Bacterial vaginosis or is it pathological condition in the body of a woman, when there is a violation of the microflora of the vagina. This disease is not inflammatory in nature, but is an imbalance caused by a decrease in the number of lacto- and bifidobacteria. Against this background, there is an active reproduction of other bacteria, including gardnerella, and the disease develops.

Gardnerellosis is not considered acute venereal disease, but the danger is that given state can cause a number of complications, including dangerous female diseases.

Treatment of gardnerella requires a special approach. In most cases, antibiotic therapy is used, but other agents are also required. What drugs are considered effective for the treatment of gardnerella?

A few words about the disease

Gardnerellosis or develops in two forms: acute and chronic. Vivid symptoms presented in an acute form. Then the woman feels profuse itching, as well as a burning sensation in the vagina, observes swelling of the labia, pain occurs during intercourse and after it. Such signs are characteristic of many diseases of a sexual nature, so it is better to consult a doctor.

Gardnerellosis is observed in representatives of any age, but the following categories fall into the risk group:

• Women during menopause;
• Often suffering from infectious diseases;
• Leading the wrong way of life, while often changing partners;
• Girls in adolescence.

This disease can develop under the influence of the following factors:

• Insufficient hygiene;
• Taking antibiotics;
• Frequent change of sexual partners;
• Low level of local immunity;
• Use of a spiral or long-term use contraceptives;
• Hormonal imbalance in the body and others.

Despite the fact that gardnerellosis can develop exclusively in female body, men can be carriers. So the only way being safe is protected sex.

Features of the treatment of gardnerellosis

This therapy has some peculiarities. There are certain schemes that make the treatment effective. To begin with, it is necessary to understand that therapy will be directed in two directions at once:

• Decreased growth;
• Population of microflora by bifido- and lactobacilli.

Such A complex approach will restore normal microflora and the symptoms will go away on their own. Need to use for this antibacterial drugs, antiseptics and probiotics.

In addition, therapy will not be effective if several principles are not followed:

• Both partners must undergo therapy, while using different drugs;
• During treatment, sexual relations should be excluded;
• It is necessary to follow strict rules of hygiene, to use for this antiseptics.

Treatment should be started at the first sign, and self-medication in this situation will not work. Symptoms are very difficult to identify. accurate diagnosis, and untimely antibiotic therapy can lead to complications in the form of other diseases of the genitourinary system.

Popular drugs for the treatment of gardnerellosis

For fast and efficient treatment this disease, it is necessary to use several drugs at once. You can not do without antibiotic therapy, the only exception is the period of pregnancy. In this case, antibiotics can cause very serious side effects. But it is impossible to leave gardnerellez without treatment, therefore, for women in position, only antiseptics of traditional and alternative medicine are used.

For all other patients, drugs are used in the form of tablets for internal use, injections, vaginal suppositories and gels. The treatment regimen depends on the stage of the disease and the characteristics of the female body.

The most popular drugs in this case:

• "Clindamycin" is a semi-synthetic antibiotic that allows you to suppress the growth of a large number of bacteria. This drug is produced in the form of a solution for injection. The course of treatment should last at least 7 days, while the injections must be done 3 times. Very often, patients refuse this remedy because of its form, preferring tablets. But the effectiveness of "Clindamycin" is very high, and side effects seen much less frequently.
• "Metronidazole". This antibacterial agent is prescribed in 50% of cases of the disease. It has high threshold efficiency due to the ability to destroy DNA in anaerobic microorganisms. "Metronidazole" is available in the form of tablets and vaginal gel, both drugs can be used to treat gardnerella, but you should not exceed daily dose. Tablets are considered more effective, but from the use local funds occurs less side effects. Treatment lasts about 7-10 days, taking the drug 2 times.
• "Macmirror" - antimicrobial agent available in the form of tablets. This drug It is considered universal, since it has a wide spectrum of action, and fights not only gardnerella, but also other infections. Also, tablets can be used for both women and men. The course of treatment is two weeks. For prevention purposes, you can also use "Macmirror", but you need to reduce the dose. It is very important not to take the drug without the instructions of a doctor, and even more so not to combine it with others. medicines, this can cause complications.
• "Ornidazole" - effective antibiotic a wide range actions. It is absorbed very quickly, so the first results are visible already two hours after ingestion. The tool helps to defeat not only gardnerellosis, but also others possible infections. You need to take the drug according to an individual scheme, it is calculated by the doctor, depending on the age of the patient and the stage of the disease. Ornidazole is tolerated normally, in the form of side effects, digestive disorders may occur.
• Unitabs is also a popular antibacterial agent that belongs to the tetracycline group. It is prescribed less often, only in the case when antibiotics of other groups are contraindicated. Its action is aimed at the destruction of protein and protein synthesis. The main advantage of this tool is the fact that it acts on harmful microorganisms, while the level of normal microflora is restored. The drug is very strong, has several contraindications, so self-medication is prohibited.

