Gardnerella causes. How to treat gardnerella: drug and alternative therapy, restoration of local immunity, methods of prevention. Diagnostic criteria for gardnerellosis are

In our body there is a huge number of not only harmful, but also beneficial bacteria. They live everywhere: on the surface of the skin, in the intestines, on the mucous membranes and in the vagina. Thus, almost every organ has its own individual microflora, which provides it normal functioning. Beneficial bacteria living in the vagina, allow him to fight with various infections. But quite often, the delicate balance of microflora is disturbed, resulting in more harmful microbes, the most common of which are gardnerella. This leads to the development of a disease of the same name that harms the body and requires treatment.

Definition of gardnerellosis in women

Gardnerellosis, or bacterial vaginosis, is pathological condition, in which the gardnerella microorganism predominates in the vagina. It is the smallest bacterium that normal conditions also lives in human body along with many others. It is believed that in a healthy woman, acidifying lactobacilli predominate in the vagina, which create an optimal environment. If this ratio is violated, gardnerellosis occurs with all the accompanying symptoms.

The disease occurs in women different ages, as well as in men. Representatives of the stronger sex suffer from the disease much less frequently, since they have a smaller volume of the mucous membrane compared to girls.

How many microorganisms in a smear is considered the norm

If the number of gardnerella exceeds allowed values, the patient begins to form the main symptoms of the disease. IN normal conditions you can also detect this bacterium in the analyzes. The following indicators are important for diagnosis:

• 10 5 -10 6 microorganisms in a smear of a healthy woman is considered the norm;
• 10 7 -10 9 - indicates a stable infection;
• 10 4 microorganisms in a pregnancy smear is a cause for concern.

Can gardnerella be in the mouth

If the disease exists in the body for a long enough time (six months or more), the bacteria gradually spread through the bloodstream and migrate into the oral cavity. Infection can also occur with oral sex without protection. Gardnerella settle on the oral mucosa and begin to actively grow and multiply, accumulating in the tonsils and pharynx. Often this ends with the development of inflammatory processes (stomatitis, pharyngitis, laryngitis).

Table: difference between gardnerellosis and thrush

Existing varieties of the disease

Classification of the disease according to the course of the pathological process:

• acute (occurs when a large dose of the pathogen enters the body during sexual contact, symptoms increase in 2-3 days);
• subacute (formed in one and a half to two weeks);
• chronic (exists for six months);
• recurrent (exacerbation phases are replaced by remission).

Varieties of the disease according to the nature of the discharge:

• serous form - a yellow tint of discharge predominates;
• purulent - mostly green color secret;
• fibrinous - there are bloody streaks in the discharge.

Classification of the disease by the presence of a secondary infection:

• isolated gardnerellosis;
• combination with:
  • chlamydia;
  • syphilis;
  • trichomoniasis;
  • gonorrhea;
  • candidiasis.

Why does gardnerellosis occur?

In order for such a disease to develop, not only the presence of a bacterium is necessary, but also some acting factors. Most often they include:

• frequent change of sexual partners;
• uncontrolled intake of antibacterial drugs;
• daily douching;
• usage ordinary soap as a means to intimate hygiene;
• visit public places by type of bath, sauna, swimming pool, gym;
• neuro-emotional shocks;
• wearing tight underwear made of synthetic fabrics;
• work in conditions of high temperature and humidity;
• infectious diseases;
• pathology immune system(HIV, primary bone marrow damage).

Ways of transmission of the disease

The disease can occur in a perfectly healthy woman if there is a violation normal microflora vagina, even if she has not had unprotected sex. However, the leading route of infection is still sexual (oral, anal and vaginal penetration have the same risk of infection). Gardnerellosis can also be transmitted by wearing shared underwear, using under-treated sex toys.

The duration of the incubation period

On average, clinical symptoms of the disease begin to appear 2-14 days after infection. Their intensity depends on the age of the patient, her state of health and the presence of other sexually transmitted diseases.

In the elderly, in 80% of cases, the disease is almost asymptomatic, which is associated with slower metabolic processes.

Video: the doctor talks about the features of the onset of the disease

The main symptomatic signs of pathology

Bacterial vaginosis is characterized by the predominance of local manifestations over the general ones. The disease progresses extremely slowly, and an increase in symptoms is observed after viral infection(SARS, colds), stress, physical activity or sexual activity.

The main symptoms of the disease:

1. Pain in the pelvic area. She wears weak aching character, the intensity increases with urination. During the period of menstruation, unpleasant sensations intensify several times, become compressive and cramping.
2. Pathological secretions. They have an unpleasant odor that can be felt from several meters away, as well as a yellow, brown or green color. The secretions are quite difficult to wash off from clothes and can overwhelm a panty liner.
3. Swelling of soft tissues. The labia minora and clitoris swell, become extremely sensitive and sharply painful. After some time, in the absence of wiping and the use of absorbent wipes, a dark coating appears on them, which is easily peeled off.
4. Itching and burning during urination indicate the penetration of bacteria into the urethra and bladder. This symptom occurs in the later stages of the development of the disease.

Gardnerellosis and childbearing

For a long time an existing disease the chance of getting pregnant decreases every year. If conception did occur, future mom faces a huge risk of infection of the baby: bacteria penetrate the fetus through the child's place. There is a high chance of infection during childbirth.

Symptoms of the disease during pregnancy intensify: a woman experiences unbearable itching and burning, and the amount of discharge increases to 300–350 milliliters per day. Often, during a night's sleep, the victim injures the mucous membrane of the external genital organs with her nails, which ends with the addition of a secondary infection.

I happened to be involved in the delivery of a woman, long time suffering from gardnerellosis. She was unable to cure the disease before pregnancy, as a result of which the baby was also confirmed to have this infection. The child was born much prematurely, as a result of which he could not breathe on his own. Doctors decided to nurse the baby in intensive care. A few months later, he began to recover, but in the future, such an infection causes a serious lag in physical and neuropsychic development from peers.

How is the disease diagnosed?

External manifestations of gardnerellosis have similar signs with many other pathologies that are sexually transmitted. This greatly complicates the diagnosis. Bacterial vaginosis has to be differentiated from:

• trichomoniasis;
• candidiasis;
• chlamydia;
• ureaplasmosis;
• mycoplasmosis;
• gonorrhea.

