How to treat staphylococcus in gynecology. Streptococcal and staphylococcal infections in gynecology: etiology, symptoms and treatment methods

At scheduled inspection A woman takes a smear from a gynecologist, and often laboratory technicians find a microorganism such as staphylococcus in it. What does this analysis result mean?

Ways of getting staphylococcus into the vagina

Let's look at where staphylococcal infection comes from.

1. Staphylococci live around us, on skin, V intestinal tract. Therefore, when washing, for example, with water, staphylococcus can move into the vagina onto the mucous membranes and begin to develop in conditions favorable to it.
2. Staphylococcus can also be introduced during medical procedures.
3. During sexual relations.

Staphylococcus aureus in the vagina

It can be especially common and dangerous. Once in the vagina, Staphylococcus aureus may not manifest itself in any way. Its appearance on the genitals can cause vulvovaginitis with painful sensations and burning sensation in the vagina, as well as the appearance of abnormal discharge. Particularly advanced forms of staphylococcus are the appearance of yellow, orange scales on the skin, which means that the disease is already breaking out.

All this can provoke the disease urinary system. Once on the urethra, staphylococcus causes a burning sensation when urinating. Vaginal staphylococcus can cause frequently recurring thrush caused by dysbacteriosis. And itching on the labia further complicates the process of transferring the disease. Vaginal Staphylococcus aureus can begin to develop if there is a violation of vaginal acidity.

Treatment of vaginal staphylococcus

If vaginal staphylococcus is suspected, a bacterial culture test is taken; if the diagnosis is confirmed, treatment should be prescribed by an infectious disease specialist. Often used in treatment are autovaccines, autohemotherapy and toxoids. Local treatment of vaginal staphylococcus is also carried out using tampons with bacteriophages.

At the same time, immunity should increase. Probiotics are prescribed to restore normal vaginal microflora. The main thing is not to overuse antibiotics during treatment, since staphylococcus quickly adapts to them, and in the future this can cause great difficulties with treatment. Treatment must be chosen extremely carefully.

Here's one of the more effective recipes treatment: Amoxiclav 3 times a day (for 10 days), also Linex Bio and.

As for vaginal suppositories for staphylococcus, it is better to use suppositories containing bifidobacteria (you can make them yourself by taking a tampon and dipping it in diluted bacteria). Antibiotic suppositories are Clindacin, which work well against infection, but only a doctor should prescribe them.

Staphylococcus in the vagina is usually found in a patient’s smear during a routine examination by a gynecologist. Most often, staphylococcus enters the vagina from the skin or intestines, during washing, when microorganisms can certain conditions penetrate the mucous structures of the vagina. Sometimes Staphylococcus aureus can spread to a woman under different medical procedures and manipulation. Intimate relationships can play a major role in the penetration of the microbe - Staphylococcus aureus most often enters a woman’s vagina during sexual intercourse.

The most common and dangerous of all varieties of this type of bacteria is Staphylococcus aureus. Penetrating into the human body, in particular into a woman’s vagina, it may not manifest itself in any way. But there are signs that help identify the role of this microorganism in the occurrence of a particular disease in a woman. For example, the invasion of these harmful bacteria can cause a disease such as vulvovaginitis in the fairer sex, the symptoms of which are as follows:

1. The patient feels an unbearable burning sensation in the vagina.
2. Severe pain syndrome develops.
3. Over time, discharge appears that is not typical for the vagina.
4. When the disease is advanced, yellow or yellow scales may appear on the woman’s skin. orange color. This happens in very severe cases, when the disease begins to break out.
5. If staphylococcus gets from the vagina into the urethra, infection with microbes can occur and the development of diseases in the urethra. genitourinary system patients, which is most often detected due to the occurrence strong burning sensation when passing urine.
6. Staphylococcus infection of vaginal structures most often causes the development of dysbacteriosis.
7. Staphylococcus that gets into the vagina can provoke recurrent thrush in a sick woman.
8. On the patient's labia, staphylococcus causes severe itching, which constantly intensifies as the disease progresses.
9. Often microorganisms of this type penetrate the vagina and begin to multiply there if there is a violation normal level acidity in vaginal structures.

How to deal with this serious disease?

Treatment of various diseases caused by Staphylococcus aureus begins with diagnosing the disease. At the first suspicion that this microorganism has entered the vaginal structures, a woman should be tested for a so-called bacterial culture (smear).

If suspicions are confirmed, then a course of treatment should be prescribed and carried out by an infectious disease specialist. In such cases, the most commonly used following methods fight against Staphylococcus aureus:

1. The patient is prescribed various types of autovaccines.
2. The doctor recommends that she use toxoids.
3. It is possible to use methods such as autohemotherapy.
4. Local methods of combating Staphylococcus aureus most often use tampons containing bacteriophages.

What is used to destroy staphylococcus that has entered the vagina?

Simultaneously with these measures, the patient’s immunity must be increased. This is achieved by assigning various drugs- probiotics. They restore the microflora destroyed by Staphylococcus aureus in the vagina of a sick woman.

If this recommendation is not taken into account, then doctors may encounter big problems during the subsequent treatment of the patient. Antibiotics must be selected very carefully and replaced frequently so that staphylococcus cannot adapt to them.

Several methods have been developed to combat these microorganisms. Here is one such way:

1. The patient is given a medication called Amoxiclav 3 times a day for 10 days.
2. Then they switch to using a drug such as Linex Bio.
3. At the same time, to cure the patient, they use Hexicon suppositories (suppositories).

This method of combating a microorganism is very effective, since it cannot adapt in time and adapt to any specific drug. Special vaginal suppositories or suppositories are selected so that they contain so-called bifidobacteria. If desired, a woman can buy a drug with these bacterial structures, dip a cotton swab in it and use it as an impromptu candle. Doctors also often recommend suppositories that contain antibiotics to patients. For example, Clindacin suppositories are very effective against Staphylococcus aureus, but only the attending physician can prescribe them.

Self-medication here can only bring harm, since any minor mistake can lead to even greater growth of staphylococcus colonies.

The timing of the course of therapy depends on the severity of the disease.

Typically, it may take from 2 weeks to a month to cure this type of microorganisms and the diseases they cause.

When especially severe lesions The treatment process may take six months. If the diagnosis is carried out correctly and the correct ones are selected medications, then in mild cases of infection with Staphylococcus aureus, some patients were cured in 10-12 days.