Normally, there are a variety of microorganisms in the vagina: lacto and bifidobacteria, which make up up to 95% of the entire microflora of the genital tract, as well as cocci, enterobacteria, E. coli, fungi of the genus Candida, Klebsiella, mycoplasma and others, including gardnerella.

What is gardnerella?

These are bacteria of the genus Gardnerella, which includes only one species - Gardnerella vaginalis. In a small amount, these microorganisms are present as part of the usual microbial association living in the vagina. healthy woman. They represent facultative anaerobes, that is, they can exist in an environment without access to oxygen.

In favorable conditions, microbes multiply rapidly in the urethra and vagina, suppressing and destroying lactic acid bacteria. A disease develops, which was formerly called gardnerellosis. Now scientists have found out that other opportunistic microbes are also actively involved in this process - mycoplasma and obligate anaerobes, capable of existing only in an oxygen-free environment (fusobacteria, bacteroids, peptostreptococci and others). Thus, gardnerellosis in women according to modern concepts — mixed infection. Currently, this disease is preferred to be called "".

This diagnosis is missing International classification diseases of the 10th revision, since the term "bacterial vaginosis" itself entered into practice later than the creation of this classification.

Causes and mechanism of the development of the disease

Gardnerellosis is not an inflammatory disease, but an imbalance in the microflora of the vagina, that is, vaginal dysbiosis. This condition develops at least once in a lifetime in a third of women. Is he dangerous? Bacterial vaginosis creates favorable conditions for the formation of genital tract infections - colpitis and others. It contributes to the formation of a precancerous condition of the cervix -. Gardnerellosis increases the risk of an unfavorable outcome of gynecological interventions, abortions and childbirth. It increases the chance of contracting HIV.

Causes of gardnerellosis in women:

• the use of antibacterial drugs, primarily antibiotics, as well as local antiseptics, for example, during douching;
• uncontrolled intake of oral contraceptives and spermicides;
• without proper medical supervision;
• hormonal disorders, accompanied by a decrease in the volume of blood released during menstruation, as well as lengthening menstrual cycle, at puberty or menopause;
• inflammatory diseases of the lower genital organs, uterus, appendages;
• promiscuity;
• immunodeficiency states in diabetes, taking immunosuppressants and cytostatics, HIV infection;
• malformations, polyps, cysts, foreign bodies vagina and uterus.

At overgrowth conditionally pathogenic microbes in the vagina, the acidity of its internal environment changes, the pH rises to 7 or more. Under these conditions, the natural protection of the genital organs weakens, infectious complications. Thus, the causes of gardnerellosis lead not only to the development of bacterial vaginosis, but also contribute to the colonization of the vagina by pathogens.

Gardnerellosis in men is much less common. Usually, these microbes are removed from the urethra in the urine stream. Isolated cases have been described. inflammatory lesion genital organs of a man with gardnerella. However, every tenth infected man becomes a carrier of the infection, spreading it through unprotected sexual intercourse. Wherein external manifestations he has no illnesses.

Clinical picture and diagnosis

The time from the onset of the disease to the formation of the first signs in most cases is 10 days.

Symptoms of gardnerellosis

appear pretty copious discharge from the vagina, itching, burning. The discharge is usually white or grey colour, they are sticky, homogeneous, foamy, with a characteristic unpleasant fishy odor. They are observed in half of the patients, irritate the walls of the genital organs, sometimes causing burning and itching. Reinforcement possible discomfort during sexual intercourse or menstrual bleeding.

These symptoms can persist for a very long time, even for many years. With such a long process of selection, they acquire a curdled character and a yellow-green color.

Every fifth patient has urination disorders: it can be frequent, painful, in small portions, accompanied by itching. At the same time, gardnerella from the urine are excreted in almost all women with bacterial vaginosis.

A feature of vaginosis is the absence of edema and redness of the walls of the vagina, that is, inflammation. However, almost half of the patients have concomitant diseases of the cervix: inflammation, cicatricial deformity, ectropion, pseudo-erosion.

Establishing diagnosis

At similar signs The doctor can make a preliminary diagnosis using the following methods:

• determination of the reaction of vaginal contents (pH-metry), in which an alkaline reaction is determined, in contrast to the normal - acidic, created by lactic acid bacteria;
• positive amine reaction: when the secretions are mixed with a solution of potassium hydroxide, a strong unpleasant fishy odor occurs.

The diagnosis is confirmed by examining stained smears under a microscope. The following specific signs of gardnerellosis are determined:

• a large number of desquamated cells lining the mucosa;
• « key cells» - epitheliocytes with gardnerella and other microbes fixed on them;
• lack of lactic acid sticks;
• the presence of gardnerella, bacteroid, fusobacteria and other pathogens of vaginosis;
• a small number of leukocytes, indicating a mild inflammation.

There are other diagnostic methods: immunofluorescence reaction, polymerase chain reaction, DNA hybridization, as well as the cultivation of microorganisms. They are aimed at identifying gardnerella in the vaginal contents. These methods are expensive, often time-consuming and cost-inefficient, so they are rarely used.