Remember that before visiting the gynecologist and taking a smear, you should not douche the vagina. antiseptic solutions. During my work in a medical laboratory, I have repeatedly encountered the fact that women independently washed off all pathogenic microflora, as a result, the study had to be redone again. If you want to get a reliable result, it is recommended to postpone the hygiene measures for a while. Only in this way will it be possible to determine the disease on early stage.

Ways to confirm the diagnosis:

Leading methods of treatment of gardnerellosis in women

Treatment of bacterial vaginosis is based on the normalization of the vaginal microflora. For this, doctors use not only pharmaceuticals, but also special diet. And also in recovery period It is permissible to use various physiological procedures that help strengthen immunity. In most cases, the disease treatment is mandatory. Extremely rare episodes self-elimination disease without medical intervention (mainly in patients young age).

The sexual partner of a woman needs therapy only if he also has an increased level of gardnerella. For this, a man needs to pass special tests from a urologist (smear from the urethra).

Video: doctor's opinion on the need for therapy

Treatment of the disease with the help of pharmaceuticals

Drug therapy for gardnerellosis includes the use of both local and generic drugs. The former can be used in the form of suppositories and solutions for douching, as well as in the form of ointments and gels. The latter are represented by tablets, capsules and injections for intramuscular or intravenous administration. The duration of therapy and the choice of drugs is determined by the gynecologist. Self-treatment can lead to aggravation of already existing problems in the body.

Gardnerella is sensitive to antimicrobials. That is why they are the first group of drugs that help to cope with the disease.

Local preparations used to combat the disease:

1. Antibiotic suppositories help prevent the growth of gardnerella and its further development in organism. The most commonly used drugs are:
   • Metronidazole;
   • Clindamycin;
   • Acylact;
   • Iodoxide;
   • Hexicon.
2. Antifungal ointments and suppositories prevent the development of fungal microflora and prevent thrush from forming. For this purpose, use:
   • Nystatin;
   • Pimafucin;
   • Levorin;
   • Fluconazole;
   • Flucostat.
3. Suppositories containing a large number of lactobacilli help to normalize internal environment vagina. The most famous drugs:
   • Lactobacterin;
   • Vaginorm-S;
   • Vagilak;
   • Lactoginal.
4. Antiseptic washing agents help to remove harmful microflora. For this purpose, diluted solutions of Miramistin, Chlorhexidine, Furacilin are used.

Photo gallery: preparations for local therapy for gardnerellosis

Polygynax - suppositories with an antibiotic that affects gardnerella Clotrimazole helps prevent thrush Lactonorm promotes the growth of lactobacilli Miramistin creates conditions for the death of harmful bacteria

Systemic drugs

Medications for systemic treatment of the disease:

1. Antibiotics in tablets and capsules are used when local therapy did not bring the expected effect. The most common drugs:
   • Azithromycin;
   • Ornidazole;
   • Dalacin;
   • Unidox Solutab.
2. Non-steroidal anti-inflammatory drugs help get rid of itching and burning, and also reduce the severity discomfort in the pelvic area. For this purpose, use:
   • Diclofenac-Sodium;
   • Indomethacin;
   • ibuprofen;
   • Pyroxifer;
   • Ortofen;
   • Rodanol;
   • Celecoxib;
   • Rofecoxib;
   • Viox;
   • Celebrex;
3. Immunostimulants improve recovery processes flowing in the body, contributing to the formation of new cells. The most famous medicines of this group:
   • Viferon;
   • Wobenzym;
   • Amiksin;
   • Polyoxidonium;
   • Tsitovir.

Photo gallery: drugs for systemic therapy of gardnerellosis

Doxycycline is an antibiotic that kills gardnerella Meloxicam relieves inflammation Immunal helps to strengthen the immune system

Traditional medicine as an aid

Quite often, patients do not have the opportunity to immediately consult a doctor (business trip, vacation), or the doctor's appointment is scheduled in a few days, and the discomfort continues to overcome. In these cases, it is permissible to use traditional medicine. Various douches and tampons will help get rid of the main manifestations of the disease and make it easier to wait. Remember that such treatment will not completely solve the problem, since pharmaceutical preparations are necessary to restore normal microflora.

I happened to encounter a patient who completely abandoned traditional therapy, preferring to use herbs and plants in order to eliminate bacterial vaginosis. Regular douching with high-dose solutions led to the fact that the patient not only did not cure gardnerella, but also acquired a serious chemical burn of the vaginal mucosa. The victim was taken by ambulance to the gynecology department, where she underwent reconstructive plastic surgery. Unfortunately, as a result of this procedure, the woman has lost her sensitivity and is experiencing problems with her sexual life.

The most popular folk recipes:

Table: physiotherapy in the treatment of the disease

Photo gallery: physiotherapy in gynecology

Radon baths cause the death of pathogenic microbes Electrical stimulation accelerates the formation of new cells Medicinal electrophoresis is used to administer anti-inflammatory and antibacterial agents.

Changes in diet and lifestyle in gardnerellosis

To restore the normal microflora of the vagina, doctors recommend that women follow a certain diet. To do this, you must adhere to the following rules:

• consume only fresh and natural products without chemical additives (can be bought on the market or from private sellers);
• Be sure to have breakfast, lunch and dinner. There should also be two snacks so that the breaks between meals do not last longer than three hours;
• drink up to one and a half liters of pure water daily;
• stop drinking alcohol;
• bake, stew or boil food so that vitamins are preserved in it;
• do not eat sweets, as they contain a lot fast carbohydrates and sugars, which create an optimal environment for the reproduction of bacteria;
• reduce the amount of salt to 5 grams per day.

What foods must be included in the diet:

Rules for women for the period of treatment

During the treatment of gardnerellosis, you will have to slightly change your usual lifestyle and give up some habits before full recovery. Do not forget that following these rules will help you achieve positive results in just a few weeks. What is not recommended for bacterial vaginosis:

• epilate bikini and perineum - these procedures are stressful for the body;
• visit baths, saunas, for a long time lie in a hot bath or jacuzzi;
• have sex - there is a risk of infecting a partner;
• drink antibiotics on your own;
• wear tight underwear;
• swim in open water and pools.

Treatment prognosis and possible adverse effects

Therapy of gardnerellosis is an extremely complex and lengthy process. Often, it takes a very long time to restore normal microflora, and some women quit treatment before even reaching half. Remember that rehabilitation after similar disease proceeds much more slowly with the following ailments:

• diabetes;
• hypertension;
• phlebeurysm.

