- Pathogenesis of gardnerellosis
- Clinical forms of gardnerellosis
- Signs of gardnerellosis in women
- Symptoms of gardnerellez in men
- Diagnosis of gardnerellosis
- Treatment of gardnerellosis
- Prophylaxis of gardnerellosis
Normal vaginal microflora is one of the main factors of nonspecific resistance. Normally, the vagina of a healthy woman is a reservoir, containing both aerobic and anaerobic microflora. However, the number of the first is ten times higher than the number of the second. Its main representatives are lactobacilli, producing hydrogen peroxide and lactic acid, which prevents reproduction of opportunistic bacteria. However, some endogenous and exogenous factors can provoke the development of an inflammatory syndrome caused by vaginal imbalance. The condition in which lactic acid bacteria are completely replaced by facultative anaerobes, present only in a small amount in a vaginal secret of a healthy woman, is called clinical bacterial vaginosis or gardnerellez. This is a fairly common pathology, which is diagnosed in 30-35% of patients with mixed urogenital infections.
Pathogen of Gardnerella
The vaginal gardnerella (Gardnerella vaginalis), which provokes the development of gardnerellez, was first isolated in patients suffering from vaginitis in 1955 by Dewkson and Gardner, who called her a hemophilic vaginal stick. This microorganism is a fixed, capsule-free, polymorphic, non-nuclear gram -variable stick (or coccobacillus), reaching a length of 2 μm and 0.7-0.9 μm in diameter. This bacterium can be presented in the form of cocci or small sticks, covered with a thin cell wall and an outer microcapsular layer. It should be noted that for some gardnerellas the membrane structure of the cell wall is characteristic, as in gram-negative bacteria, and in others - homogeneous - as in gram-positive microorganisms.
This is an optional anaerobic that is able to multiply even in the absence of oxygen, producing amino acids and acetic acid in the course of its life. In the event that, for certain reasons, the gardnerella becomes aggressive and begins to grow uncontrollably, the products of its vital activity change the pH of the vagina for a short time and are able to completely destroy all of its normal microflora, of which 90% is normally found in lactic acid bacteria.
On open surfaces, the pathogen can maintain its viability for 3-6 hours (in the layer of mucous secretions), and in inactive forms (in the form of spores) - up to a year. Therefore, there is a danger of infection with garnerellosis in public toilets and in inactive reservoirs.
гарднерелла – это условно-патогенный микроорганизм, который может присутствовать у большинства здоровых женщин, не проявляя патогенных свойств. Note: Gardnerella is a conditionally pathogenic microorganism that can be present in most healthy women without manifesting pathogenic properties.
Prevalence of the disease
According to WHO statistics, gardnerellez is one of the most common sexually transmitted diseases, which most often affects women of reproductive age. In men, such a disease is much less common. This pathology is detected in 30-80% of patients suffering from various inflammations of the genital organs, and it is revealed during preventive examinations in a quarter of healthy women.
Risk factors, sources of infection and ways of transmission of gardnerellosis
According to experts, the development of gardnerelleza is directly dependent on the nature of sexual life. This pathology is never detected in healthy virgins, as well as in women who do not suffer from vaginitis. Therefore, predisposing factors include:
- Promiscuous sex life;
- Previous infections;
- Disorders of the menstrual cycle;
- Use of intrauterine contraceptives;
- Long-term use of antibacterial drugs and antidepressants, leading to an imbalance of the vaginal microflora;
- The use of contraceptives that disrupt the hormonal background;
- Use of douche chlorinated antiseptics;
- Stressful situations;
- Long-term wearing tightly adhering to the body of synthetic linen;
- The absence in the diet of diary products, which are the source of lactobacilli.
The main way of transmission is sexual. However, the infection can be transmitted from the infected mother to the child when passing through the infected birth canal, or due to intrauterine infection.
Pathogenesis of gardnerellosis
The virulence of this microorganism is relatively small, and only in some strains of gardnerella the final product of fermentation is acetic acid and amino acids. Others produce in the course of their life milk and formic acid. Therefore, some authors tend to believe that this bacterium does not have pathogenic properties, but refers to the saprophytes of the urogenital tract.
During sexual contact with a woman suffering from gardnerellez (or bacterial carrier), the pathogen enters the male urethral epithelium, and subsequently, with the next sexual contact, infects or re-affects the female reproductive tract.
Attaching to the surface of multilayered planar epithelium, gardnerella are able to form characteristic formations, which in clinical practice are called "key cells". It is their detection during the bacterioscopic examination of swabs from the genitals has an important diagnostic value.