Features of the course of the disease in pregnant women

Gardnerella during pregnancy is less common than outside this state, due to the physiological increase in the number of lactobacilli in the expectant mother. They are designed to create an acidic environment in the vagina. Thus, lactobacilli protect the fetus from the penetration of infectious agents through the cervix.

Diagnosis and treatment of gardnerellosis in pregnant women should be given Special attention, as it can cause pregnancy complications (chorioamnionitis, abortion early dates, doubling the likelihood of preterm birth, postpartum endometritis, and sepsis). There is usually no direct effect on the fetus, however, an increased frequency of preterm birth leads to the birth of premature babies.

Thus, untreated gardnerellosis during pregnancy is not a harmless condition, it is dangerous for a woman and her unborn child. This condition must be treated. Treatment is hampered by the fact that many antibacterial drugs during pregnancy (especially during the first trimester) are contraindicated.

Therapy

During the course of therapy for gardnerellosis, a woman is recommended to abandon fatty and sweet food, take more fluids, dairy products, normalize stools with the help of vegetable fiber (vegetables). The patient can take a shower, go to the bath, but do not bathe. Baths should be avoided.

Treatment of the sexual partner is carried out only if he has inflammation urethra- urethritis. In other situations, drugs are not prescribed to a man. It is advisable to use condoms to reduce the risk of infection by others infectious diseases from a partner, although according to some recommendations it is not necessary. Bacterial vaginosis is not sexually transmitted.

It is necessary to treat the disease in all cases, especially before abortion.

Treatment of gardnerellosis is based on the following principles:

• antibacterial therapy;
• normalization of the microbial flora of the vagina;
• strengthening immunity and preventing relapses.

With gardnerellosis, tetracyclines, cephalosporins, aminoglycosides are not used. The basis of treatment is Metronidazole, less often Ampicillin and Clindamycin are used.

These drugs can be used both in tablet form and topically. Inside appoint Metronidazole or Clindamycin for a week. During this time and the next day, a woman is forbidden to drink alcohol.

Terzhinan candles have proven themselves well, they need to be used within ten days. Metronidazole-gel, vaginal cream Cleocin is used. Simultaneously with these drugs, antifungal drugs are prescribed for prevention, in particular, fluconazole for oral or topical use.

Treatment of gardnerellosis during pregnancy is carried out using local preparations, insofar as system tools may harm the child. In the 2nd and 3rd trimesters, Dalacin vaginal cream with clindamycin has proven itself well. Additionally, for the prevention of candidiasis, pregnant women are prescribed candles Natalsid, Pimafutsin, Gino-pevaril.

In parallel with the use of antibiotics, antiseptics can also be used to local application eg Betadine (Povidone-iodine), Chlorhexidine. This will speed up your recovery.

3 days after the end of the course of antimicrobial therapy, agents are prescribed that restore the normal sour-milk flora of the vagina - Acylact (tablets, suppositories, powder for suspension preparation), Lactobacterin. Bifidumbacterin is used to restore bifidobacteria. You can assign and combined means, for example, Lineks, Bifiliz and others. They can be used both internally and locally, given the fact that bacterial vaginosis is very often combined with a violation of the composition intestinal microflora. At the same time, multivitamin complexes are prescribed.

For the prevention and treatment of recurrent gardnerellosis, the Solkotrikhovak vaccine is used. It enhances local immune responses, promotes the development of lactobacilli, inhibits the reproduction of opportunistic flora. There are features of the introduction of the vaccine, so only a doctor should prescribe and control the treatment.

Treatment at home should be carried out as prescribed by a doctor. Additionally, after the exacerbation subsides, douching with chamomile, oak bark, aloe juice, calendula and other herbs with anti-inflammatory and antiseptic properties. However, it should be understood: douching washes beneficial microorganisms which can further delay recovery. Only folk remedies getting rid of gardnerellosis is almost impossible.

Usually, treatment takes about 2 months: 10 days of antibiotic therapy, followed by restoration of the microflora of the genital tract. Evaluation of the effectiveness of therapy is carried out after the complete disappearance of symptoms.

Prevention includes the following areas:

• achievement of a normal hormonal background;
• treatment with antibiotics only as prescribed by a doctor;
• compliance with the usual rules of personal hygiene, without frequent douching;
• refusal to have sexual intercourse with different partners;
• treatment of intestinal dysbacteriosis and infections of the genitourinary system.

– vaginal dysbacteriosis associated with a sharp quantitative and qualitative violation normal vaginal microflora, a decrease in the number of lactobacilli and the reproduction of conditionally pathogenic microorganisms, including gardnerella. It is characterized by the appearance of profuse vaginal discharge of a grayish tint with an unpleasant odor. Untreated bacterial vaginosis increases the risk of developing inflammatory diseases female genital area and miscarriage.