When diagnosed with staphylococcus, there is no need to panic, since almost all sick women sooner or later get rid of this unwanted “guest”.

As a rule, the source of any staphylococcal infection is infected people. Often, staphylococcus, together with pathogenic microbes such as gonococcus, chlamydia, trichomonas, penetrates the genitourinary tract during sexual intercourse and during simple gynecological manipulations.

Staphylococcal infection accounts for about 8-10% of all diseases in gynecology. A large number of factors often contribute to its appearance. The main thing is to reduce immune defense female body as a result of exacerbation of existing chronic diseases. Often the development of staphylococcal gynecological infections is the result of changes in the acidity of the genital tract.

Incubation period Staphylococcus aureus, which is the cause of all gynecological staphylococcal infections, is 6-10 days. This is why the infection does not appear immediately. Symptoms of staphylococcal gynecological infection are few in number. The main ones include:

For differentiation staphylococcal bacteriophage used in gynecology different kinds research. The main one is laboratory test, in which bacterial material taken from a woman is sown on previously prepared nutrient media.

Special attention is paid to the treatment of any type of staphylococcal infection, especially in gynecology. Today, a wide range of antibiotics are produced that can successfully fight this microorganism. The main thing is not to start taking antibiotics until microorganisms are sensitive to it, and not to stop immediately after symptoms are relieved, when treatment is not yet fully completed.

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How does staphylococcal infection manifest in gynecology: treatment with antibiotics

Such a cunning enemy women's health, like a staphylococcal infection in gynecology, treatment involves antibacterial treatment in combination with other restorative and local techniques. Staphylococcal infection in women is caused by pathogenic staphylococci. The microorganism staphylococcus is widespread in nature, so it is not difficult to become infected with it.

Methods of contracting staphylococcal infection

It is possible to become infected with staphylococcus through another person suffering from staphylococcal sore throat or carrying staphylococcus on their mucous membranes, as well as through objects. Along with other infectious agents (gonococci, chlamydia, trichomonas, mycoplasmas, etc.), it is possible to become infected with staphylococcus through sexual contact, through various gynecological manipulations (during smear collection, urethroscopy, etc.) or independently if the commandments of hygiene are not followed. Primary focus lesions become a point of spread of staphylococcus in the human body, including genitourinary organs, through the blood circulation and lymphatic pathways. Often, inflammatory disease of the genitourinary organ is caused by a combined effect various kinds microbes, for example staphylococci with gonococci, chlamydia, trichomonas, etc. Therefore, it is of considerable importance for various infections genitourinary tract is given specifically to staphylococcus.

Causes of staphylococcal infection

Prevalence among other gynecological inflammatory diseases is 8-10%. What should you know in such a situation? The first thing you need to pay attention to is the similarity of the course of the infection with the gonorrheal process, especially in the chronic form. The second thing to consider is that despite the similarity of the course of gonococcal and staphylococcal pathologies, they have differences. The spread of gonococci is usually associated with mucous membranes in the body. A number of predisposing factors cause staphylococcal pathologies:

• decreased body immunity due to intoxication or infection;
• hormonal disorders;
• decline local immunity(in the genitourinary organs) as a result transferred process inflammation;
• ineffective local treatment;
• development of dysbacteriosis;
• deviations in the level of acidity of the environment;
• other factors.

Interval incubation period ranges from 5 to 10 days. However, it may shorten to 2 days or increase to a month or two. Typically, the course of the inflammation process is characterized by a sluggish state that does not show obvious signs, but an acute form of manifestation is also possible. In some patients, the disease subsides at times, while in others, on the contrary, it worsens. The disease may spontaneously disappear after a short period of time and the onset of the recovery phase. But in most cases, patients experience a long-term course of chronic staphylococcal infection.

Gynecological staphylococcal diseases

It is not typical for gonococci to penetrate deeper tissue layers. While staphylococci (and streptococci too) penetrate through the injured surface into deep sections tissues and immediately spread with blood throughout the body. In the internal space of the uterus, due to the presence of microbes, the mucous membrane becomes inflamed, but the entire thickness of the walls of the uterus can be affected. The following manifestations of this process are possible:

• purulent leucorrhoea;
• pain in the lower abdomen and lumbar region;
• atypical course of menstruation.

Menstruation disorder can be accompanied by pain, excessive bleeding and manifest itself in cyclical irregularities. At the very beginning of infection with pathogenic microorganisms, an increase in body temperature is possible. From the mucous membrane of the uterus, inflammation can spread to the tubes with the ovaries. Then we are talking about the development of inflammation in the uterine appendages. Following this, infection of the peritoneum is possible. Unlike gonococcal pathology, infection with staphylococci does not lead to such rapid formation adhesive process on the tubes and ovaries and the inflammation it causes. Often noted general inflammation peritoneum, which is classified as a serious and dangerous disease.

During childbirth or abortion, the cervix and vaginal walls are injured. Therefore, it is very easy for infections to penetrate through tears in the tissues and get into the loose layer of fiber found in the uterus, rectum, and bladder. With such a lesion, body temperature rises sharply, severe pain in the lower abdomen, the patient begins to shiver. An inflammatory tumor develops in the pelvic area, which is initially represented by an increase due to edema with tissue, and then with purulent tissue (with purulent parametritis). Inflammation of the fiber lasts long and painfully. The resorption of the fiber abscess occurs very slowly, and therefore takes a long time to diagnose painful lump behind or to the side of the uterus. Pain is a frequent accompaniment of this pathological condition. aching character, episodic fever, dysfunction Bladder and difficulty having bowel movements.

Staphylococci, together with streptococci, can enter the blood vessels from the affected area in the genital tract. This route of infection spread is especially typical for situations related to artificial termination of pregnancy performed outside medical institution and incompetent persons. Often during such abortions there can be no question of compliance with mandatory requirements for surgical intervention. The postpartum period in a woman’s life also favors infection. In this case there is high risk development of infection against the background of damage to the mucous membrane and injured tissues of the perineum, vagina, uterus and cervix with labor activity as a result of failure to comply with the rules of personal hygiene of the mother who gave birth. The infection process may not stop at the genital tract.

Pathology can spread beyond their borders. Complications of this condition may include developing thrombophlebitis (inflammation of the veins lower limbs), purulent processes in the lungs and other organs. Pikov and most dangerous complication Staphylococcal infection can cause general blood damage - sepsis.

