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Genital bacterial infection. Bacterial Vaginosis: Symptoms, Causes, and Treatment Options

by alexxlab

What are the common symptoms of bacterial vaginosis. How is bacterial vaginosis diagnosed and treated. Can bacterial vaginosis increase the risk of other health complications. What preventive measures can help reduce the risk of developing bacterial vaginosis.

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Understanding Bacterial Vaginosis: A Common Vaginal Condition

Bacterial vaginosis (BV) is a prevalent vaginal infection that affects millions of women worldwide. It occurs when there’s an imbalance in the natural bacterial flora of the vagina, leading to an overgrowth of certain harmful bacteria. Despite its commonality, many women remain unaware of its symptoms, causes, and potential health risks.

BV is the most common vaginal condition in women aged 15-44, highlighting its significance in women’s health. While it’s not classified as a sexually transmitted disease (STD), sexual activity can increase the risk of developing BV. Understanding this condition is crucial for maintaining optimal vaginal health and preventing potential complications.

Recognizing the Symptoms of Bacterial Vaginosis

Identifying BV can be challenging, as many women experience no symptoms at all. However, when symptoms do occur, they can be quite distinctive. What are the telltale signs of bacterial vaginosis?

  • A thin, white or gray vaginal discharge
  • A strong, fishy odor, particularly noticeable after sexual intercourse
  • Burning sensation during urination
  • Itching or irritation around the vaginal area
  • Pain or discomfort during sexual intercourse

It’s important to note that these symptoms can mimic other vaginal infections, such as yeast infections. However, BV typically doesn’t cause the thick, white, odorless discharge characteristic of yeast infections. If you experience any of these symptoms, it’s advisable to consult a healthcare provider for an accurate diagnosis.

The Causes and Risk Factors of Bacterial Vaginosis

While the exact cause of BV remains unclear, researchers have identified several factors that can disrupt the vaginal bacterial balance and increase the risk of developing this condition. What contributes to the development of bacterial vaginosis?

  • Sexual activity, especially with new or multiple partners
  • Douching or excessive vaginal cleaning
  • Use of scented hygiene products in the vaginal area
  • Hormonal changes, such as those during menstruation or pregnancy
  • Smoking
  • Lack of lactobacilli, the “good” bacteria in the vagina

It’s worth noting that BV rarely affects women who have never had sexual intercourse. However, it’s not considered a sexually transmitted infection in the traditional sense. The condition results from an imbalance between beneficial and harmful bacteria in the vagina, rather than the introduction of a specific pathogen.

Diagnosing Bacterial Vaginosis: What to Expect

Proper diagnosis of BV is crucial for effective treatment. How do healthcare providers diagnose bacterial vaginosis? The process typically involves a combination of methods:

  1. Physical examination: The healthcare provider will examine the vagina for signs of discharge or inflammation.
  2. pH testing: BV often raises the vaginal pH above 4.5.
  3. Microscopic examination: A sample of vaginal fluid is examined under a microscope for the presence of “clue cells,” which are indicative of BV.
  4. Whiff test: Adding potassium hydroxide to a sample of vaginal discharge produces a strong fishy odor in the presence of BV.

These diagnostic methods help differentiate BV from other vaginal infections, ensuring that the appropriate treatment is prescribed. If you suspect you may have BV, it’s important to seek medical attention rather than attempting self-diagnosis or treatment.

Treatment Options for Bacterial Vaginosis

Once diagnosed, BV is typically treated with antibiotics. What are the common treatment approaches for bacterial vaginosis?

  • Metronidazole: Available as an oral tablet or vaginal gel
  • Clindamycin: Prescribed as a vaginal cream
  • Tinidazole: An oral antibiotic similar to metronidazole

The course of treatment usually lasts between 5 to 7 days. It’s crucial to complete the entire course of antibiotics, even if symptoms improve before finishing the medication. This helps prevent the recurrence of BV and the development of antibiotic-resistant bacteria.

Can probiotics help in treating bacterial vaginosis? While not a replacement for antibiotics, some studies suggest that probiotics containing Lactobacillus species may help restore the natural bacterial balance in the vagina and reduce the risk of BV recurrence. However, more research is needed to confirm their effectiveness.

Potential Complications of Untreated Bacterial Vaginosis

While BV often resolves on its own, leaving it untreated can lead to several health complications. What are the risks associated with untreated bacterial vaginosis?

  • Increased susceptibility to sexually transmitted infections, including HIV
  • Higher risk of pelvic inflammatory disease (PID)
  • Complications during pregnancy, such as premature birth or low birth weight
  • Increased risk of post-surgical infections, particularly after gynecologic procedures

For pregnant women, the implications of untreated BV can be particularly serious. The condition has been associated with an increased risk of miscarriage, preterm labor, and premature rupture of membranes. Therefore, prompt diagnosis and treatment of BV during pregnancy is crucial for both maternal and fetal health.