General information

is the most common variant of bacterial vaginosis, i.e., an imbalance in the composition of the natural microflora of the female genital organs. Gardnerellosis is observed in 20% of women in reproductive period. Lactic acid microflora, normally predominant in the vagina, with bacterial vaginosis replaced by opportunistic species, the leader among which is gardnerella. The way of transmission of gardnerellosis is sexual, more often gardnerella is detected in women who are active in sexual life. Men usually act as carriers of the infection, therefore, in order to exclude relapses of gardnerellosis, simultaneous treatment of all sexual partners should be carried out.

Gardnerellosis in running form can cause inflammation urinary tract, uterus and appendages, infertility, complications during pregnancy and childbirth. With gardnerellosis, mixed infection with other microorganisms is often noted: gonococci, trichomonads, mycoplasmas, chlamydia, candida, etc.

Symptoms of gardnerellosis

Gardnerellosis has a course somewhat similar to other inflammatory diseases of the genitals in women. With gardnerellosis, there are: discharge from the vagina (grayish-white, homogeneous, pasty, with an unpleasant "fishy" odor); burning, itching, discomfort during urination and sexual intercourse. Gardnerellosis is accompanied inflammatory changes in the vagina, urethra and cervix. When using intrauterine devices, after menstruation, abortion and childbirth, gardnerellosis can be complicated by endometritis, inflammation of the uterine appendages. Gardnerellosis adversely affects pregnancy: premature births are more common, children are born weakened, premature, infection of the fetus during childbirth is possible.

The presence of gardnerella in the urogenital tract of men, in most cases, does not manifest itself in any way, occasionally causes a sluggish inflammatory process with signs of urethritis. Then they may appear small discharge from the urethra (serous-purulent, grayish in color with a "fishy" smell), discomfort during urination. Possible complications in the form of prostatitis, inflammation of the testicles and appendages, the development of infertility.

Causes of gardnerellosis

Bacterial vaginosis (gardnerellosis) occurs as an imbalance in the composition of the natural microflora of the vagina, when “non-physiological” types of microorganisms, primarily gardnerella, begin to dominate. Violate the normal microflora of the genitourinary organs can be external and internal factors.

Among the external factors that determine the development of gardnerellosis, the following prevail:

• unfavorable ecology;
• recent and frequent change sexual partner;
• irrational nutrition, diets with a lack of lactic acid products;
• the use of antibiotics (including suppositories, ointments);
• the use of contraceptives (vaginal suppositories containing 9-nonoxynol, condoms with spermicidal lubricant, hormonal preparations);
• usage hygiene products(pads, tampons, perfumed intimate hygiene products) and frequent douching;
• wearing underwear and clothes made of synthetic materials that tightly fit the figure.

TO internal factors that cause gardnerellosis include:

• endocrine disorders and changes (including pregnancy);
• level reduction immune protection, immunodeficiency states;
• emotional and physical overwork, stress;
• chronic diseases, imbalance of the microflora of the intestinal and genitourinary tract.

Development of gardnerellosis

Normally in the vagina adult woman more than 15 types of microorganisms are found. Acidophilic lactobacilli predominate, the smaller part is bifidobacteria (10%), peptostreptococci (~ 5%). Lactoflora, thanks to lactic acid, maintains the acidic environment of the genital mucosa, which performs local protective and immune functions.

Anaerobic bacteria (mobiluncus, bacteroids, gardnerella, etc.), genital mycoplasmas, trichomonas, candida are found in small quantities in the vagina of women. Sharp increase the number of these microorganisms violates the microbiological balance, vaginal dysbacteriosis or bacterial vaginosis occurs. It is characterized by a decrease in the number of Doderlein microflora (lactobacilli) and the predominance of opportunistic species. More often than others, women with bacterial vaginosis are found to have vaginal gardnerella, which is the main, although not the only, cause of these disorders. Therefore, the condition of bacterial vaginosis is called gardnerellosis.

In addition to gardnerella, the number of other bacteria increases (coccal species, trichomonads, mycoplasmas, mobiluncus, yeast-like fungi). The role of gardnerella in the development of bacterial vaginosis is that it creates a favorable background for the reproduction of opportunistic and pathogenic microorganisms. The vaginal environment is alkalized, the metabolic products of gardnerella exacerbate the resulting mucosal disorders, and a basis for the penetration of other infections arises. Therefore, gardnerellosis contributes to the development of inflammatory diseases of the genitourinary system of women.

Diagnosis of gardnerellosis

To confirm the diagnosis of gardnerellez at a gynecologist's consultation, swabs are taken from the woman's vagina. In the diagnosis of gardnerellosis, it is not so much the presence of gardnerella that matters, but their number and the ratio of microorganisms in the composition. vaginal secretion. Gardnerella are present in the vaginal flora of most healthy women without the development of dysbacteriosis. The diagnosis of "gardnerellosis" is established on the basis of:

• patient complaints and clinical manifestations(the presence of homogeneous pasty secretions of a grayish-white color);
• increase in the pH of the vaginal secretion (> 4.5);
• the presence of "key" cells in the microscopy of smears from the vagina and urethra ("key cells" - epithelial cells covered with small sticks (gardnerella) - important feature gardnerellosis);
• amine test

With gardnerellosis, in the course of their life, gardnerella and anaerobic microorganisms volatile amines are formed (putrescine, triethylamine, cadaverine), which, when decomposed, give an unpleasant "fishy" smell. The basis for the diagnosis of gardnerellosis is the detection of at least three of these criteria. It is also necessary to be examined for the presence of intestinal dysbacteriosis, which can provoke the development of bacterial vaginosis, and to treat it. This will reduce the risk of recurrence of gardnerellosis.