In adolescent girls and young people, gardnerellosis disappears with practically no visible consequences if therapy is started in a timely manner. In older women and the elderly population, due to slow metabolic processes, rehabilitation lasts up to several years.

The disease is prone to recurrence. A cure does not guarantee that in a couple of months or years you will not have gardnerellosis again.

Compliance with the rules of personal hygiene plays a special role in restoring the normal microflora of the vagina. During the treatment period, it is extremely important that you have the opportunity to clean the perineum every few hours and change the pads. I happened to participate in the treatment of a patient who spent twelve hours at work in a hot shop. She practically did not have the opportunity to wash herself, and in the hot season, even despite the ventilation, the temperature in the room was high, as a result of which the woman was constantly sweating. Excessive formation of sebum contributed to the appearance of itching and burning, and all ongoing therapy for gardnerellosis was useless. Only after the patient managed to take a vacation for two months and go to a sanatorium, the treatment became effective. Sea water and warm air, combined with pharmaceuticals and good hygiene, helped the woman forget about her illness.

What complications and Negative consequences occur in patients with gardnerellosis:

• problems with conception - an altered microflora causes the death of spermatozoa when they do not have time to reach the egg;
• formation of adhesions - growths connective tissue in the pelvic cavity, which disrupt the normal attachment of the embryo in the uterus;
• long-term infertility of a different nature;
• inflammatory diseases of the pelvic organs: uterus, tubes, ovaries, Bladder and urethra;
• decreased immunity;
• intrauterine infection of the fetus;
• the penetration of bacteria into the body of the child during childbirth.

Photo gallery: complications of the disease

Long-term jaundice indicates infection of the newborn Inflammation of the ovaries occurs when the microflora penetrates from the vagina adhesive process characterized by proliferation of connective tissue and disrupts the processes of conception and fetal development

How to protect yourself from developing the disease

Treatment of gardnerellosis requires costs a large number forces and means. That is why it is much easier to protect your body from the development of such a disease than to undergo a course of therapy. To this end, doctors have developed rules for individual prevention of the disease.

During the fourth year medical university I had a chance to train for several months in the department of gynecology in Serbia. At this time, doctors were just conducting a study on the prevention of bacterial vaginosis by taking lactobacilli and dairy products. For the study, a group of patients was selected, who throughout their lives in winter time years faced with garnerellosis and its backfire. More than half of them had problems with immunity (often got sick, caught a cold). Throughout the autumn, doctors recommended that they take certain pills with high content Latobacteria, as well as women, added dairy products (cheeses, sour cream, sourdough) to the diet, which they consumed several times every day. With the approach of cold weather, doctors were taken from patients necessary tests- smears from the vagina. In 95% of the studied patients, practically no gardnerella was observed in the material. Another 5% admitted that they did not always strictly follow the recommendations of doctors and used alcoholic drinks. Thanks to this technique, most of all the victims were able to forget about their disease forever.

Rules for individual prevention of gardnerellosis in women:

Gardnerellosis is a disease of the female reproductive system that has infectious origin but not related to STIs. The causative agent is the anaerobic bacterium gardnerella, which is part of the vaginal microflora (no more than 1% of all living microorganisms). A change in the composition of the microflora causes the development of gardnerellosis and other non-inflammatory diseases reproductive system women.

It is known that gardnerella can be transmitted to a man from a sick woman during intercourse. That is why often this infection confused with venereal diseases. In men, this microbe, as a rule, does not cause any unpleasant symptoms. Its main carrier is women of any age, regardless of the presence or absence of sexual activity. Cases of gardnerellosis are recorded even in little girls. This is due to violations by various systems organism.

Causes of gardnerella

Gardnerellosis occurs when the composition changes vaginal microflora. On the onset certain conditions the number of beneficial microorganisms (lactobacilli) inhabiting this organ decreases, and conditionally pathogenic (pathogenic) bacteria increases. This imbalance can be caused by the following reasons:

The disease is transmitted from an affected mother to her child, usually a girl at birth, but newborn children similar diagnosis not set. To prevent the onset of symptoms of the disease, the infant may be prescribed drug therapy.

Gardnerella symptoms

A slight change in the microflora of the vagina can go unnoticed by a woman. Gardnerellosis occurs in chronic or acute form. In the first case, there are no signs. When the disease progresses to sharp shape a woman experiences discomfort in the perineum: burning, pain during sexual intercourse.

It is impossible to differentiate gardnerella from STIs according to the main manifestations, since all infections of the female genital area are accompanied by similar signs.

With gardnerellosis, there may also be an increase in the number, a change in their smell, color, and consistency. Similar symptoms characteristic of candidiasis, chlamydia and gonorrhea. Another sign to look out for is smell. If not disappearing even after acceptance water procedures, it is safe to say that there is an infection in the body. What, only a specialist can say.
The exacerbation of gardnerellosis is facilitated by a change hormonal background body, especially pregnancy.

Treatment of gardnerella

With a question about how to treat gardnerella in women you need to see a gynecologist. There are several approaches to the treatment of gardnerellosis. First, the exact cause of its occurrence is established. If this venereal disease, all efforts are directed primarily to its elimination. Therapy involves the use of antibiotics (Trichopol) in the form of tablets for oral administration, vaginal tablets and candles. Additionally, vaginal douching with antibacterial solutions may be prescribed. Often, to eliminate gardnerellosis, it is enough to undergo a thorough treatment of the underlying disease. The drugs for the treatment of gardnerella include Clindamycin, Metronidazole and other antibiotics that are active against various kinds bacteria.

Any antibiotics, especially those used vaginally, contribute to the disruption of the vaginal microflora, so their use must be combined with drugs whose action is aimed at colonizing the vagina with beneficial bacteria (Vagilak). As a result of such treatment, the balance of the vaginal microflora is restored, and the unpleasant symptoms of the disease completely disappear.

Diagnosis of gardnerella

To establish a diagnosis, some research is required. First of all, a woman is interviewed and examined by a gynecologist. During the examination, a vaginal secretion (smear) is taken, followed by its study in the laboratory. Installing gardnerellosis in the presence of such material is very simple.

In some cases, analysis for gardnerella involves more extensive laboratory studies, in particular PCR. PCR diagnostics allows you to accurately determine the presence in the human body of one or another pathogen, be it chlamydia, Trichomonas, gonococci, etc., contributing to the violation of the vaginal microflora and an increase in its composition of pathogenic microorganisms such as gardnerella.