When conducting a differential diagnosis, the attending physician should be puzzled by the similarity of the signs of diseases provoked by streptococci and staphylococci with the course of gonorrhea. Therefore, for the sick priority is to immediately contact an obstetrician-gynecologist if symptoms such as:

• acts of urination with a feeling of pain and burning;
• icteric discharge with the presence of blood fragments;
• pain syndrome (most often the lower abdomen hurts and lumbar region back);
• pathological menstruation.

Prevention and therapy for staphylococcal infection

Staphylococcus is treated with antibacterial drugs. However, microorganisms quickly develop resistance to the antibiotics used. In this connection, it is recommended: in case of infection of the genitourinary organs with staphylococci, use combinations antibacterial agents. If the process is sluggish and chronic with complications, then nonspecific immunological and hyposensitizing therapies and physical therapy are used. They are supplemented with adequate local treatment. Since staphylococcal infection infects all contact persons, similar treatment is mandatory for all such persons. Taking antibiotics is recommended when the sensitivity of the pathogen is revealed.

During prevention, compliance with the rules of septic and antiseptics during local treatment and gynecological procedures on the genitals is of particular importance. It is important to pay attention to the basics of personal hygiene, since pathogens can freely move from one affected area to another by the hands of an infected person.

The success of treating staphylococcal infections in gynecology and preventing the development of complications is largely due to timely visits to the doctor and strict implementation of his recommendations.

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Staphylococcus in a smear in women

Staphylococcus in a smear in women is a detection in vaginal microflora opportunistic bacteria. To identify it, it is necessary to collect mucous secretions during gynecological examination.

The smear is sent for bacteriological examination, which determines the presence or absence of opportunistic microflora.

The fact that this bacterium is found in a woman’s smear is not a pathology, but only if its content does not exceed 1% of the total number of microorganisms present there.

The norm and deviations from the norm are determined by the degree of purity of the smear.

Symptoms of staphylococcus in a smear in women

If the number of staphylococci detected in a woman’s smear is minimal, then she will not experience any signs of the disease.

However, in the presence of predisposing factors, staphylococci can begin to actively grow, which will lead to the following symptoms:

Itching in the genital area.

Discharge of various nature, most often with an unpleasant odor.

Painful sensations during sexual intercourse.

The impossibility of a full night's rest, as the feeling of itching and burning intensifies at night.

Increased irritability, nervousness.

Rashes in the area of ​​the labia minora, similar to pustules, are possible.

However, all these symptoms occur only if the number of staphylococci in the smear is significantly higher than normal. In addition, an overestimation of indicators often serves as a signal that a woman has some kind of sexually transmitted infection. Therefore, it makes sense to undergo a full examination and eliminate the cause of staphylococcus growth in the vagina. As a rule, against the background of growth of coccal flora, there is an increase in the number of leukocytes in the smear, with a minimum content of lactobacilli.

Causes of staphylococcus in a smear in women

Staphylococcus can enter the vagina in several ways, including:

Performing intimate hygiene. The bacterium normally exists on the skin of even a completely healthy person; when washed, it, together with water, can penetrate the mucous membranes of the vagina. If conditions are favorable for it, the bacterium will begin to reproduce. In addition, staphylococcus can be introduced from the intestines as a result of improper washing or self-care after defecation.

Entry into the vagina due to unqualified actions medical workers. As a result, for example, of a gynecological examination using unsterile instruments, infection can occur. Surgery- another way of infection by bacteria. Although this route of infection is quite rare and accounts for no more than 1%.

Unprotected sexual intercourse.

For a long time, staphylococcus may not show its presence at all. However, under the influence of a number of provoking factors, the bacterium begins to actively multiply.

The impetus for the development of the inflammatory process can be:

Diseases of the genital area;

Long-term drug therapy;

Relapses of chronic diseases;

Weakening of immune defense, HIV;

Injury to the vaginal mucosa;

Disruptions in the hormonal system;

A common cause of the appearance of staphylococcus in a smear is the regular use of tampons. It is the synthetic materials from which these hygiene products are made that are a favorable place for bacteria to multiply. The result is an increase in the number of staphylococci and their suppression of the beneficial microflora of the vagina.

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Treatment of staphylococcus in a smear in women

In most cases, there is no need to eliminate the bacterium, since in minimal quantities it is not able to cause infectious process. However, if its indicators exceed the norm, it is necessary to undergo a therapeutic course, which should primarily be aimed at eliminating the factor that led to a shift in the vaginal flora.

It is worth understanding that analyzing a smear for flora and detecting an excess of staphylococcal infection in it is only First stage in the diagnosis of the disease. To clarify the diagnosis, it will be necessary to carry out additional research, for example, diagnostics using the PCR method, which makes it possible to detect even hidden genital tract infections.

The treatment regimen is selected individually and depends on the nature of the disease. Most often, a woman is prescribed anti-inflammatory drugs and local treatment. It comes down to regular sanitation of the vagina using antiseptic solutions. For this purpose, miramistin, chlorophyllipt, streptomycin are used.

The choice of vaginal suppositories is made by a doctor. It depends on the nature of the disease. Suppositories such as Terzhinan, Pimafucin, Genferon or Vokadin are often prescribed. They have a wide spectrum of action and are able to suppress both microbial and fungal flora.

Prevention of staphylococcus in women

In order to prevent staphylococcal infection from entering the vaginal cavity, it is necessary to observe simple rules, among which:

Practice protected sexual intercourse using a condom.

Get rid of gynecological inflammatory processes in a timely manner.

Properly perform intimate hygiene, in particular when washing, movements should be directed from front to back. The same rule applies to execution hygiene procedures after the act of defecation. Hands should always be clean.

You should stop not only from regularly using tampons, but also from wearing synthetic underwear.

To undergo diagnostic procedures in the area of ​​the reproductive system, you should only contact trusted clinics that comply with sanitary and hygienic requirements.

Douching should not be done without medical advice.

It is important not to take antibacterial agents without a doctor's prescription.

Compliance with these rules will allow the beneficial bacteria present in the vagina to prevent the growth of staphylococcus, and it will be detected in the smear in the minimum permissible titres.

The danger of these microorganisms is that they produce toxins and enzymes that are pathogenic for cells and disrupt their vital functions. Bacteria have a destructive effect on connective tissues, skin and subcutaneous tissue. They cause a number of dangerous diseases, including:

Among traditional methods of treatment and prevention of Staphylococcus aureus special attention deserves treatment with copper or metal therapy, known since the time of Aristotle. Aristotle in his works mentions the treatment of bruises, ulcers and swelling by applying copper.

