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Gardnerella and Gardnerella

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Gardnerella The normal microflora of the vagina is one of the main factors of nonspecific resistance. Normally, a healthy woman's vagina is a reservoir that holds both aerobic and anaerobic microflora. However, the number of the first is ten times the number of the second. Its main representatives are lactobacilli, producing hydrogen peroxide and lactic acid, which prevents the growth of opportunistic bacteria. However, some endogenous and exogenous factors can trigger the development of inflammatory syndrome due to vaginal imbalance. The condition in which lactic acid bacteria are completely replaced by facultative anaerobes, which are present only in an insignificant amount in the vaginal secretion of a healthy woman, is called in clinical practice bacterial vaginosis or gardnerellosis. This is a fairly common pathology, which is diagnosed in 30-35% of patients with mixed urogenital infections.



Causative agent of gardnerella

Vaginal gardnerella (Gardnerella vaginalis), provoking the development of gardnerelleza, was first isolated from patients suffering from vaginitis in 1955 by Duxon and Gardner, who called it hemophilic vaginal sticks. This microorganism is an immobile, capsule-free polymorphic, nuclear-free gramvariable rod (or coccobacillus), reaching a length of 2 microns and 0.7-0.9 microns in diameter. This bacterium can be represented in the form of cocci or small sticks covered with a thinnest cell wall and the outer microcapsular layer. It should be noted that for some Gardnerell the membrane structure of the cell wall is typical, as in gram-negative bacteria, while in others - homogeneous - as in gram-positive microorganisms.

It is an optional anaerobic that can multiply even in the absence of oxygen, producing amino acids and acetic acid during its vital activity. In the case when, due to certain reasons, Gardnerella becomes aggressive and begins to multiply uncontrollably, the products of its vital activity in a short time change the pH of the vagina and are able to completely destroy all its normal microflora, of which 90% are normally accounted for lactic acid bacteria.

On open surfaces, the pathogen can retain 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 non-flowing water bodies.

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 showing pathogenic properties.

Prevalence of disease

According to WHO statistics, Gardnerella is one of the most common sexually transmitted diseases, which most often affects women of reproductive age. In men, this 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 also detected during preventive examinations in a quarter of healthy women.

Risk factors, sources of infection, and ways of transmission of Gardnerella

According to experts, the development of gardnerella is directly dependent on the nature of sexual life. This pathology is never detected in healthy virgins, as well as in women without vaginitis. Therefore, predisposing factors include:

  • promiscuous sex life;
  • previous infections;
  • menstrual disorders;
  • use of intrauterine contraceptives;
  • long-term use of antibacterial drugs and antidepressants, leading to an imbalance of the vaginal microflora;
  • use of contraceptives that violate hormones;
  • use when douching chlorine-containing antiseptics;
  • stressful situations;
  • prolonged wearing of synthetic underwear;
  • the absence in the diet of fermented milk products, which are a source of lactobacilli.

It should be emphasized that most often gardnerellosis occurs against the background of other urogenital infections (trichomoniasis, gonorrhea , chlamydia , ureaplasmosis , etc.).

The main route of transmission is sexual. However, the infection can be transmitted from an infected mother to a child when passing through an infected birth canal, or as a result of intrauterine infection.

Pathogenesis of Gardnerella

The virulence of this microorganism is relatively small, and only in some strains of Gardnerell the final fermentation product is acetic acid and amino acids. Others produce lactic and formic acid in the course of their life. Therefore, some authors are inclined to believe that this bacterium does not possess pathogenic properties, but refers to the saprophytes of the urogenital tract.

During sexual intercourse with a woman (or a carrier) suffering from Gardnerella, the pathogen enters the male urethral epithelium, and subsequently, during the next sexual contact, it infects or reinfects the female genital tract.

By attaching to the surface of a stratified squamous epithelium, gardnerella is able to form characteristic formations, which are called “key cells” in clinical practice. It is their detection in the course of bacterioscopic examination of smears from the genital organs that has important diagnostic value.

Unfortunately, until now, the pathogenesis of this disease is not completely clear. However, scientists have found that Gardnerella damages the vaginal epithelial cells and also causes autolysis (dissolution) of phagocytes.

Clinical Forms of Gardnerella

To describe the clinical signs of urogenital pathologies triggered by anaerobic microorganisms, scientists have developed a special classification that includes the following forms of gardnerelleza:

  1. Bacterial vaginosis;
  2. Bacterial lesion of the upper genital tract;
  3. Gardnerellosis of the female urinary tract;
  4. Gardnerellosis of the male urinary tract;
  5. Gardnerellosis pregnant.