Unfortunately, until now the pathogenesis of this disease is not fully understood. Nevertheless, the scientists found that the gardnerella damages the epithelial cells of the vagina, and also causes autolysis (dissolution) of phagocytes.
Clinical forms of gardnerellosis
To describe the clinical signs of urogenital pathologies provoked by anaerobic microorganisms, scientists developed a special classification, which includes the following forms of gardnerellez:
- Bacterial vaginosis;
- Bacterial damage of the upper genital tract;
- Gardnerella of the female urinary tract;
- Gardnerella of the male urinary tract;
- Gardnerella of pregnant women.
This, according to experts, is the most common clinical form of the disease. As a rule, during the diagnostic study, other representatives of anaerobic microflora (leptostreptococci, mobiluncus, bacteroids, etc.) are found along with the gardnerella, but at the same time, there are no sexually transmitted pathogens. In 50% of patients with bacterial vaginosis, the main symptoms are discharge with an unpleasant odor of rotten fish. In the other half of patients with this form of pathology, objective and subjective symptoms are not detected.
Unpleasant smell, according to experts, arises due to the formation of biogenic amines in the metabolism of gardnerella and other non-sporogenous anaerobes. Putrescine and cadaverine (pathological amines), presented as non-volatile salts, become rapidly evaporating substances during the alkalization process, which exude a strong fishy smell.
Gardnerella of the upper genital tract
With this form of pathology, infection can occur directly through the peritoneal tissue, as well as lymphogenically or hematogenically. There are cases when this form of gardnerellez became the cause of development of endometritis and salpingo-oophoritis, and some authors describe cases of blood contamination by gardnerella (gardnerella septicemia) leading to severe endotoxic shock and postoperative complications in gynecological patients.
именно поэтому всех женщин, готовящихся на операцию, следует в обязательном порядке обследовать на бактериальный вагиноз. Note: this is why all women preparing for surgery should be examined for bacterial vaginosis without fail.
Gardnerelosis of the urinary tract in women
The development of this pathology is explained by the anatomical proximity of the vagina and urethra, as a result of which there is a transfer of the pathogen from the genital organs to the urinary tract.
There is evidence that gardnerella is very often isolated from urine of practically healthy women. However, it is possible to diagnose garnerelosis only when there are more than 1000 cfu of bacteria in one milliliter of urine taken by a catheter.
Gardnerella of the male urinary tract
In men, this disease is not as common as in women. Often when a gardnerella is found in a compartment with other bacteroids, the forebrain becomes inflamed in the stronger sex. In this case there is a lingering course of urethritis, with mildly expressed clinical symptoms. Patients complain of the appearance of lean mucous-serous secretions, without pain and discomfort. Complications of gardnerelleza in men in clinical practice is very rare. There are isolated reports of the development of gardnerelleous prostatitis, cystitis, epididymitis and pyelonephritis. In the manifest forms of the disease, the characteristics of the clinical course, as a rule, are determined precisely by those pathogenic microorganisms with which the causative agent of gardnerelleza joins the association.
мужчины, которые страдают бессимптомной (или малосимптомной) формой заболевания, зачастую являются источниками заражения своих половых партнерш. Note: men who suffer from asymptomatic (or low-symptom) form of the disease are often the sources of infection of their sexual partners.
Gardnerella of pregnant women
In gynecological practice this form of pathology occurs in almost 20% of pregnant women. But fortunately, intrauterine infection develops very rarely, because during this period, active protective mechanisms increase. At the same time, some authors note the possibility of a moderate suppression of cellular immunity. Very often bacterial vaginosis becomes the cause of various disorders in the course of pregnancy, and the disease can provoke the development of postpartum complications.
Women with a diagnosis of "gardnerellez" are twice as likely to experience premature births, and a tenth of parturients in the amniotic fluid are found to have gardnerella and other microorganisms, although I normally should be sterile.
There is also evidence that bacterial vaginosis can be associated with chorionamnionitis (a purulent-septic complication that also leads to premature birth), and, according to some experts, a gardnerella can provoke postpartum or post-abortion sepsis.
Signs of gardnerellosis in women
With the development of the pathological process, patients develop abundant, unpleasantly smelling foaming vaginal discharge, and, during special laboratory tests, the acidity of the vaginal fluid decreases. Often, women complain of severe itching and burning in the area of the external genitalia and perineum.
At the same time, patients have hyperemia of the vaginal mucosa, urethra and cervix. When fresh acute gardnerelleza vaginal discharge is very abundant, dense and homogeneous, white and gray, and the discharge from the urethra and the cervical canal is rather meager.