Prevention of gardnerella

First of all, it is necessary to limit promiscuous sexual relations that contribute to the spread of STIs, to treat them in a timely manner various diseases body, primarily related to its hormonal background and the genital area, eat right, give great importance rest, avoid stress that affects the state of immunity. Twice a year it is recommended to visit a gynecologist even for a completely healthy woman, at least in order to once again make sure that everything is in order with her health.

Gardnerellosis, which may also be known to you as bacterial vaginosis, is one of the most common types of infectious pathology that occurs in the genital area. Gardnerellosis, the symptoms of which are mainly relevant for women of the category childbearing age and are manifested, first of all, in the appearance of characteristic secretions with a "fishy" smell, which, meanwhile, can also occur among men.

general description

Gardnerellosis, as we have already noted, is a fairly common disease. It is caused by a bacterium corresponding to the name that enters the vaginal mucosa. A small amount of these microorganisms can also be contained in the body of a healthy woman, but the manifestation of the symptoms characteristic of the disease is accompanied by an excess of the concentration level in the vagina of gardnerella.

Bacteria are usually transmitted sexually. As for other factors predisposing to the appearance of the disease, these include pregnancy, hormonal disorders, and a series of another type endocrine diseases. Duration incubation period gardnerellosis, as a rule, is about 3-10 days.

When considering male morbidity, it can be noted that in this case, gardnerellosis occurs no less often, however, the features of the course of the disease, characterized by the virtual absence of symptoms at an early stage, do not allow for its timely diagnosis.

Symptoms of gardnerellosis in women

The most favorable environment for the reproduction of gardnerella is the vagina. The features of the disease in women are in the mass reproduction that this microorganism begins to carry out, as well as in the gradual displacement of bacteria that form a normal environment for the vagina. Due to such a violation of the vaginal microbiocenosis, characteristic gynecological inflammations begin to appear.

In addition, there are also copious discharge greyish-green color of uniform consistency and sticking to the vaginal walls. Also, their peculiarity lies in the presence of a specific fishy smell. Among the manifestations severe itching and burning in the genital area.

In particular, an increase in symptoms is noted after sexual contact due to the alkaline environment of sperm. In general, it should be noted that the interaction of secretions during gardenerellosis with any type of alkali provokes an even greater increase bad smell. Accordingly, even the use of soap for hygienic purposes enhances this manifestation.

Launched cases of the course of the disease often develop into or into. In case of relevance of the disease in pregnant women, it is possible uterine bleeding. In addition, they can also break membranes, may start and premature birth. Subsequently, as a result of the disease in question, the newborn is underweight, the woman in labor experiences symptoms characteristic of postpartum endometritis.

Gardnerellosis: symptoms in men

Gardnerellosis is an actual disease among men, however, they mostly have no symptoms. This is explained by the fact that gardnerella are bacteria that specifically affect the squamous epithelium, and it, in turn, is located in the vagina. In men squamous epithelium only the first 5 centimeters of the urethra are lined, which, accordingly, affects only the navicular fossa. So the male urethra is not the environment that would provide normal conditions conducive to the development of gardnerella.

In some cases, in which gardnerellosis is accompanied by another sexually transmitted disease, it becomes possible to diagnose it, which in other cases practically does not occur due to the characteristics of the disease. The course of gardnerellosis in men can occur in the form of balanoposthitis. In this case, sharp severe symptoms, again, are absent, but the determining factor for the disease is the appearance in the area foreskin and the surface of the head of a characteristic unpleasant odor.

In general, for men it can be noted that the disease is not dangerous. The emergence serious problems relating to reproductive health is noted only in cases reduced immunity or with enough high degree gardnerella concentrations.

Also medical practice indicates cases in which gardenerellosis in men led to and, as well as inflammation of the seminal appendages (epididymitis). In any case, the listed serious complications, which can provoke this disease, are rather an exception to the rule. male body copes with the causative agent of the disease within two to three days. In some cases, men are noted to be carriers of the virus, which, however, excludes the relevance of the appearance of symptoms characteristic of the disease.

Diagnosis of gardnerellosis

Diagnosis of the disease in women provides for the need for appropriate laboratory research desquamated cells of the vaginal mucosa, as well as secretions. Indicates the presence of gardnerellosis elevated level acidity noted in the vaginal environment, a positive amine test result and, of course, the presence of directly microorganisms that cause this disease.

It should be noted that a pathogenic bacterium in itself is not yet evidence of the relevance of gardnerellosis, because a small number of pathogenic microorganisms of this type, as we have already noted, is acceptable in a normal and healthy state of the body.

The most informative option for determining gardnerellosis in women is PCR (that is, polymerase chain reaction technology). It is also applicable in diagnosing a disease in men in the analysis of semen, urine and scrapings. It is noteworthy that the sensitivity of this method is almost 100%.

Treatment of gardnerellosis

The treatment provided for gardnerellosis in women is complex in itself. This, in turn, provides for therapy aimed at reducing total microorganisms, as well as the settlement of valuable lactobacilli in the vaginal area with a general increase in immunity characteristic of the body. Are destroyed pathogenic bacteria mainly with the use of antibiotic therapy at the local level. Immunomodulators are used to strengthen the immune system.

The most difficult, as, in fact, the longest stage of treatment for women is to colonize the vaginal area with beneficial bacteria. IN this case eubiotics saturated with live bacteria are applicable. To determine the effectiveness of treatment, special control tests are used, carried out at intervals of several weeks.

As for the treatment of men, it is carried out at the local level, while there is no need for antibiotic therapy.

To avoid reinfection, therapy should be carried out for both partners. During the period of treatment, it is strongly recommended to avoid unprotected sexual intercourse, using barrier methods contraception.

To diagnose the disease and prescribe appropriate therapy, you need to contact several specialists: a gynecologist, a urologist and a microbiologist.

In our body there is a huge number of not only harmful, but also beneficial bacteria. They live everywhere: on the surface of the skin, in the intestines, on the mucous membranes and in the vagina. Thus, almost every organ has its own individual microflora, which ensures its normal functioning. The beneficial bacteria that live in the vagina allow it to fight various infections. But quite often, the delicate balance of microflora is disturbed, resulting in more harmful microbes, the most common of which are gardnerella. This leads to the development of a disease of the same name that harms the body and requires treatment.