Bacterial vaginosis

This, according to experts, the most common clinical form of the disease. As a rule, in the course of a diagnostic study, along with gardnerella, other representatives of anaerobic microflora (leptostreptococci, mobilunkus, bacteroids, etc.) are found in the discharge from the genital organs, 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 smell of rotten fish. In the other half of patients with this form of pathology, objective and subjective symptoms are not detected.

Unpleasant odor, according to experts, occurs due to the formation of biogenic amines in the process of metabolism of Gardnerell and other non-sporching anaerobes. Putrestsin and cadaverine (pathological amines), presented in the form of nonvolatile salts, in the process of alkalization become rapidly evaporating substances that emit a strong fishy smell.

Gardnerellosis of the upper genital tract

With this form of pathology, infection can occur directly through the periolate fiber, as well as lymphogenous or hematogenous. There are cases when this form of gardnerelleza caused the development of endometritis and salpingoophoritis, as well as some authors describe cases of blood infection with 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: that is why all women preparing for surgery should be examined for bacterial vaginosis.

Gardnerellosis 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 the pathogen is transferred from the genital organs to the urinary tract.

There is evidence that Gardnerella is very often isolated from the urine of practically healthy women. However, it is possible to diagnose garnerellosis only if there is more than 1000 CFU of bacteria in one milliliter of urine taken by the catheter.

Gardnerellosis of the male urinary tract

In men, the disease is not as common as in women. Often, when Gardnerella is found in a compartment with other bacteroids, the front urethra is inflamed in the stronger sex. In this case, there is a sluggish course of urethritis, with mild clinical symptoms. Patients complain of the occurrence of scanty mucous-serous discharge, without pain and discomfort. Complications of Gardnerella in men in clinical practice is very rare. There are isolated reports on the development of Gardnerella prostatitis, cystitis, epididymitis and pyelonephritis. In case of manifest forms of the disease, the clinical course features, as a rule, determine precisely those pathogenic microorganisms with which the pathogen of gardnerellosis is associated.

мужчины, которые страдают бессимптомной (или малосимптомной) формой заболевания, зачастую являются источниками заражения своих половых партнерш. Note: Men who suffer from the asymptomatic (or oligosymptomatic) form of the disease are often the source of infection of their sexual partners.

Pregnant gardnerellosis

In gynecological practice, this form of pathology occurs in almost 20% of pregnant women. But fortunately, intrauterine infection develops very rarely, since during this period active protective mechanisms increase. However, some authors have noted the possibility of moderate suppression of cellular immunity. Very often, bacterial vaginosis causes various abnormalities in the course of pregnancy, and the disease can provoke the development of postpartum complications.

In women with a diagnosis of Gardnerellosis, premature labor occurs twice as often, and in a tenth part of the parturient women in the amniotic fluid Gardnerella and other microorganisms are found, although I normally have to be sterile.

There is also evidence that bacterial vaginosis may be associated with chorionamnionitis (purulent-septic complication, also leading to premature birth), and, according to some experts, gardnerella can cause postpartum or post-abortion sepsis.

Symptoms of Gardnerella in women

With the development of the pathological process in patients there are abundant, unpleasant-smelling foaming vaginal discharge, as well as, during the conduct of special laboratory tests revealed a decrease in the acidity of the vaginal environment. Often, women complain of severe itching and burning in the area of ​​the external genitalia and perineum.

However, patients marked hyperemia of the mucous membrane of the vagina, urethra and cervix. With fresh acute gardnerella, vaginal discharge is very abundant, thick and homogeneous, white-gray in color, and discharge from the urethra and cervical canal is quite scarce.

In the case when the uterus and fallopian tubes are involved in the pathological process, salpingitis is diagnosed.

Symptoms of Gardnerella in Men

The representatives of the stronger sex, the disease often occurs exclusively in the form of inflammation of the external genital organs. As a rule, the pathogen of Gardnerella after two or three days is removed from the urinary tract (in their healthy state). However, when hypothermia, reduced immunity or in the presence of associated pathologies, gardnerella becomes aggressive, begins to multiply and leads to inflammation of the urethral mucosa.

Sometimes the disease occurs in a latent form, not showing anything, and, in the absence of complaints, the man becomes a bacteriocarrier.