Symptoms of gardnerellez in men
In representatives of the stronger sex, this disease often occurs solely as an inflammation of the external genitalia. As a rule, the causative agent gardnerelleza in two or three days is removed from the urinary tract (in their healthy state). However, when hypothermia, reduced immunity or in the presence of accompanying pathologies, the gardnerella becomes aggressive, begins to multiply and leads to inflammation of the mucous membrane of the urethra.
Sometimes the disease runs in a latent form, showing no self, and, in the absence of complaints, a man becomes a carrier.
Symptomatic gardnerelleza in men is completely similar to the symptoms of urethritis. With inflammation of the mucous membrane of the urethra in the urethra, there is a burning sensation, discomfort in the process of urination, and mucus-serous discharge also appears.
Diagnosis of gardnerellosis
As a rule, when making a diagnosis, patient complaints, examination data and laboratory test results are taken into account.
As a material for the study, it is used to separate from the urethra, the cervical canal, the walls and vaults of the vagina, and urine.
During the bacterioscopy in the smears of patients in the absence of leukocytes, the key cells (cells of the flat epithelium, practically "plastered" with gram-positive kokkobacteria) are detected. There is also a decrease in the acidity of the vaginal medium (pH> 4.5), the result of the amine test is positive, the lactic acid bacteria are completely absent, and the number of anaerobes exceeds the number of aerobes.
зачастую гарднереллез развивается у тех пациенток, которым ранее назначалось антибактериальное лечение кольпита. Note: often gardnerellez develops in those patients who previously received antibacterial colpitis treatment. In this case, it is antibiotics that aggravate the course of the pathological process.
Treatment of gardnerellosis
Treatment gardnerelleza carried out in a complex aimed at restoring normal vaginal flora and creating the optimal physiological environment. Local treatment, as a rule, should be conducted not less than ten days. It involves the treatment of the vagina with a solution of miramistine or metronidazole, and also patients are prescribed syringing with soda and chamomile baths.
Without fail, during the treatment, the use of drugs stimulating the immune forces of the body and vitamin complexes is shown.
With systemic therapy, specialized drugs are prescribed in which active ingredient is metronidazole or clindamycin. Also, experts recommend using biogenic stimulants and medications that normalize the microbiocenosis of the intestine and vagina.
In the acute form of the pathological process, patients are assigned a two-week antibacterial therapy. However, sometimes for a complete cure, at least two, and sometimes three, treatments are required.
The main problem that arises in the treatment of gardnerelleza is that the causative agent of this disease is a conditionally pathogenic microorganism, and therefore, when it lives in the body of an absolutely healthy woman, under the influence of unfavorable factors it becomes aggressive and begins to multiply uncontrollably.
Gardnerella is a microorganism resistant to the action of tetracyclines and macrolides. Therefore, before proceeding to treatment, it is necessary to undergo all necessary examinations and pass bacussis to sensitivity to antibacterial drugs.
People's treatment of gardnerellez is not bad. In order to get rid of this disease, folk healers recommend using herbal preparations. However, it is necessary to understand that to achieve a lasting effect they need to be taken very long (6-12 months). As a biogenic stimulant, contributing to the normalization of the vaginal and intestinal microflora in folk medicine use Schizandra, aralia and lefthose saffronite.
Prophylaxis of gardnerellosis
Women suffering from bacterial vaginosis should pay attention to the state of the immune system, since it is the decrease in immunity that leads to a violation of the microflora of the vagina and leads to hormonal disorders. The main methods of prevention gardnerelleza include a healthy lifestyle, proper nutrition, normal sleep, regular walks in the fresh air. It is very important to observe the hygiene of the external genitalia and to avoid hypothermia. At casual sexual contacts it is not necessary to forget about means of individual defense, and also it will be not superfluous to process external genitals within two hours by special antiseptics.
Practically all experts recommend that for the prevention of gardnerellosis refuse daily douching, as such procedures not only can trigger the development of allergic reactions, but also irritate the mucous membrane of the vagina, washing away the natural lubrication and changing acidity, which ultimately leads to suppression of the natural microflora.
To ensure that there are enough lactic-acid bacteria in the vagina, a variety of vegetables and fruits, sauerkraut, biochephors and yoghurts should be present in the diet.
On a mandatory basis, attention should be paid to the state of the intestinal microflora. In case of a violation, a special course of treatment should be carried out, since opportunistic microorganisms that live in the intestine easily cross the thin wall and penetrate the vagina. According to experts, treatment gardnerelleza in patients with intestinal dysbiosis is the most difficult.
With adequate timely treatment, after two or four weeks, the microflora of the vagina is completely restored. Otherwise, the pathological process can provoke inflammation of the appendages, development of various complications in pregnancy, premature birth and female infertility.