Definition of gardnerellosis in women

Gardnerellosis, or bacterial vaginosis, is a pathological condition in which the gardnerella microorganism predominates in the vagina. It is the smallest bacterium that, under normal conditions, also lives in the human body along with many others. It is believed that in a healthy woman, acidifying lactobacilli predominate in the vagina, which create an optimal environment. If this ratio is violated, gardnerellosis occurs with all the accompanying symptoms.

The disease occurs both in women of all ages, and in men. Representatives of the stronger sex suffer from the disease much less frequently, since they have a smaller volume of the mucous membrane compared to girls.

How many microorganisms in a smear is considered the norm

If the number of gardnerella exceeds the allowable values, the patient begins to form the main symptoms of the disease. Under normal conditions, this bacterium can also be detected in analyzes. The following indicators are important for diagnosis:

• 10 5 -10 6 microorganisms in a smear of a healthy woman is considered the norm;
• 10 7 -10 9 - indicates a stable infection;
• 10 4 microorganisms in a pregnancy smear is a cause for concern.

Can gardnerella be in the mouth

If the disease exists in the body for a long enough time (six months or more), the bacteria gradually spread through the bloodstream and migrate into the oral cavity. And also infection can occur during oral sex without protection. Gardnerella settle on the oral mucosa and begin to actively grow and multiply, accumulating in the tonsils and pharynx. Often this ends with the development of inflammatory processes (stomatitis, pharyngitis, laryngitis).

Table: difference between gardnerellosis and thrush

Existing varieties of the disease

Classification of the disease according to the course of the pathological process:

• acute (occurs when a large dose of the pathogen enters the body during sexual contact, symptoms increase in 2-3 days);
• subacute (formed in one and a half to two weeks);
• chronic (exists for six months);
• recurrent (exacerbation phases are replaced by remission).

Varieties of the disease according to the nature of the discharge:

• serous form - a yellow tint of discharge predominates;
• purulent - mostly green color of the secret;
• fibrinous - there are bloody streaks in the discharge.

Classification of the disease by the presence of a secondary infection:

• isolated gardnerellosis;
• combination with:
  • chlamydia;
  • syphilis;
  • trichomoniasis;
  • gonorrhea;
  • candidiasis.

Why does gardnerellosis occur?

In order for such a disease to develop, not only the presence of a bacterium is necessary, but also some acting factors. Most often they include:

• frequent change of sexual partners;
• uncontrolled intake of antibacterial drugs;
• daily douching;
• the use of ordinary soap as a means for intimate hygiene;
• visits to public places such as baths, saunas, swimming pools, gyms;
• neuro-emotional shocks;
• wearing tight underwear made of synthetic fabrics;
• work in conditions of high temperature and humidity;
• infectious diseases;
• pathologies of the immune system (HIV, primary damage to the bone marrow).

Ways of transmission of the disease

The disease can occur in a perfectly healthy woman if the normal microflora of the vagina is disturbed, even if she did not have unprotected sexual intercourse. However, the leading route of infection is still sexual (oral, anal and vaginal penetration have the same risk of infection). Gardnerellosis can also be transmitted by wearing shared underwear, using under-treated sex toys.

The duration of the incubation period

On average, clinical symptoms of the disease begin to appear 2-14 days after infection. Their intensity depends on the age of the patient, her state of health and the presence of other sexually transmitted diseases.

In the elderly, in 80% of cases, the disease is almost asymptomatic, which is associated with slower metabolic processes.

Video: the doctor talks about the features of the onset of the disease

The main symptomatic signs of pathology

Bacterial vaginosis is characterized by the predominance of local manifestations over the general ones. The disease progresses extremely slowly, and an increase in symptoms is observed after a viral infection (SARS, colds), stress, physical activity or sexual activity.

The main symptoms of the disease:

1. Pain in the pelvic area. It has a weak aching character, the intensity increases with urination. During the period of menstruation, unpleasant sensations intensify several times, become compressive and cramping.
2. Pathological secretions. They have an unpleasant odor that can be felt from several meters away, as well as a yellow, brown or green color. The secretions are quite difficult to wash off from clothes and can overwhelm a panty liner.
3. Swelling of soft tissues. The labia minora and clitoris swell, become extremely sensitive and sharply painful. After some time, in the absence of wiping and the use of absorbent wipes, a dark coating appears on them, which is easily peeled off.
4. Itching and burning during urination indicate the penetration of bacteria into the urethra and bladder. This symptom occurs in the later stages of the development of the disease.

Gardnerellosis and childbearing

With a long-term disease, the likelihood of becoming pregnant decreases every year. If conception did occur, the expectant mother faces a huge risk of infection for the baby: bacteria enter the fetus through the child's place. There is a high chance of infection during childbirth.

Symptoms of the disease during pregnancy intensify: a woman experiences unbearable itching and burning, and the amount of discharge increases to 300–350 milliliters per day. Often, during a night's sleep, the victim injures the mucous membrane of the external genital organs with her nails, which ends with the addition of a secondary infection.

I happened to participate in the delivery of a woman who had suffered from gardnerellosis for a long time. She was unable to cure the disease before pregnancy, as a result of which the baby was also confirmed to have this infection. The child was born much prematurely, as a result of which he could not breathe on his own. Doctors decided to nurse the baby in intensive care. A few months later, he began to recover, but in the future, such an infection causes a serious lag in physical and neuropsychic development from peers.

How is the disease diagnosed?

External manifestations of gardnerellosis have similar signs with many other pathologies that are sexually transmitted. This greatly complicates the diagnosis. Bacterial vaginosis has to be differentiated from:

• trichomoniasis;
• candidiasis;
• chlamydia;
• ureaplasmosis;
• mycoplasmosis;
• gonorrhea.

Remember that before visiting the gynecologist and taking a smear, you should not douche the vagina with antiseptic solutions. During my work in a medical laboratory, I have repeatedly encountered the fact that women independently washed off all pathogenic microflora, as a result, the study had to be redone again. If you want to get a reliable result, it is recommended to postpone the hygiene measures for a while. This is the only way to identify the disease at an early stage.

Ways to confirm the diagnosis:

Leading methods of treatment of gardnerellosis in women

Treatment of bacterial vaginosis is based on the normalization of the vaginal microflora. For this, doctors use not only pharmaceuticals, but also a special diet. And also in the recovery period, it is permissible to use various physiological procedures that help strengthen immunity. In most cases, the disease treatment is mandatory. Extremely rare episodes of self-elimination of the disease without medical intervention (mainly in young patients).