Preventing Bacterial Vaginosis: Strategies for Maintaining Vaginal Health

While it’s not always possible to prevent BV, several measures can help reduce the risk of developing this condition. How can you lower your chances of getting bacterial vaginosis?

  • Practice safe sex: Use condoms consistently and correctly
  • Limit sexual partners: Having multiple sexual partners increases the risk of BV
  • Avoid douching: This practice can disrupt the natural bacterial balance in the vagina
  • Use unscented hygiene products: Fragranced soaps and feminine hygiene products can irritate the vaginal area
  • Wear breathable underwear: Cotton underwear allows for better air circulation
  • Maintain a healthy diet: A balanced diet rich in probiotics may help maintain vaginal health

It’s important to remember that while these measures can help reduce the risk of BV, they don’t guarantee prevention. Regular gynecological check-ups and open communication with your healthcare provider about any unusual symptoms are key to maintaining optimal vaginal health.

The Relationship Between Bacterial Vaginosis and Sexual Health

While BV is not classified as a sexually transmitted infection, it’s closely linked to sexual activity. How does bacterial vaginosis impact sexual health?

  • Increased susceptibility to STIs: BV can make the vaginal environment more susceptible to other infections
  • Transmission between female sexual partners: BV can spread between women who have sex with women
  • Impact on fertility: Recurrent BV may affect fertility by altering the vaginal microbiome
  • Sexual discomfort: The symptoms of BV can cause discomfort during sexual intercourse

It’s important to note that male sexual partners of women with BV typically don’t require treatment. However, the condition can recur even after successful treatment, particularly if sexual practices that may disrupt vaginal flora continue.

Do condoms protect against bacterial vaginosis? While condoms can’t entirely prevent BV, consistent and correct use can help reduce the risk of developing the condition. Condoms act as a barrier, limiting the exchange of bacteria during sexual activity.

The Role of Probiotics in Managing Bacterial Vaginosis

Recent research has shown growing interest in the use of probiotics for preventing and managing BV. How can probiotics potentially help with bacterial vaginosis?

  • Restoring vaginal flora: Probiotics can help replenish beneficial bacteria in the vagina
  • Reducing recurrence: Some studies suggest probiotics may lower the risk of BV recurrence
  • Complementing antibiotic treatment: Probiotics may enhance the effectiveness of antibiotic therapy

While promising, it’s important to note that more research is needed to definitively establish the role of probiotics in BV management. Always consult with a healthcare provider before starting any new supplement regimen.

Bacterial Vaginosis and Pregnancy: Special Considerations

Pregnant women with BV require special attention due to the potential risks associated with the condition. What are the implications of bacterial vaginosis during pregnancy?

  • Increased risk of preterm birth
  • Higher likelihood of low birth weight babies
  • Potential for premature rupture of membranes
  • Increased susceptibility to postpartum endometritis

Given these risks, healthcare providers often recommend screening for BV in pregnant women, especially those with a history of preterm birth. Treatment during pregnancy typically involves antibiotics that are safe for both mother and fetus.

Recurrent Bacterial Vaginosis: Causes and Management

Some women experience recurrent episodes of BV, which can be frustrating and concerning. What factors contribute to recurrent bacterial vaginosis?

  • Incomplete eradication of BV-associated bacteria
  • Persistent disruption of vaginal flora
  • Genetic factors influencing vaginal microbiome composition
  • Hormonal fluctuations

Managing recurrent BV often involves a combination of strategies, including extended antibiotic therapy, use of boric acid suppositories, and lifestyle modifications. In some cases, suppressive antibiotic therapy may be recommended to prevent recurrence.

The Impact of Bacterial Vaginosis on Quality of Life

Beyond its physical symptoms, BV can significantly impact a woman’s quality of life. How does bacterial vaginosis affect daily life and well-being?

  • Emotional distress: Symptoms like odor can cause embarrassment and anxiety
  • Sexual relationship challenges: BV can interfere with sexual intimacy
  • Self-esteem issues: Recurrent infections may affect body image and confidence
  • Healthcare burden: Frequent medical visits and treatments can be time-consuming and costly

Addressing the psychological impact of BV is an important aspect of comprehensive care. Healthcare providers should be sensitive to these issues and provide appropriate support and resources.

Emerging Research in Bacterial Vaginosis

The field of BV research is continually evolving, with new insights emerging regularly. What are some of the latest developments in bacterial vaginosis research?

  • Exploration of novel treatment approaches, including bacteriophage therapy
  • Investigation of the role of biofilms in BV persistence and recurrence
  • Development of rapid diagnostic tests for more accurate and timely diagnosis
  • Studies on the interaction between BV and the broader vaginal microbiome

These research directions hold promise for improving our understanding of BV and developing more effective prevention and treatment strategies in the future.