Treatment of gardnerellosis

Early and accurate diagnosis gardnerellosis allows timely treatment. The methods of therapy used by modern gynecology allow the patient to recover and avoid the development of complications, but do not guarantee the absence of recurrence of the disease in the future. Therapeutic treatment gardnerellosis should eliminate the causes and manifestations of the disease and create conditions for the normalization of the microflora of the genital organs.

At the first stage of treatment of gardnerellosis, women are prescribed clindamycin and metronidazole preparations (orally and intravaginally): clindamycin phosphate - capsules and vaginal cream (2%); metronidazole - tablets and gel (0.75%). To avoid the development of vaginal candidiasis in the treatment of gardnerellosis, prescribe clotrimoxazole (cream). When managing pregnancy in women suffering from gardnerellosis, treatment begins in the second trimester of pregnancy with the same drugs (orally and locally as prescribed by a doctor). In the first trimester oral administration metronidazole and clindamycin are unacceptable.

Treatment of gardnerellosis is carried out under the control of clinical and laboratory tests, and is considered completed when complaints, symptoms disappear and normalize laboratory criteria. During the treatment of gardnerellosis, it is necessary to avoid sexual intercourse without a condom, give up alcohol, do not use pads for "every" day, tight synthetic underwear. The second stage of treatment of gardnerellosis includes the use of oral and local preparations containing lacto- and bifidumbacteria, vitamins, immunostimulants.

The need for examination and treatment of men - sexual partners of women with gardnerellosis remains debatable. Relapses of gardnerellosis in women can also occur after treatment of both sexual partners. Nevertheless, it is advisable for persistent and recurrent cases of gardnerellosis to carry out such treatment in the representatives of the stronger sex.

Prevention of gardnerellosis

To avoid the development of gardnerellosis and its recurrence will help preventive measures aimed at eliminating the causes of bacterial vaginosis. The wide prevalence and danger of the consequences of gardnerellosis require not only immediate treatment of the disease, but also its regular household and medical prevention. Women are advised:

• have a permanent sexual partner and exclude casual sex;
• enjoy barrier method contraception (condom), minimize the use of local contraceptives;
• do not use frequently and without control of vaginal antibacterial suppositories and tablets;
• use vaccination to create local immunity;
• observe general and intimate hygiene.

Garderellosis, or, as doctors also call it, bacterial vaginosis, is a mysterious disease. Some specialists, having discovered it, prescribe a bunch of antibiotics, others condescendingly wave their hands, they say, it's okay.

And who to believe? What is this infection? What danger does she pose in herself? How to treat gardnerellosis, and in what cases should it be done? We will answer these and other questions in our review and video in this article.

Refers to infections transmitted primarily through sexual contact. When its causative agent, the anaerobic bacterium Gardnerella vaginalis, was first discovered, scientists classified the disease as a sexually transmitted disease.

However, upon closer examination, it turned out that this microorganism can be considered opportunistic: in a small amount it is found in the vaginal flora of almost every healthy woman, peacefully coexisting with beneficial lactobacteria and bifidobacteria. Gardnerella is activated only under certain conditions, causing such unpleasant state, like bacterial vaginosis (otherwise - dysbiotic changes in the vaginal microflora).

It is interesting. For a long time gardnerellosis was considered exclusively a "female" sore. A little later it became clear that getting infected with a microbe in rare cases maybe a man, but the representatives strong half humanity infection is almost asymptomatic.

To provoke the development of the disease can:

• frequent change of sexual partners;
• abuse of antiseptics (for example, constant washing antibacterial soap, frequent douching, the use of spermicides with disinfecting components for contraception);
• pregnancy (read more);
• long-term treatment antibiotics.

Symptoms of a gardnerella infection are rather scarce. Among them:

• vaginal discharge(their number may vary) white or yellowish color;
• spoiled fish.

Note! In the case of joining the above symptoms of itching, pain and burning sensation in the area of ​​the NGO, we can talk about the development of gardnerella vulvitis or vaginitis.

Diagnosis of the disease requires an integrated approach.

Standard medical instruction according to the examination of the patient includes:

1. Collection of complaints and anamnesis, during which the doctor will determine when the first complaints appeared and how the disease proceeds.
2. Smear for purity.
3. Determination of the pH of the vagina (with dysbiosis, the vagina remains alkaline).
4. PCR diagnostics.
5. Bakposev.