The sexual partner of a woman needs therapy only if he also has an increased level of gardnerella. For this, a man needs to pass special tests from a urologist (smear from the urethra).

Video: doctor's opinion on the need for therapy

Treatment of the disease with the help of pharmaceuticals

Drug therapy for gardnerellosis includes the use of both local and general drugs. The former can be used in the form of suppositories and solutions for douching, as well as in the form of ointments and gels. The latter are represented by tablets, capsules and injections for intramuscular or intravenous administration. The duration of therapy and the choice of drugs is determined by the gynecologist. Self-treatment can lead to aggravation of already existing problems in the body.

Gardnerella is sensitive to antimicrobial agents. That is why they are the first group of drugs that help to cope with the disease.

Local preparations used to combat the disease:

1. Candles with an antibiotic can prevent the growth of gardnerella and its further development in the body. The most commonly used drugs are:
   • Metronidazole;
   • Clindamycin;
   • Acylact;
   • Iodoxide;
   • Hexicon.
2. Antifungal ointments and suppositories prevent the development of fungal microflora and prevent thrush from forming. For this purpose, use:
   • Nystatin;
   • Pimafucin;
   • Levorin;
   • Fluconazole;
   • Flucostat.
3. Candles containing a large number of lactobacilli help to normalize the internal environment of the vagina. The most famous drugs:
   • Lactobacterin;
   • Vaginorm-S;
   • Vagilak;
   • Lactoginal.
4. Antiseptic washing agents help to remove harmful microflora. For this purpose, diluted solutions of Miramistin, Chlorhexidine, Furacilin are used.

Photo gallery: preparations for local therapy for gardnerellosis

Polygynax - suppositories with an antibiotic that affects gardnerella Clotrimazole helps prevent thrush Lactonorm promotes the growth of lactobacilli Miramistin creates conditions for the death of harmful bacteria

Systemic drugs

Medications for systemic treatment of the disease:

1. Antibiotics in tablets and capsules are used when local therapy has not brought the expected effect. The most common drugs:
   • Azithromycin;
   • Ornidazole;
   • Dalacin;
   • Unidox Solutab.
2. Non-steroidal anti-inflammatory drugs help to get rid of itching and burning, and also reduce the severity of discomfort in the pelvic area. For this purpose, use:
   • Diclofenac-Sodium;
   • Indomethacin;
   • ibuprofen;
   • Pyroxifer;
   • Ortofen;
   • Rodanol;
   • Celecoxib;
   • Rofecoxib;
   • Viox;
   • Celebrex;
3. Immunostimulants improve the recovery processes in the body, promoting the formation of new cells. The most famous medicines of this group:
   • Viferon;
   • Wobenzym;
   • Amiksin;
   • Polyoxidonium;
   • Tsitovir.

Photo gallery: drugs for systemic therapy of gardnerellosis

Doxycycline is an antibiotic that kills gardnerella Meloxicam relieves inflammation Immunal helps to strengthen the immune system

Traditional medicine as an aid

Quite often, patients do not have the opportunity to immediately consult a doctor (business trip, vacation), or the doctor's appointment is scheduled in a few days, and the discomfort continues to overcome. In these cases, the use of traditional medicine is acceptable. Various douches and tampons will help get rid of the main manifestations of the disease and make it easier to wait. Remember that such treatment will not completely solve the problem, since pharmaceutical preparations are necessary to restore normal microflora.

I happened to encounter a patient who completely abandoned traditional therapy, preferring to use herbs and plants in order to eliminate bacterial vaginosis. Regular douching with high-dose solutions led to the fact that the patient not only did not cure gardnerella, but also acquired a serious chemical burn of the vaginal mucosa. The victim was taken by ambulance to the gynecology department, where she underwent reconstructive plastic surgery. Unfortunately, as a result of this procedure, the woman has lost her sensitivity and is experiencing problems with her sexual life.

The most popular folk recipes:

Table: physiotherapy in the treatment of the disease

Photo gallery: physiotherapy in gynecology

Radon baths cause the death of pathogenic microbes Electrical stimulation accelerates the formation of new cells Medicinal electrophoresis is used to administer anti-inflammatory and antibacterial agents.

Changes in diet and lifestyle in gardnerellosis

To restore the normal microflora of the vagina, doctors recommend that women follow a certain diet. To do this, you must adhere to the following rules:

• use only fresh and natural products without chemical additives (you can buy on the market or from private sellers);
• Be sure to have breakfast, lunch and dinner. There should also be two snacks so that the breaks between meals do not last longer than three hours;
• drink up to one and a half liters of pure water daily;
• stop drinking alcohol;
• bake, stew or boil food so that vitamins are preserved in it;
• do not eat sweets, as they contain a lot of fast carbohydrates and sugars, which create an optimal environment for the reproduction of bacteria;
• reduce the amount of salt to 5 grams per day.

What foods must be included in the diet:

Rules for women for the period of treatment

During the treatment of gardnerellosis, you will have to slightly change your usual lifestyle and give up some habits until you fully recover. Do not forget that following these rules will help you achieve positive results in just a few weeks. What is not recommended for bacterial vaginosis:

• epilate bikini and perineum - these procedures are stressful for the body;
• visit baths, saunas, lie in a hot tub or jacuzzi for a long time;
• have sex - there is a risk of infecting a partner;
• drink antibiotics on your own;
• wear tight underwear;
• swim in open water and pools.

Treatment prognosis and possible adverse effects

Therapy of gardnerellosis is an extremely complex and lengthy process. Often, it takes a very long time to restore normal microflora, and some women quit treatment before even reaching half. Remember that rehabilitation after such a disease is much slower with the following ailments:

• diabetes;
• hypertension;
• phlebeurysm.

In adolescent girls and young people, gardnerellosis disappears with practically no visible consequences if therapy is started in a timely manner. In older women and the elderly population, due to slow metabolic processes, rehabilitation lasts up to several years.

The disease is prone to recurrence. A cure does not guarantee that in a couple of months or years you will not have gardnerellosis again.

Compliance with the rules of personal hygiene plays a special role in restoring the normal microflora of the vagina. During the treatment period, it is extremely important that you have the opportunity to clean the perineum every few hours and change the pads. I happened to participate in the treatment of a patient who spent twelve hours at work in a hot shop. She practically did not have the opportunity to wash herself, and in the hot season, even despite the ventilation, the temperature in the room was high, as a result of which the woman was constantly sweating. Excessive formation of sebum contributed to the appearance of itching and burning, and all ongoing therapy for gardnerellosis was useless. Only after the patient managed to take a vacation for two months and go to a sanatorium, the treatment became effective. Sea water and warm air, combined with pharmaceuticals and good hygiene, helped the woman forget about her illness.