How can a child become infected with staphylococcus? The bearers of this dangerous bacteria are both sick and healthy people, because they exist different shapes carriage of infection (temporary and permanent). The course of the disease can also occur in mild and severe forms.

In fact, there is only one objective reason for using antibiotics against such a stable and flexible pathogen as staphylococcus - the expected benefit will exceed the inevitable harm. Only in the case when the infection has spread throughout the body, entered the bloodstream, caused fever, and...

Staphylococcus in the nose is the presence of bacteria in the nasal mucosa that can cause a purulent-inflammatory disease. There are more than 20 varieties of staphylococcus, and most of them are constant companions of humans and are normally present on the mucous membranes, including.

Staphylococcus in the throat is the presence of bacteria in the mucous membrane of the pharynx or larynx that can cause infectious inflammatory process. The microbe can exist there as an opportunistic microflora, that is, without causing disease, but can cause an inflammatory reaction.

Staphylococcus aureus in the intestine is the colonization of its mucous membrane by a bacterium belonging to the group of staphylococci and capable of causing an infectious and inflammatory process. This bacterium does not always cause an inflammatory reaction in the intestines, but only if its concentration exceeds the permissible limits.

The information on the site is intended for informational purposes only and does not encourage self-treatment; consultation with a doctor is required!

Staphylococcus and streptococcus in a smear in women

For whatever reasons women visit a gynecologist, the examination begins with taking a smear from the vagina for examination for microbiological culture. The vaginal microflora is represented by various bacteria - there are more than 100 species. A woman is considered healthy if 94-95% of this microflora is Dederlein bacillus or lactobacilli.

If the smear contains a small number of opportunistic microorganisms - cocci, but there is no inflammation - the number of leukocytes is normal - then you can ignore the cocci.

An increase in the number of streptococci and staphylococci causes unpleasant symptoms, and during pregnancy can affect its outcome. If staphylococcus is detected during pregnancy, even with slight increase leukocytes – treatment is required.

Why is coccal flora dangerous and why do you need to get rid of it?

Streptococci

The bearers of this conditionally pathogenic flora are almost all adults. If there are few of them and they are on the surface of the skin and mucous membranes, then there is no need to worry.

But when they enter the body through microdamages and wounds, bacteria cause serious complications– rheumatism, glomerulonephritis, sepsis, meningitis...

• Streptococcus strain A is especially dangerous. If it penetrates the body, it can cause toxic shock.
• Strain B is most often found during pregnancy. These pathogens can cross the placenta and infect the fetus, which can lead to miscarriage.
• Hemolytic streptococcus. Location: intestines and genitals. During pregnancy, it is necessary to get rid of it - infection of the baby can occur when it passes through birth canal. In the future, the baby may develop dangerous complications.

Reason for activation of streptococcal flora:

• antibiotic treatment;
• weakening of the immune system, regardless of the reasons that caused it;
• increased physical activity;
• stress;
• sexual infections;
• neglect of hygiene measures or passion for douching.

During pregnancy, streptococci increase activity due to hormonal changes. U healthy woman in the vaginal environment the norm of streptococci is 104 CFU/ml.

Opportunistic bacteria are represented by strains:

• serological group B;
• green – viridans;
• enterococci – group D.

Strain A is missing.

If the norm is exceeded, then treatment is carried out using general and local action. Antibiotics of the penicillin group are usually prescribed, but when allergic reactions they are looking for alternative remedy. During pregnancy, antibacterial drugs are administered by infusion.

After antibiotic therapy, prebiotics and probiotics must be prescribed to restore the intestinal and vaginal flora.

Staphylococci in a smear in women

Staphylococci are also opportunistic microorganisms that pose a danger when introduced into the bloodstream against the background of a general decrease in immunity.

The following strains of these microorganisms are most often encountered. Staphylococcus aureus, or golden, got its name for the golden-colored toxins released by life. This is the most dangerous look microbacteria that provoke purulent-inflammatory processes in all tissues and organs.

During pregnancy, it is able to penetrate the placenta, infecting the fetus. For the production of a special enzyme - coagulase - it is also called coagulase-positive staphylococcus.

It is resistant to penicillin and cephalosporin antibacterial drugs and is very difficult to treat.

• Staphylococcus epidermidis, or epidermal, penetrates into the mucous membrane, causing conjunctivitis, sepsis, endocarditis and purulent infections genitourinary organs.
• Staphylococcus saprophyticus, or saprophytic, prefers the external genitalia, provokes the occurrence of urethritis and cystitis in acute form.
• Staphylococcus haemolyticus, or hemolytic, can invade any organ. It got its name because of its ability to destroy red blood cells. It is less common in humans than other strains.

If there is less than 1% staphylococcus in a smear in women, no treatment is required. During pregnancy, microflora smears are taken several times - an increased number of them in the microflora of the birth canal can cause serious complications in the unborn baby.

Symptoms of staphylococcal infection of gynecological organs:

• the appearance of discharge with an unpleasant aroma;
• a feeling of dryness of the vaginal mucosa, as a result of which sexual intercourse causes unpleasant and even painful sensations;
• burning in the genital tract, worsening at night;
• pyoderma of the vaginal mucosa;
• increased irritability.

Particularly dangerous increased activity staphylococcus during pregnancy.

Hemolytic staphylococcus causes inflammation of the urinary system, affects the respiratory system, intestines - it can penetrate through the bloodstream into all organs and systems. During pregnancy, treatment should begin with identifying the sensitivity of this type of pathogenic microorganism to antibiotics in order to reduce the danger from treatment. Eliminate hemolytic staphylococcus not difficult - it shows sensitivity to antibacterial drugs from a number of penicillins, cephalosparins, lincosamides, macrolides... Local drugs are used at the same time.

During the 3rd trimester of pregnancy, symptomatic treatment with sanitation of the birth canal is possible. Therapy for saprophytic and epidermal staphylococcus is similar to inhibition of hemolytic activity.

Staphylococcus aureus during pregnancy in a smear

Increased activity of Staphylococcus aureus during pregnancy poses a serious threat to the fetus. It can infect the membranes of the ovum, cause miscarriage, infect the baby while passing through the birth canal, penetrate the bloodstream into the mammary glands and cause purulent mastitis.

Its entry into the bloodstream can stimulate very dangerous disease– endocarditis. During pregnancy, this condition can be fatal.