Important! The very fact of detecting gardnerella in the body is not a reason to start taking medication for gardnerellosis. An infection is diagnosed only if the number of pathogens exceeds 106-107 and is constantly increasing.

Principles of therapy

So, we found out that the main risk factors are changes in the normal microflora and a decrease in immunity. Therefore, the main treatment should be aimed at their elimination.

Therapy with antibiotics effective against the infectious agent is indicated for:

• development inflammatory process the vulva or vagina in women or the urethra in men;
• during pregnancy in the 2-3 trimester (to exclude the possibility of infection of the fetus);
• with the ineffectiveness of general measures and lifestyle correction.

Note! Only an experienced specialist should recommend treatment to a future mother. Facilities systemic action contraindicated. Preference is given to local dosage forms, and pregnant women are usually prescribed vaginal creams and suppositories for gardnerellosis.

Effective drugs

So, what drugs to treat gardnerellosis? In the sections below, we will analyze the most effective medicines.

Metronidazole

Metronidazole is one of the popular drugs for the treatment of STDs in Russia. According to pharmacological advice, it belongs to synthetic antimicrobial agents.

Has the following effect:

• antibacterial;
• antiprotozoal;
• trichomonadocidal.

The agent acts on anaerobic microorganisms, destroying their DNA structure, disrupting the reproduction processes and causing death.

Metronidazole with gardnerellosis can be administered both orally (by mouth) and locally. Tablets are usually taken twice a day for 5-10 days (depending on the severity of the infection).

Important! Metronidazole (like other antibiotics for gardnerellosis) is strictly forbidden to use with any kind of alcohol.

Local therapy involves the use of vaginal suppositories or gel 1-2 r / d. With the introduction of the drug exclusively into the vagina, the risk of side effects is significantly reduced.

The use of the drug is contraindicated:

• in the 1st trimester of pregnancy;
• when breastfeeding;
• with individual intolerance;
• with severe liver failure.

Clindamycin

Clindamycin is a drug from the group of lincosamides. It has a bacteriostatic effect: it disrupts the synthesis of proteins in a microbial cell, thereby causing its death. It is administered orally at 150 mg every 6-8 hours. The course of treatment is set individually.

The drug is not used for hypersensitivity to its components, pregnancy, impaired renal function.

Tinidazole is another popular antimicrobial and antiprotozoal agent. It has a high percentage of lipophilicity, which means it is easily absorbed from the gastrointestinal tract and spreads with the blood throughout the body, quickly creating a therapeutic concentration in the focus of infection.

How to take Tinidazole with gardnerellosis, the doctor selects individually. On average, a full course of therapy will take from 4 to 10 days.

The drug is contraindicated:

• pregnant women;
• mothers during lactation;
• with diseases of the hematopoietic system;
• with lesions nervous system different genesis.

Ornidazole

Ornidazole is a derivative of 5-nitroimidazole. His pharmacological effect is also based on interaction with anaerobe DNA and its destruction.

It is a less popular medicine for fighting the disease, but very effective. Within 2 hours after the first dose, the required concentration is reached in the body.

Ornidazole with gardnerellosis is taken according to an individual scheme. The "working" dosage of the drug for adults is 2.5 g, divided into several doses.

The tool has standard contraindications:

• individual intolerance;
• the first weeks of pregnancy;
• lactation.

Note! Ornidazole is an active ingredient that is part of the drug of the same name, as well as many others. Among them are Ornisid, Avrazor, Gyro, Dazolik, Tiberal: with gardnerellosis, they have almost the same effectiveness.

Vilprafen tablets (the active ingredient is Josamycin) are among the newest representatives of macrolides. Today this pharmacological group is one of promising directions v drug treatment infections of the genitourinary system.

Especially high sensitivity anaerobes show to the drug, so experts are increasingly prescribing Vilprafen for gardnerellosis.

To get what you want therapeutic effect, you must take at least three tablets of the drug per day ( exact dosage the doctor will determine individually based on the results of the tests). The advantage of Vilprafen can be considered that the drug is allowed to be used during pregnancy (under the supervision of a specialist) and lactation.

Contraindications to its appointment are:

• hypersensitivity to representatives of the pharmacological group;
• severe violations of the functions of internal organs (liver, kidneys).

Azithromycin is another popular macrolide used to treat urinary tract infections. However, with bacterial vaginosis, the drug is prescribed with caution, since it destroys the normal vaginal flora with the same success and can exacerbate the problem of dysbacteriosis.

If Azithromycin is nevertheless prescribed for gardnerellosis, it is not recommended to exceed the standard five-day course of treatment. In addition, after the end of the drug, you will have to start restoring the number of bifidobacteria and lactobacilli.

• during pregnancy;
• during breastfeeding;
• with decompensated diseases of the liver and kidneys;
• with disorders of the blood coagulation system.

Macmirror is a drug from the group of nitrofurans with active substance nifuratel. It has a complex antimicrobial, antiprotozoal and antifungal action.

Due to its wide spectrum of activity and low toxicity, it is used to treat many infections, including the female genital area.