What complications and negative consequences occur in patients with gardnerellosis:

• problems with conception - an altered microflora causes the death of spermatozoa when they do not have time to reach the egg;
• the formation of adhesions - growths of connective tissue in the pelvic cavity, which disrupt the normal attachment of the embryo in the uterus;
• long-term infertility of a different nature;
• inflammatory diseases of the pelvic organs: uterus, tubes, ovaries, bladder and urethra;
• decreased immunity;
• intrauterine infection of the fetus;
• the penetration of bacteria into the body of the child during childbirth.

Photo gallery: complications of the disease

Long-term jaundice indicates infection of the newborn Inflammation of the ovaries occurs when the microflora penetrates from the vagina The adhesive process is characterized by the growth of connective tissue and disrupts the processes of conception and fetal development.

How to protect yourself from developing the disease

Treatment of gardnerellosis requires a large amount of effort and money. That is why it is much easier to protect your body from the development of such a disease than to undergo a course of therapy. To this end, doctors have developed rules for individual prevention of the disease.

During my fourth year at the Medical University, I had the opportunity to do an internship at the Department of Gynecology in Serbia for several months. At this time, doctors were just conducting a study on the prevention of bacterial vaginosis by taking lactobacilli and dairy products. For the study, a group of patients was selected who throughout their lives in the winter season faced with garnerellosis and its unpleasant consequences. More than half of them had problems with immunity (often got sick, caught a cold). Throughout the autumn, doctors recommended that they take certain tablets with a high content of Latobacteria, and the women added dairy products (cheeses, sour cream, sourdough) to their diet, which they consumed several times every day. With the approach of cold weather, the doctors took the necessary tests from the patients - swabs from the vagina. In 95% of the studied patients, practically no gardnerella was observed in the material. Another 5% admitted that they did not always strictly follow the recommendations of doctors and consumed alcoholic beverages. Thanks to this technique, most of all the victims were able to forget about their disease forever.

Rules for individual prevention of gardnerellosis in women:

Gardnerellosis is called inflammatory disease, due to the active reproduction of gardnerella in the genitals. Women face this problem more often. Normally, these microorganisms are present in the natural microflora of the vagina in a minimum concentration. Under influence negative factors their number begins to increase rapidly, from which gardnerellosis develops in women.

The disease can manifest itself at any age. Therefore, it is important for every woman to understand where gardnerella comes from in women, to know the symptoms and rules of therapy.

Features of the disease and its causative agent

The natural microflora of the vagina includes a huge number of microorganisms. Most of them are beneficial lactobacilli. They allow you to maintain normal acidity of the environment, which prevents reproduction. pathogenic bacteria. There are about 95% of them. The rest is occupied by conditionally pathogenic microorganisms: Candida fungi, enterobacteria, cocci and others. The presence of gardnerella in a woman on the walls of the vagina in a minimal amount is also recognized as the norm. Its concentration is so low that it poses no threat.

Under the influence of some negative factors, dysbacteriosis may appear. It is accompanied by the rapid death of lactobacilli. As a result, the acidity of the environment decreases. This allows pathogenic microorganisms to actively multiply.

What is gardnerella modern science well known. In the photo taken with a microscope, it looks like a stick, the size of which does not exceed 1.5 microns. Only her appearance is known Gardnerella vaginalis. Bacteria belong to the group of anaerobic, that is, the presence of air is not necessary for their vital activity. At favorable conditions they multiply rapidly on the mucous surfaces of the organs of the genitourinary system.

Gardnerella vaginalis, in the course of its life, throws into environment ketabolites. These substances inhibit local immunity and contribute to the death of leukocytes. Due to this, microorganisms can penetrate into the deep layers of mucous surfaces.

Recent studies have shown that the development of gardnerellosis is influenced by mycoplasmas, peptostreptococci and other anaerobes. Therefore, the disease is considered a mixed infection and is often called bacterial vaginosis.

Key causes of the development of the disease

Gardnerellosis - dangerous for women's health disease. It is not enough to understand what it is, it is important to remember the main reasons for its development. Among them are:

• Sudden change in hormonal levels. Related to this is the fact that the problem often worries young girls who are at the stage of puberty, as well as women in menopause. Often the disease is diagnosed during pregnancy.
• Severe poisoning. Intoxication of the body provokes death beneficial microflora intestines and vagina, which causes dysbacteriosis. At the same time, harmful bacteria enter an environment comfortable for reproduction.
• Diabetes. The causes of gardnellosis lie in the increase in blood sugar levels. This helps to reduce the acidity of the vagina, which leads to the active reproduction of pathogenic microflora.
• Injuries of the organs of the reproductive system. This is possible with emergency situations, and surgical intervention or having an abortion.
• decline protective properties organism. The suppression of the immune system often occurs in stressful situations, infectious diseases, changing climatic conditions of residence, as well as long-term use some medicines.
• Violation of the rules of intimate hygiene. Insufficient toilet of the genital organs provokes an increase in the number of pathogenic microflora. It is especially important to prevent the spread of bacteria into the vagina from the intestines. For this, washing is carried out after each bowel movement. But excessive hygiene can lead to the development of pathology. Bacterial vaginosis is common in women who regularly douche or use harsh detergents.
• Intestinal dysbacteriosis. Pathogenic microflora from digestive system can easily move into the vagina. Therefore, it is important to treat all diseases of the gastrointestinal tract in a timely manner.

Wearing tight underwear made from synthetic fabrics can cause gardnerellosis in women. It creates Greenhouse effect around the genitals. Such an environment becomes comfortable for the life of microbes.

Theoretically, bacteria can live for some time on the surface of towels, washcloths, bedding and other personal items. But such an infection is extremely rare.

Characteristic symptoms

Symptoms of gardnerellosis in women do not always appear. About 50% of patients learn about their illness only after undergoing an examination by a gynecologist. Development inflammatory process takes about 20 days. During this time, pathogenic microorganisms have time to multiply to impressive numbers and begin to spread to the organs of the genitourinary system.

