Gardnerella vaginalis is a vaginal dysbiosis associated with a sharp quantitative and qualitative violation of the normal vaginal microflora, a decrease in the number of lactobacilli and the proliferation of opportunistic microorganisms, including gardnerella. It is characterized by the appearance of abundant vaginal discharge of a grayish hue with an unpleasant odor. Untreated bacterial vaginosis increases the risk of developing inflammatory diseases of the female genital area and miscarriage.
Gardnerella vaginalis is the most common variant of bacterial vaginosis, i.e. imbalance in the composition of the natural microflora of the female genital organs. Gardnerella vaginalis is observed in 20% of women in the reproductive period. Lactic acid microflora, normally predominant in the vagina, is displaced by conditionally pathogenic species with bacterial vaginosis, the leader among which is Gardnerella. The pathway of transmission is sexual, more often gardnerella is detected in women active in sexual life. Men usually act as carriers of infection, therefore, in order to exclude relapses of gardnerella vaginalis, simultaneous treatment of all sexual partners should be carried out.
Gardnerella vaginalis in advanced form can cause the development of inflammation of the urinary tract, uterus and appendages, infertility, complications during pregnancy and childbirth. With gardnerella vaginalis, mixed infection with other microorganisms is often noted: gonococci, trichomonas, mycoplasmas, chlamydia, candida, etc.
Bacterial vaginosis (gardnerella vaginalis) 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. External and internal factors can disrupt the normal microflora of the genitourinary organs.
Among the external factors contributing to the development of gardnerella vaginalis, the following prevail:
- unfavorable ecology;
- recent and frequent change of sexual partner;
- irrational nutrition, diets with a lack of lactic acid products;
- venereal diseases;
- the use of antibiotics (including candles, ointments);
- the use of contraceptives (vaginal candles containing 9-nonoxynol, condoms with spermicidal lubricant, hormonal drugs);
- the use of hygiene products (pads, tampons, perfumed intimate hygiene products) and frequent douching;
- wearing underwear and clothing made of synthetic materials that tightly fit the figure.
- Internal factors causing gardnerella vaginalis include:
- endocrine disorders and changes (including pregnancy);
- decreased level of immune protection, immunodeficiency states;
- emotional and physical fatigue, stress;
- chronic diseases, imbalance of intestinal and genitourinary tract microflora.
Normally, more than 15 types of microorganisms are found in the vagina of an adult woman. Acidophilic lactobacilli predominate, a smaller part are bifidobacteria (10%), peptostreptococci (~ 5%). Lactoflora, thanks to lactic acid, supports 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. A sharp increase in the number of these microorganisms disrupts the microbiological balance, vaginal dysbiosis or bacterial vaginosis occurs. It is characterized by a decrease in the amount 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 gardnerella vaginalis.
In addition to Gardnerella, the number of other bacteria is increasing (coccal species, trichomonas, 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 latched, the products of Gardnerell metabolism aggravate the resulting mucosal disorders, there is a basis for the penetration of other infections. Therefore, disease contributes to the development of inflammatory diseases of the genitourinary system of women.
Gardnerella vaginalis has a course somewhat similar to other inflammatory diseases of the genitals in women. With this disease, there are: grayish vaginal discharge (homogeneous, pasty, with an unpleasant “fishy” smell); burning, itching, discomfort during urination and sexual contact. Disease is accompanied by inflammatory changes in the vagina, urethra and cervix. When using intrauterine spirals, after menstruation, abortions of pregnancy and childbirth, gardnerella vaginalis can be complicated by endometritis, inflammation of the uterine appendages. Gardnerella vaginalis adversely affects pregnancy: premature birth is 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 there may be small discharge from the urethra (serous-purulent, grayish in color with a “fishy” smell), discomfort when urinating. Possible complications in the form of prostatitis, inflammation of the testicles and appendages, the development of infertility.
To confirm the diagnosis of gardnerella vaginalis, a woman’s vaginal swabs are taken at a gynecologist’s consultation. In the diagnosis of gardnerella vaginalis, it is not so much the presence of gardnerella that matters, as their number and the ratio of microorganisms in the vaginal secretions. Gardnerella are present in the vaginal flora of most healthy women without the development of dysbiosis. The diagnosis of “gardnerella vaginalis” is established on the basis of:
- complaints of patients and clinical manifestations (the presence of homogeneous pasty discharge of grayish-white color);
- increases in the PH of vaginal secretions (> 4.5);
- the presence of “key” cells in the microscopy of smears from the vagina and urethra (“key cells” – epithelial cells, plastered with small sticks (gardnerella) – an important sign of gardnerella vaginalis);
- amine test
With gardnerella vaginalis, in the course of their vital activity, gardnerella and anaerobic microorganisms form volatile amines (putrescine, triethylamine, cadaverine), which, when decomposed, give an unpleasant “fishy” smell. The basis for the diagnosis is the detection of at least three of these criteria. It is also necessary to be examined for the presence of intestinal dysbiosis, which can provoke the development of bacterial vaginosis, and to treat it. This will reduce the risk of recurrence of gardnerella vaginalis.
Early and accurate diagnosis of gardnerella vaginalis allows its timely treatment. The methods of therapy used by modern gynecology make it possible to achieve the patient’s recovery and avoid the development of complications, but they do not guarantee the absence of relapses of the disease in the future. Therapeutic treatment should eliminate the causes and manifestations of the disease and create conditions for the normalization of the microflora of the genitals.
At the first stage of treatment of gardnerella vaginalis, women are prescribed clindamycin and metronidazole (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 gardnerella vaginalis, clotrimoxazole (cream) is prescribed. In the management of pregnancy in women suffering from gardnerella vaginalis, treatment begins in the second trimester of pregnancy with the same drugs (orally and topically as prescribed by a doctor). In the first trimester, oral administration of metronidazole and clindamycin is unacceptable.
Treatment is carried out under the supervision of clinical and laboratory tests, and is considered completed when complaints, symptoms disappear and laboratory criteria are normalized. During the treatment of gardnerella vaginalis, it is necessary to avoid sexual intercourse without a condom, refuse alcoholic beverages, do not use pads for “every” day, tight synthetic underwear. The second stage of treatment of gardnerella vaginalis includes the use of oral and topical preparations containing lacto- and bifidumbacteria, vitamins, immunostimulants.
The need for examination and treatment of male sexual partners of women with gardnerella vaginalis remains controversial. Relapses in women can occur after treatment of both sexual partners. Nevertheless, it is advisable in persistent and recurrent cases to carry out such treatment in representatives of the stronger sex.
Preventative measures aimed at eliminating the causes of bacterial vaginosis will help to avoid the development of gardnerella vaginalis and its relapses. The widespread prevalence and danger of the consequences of gardnerella vaginalis require not only immediate treatment of the disease, but also its regular household and medical prevention. Women are recommended to:
- have a permanent sexual partner and exclude casual sexual relations;
- use a barrier method of contraception (condom), minimize the use of local contraceptives;
- do not use frequently and without control of vaginal antibacterial candles and tablets;
- use vaccination to create local immunity;
- observe general and intimate hygiene.