Macmiror is prescribed for gardnerellosis in the form of tablets according to an individually selected scheme (usually at least 3 r / d). The course of therapy is 7-14 days. The drug can be used during pregnancy, but only if the expected effect of the treatment exceeds possible risk for the fetus.

Local treatment

You can enhance the effect of systemic antibiotics with the help of local dosage forms.

Most often, experts prefer the drug Hexicon for gardnerellosis. active ingredient it contains chlorhexidine. This antiseptic is detrimental to many pathogenic bacteria, but does not cause a significant decrease in the number of normal vaginal microflora.

As a rule, the effect of the treatment is noticeable after a few days. Another positive moment- Possibility of use during pregnancy.

Terzhinan - popular drug based on neomycin sulfate, available in the form of vaginal suppositories. It is effective both in combination with oral antibiotics and individually. In the absence of complications, Terzhinan for gardnerellosis is prescribed for a ten-day course.

Polygynax for gardnerellosis is prescribed in cases where Gardnerella vaginalis "adjacent" to others pathogenic microorganisms(mycoplasmas, chlamydia). However, with combined infections, systemic antibiotic therapy cannot be dispensed with. Clotrimazole for gardnerellosis is recommended in situations where anaerobic infection is combined with candidiasis (thrush).

Douching with gardnerellosis has questionable effectiveness and is not recommended by official sources. However, some doctors prescribe such a procedure to patients. The drugs of choice are the popular antiseptics Chlorhexidine and hydrogen peroxide: with gardnerellosis, they reduce the concentration of harmful anaerobes.

Summing up

So, how do doctors treat gardnerellosis today?

The general scheme of therapy can be described by the following algorithm:

1. Elimination of an excessive amount of gardnerella in the genital tract. First-line antibiotics - Metronidazole and Clindamycin (during pregnancy - Ampicillin and Metronidazole). Both oral and topical application is possible.
2. Restoration of the normal microflora of the vagina. The most commonly used vaginal suppositories containing beneficial lactobacilli(Laktonorm, Atsilakt). In addition, a diet with the exception of acute and fatty foods, alcohol and sweets. It is advisable to eat a large number of dairy products(kefir, yogurt).
3. According to indications - taking immunomodulators (setting Echinacea, Immunal, Immunorm).

Table: Popular antibiotics for the treatment of gardnerella infection:

Prevention methods

If we are talking about the prevention of gardnerellosis, it will not be superfluous to talk about small changes in nutrition. First you need to exclude alcohol, spices, fatty, fried, sour, spicy and pickled dishes.

Enrich your diet with dairy and fermented milk products, vegetables. Prophylactic use of prebiotics will be necessary to avoid intestinal dysbacteriosis. Linex or bifidumbacterin are excellent for these purposes.

Women should stop douching and drinking birth control pills, which include 9-nonoxynol. Moreover, important aspect is the regular observance of general and intimate hygiene.

Questions to the doctor

Dosage selection

Girl, I'm 22 years old. Two months ago, vaginal discharge with an unpleasant odor began to bother. Examined, gardnerellez was found out. The gynecologist prescribed Amoxiclav for 5 days and Pimafucin suppositories: with gardnerellez this effective treatment? Tell me what dosage of antibiotic I should buy, 250 or 500, the doctor for some reason did not specify.

Hello! Amoxiclav with gardnerellosis is not the drug of choice. With this disease, this medicine can only be prescribed to pregnant women, but only because there is nothing more to treat the infection with (many antibiotics are contraindicated for expectant mothers). The standard treatment regimen for the disease involves the appointment of Metronidazole or Clindamycin.

STD treatment course for a sexual partner

Hello! Recently I took a smear from the urethra - they found gardnerella and ureaplasma. A few days before it was unprotected sex with a girl (virgin). After that, she began to have symptoms similar to cystitis (burning, pain when urinating). Now I am receiving treatment prescribed by a doctor - Ofloxacin, Metronidazole, Flucostat. Will it suit a girl?

Good day! This treatment can be taken by both partners. Also, upon completion, you can drink probiotics, an immunomodulator. After antibiotic therapy, you and your partner should definitely pass control tests. During treatment, observe sexual rest.

controversial issue

Greetings. Now I am being treated for gardnerellosis and the question arose: how to treat a partner with gardnerellosis and is it necessary at all? My partner has no signs of illness.

Hello. In some cases, men may have no symptoms, then it would be logical to assume that he is only a carrier of the infection. The need for treatment in asymptomatic men is still controversial issue, as this does not exclude the recurrence of the disease in a woman.

) is due to an imbalance in the microflora of the vagina. Normally, it is represented mainly by lactobacilli. These bacteria form lactic acid and hydrogen peroxide, preventing the reproduction of opportunistic microorganisms. The composition of the normal microflora of the vagina in a small amount may include and anaerobic bacteria (genus Mobiluncus and others). These microorganisms are present in small amounts in the vagina of most healthy women.