Treatment of pregnant women for Staphylococcus aureus is carried out with the help of general and local antibacterial drugs; immunomodulatory drugs and bacteriophages are necessarily prescribed. All therapeutic measures are carried out only after receiving the results of a test for the sensitivity of staphylococcus to antibiotics - this strain of an opportunistic microorganism exhibits high resistance to antibacterial agents.

Prevention of staphylococcal infection

To ensure that the coccal flora remains opportunistic and does not increase activity, it is recommended to follow the following rules:

• prevent decline immune status– take immunomodulators and vitamin-mineral complexes during the off-season;
• observe the rules of personal hygiene;
• Healthy food;
• try to lead healthy image life;
• refuse synthetic underwear;
• use tampons only when necessary;
• avoid unprotected sex;
• refuse douching unless prescribed by a gynecologist.

When signs indicating the onset of gynecological diseases, consult a doctor immediately.

Staphylococcus

I was diagnosed with infantilism of the genital organs or “baby uterus”, what is it, what does it mean, and how is it treated? I also cannot cure Staphylococcus aureus, how is it transmitted?, what do you recommend for its treatment.

Genital infantilism is a form of delayed puberty and is characterized by underdevelopment of the genital organs, a decrease in the hormonal activity of the ovaries and the receptor function of the uterus. This disease can cause problems menstrual cycle, sexual and reproductive function (infertility, spontaneous miscarriage, ectopic pregnancy etc.). Treatment of genital infantilism depends on the degree of its severity (physiotherapy, hormonal therapy, etc.). You need to see an obstetrician-gynecologist who, after full examination and clarify the diagnosis, prescribe treatment for you. As for Staphylococcus aureus, you need to conduct a culture test to determine sensitivity to antibiotics and bacteriophages.

My partner has sexual diseases group B (or D) staphylococcus and candidiasis. Please advise what medications these diseases can be cured for both her and me.

First of all, these are not sexual diseases. Both staphylococcus and Candida fungi are normal flora of the genital tract. In a certain situation (decreased immunity, dysbiosis, stress, etc.) their number may increase, then they cause an inflammatory process, which manifests itself heavy discharge and discomfort in the genital tract and abnormalities in the vaginal smear. Treatment can be prescribed only after examining the patient and reviewing the tests.

I was diagnosed with cervical erosion, and during bacterial culture - staphylococcus. The doctor said that in order to do a biopsy, you need to get rid of staphylococcus. I was prescribed clindomycin 0.15 x 3 times 10 days (it was indicated in the antibiotic sensitivity test), nystatin 500 x 4 times, betadine suppositories 1st. at night - 10 days. After this treatment, analysis showed the presence of staphylococcus. I was prescribed bifidumbacterin suppositories. And after that, staphylococcus was discovered. What should I do, tell me.

1. The most simple reason- incorrect collection of material. This is done using a special disposable sealed tube containing a sterile collection swab. In your presence, this tube is opened (it is factory sealed) and, without touching anything, a tampon is inserted into the cervical canal. One movement and, without touching anything, the tampon is returned to the test tube and closed tightly. Staphylococcus is present in the air and on all objects and external genitalia. Sowing is done in oxygen conditions, while ordinary bacteria, often living in the cervix, do not grow, but staphylococcus grows. You need to do a routine smear and see if there are signs of a staph infection.

2. If the material is collected correctly, it means there is staphylococcus. For any infection, both partners are treated. Both you and your man need to take a course of antibiotics, and use a condom during treatment. Otherwise, you will constantly re-infect each other, and the infection will not go away.

3. Staphylococcus can come to the cervix from the vagina. In this case it will help more local drugs antibiotics: in addition to tablets, there are also vaginal forms: for example, Dalacin C cream (the same clindamycin) or tetracycline ointment. The husband can also use it.

4. Another route for staphylococcus is from the uterus. This is a sign of endometritis - inflammation of the uterine mucosa. True, it must be accompanied by complaints, but it can also be asymptomatic. It is treated comprehensively, using physiotherapy.

5. Erosion itself can support the infection. Its removal may lead to recovery. The best tactic is to sanitize the vagina with betadine (solution), a weak solution of potassium permanganate, chamomile, sage, etc. under the control of a smear, and if it improves - a biopsy of the erosion, and in the absence of contraindications - its removal (laser or liquid nitrogen).

The doctor should decide which tactics are best for you to follow. Just remember point 2.

Unfortunately, you do not indicate the type of staphylococcus cultured. However, the genital tract should normally contain some types of staphylococci, even aureus, but in small quantities. If a regular smear on the flora does not reveal the inflammatory process ( increased number leukocytes) or other abnormalities, then a biopsy can be done even if staphylococcus is present in the culture.

I drink Triregol, every day at 1200 (afternoon). I missed one day, took another pill in the morning. day, second in the afternoon. Is additional protection necessary or is this possible? They also found staphylococcus in me, the doctor suggests suppositories with nystatin for treatment, although I came across information that nystatin is, in principle, an outdated drug, especially since I previously treated candidiasis with it.

According to the instructions, effectiveness hormonal contraception guaranteed if the interval between two tablets does not exceed 36 hours. In your case it was more. Therefore, according to the rules, you need to protect yourself with a condom until the end of the cycle, while continuing to take Triquilar.

Based on this, it is better to take birth control pills at night, before bed. Firstly, the severity decreases side effects, if they exist, and secondly, if you forgot the pill in the evening, then drink it in the morning next day, You won't be late.

Nystatin is really not effective against staphylococcus. In this case, the drug Polygynax or Terzhinan or douching with conventional antiseptics is more indicated: infusion of chamomile, calendula or St. John's wort, a weak solution of furatsilin or potassium permanganate.

When I came to register at the hospital at 12 weeks of pregnancy, the doctor said that I had cervical erosion. After the birth, the doctor did a biopsy and said that it was not erosion and directed me to take a smear for ureaplasma, mycoplasma, chlamydia, herpes virus and blood from a vein for toxoplasmosis and cytoplasmovirus. I've passed. Then it turned out that instead of a smear for ureaplasma, they took a smear for Trichomonas vaginalis. But the doctor said that if there is no Trichomonas vaginali, then most likely there will be no ureaplasma. And she said you don’t have to test for toxoplasmosis at all, since it most likely won’t happen (since I didn’t have a miscarriage during this pregnancy, everything is fine with the child and nothing bad happened to him at all). As a result, chlamydia, mycoplasma, herpes virus, Trichomonas vaginalis and toxoplasma were not found. But I have something on the cervix (it looks like erosion, but not erosion). The doctor believes that this is due to hormonal disorders during pregnancy.