Symptoms of Gardnerella in men is completely similar to the symptoms of urethritis. When inflammation of the mucous membrane of the urethra in the urethra there is a burning sensation, discomfort in the process of urination, and mucous-serous discharge.

Diagnosis of Gardnerella

As a rule, when making a diagnosis, patient complaints, examination data and laboratory results are taken into account.

The material used for the study is the discharge from the urethra, the cervical canal, the walls and vaults of the vagina, as well as urine.

During bacterioscopy, in smears of patients in the absence of leukocytes, key cells are identified (squamous epithelial cells, practically “plastered” with gramvariable coccobacteria). There is also a decrease in the acidity of the vaginal environment (pH> 4.5), the result of the amine test is positive, 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: Gardnerella often develops in those patients who have previously been prescribed antimicrobial treatment of colpitis. In this case, it is antibiotics that aggravate the course of the pathological process.

At the present stage, along with bacterioscopic studies, microbiological techniques, DNA hybridization, RIF (immunofluorescence reaction) and PCR are used to detect gardnerellaosis.

Gardnerella treatment

Gardnerellosis treatment is carried out in a complex aimed at restoring the normal microflora of the vagina and creating an optimal physiological environment. Local treatment, as a rule, should be held for at least ten days. It involves treating the vagina with Miramistin's solution or metronidazole, and patients are prescribed douching with soda solution and chamomile baths.

In the course of treatment, the use of drugs that stimulate the body's immune forces and vitamin complexes is mandatory.

In systemic therapy, specialized drugs are prescribed in which the active ingredient is metronidazole or clindamycin. Also, experts recommend the use of biogenic stimulants and medications that normalize the microbiocenosis of the intestine and vagina.

In the acute form of the pathological process, patients are prescribed two-week antibacterial therapy. However, sometimes for a complete cure it takes at least two and sometimes three courses of treatment.

The main problem that arises in the treatment of gardnerellosis is that the causative agent of this disease is a conditionally pathogenic microorganism, and therefore, living in the body of an absolutely healthy woman, under the influence of adverse factors, it becomes aggressive and begins to multiply uncontrollably.

Gardnerella is a microorganism resistant to the action of tetracyclines and macrolides. Therefore, before embarking on treatment, one should go through all the necessary examinations and pass back test for sensitivity to antibacterial drugs.

Not bad proved popular treatment Gardnerella. In order to get rid of this ailment, traditional healers recommend the use of herbal. However, it must be understood that in order to achieve a lasting effect, they must be taken for a very long time (6-12 months). In folk medicine, lemongrass, aralia and levzeyu safroliform are used as biogenic stimulants to normalize the vaginal and intestinal microflora in folk medicine.

Experts strongly recommend not to neglect the treatment of Gardnerella, as the pathological process can go into a chronic stage and provoke the development of various complications.

Prevention of Gardnerella

Women suffering from bacterial vaginosis should pay attention to the state of the immune system, since it is a decrease in immunity that leads to a violation of the microflora of the vagina and leads to hormonal disorders. The main methods of prevention of Gardnerella 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 genital organs and not to allow hypothermia. In case of casual sexual intercourse, one should not forget about personal protective equipment, and it is also useful that the external genitals be treated with special antiseptics for two hours.

Practically all experts recommend that in order to prevent Gardnerella, to stop daily douching, as such procedures can not only provoke allergic reactions, but also irritate the vaginal mucosa, washing away natural lubrication and altering acidity, which ultimately leads to inhibition of the natural microflora.

In order for lactic acid bacteria to be in sufficient quantity in the vagina, a variety of vegetables and fruits, sauerkraut, biokefir and yogurt should be present in the diet.

В обязательном порядке следует обратить внимание на состояние микрофлоры кишечника. В случае нарушения необходимо провести специальный курс лечения, так как условно-патогенные микроорганизмы, обитающие в кишечнике, без труда преодолевают тонкую стенку и проникают во влагалище. По мнению специалистов, лечение гарднереллеза у пациенток с кишечным дисбактериозом является самым сложным.

При проведении адекватного своевременного лечения уже через две или четыре недели микрофлора влагалища полностью восстанавливается. В противном случае патологический процесс может спровоцировать воспаление придатков, развитие различных осложнений при беременности, преждевременные роды и женское бесплодие.


7 Апрель 2014 | 5 067 | Uncategorized
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