As a result of douching; the use of contraceptives containing 9-nonoxynol (candles "Patentex Oval", candles "Nonoxynol"); change of sexual partner, the proportion of lactobacilli in the vaginal microflora decreases. At the same time, the proportion Gardnerella vaginalis, Mycoplasma hominis and anaerobic bacteria. In this case, there is a dysbacteriosis of the vagina - the so-called gardnerellosis.

Gardnerellosis in men

Gardnerellosis, by definition, is a dysbacteriosis of the vagina. Therefore, it is wrong to make such a diagnosis for men. Sometimes pathogens of gardnerellosis cause urethritis in men, which is manifested by burning and pain during urination. In this case, treatment is necessary. In other cases (detection Gardnerella vaginalis precise methods; gardnerellosis in a sexual partner) there is no need to treat men.

Infection with gardnerellosis

Gardnerellosis does not apply to sexually transmitted diseases. Sexual transmission has not been proven. However, it is closely associated with risk factors for sexually transmitted diseases (multiple sexual partners, recent change of sexual partner). Therefore, it is advisable to examine women with gardnerellosis for major sexually transmitted diseases.

Factors contributing to the development of gardnerellosis:

douching

Douching with chlorine-containing antiseptics (Gibitan, Miramistin)

The use of contraceptives containing 9-nonoxynol (candles "Patentex Oval", candles "Nonoxynol")

Use of condoms with spermicidal lubricant (9-nonoxynol)

Many sexual partners

Recent change of sexual partner

Taking broad-spectrum antibiotics

Application vaginal tablets and broad-spectrum suppositories (Terzhinan, Poligynax, Betadine)

More about the role of douching in the development of gardnerellosis

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

Often, women with symptoms of gardnerellosis ( bad smell vaginal discharge) independently resort to douching, associating an unpleasant odor with poor hygiene. In this case, douching causes an even greater exacerbation of gardnerellosis.

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

Symptoms of gardnerellosis in women

Symptoms of gardnerellosis in women include mild, foul-smelling, homogeneous, watery, grayish-white discharge from the vagina, evenly covering its walls.

At the same time, the smell of vaginal discharge resembles the smell of rotten fish.

Fig 1 Gardnerellosis, photo © Illustration courtesy of BINOM.

Complications of gardnerellosis

Previously, it was believed that this gardnerellosis does no harm. It is currently considered a risk factor for inflammation of the uterine appendages, female infertility, preterm birth, complications of pregnancy and childbirth.

Diagnosis of gardnerellosis

Diagnosis is based on clinical picture and overall smear results. Identification of causative agents of gardnerellosis ( Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus spp.) when sowing, by direct immunofluorescence (DIF) and by DNA diagnostics (PCR) it does not matter, since with gardnerellosis it is important not just the presence, but number these bacteria. They are present in small amounts in the vagina of most healthy women.

Treatment of gardnerellosis

Treatment of gardnerellosis includes topical preparations (vaginal tablets and suppositories) and oral administration (tablets or capsules).

Preparations for local treatment include (first are given international titles followed by commercial names in parentheses):

Metronidazole, 0.75% gel (Metrogil, Flagyl, Klion-D 100). The drug is injected into the vagina 2 times a day for 5 days.

Clindamycin 2% cream (Dalacin). The drug is injected into the vagina 1 time per day (at night) for 7 days.

Oral preparations include (international names listed first, followed by trade names in parentheses):

Metronidazole (Klion, Metronidazole, Medazol, Metrogil, Trichopolum, Flagyl, Efloran). The drug is taken 500 mg orally 2 times a day for 7 days. Metronidazole is absolutely incompatible with alcohol!

Clindamycin (Dalacin, Climycin, Clindamycin). The drug is taken 300 mg orally 2 times a day for 7 days.

Side effects of local treatment are less than with systemic treatment. However, given the role of gardnerellosis in the development of inflammation of the appendages and female infertility, now more and more preference is given to drugs for oral administration.

In some cases, additional treatment is prescribed antibiotic therapy(immunotherapy, restorative drugs, physiotherapy, etc.).

Treatment of gardnerellosis in pregnant women

Treatment of gardnerellosis during pregnancy should be carried out under the supervision of a gynecologist. Self-treatment unacceptable. Clindamycin (both topically and orally) is contraindicated during pregnancy.

In the first trimester of pregnancy, metronidazole is also contraindicated. With exacerbation of gardnerellosis in the first trimester of pregnancy, ampicillin is prescribed. In the II and III trimesters, metronidazole is prescribed, which is more effective than ampicillin.

Prevention of gardnerellosis

Prevention is reduced to the refusal of douching and the use of contraceptives containing 9-nonoxynol (Patentex Oval, Nonoxynol). Condoms should be used for casual sexual intercourse and for contacts with non-permanent sexual partners.

The use of broad-spectrum vaginal tablets and suppositories (Terzhinan, Polygynax, Betadine) can also contribute to the development of gardnerellosis. These drugs include antibacterial agents broad spectrum of action, suppressing the normal microflora of the vagina.

sexual partners