1. What could be wrong with me?

2. Is it true that since there is no Trichomonas vaginalis, then there are no ureaplasmas?

3. Is it true that there should be no toxoplasma, since the child is healthy and was born normal?

4. Could this be caused by Staphylococcus aureus in me (it was discovered in the child after birth, but it is not in the milk) and how can I determine if I have it (they took a simple smear from me after giving birth, they discovered colpitis, I have already cured it): Would they have found it with a regular smear if it was there, or do we need to do a special test for staphylococcus?

1. What is cervical erosion and what is the essence of treatment. With erosion of the cervix, the columnar epithelium (mucous membrane) of the inner part of the cervical canal is located on its vaginal part, where it should be squamous epithelium(mucous membrane of the outer part of the cervix). The reason may be the youthful structure of the cervix. In women over 24 years of age, this structure is considered pathological. The cause of erosion in adulthood is most often the inflammatory process in the cervix, and in second place - hormonal disorders. When it is cured, erosion, if it is small, can heal itself. During childbirth, tears and tears form in the cervix, as a result of which the cervix seems to turn out a little. In this case, the mucous membrane of the cervical canal is everted into the vagina. This is no longer called erosion, but ectropion. The cervix becomes loose and easily vulnerable. At the same time, various pathological processes. The risk of developing pathology is higher with a large size of erosion. If the erosion is large or has pathological changes, treatment is necessary. Erosion therapy consists of destroying the pathological epithelium, then forming a normal one in its place. For women who have not given birth or who have given birth, but with very slight erosion, they do not cauterize it, unless it turns into leukoplakia, dysplasia, etc. It is recommended to see a gynecologist once every 6 months. If treatment is still necessary. Erosion is cauterized using a laser; cryodestruction (freezing) and diathermocoagulation are also used. The latter is less preferable due to side effects. In addition, upon examination, inflammation of the cervix - cervicitis - can be mistaken for erosion. If the biopsy does not reveal pathological changes, the most common of which are dysplasia and leukoplakia. Then you can simply be observed once every 6 months. see the doctor, there is nothing wrong with you. Otherwise it is necessary to be treated.

2. Ureaplasma is represented in 30% of men and women normal microflora genital tract. Most often they occur in sexually active people. If they do not cause inflammation in partners, then no treatment is required. If inflammation is present, appropriate therapy is carried out. Trichomonas vaginalis is a sexually transmitted infection. So the absence of one does not absolutely exclude the presence of the other.

3. If you have pets, especially cats, that roam the street, then there is a possibility that you have toxoplasmosis. But since the child was born healthy, and the pregnancy proceeded without complications, then the disease is either in a dormant form or it really does not exist.

4. In order to find out whether you have Staphylococcus aureus, you need to do a culture. Secretions are taken from the genital tract and placed on a nutrient medium. Within a week, microorganisms living in the vagina germinate, and then determine what kind of bacteria they are and which antibiotics they are sensitive to. But keep in mind that small amounts of Staphylococcus aureus can be found in the genital tract normally.

Please tell me how dangerous staphylococcus epidermidis found in the nasal cavity is during pregnancy, and whether the presence of this disease entails being under observation in the maternity hospital or any other troubles.

Staphylococcus epidermidis is a microorganism that normally lives on the surface of human skin and its mucous membranes. It all depends on how much it is found in you. If this is within normal limits, then there is nothing to worry about. You can send your conclusion, then it will be possible to answer the question more fully.

Please tell me, is it possible to cure staphylococcus with the drug metronidazole? They prescribed 2t x 3 times a day and two tablets at night in the vagina. Can this drug also cure thrush?

What do you mean by thrush? For vaginal discharge (thrush), a smear is analyzed, the pathogen is determined and a diagnosis is made. If you have been diagnosed with staphylococcus, it means that you need to treat it as the causative agent of thrush. In the strict sense, “thrush” is a disease caused by fungi, do you have it, are fungi found in the smear? Then they must be treated separately. Metronidazole is not intended as a drug against staphylococcus; it is more often used for other infections. You are better advised to take 1 tablet of doxycycline 2 times a day for 10 days, and suppositories - Polygynax or Terzhinan for at least 6 suppositories (1 per night in the vagina). After treatment, after 1-2 weeks you need to take a second smear and make sure that there is no “thrush” of candidiasis.

I was diagnosed with trichomoniasis, staphylococcal infection and cervical erosion. I’m wondering which doctor to go to first and how I can treat erosion if I haven’t given birth or had an abortion (where could I have gotten it from?). How is this staphylococcus treated (if I had it when I was still in the maternity hospital). And finally: is it true that prolonged trichomoniasis can develop into gonorrhea or is this just a children's fairy tale?

Heals everything listed diseases gynecologist. Erosion is usually a consequence of the inflammatory process. First, therapy is carried out infectious diseases. Cervical erosion nulliparous women cauterize only in case of extensive damage or development of complications. Staphylococcal infection is most likely a consequence of weakening protective properties organism due to trichomoniasis.

My doctor diagnosed endometritis. A smear examination showed staphylococcus. She prescribed me treatment with gentamicin 80 mcg 2 times a day for 5 days intramuscularly starting from the 1st day of menstruation. Inadvertently: ((I injected 80 mcg once a day for 5 days, i.e. 2 times less. And my question is the following: what should I what should I do now? is it possible to repeat this course and what would you advise me? (I also had a sore throat at that time and was prescribed bicillin, which lasts for a month, that’s what the otolaryngologist said).

It is very unfortunate that you did not follow the doctor's instructions. Since the danger of incorrect use of antibiotics is that they do not cope with the infection, but cause microorganisms to become addicted to this drug and in the future it no longer affects them. However, staphylococcus is sensitive to bicillin. So, the treatment can be considered complete. You should contact your doctor for an examination to determine your health status.

As a result microbiological research and determining the sensitivity of the isolated cultures to antibiotics, the following is said: "... during a bacteriological study from direct bacterial culture, a culture was isolated: 1. Pat. Staphylococci 2. Streptococci" and then the sensitivity of No. 1 and No. 2 to a number of antibiotics was determined (40 points). Does this mean that staphylococci and streptococci “live” in the vagina?