At an early stage of the disease, symptoms are mild. A woman feels only slight discomfort in the vagina. Later, other signs of a problem are found:

• There are unnatural secretions. Initially, they may have a slimy consistency. Their color is translucent whitish. As inflammation develops, the color of the vaginal secretion changes to gray. Chronic gardnerellosis accompanied by secretions of a rich yellow or green hue. After sexual intercourse, their volume increases several times. Basic distinctive feature such a secret becomes its repulsive fishy smell.
• Due to the accumulation of secretions during gardnerellosis, swelling and redness of the tissues may appear on the walls of the vagina.
• There are problems with the urinary system. Feeling while going to the toilet severe burning or itching.
• Sexual intercourse brings pain. Because of this, a woman wants to have sex less and less, her libido suffers significantly.
• Feeling of weakness, weakness, decreased performance.

With intensive reproduction of pathogenic microflora, an increase in body temperature is also possible. In such a situation, it is important for women to see a doctor as soon as possible and start treatment. Otherwise, serious complications may develop.

Diagnostic methods

Symptoms of gardnerellosis are easily confused with manifestations of other diseases. An accurate diagnosis can be made only after a complete medical examination. Doctors use the following diagnostic methods:

• Collection of anamnesis and examination of the genital organs. The specialist must determine whether external factors, which could give impetus to the development of the disease, as well as determine the presence of characteristic symptoms.
• Examination of a smear from the vagina under a microscope. Gardnerella under high magnification is clearly distinguishable.
• pH measurement. For this, special test strips are used. If the acidity of the medium is lowered, one can judge the dysbacteriosis of the vagina.
• The study of a smear from the genital organs using the polymerase chain reaction technique. This test allows you to detect the presence of bacteria and determine their concentration.
• Detection of the presence of isonitrile in biological material. It is this substance that is responsible for the appearance of an unpleasant fishy smell from the genitals.

Based on the results of the studies received, the doctor can develop a plan for how to treat the disease. The study of blood and urine samples also helps to determine the severity of the disease. If infection is suspected nearby organs pelvic ultrasound is prescribed.

Therapy

To maintain health, it is important to recognize the symptoms in women in time and begin treatment for gardnerellosis. If the disease is diagnosed at an early stage, then the duration of therapy is no more than 7 days. During this time, two main tasks need to be solved:

• Get rid of excess harmful bacteria.
• Restore the natural microflora of the vagina.

The main method of how to completely cure gardnerella is the use of medicines. At the same time, you need to adjust your lifestyle. It is important to refuse bad habits and direct all efforts to stimulate the immune system.

In respect of medical measures there must be a diet. Daily menu made up mainly of herbal products. Fatty and fried foods, smoked meats, marinades, convenience foods and fast food should be completely abandoned. The use of fermented milk products positively affects the restoration of microflora. Avoid high blood sugar levels by avoiding confectionery and all kinds of baked goods.

A week after the completion of the course of therapy, repeated tests are given. They will allow you to check how effective it turned out drug treatment. You will have to undergo another examination in a month to make sure that there is no relapse.

During pregnancy, getting rid of gardnerellosis is extremely difficult. It is forbidden for expectant mothers to use antibacterial drugs, and without them it is impossible to defeat bacteria. Therefore, in the process of delivery, pathogens can be easily transmitted to the child. Having appeared in the body, they do not manifest themselves in any way. For the development of the disease, exposure to adverse factors is necessary.

Pathogen elimination

Treatment of gardnerellosis in women is carried out with mandatory application antibacterial drugs. To choose the right medication, a test for the sensitivity of bacteria to medications is prescribed. The most commonly used medications are:

• Tinidazole. It helps to cope not only with gardnerella, but also with Trichomonas, which, against the background of vaginal dysbacteriosis, also begin to actively multiply.
• Metronidazole. strong antibiotic wide spectrum of action. Under its influence, the destruction of the DNA of pathogenic microorganisms occurs. Such a remedy is contraindicated in severe liver pathologies, as well as during childbearing and breastfeeding.
• Clindamycin. It belongs to the group of lincosamides. Produced in the form of tablets. Its use provokes the cessation of protein synthesis in gardnerella cells, which leads to the death of bacteria. The use of this medicine becomes one of the better ways how to get rid of pathogenic microflora.
• Macmirror. This drug belongs to the category of nitrofurans. Has a strong antibacterial effect. It has low toxicity and wide range actions.
• Metrovagin. Produced in the form of candles. In women, treatment with this remedy helps to quickly achieve positive result. This formulation will allow you to deliver active substance directly to the site of infection. Vaginal suppository injected once a day.
• Terzhinan. Combined drug with antibacterial and antifungal action. Produced in the form of candles.

How to treat gardnerellez you should be told by the specialist you are seeing. He will select the exact dosage and duration of the course. You will need to strictly follow all the doctor's instructions. Unauthorized replacement of drugs with analogues and interruption of the course is fraught with the development of dangerous complications.

Restoration of microflora

The treatment regimen for gardnerellosis involves taking funds that allow you to restore the natural balance of the vaginal microflora. For this purpose, the following drugs are used:

• Linex.
• Bifidumbacterin.
• Acylact.
• Lactobacterin.
• Duphalac.

Treatment of gardnerellosis with such medicines begins as soon as the woman has got rid of the causative agent of the disease and lasts at least two weeks. You can also supplement therapy with drugs that stimulate the immune system. These include Interferon, Wobenzym, Genferon.

Possible complications

Previously, doctors believed that gardnerella in women did not pose a health hazard. modern medicine thinks otherwise. Experts managed to determine an extensive list of what the disease is dangerous for. It can cause the following complications:

• Inflammatory processes in the pelvic organs. The infection spreads rapidly genitourinary system, involving large areas of tissues in the destructive process.
• Endometritis.
• urethral syndrome.
• Bartholinitis.
• Problems with conceiving a child up to irreversible infertility.

If the disease occurs during pregnancy, the risk of infection of the fetus increases. The baby may be born with a significant underweight or have congenital diseases. On early term exposure to pathogenic microflora can provoke a rupture of the amniotic membrane.

Treatment of gardnerella unpleasant process. It should be started when the first unpleasant symptoms appear. The woman will have to take medication and be constantly under the supervision of the attending physician. Observance of the elementary rules of prevention will help to avoid this: hygiene, fidelity to a permanent sexual partner, strengthening immunity, and giving up bad habits. And remember that after a course of therapy, you will not get rid of bacteria forever. A relapse can happen at any time.