The fact is that staphylo- and streptococci should be present in the vagina in small quantities. To interpret the culture of vaginal contents, it is important to know the quantity of microorganisms isolated, as well as whether there is an inflammatory process in the genital tract. The presence of inflammation is determined in regular smear on flora by the number of leukocytes.

IN different periods In life, the composition of microorganisms in a woman’s vagina is different. In the first hours and days of a girl’s life, her vagina is completely sterile and is just beginning to populate. beneficial microflora. First, lacto and bifidumbacteria are found in the genitals. Then there is a gradual decrease in the number of lactobacilli, and they are replaced by various coccal microorganisms. By puberty there is an increase in the number again beneficial bacteria, and in old age it increases again, predominantly staphylococci.

Staphylococcus aureus in the vagina is not always diagnosed in a microflora smear, but is also considered a normal variant. However, an increase in its amount may indicate various pathologies.

Staphylococcus aureus is a microorganism that is found in the vagina of a healthy woman, but its quantity should not exceed 1 % from all bacteria found in the smear. Intensive reproduction of vaginal staphylococcus can cause several nonspecific inflammatory pathologies of the woman’s reproductive system.

The reasons for the increase in the number of this microorganism in women are rarely associated with sexual partners, but this etiological factor may also be present. The main reasons for the excessive proliferation of staphylococcus in the vagina:

1. Introducing bacteria from the intestines during washing or improper washing of girls;
2. Invasive diagnostic and therapeutic procedures;
3. Reduced body resistance;
4. Long or overuse antibacterial drugs;
5. Hormonal imbalances (especially in the genital area).

An increased amount of vaginal Staphylococcus aureus may indicate the development of some sexually transmitted pathology. In such cases, a specific pathogen is simultaneously identified, for example, Trichomonas, mycoplasma, ureaplasma or other types of bacteria.

Characteristics of diseases caused by staphylococcus

If Staphylococcus aureus is detected in the vagina, we can confidently speak about dysbacteriosis of this organ. However, vaginal dysbiosis does not always occur in the same way and has several varieties.

Forms of vaginal dysbiosis associated with excessive development of staphylococcus:

• Gardnerellosis. Disturbance in the balance of beneficial and opportunistic bacteria leads to the creation ideal conditions for the life of Gardnerella. This microorganism causes a nonspecific inflammatory process in female vagina, quickly absorbs all lacto and bifidumbacteria and is very difficult to remove during treatment attempts.
• Bacterial vaginosis. This disorder of the vaginal microflora is characterized by a decrease in beneficial bacteria and excessive development of all types of opportunistic flora, which leads to a nonspecific inflammatory process.
• Colpitis. Inflammation of the mucous membranes of the vagina caused by direct exposure to Staphylococcus aureus. The pathology easily becomes chronic, which may make it difficult to treat.
• Vulvovaginitis. This condition is characterized by damage not only to the vagina, but also to other external genitalia. Inflammation may be caused different microflora, but more often associated with excessive growth of Candida fungi against the background of an increase in the number of Staphylococcus aureus. In such cases, the pathology is called thrush.

Symptoms of vaginal staphylococcus, no matter what form the lesion takes, are the same and include the following:

1. The presence of discharge of a different nature (depending on the predominant pathogen);
2. Itching and burning in the affected area;
3. Pain during urination and during sexual intercourse;
4. Pain in the lower abdomen.

Also, excessive proliferation of staphylococcus may be associated with misuse synthetic tampons. In such situations, there is a high risk of dangerous conditions such as toxic shock.

Toxic shock

Such severe intoxication of the body is relatively rare, but you should not forget about it, since the use of tampons is becoming an increasingly common way to maintain hygiene during menstruation every year. If tampons are changed less frequently than necessary, then the accumulation and proliferation of pathogenic staphylococcus occurs, which actively produces a toxin that is absorbed into the blood, causing severe intoxication.

The clinical picture of shock includes the following symptoms:

• High temperature (over 40 degrees);
• The appearance of a rash and peeling of the skin;
• A sharp and significant decrease in blood pressure;
• Nausea followed by vomiting;
• Strong headache;
• Thread-like pulse, which is practically not palpable;
• Tachycardia or bradycardia depending on the degree of intoxication;
• Problems in the functioning of the kidneys (up to the development of acute renal failure).

This condition requires immediate medical intervention and emergency measures.

The first thing to do when diagnosing such shock is to remove the tampon from the vagina and then wait for an ambulance.

In addition to the use of tampons, it is very rare, but still, shock can develop into postpartum period when a woman is weakened and there is excessive development of staphylococcus. Development this state also contribute traumatic injuries genital organs, in particular abortions performed outside medical conditions, without observing the rules of asepsis.

Diagnostics

Determination of Staphylococcus aureus in the vagina occurs by taking a smear followed by bacterial culture of the material. The study is microbiological and is carried out using special nutrient media. When taking a smear from the vagina, the laboratory technician sifts out all possible types bacteria and evaluates not only the detected species, but also their quantity, as well as their relationship to each other.

If any pathogenic changes are detected, a sensitivity test to antibacterial drugs is performed to help in choosing further treatment. The test is also carried out on the strain that should be eliminated. If there are several such types, then all are taken into account.

The advantages of identifying staphylococcus in this way include the following:

1. Absence false results(at the right fence material);
2. Combining diagnosis and partial determination of treatment tactics.

However, the technique also has disadvantages:

• Duration (in most cases, if any bacterial flora is suspected, doctors begin treatment with drugs before receiving the results of the study wide range actions);
• Strict rules for collecting material;
• Certain experience and high education of laboratory workers, since growing bacteria requires certain conditions.

Treatment

If Staphylococcus aureus is detected in a smear taken from the vagina, therapeutic measures are not always required. It all depends on the number of microorganisms and on its percentage with other strains. Also of certain importance is the clinical picture of the pathology, in the presence of which treatment begins regardless of the obtained indicators.

Treatment of Staphylococcus aureus in the vagina is a difficult task, since the microorganism successfully fights the harmful effects. Systemic treatment with antibacterial drugs is carried out. First, broad-spectrum medications are prescribed, and it should be taken into account allergy history patients and be sure to conduct tests. For local treatment, vaginal suppositories for staphylococcus are used, which can contain either antibiotics or probiotics to populate the vagina with beneficial microflora. However this microorganism has the ability to adapt to antibiotics, which is why the doctor may periodically need to change the treatment regimen.

If the addition of another infection is noted, then additional therapy is prescribed for its causative agent, for example, antifungal drugs with candidiasis. Since the excessive development of staphylococcus is often associated with a decrease in the body’s immune forces, it is possible to prescribe immunomodulators, but one should be very careful with their use. Self-treatment reduced resistance is unacceptable, since drugs can only be prescribed under the control of an immunogram.

Prognosis and prevention

Inflammatory processes caused by staphylococcus in the vagina tend to recur, which is why a woman will have to be very attentive to changes in her condition. It will be necessary to maintain a high level of immunity and adequate sexual activity with a single and trusted partner. A woman should avoid prolonged, uncontrolled and unjustified use of antibiotics and always take them together with drugs that correct the balance of bacterial microorganisms.

In general, if you consult a doctor in a timely manner and proper treatment If staphylococcus is too active, the prognosis is favorable. The main thing is that the woman does not try to fight it on her own, using traditional medicine, as this will only aggravate the disease and complicate further treatment.

Such an insidious enemy of women's health as staphylococcal infection in gynecology, treatment involves antibacterial treatment in combination with other restorative and local methods. Staphylococcal infection in women is caused by pathogenic staphylococci. The microorganism staphylococcus is widespread in nature, so it is not difficult to become infected with it.

Methods of contracting staphylococcal infection

It is possible to become infected with staphylococcus through another person suffering from staphylococcal sore throat or carrying staphylococcus on their mucous membranes, as well as through objects. Along with other infectious agents (gonococci, chlamydia, trichomonas, mycoplasmas, etc.), it is possible to become infected with staphylococcus through sexual contact, through various gynecological manipulations (during smear collection, urethroscopy, etc.) or independently if the commandments of hygiene are not followed. The primary lesion becomes the point of spread of staphylococcus in the human body, including the genitourinary organs, through the blood circulation and lymphatic tract. Often, inflammatory disease of the genitourinary organ is caused by the combined effects of various types of microbes, for example, staphylococci with gonococci, chlamydia, trichomonas, etc. Therefore, staphylococcus is of considerable importance in various genitourinary tract infections.

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Causes of staphylococcal infection

The prevalence among other gynecological inflammatory diseases is 8-10%. What should you know in such a situation? The first thing you need to pay attention to is the similarity of the course of the infection with the gonorrheal process, especially in the chronic form. The second thing to consider is that despite the similarity of the course of gonococcal and staphylococcal pathologies, they have differences. The spread of gonococci is usually associated with mucous membranes in the body. A number of predisposing factors cause staphylococcal pathologies:

• decreased body immunity due to intoxication or infection;
• hormonal disorders;
• decreased local immunity (in the genitourinary organs) as a result of the inflammation process;
• ineffective local treatment;
• development of dysbacteriosis;
• deviations in the level of acidity of the environment;
• other factors.

The incubation period ranges from 5 to 10 days. However, it may shorten to 2 days or increase to a month or two. Typically, the process of inflammation is characterized by a sluggish state that does not show obvious signs, but an acute form of manifestation is also possible. In some patients, the disease subsides at times, while in others, on the contrary, it worsens. The disease may spontaneously disappear after a short period of time and the onset of the recovery phase. But in most cases, patients experience a long-term course of chronic staphylococcal infection.

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Gynecological staphylococcal diseases

It is not typical for gonococci to penetrate deeper tissue layers. Whereas staphylococci (and streptococci too) penetrate through the injured surface into the deep tissue and immediately spread with the blood throughout the body. In the internal space of the uterus, due to the presence of microbes, the mucous membrane becomes inflamed, but the entire thickness of the walls of the uterus can be affected. The following manifestations of this process are possible:

• purulent leucorrhoea;
• pain in the lower abdomen and lumbar region;
• atypical course of menstruation.

Menstruation disorder can be accompanied by pain, excessive bleeding and manifest itself in cyclical irregularities. At the very beginning of infection with pathogenic microorganisms, an increase in body temperature is possible. From the mucous membrane of the uterus, inflammation can spread to the tubes with the ovaries. Then we are talking about the development of inflammation in the uterine appendages. Following this, infection of the peritoneum is possible. Unlike gonococcal pathology, infection with staphylococci does not lead to such rapid formation of adhesions on the tubes and ovaries and the inflammation it causes. Often there is a general inflammation of the peritoneum, which is classified as a serious and dangerous disease.

During childbirth or abortion, the cervix and vaginal walls are injured. Therefore, it is very easy for infections to penetrate through tears in the tissues and get into the loose layer of fiber found in the uterus, rectum, and bladder. With such a lesion, the body temperature rises sharply, severe pain appears in the lower abdomen, and the patient begins to shiver. An inflammatory tumor develops in the pelvic area, which is initially represented by an increase due to edema with tissue, and then with purulent tissue (with purulent parametritis). Inflammation of the fiber lasts long and painfully. Resorption of the tissue abscess occurs very slowly, and therefore a painful compaction behind or on the side of the uterus is diagnosed for a long time. Frequent accompaniments of this pathological condition are aching pain, occasional fever, bladder dysfunction and difficulties with bowel movements.

Staphylococci, together with streptococci, can enter the blood vessels from the affected area in the genital tract. This route of infection spread is especially typical for situations involving artificial termination of pregnancy performed outside a medical facility and by incompetent persons. Often during such abortions there can be no question of compliance with mandatory requirements for surgical intervention. The postpartum period in a woman’s life also favors infection. In this case, there is a high risk of developing infection against the background of damage to the mucous membrane and injured tissues of the perineum, vagina, uterus and cervix during labor as a result of failure to comply with the rules of personal hygiene of the mother. The infection process may not stop at the genital tract.

Pathology can spread beyond their borders. Complications of this condition may include developed thrombophlebitis (inflammation of the veins of the lower extremities), purulent processes in the lungs and other organs. The peak and most dangerous complication of staphylococcal infection can be general blood damage - sepsis.

When conducting a differential diagnosis, the attending physician should be puzzled by the similarity of the signs of diseases provoked by streptococci and staphylococci with the course of gonorrhea. Therefore, the first priority for the sick person is to immediately contact an obstetrician-gynecologist if symptoms such as:

• acts of urination with a feeling of pain and burning;
• icteric discharge with the presence of blood fragments;
• pain syndrome (most often the lower abdomen and lumbar back hurt);
• pathological menstruation.