In conclusion, bacterial vaginosis is a complex and common vaginal condition that requires attention and proper management. By understanding its symptoms, causes, and treatment options, women can take proactive steps to maintain their vaginal health and overall well-being. Regular check-ups, open communication with healthcare providers, and adherence to preventive measures are key to managing and preventing BV. As research in this field continues to advance, we can look forward to improved diagnostic tools and treatment options, ultimately enhancing women’s reproductive health worldwide.

STD Facts – Bacterial Vaginosis

Bacterial vaginosis is a common, treatable, vaginal condition. BV can increase your chance of getting a sexually transmitted disease (STD). This fact sheet answers general questions about BV.

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV) is a condition that happens when there is too much of certain bacteria in the vagina. This changes the normal balance of bacteria in the vagina.

How common is BV?

BV is the most common vaginal condition in women ages 15-44.

How is BV spread?

Researchers do not know the cause of BV. However, we do know the condition most often occurs in those who are sexually active. BV is a result of an imbalance of “good” and “harmful” bacteria in a vagina. Douching, not using condoms, and having new or multiple sex partners can upset the normal balance of vaginal bacteria, increasing your risk for getting BV.

We also do not know how sex causes BV. There also is no research to show that treating a sex partner affects whether someone gets BV. Having BV can increase your chances of getting other STDs.

BV rarely affects those who have never had sex.

You cannot get BV from toilet seats, bedding, or swimming pools.

How can I avoid getting BV?

Healthcare providers and scientists do not completely understand how BV spreads or know how best to prevent it.

The following basic prevention steps may help lower your risk of getting BV:

  • Not having sex;
  • Limiting your number of sex partners;
  • Not douching; and
  • Using condoms the right way every time you have sex.

I’m pregnant. How does BV affect my baby?

Treating BV during pregnancy is very important. If you are pregnant and have BV, your baby is more likely to be born early (premature) or at a low birth weight. Low birth weight means having a baby that weighs less than 5.5 pounds at birth.

How do I know if I have BV?

Many people with BV do not have symptoms. If you do have symptoms, you may notice:

  • A thin white or gray vaginal discharge;
  • Pain, itching, or burning in the vagina;
  • A strong fish-like odor, especially after sex;
  • Burning when peeing; and
  • Itching around the outside of the vagina.

How will my healthcare provider know if I have BV?

A healthcare provider will examine your vagina for signs of discharge. They also can test a sample of vaginal fluid to determine if BV is present.

Is there a cure for BV?

A healthcare provider can treat BV with antibiotics. If you have symptoms, you should be checked and treated by a healthcare provider. It is important to take all the medicine your provider prescribes, even if your symptoms go away. Treatment also may reduce the risk for getting other STDs. BV can return even after treatment.

Male sex partners of women with BV do not need treatment. However, BV can spread between female sex partners.

What happens if I don’t receive treatment?

At times, BV will go away without treatment. However, treatment can help avoid the increased chance of some serious health risks associated with BV, including:

  • Getting or transmitting HIV;
  • Delivering your baby too early if you have BV while pregnant; and
  • Getting other STDs like chlamydia and gonorrhea. These bacteria can cause pelvic inflammatory disease (PID), which can make it difficult for you to have children.

Sources

Workowski, KA, Bachmann, LH, Chang, PA, et. al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70(No. 4): 1-187.

Hillier S and Holmes K. Bacterial vaginosis. In: K. Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, 563-586.

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Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications

Written by WebMD Editorial Contributors

Medically Reviewed by Nivin Todd, MD on November 06, 2022

  • What Is Bacterial Vaginosis?
  • Bacterial Vaginosis Symptoms
  • When to See a Doctor About BV
  • Bacterial Vaginosis Causes
  • Bacterial Vaginosis Risk Factors
  • Bacterial Vaginosis Diagnosis
  • Bacterial Vaginosis Treatment
  • Bacterial Vaginosis Complications
  • Bacterial Vaginosis Prevention
  • More

Bacterial vaginosis (BV) is an infection of the vagina. It results from a change in the normal balance of vaginal bacteria.

BV usually doesn’t cause any other health problems. But it can lead to issues, especially when you’re pregnant or trying to get pregnant.

 

About half of the time, women with BV have no symptoms. But they can include:

  • Burning feeling when you pee

  • Fishy smell that gets stronger after sex

  • Itching

  • Thin white, gray, or green discharge

It isn’t the same as a yeast infection. Those often have a thick white discharge that doesn’t smell.

Because BV symptoms can look like those from other infections, it’s important to find out the cause. See your doctor if you:

  • Have a new vaginal discharge along with a smell or a fever

  • Have more than one intimate partner or a new partner (You might need to be checked for a sexually transmitted disease. )

  • Used an over-the-counter medicine for a yeast infection but still have symptoms

A type of bacteria called lactobacillus keeps your vagina slightly acidic so bad bacteria don’t grow well. If your lactobacillus levels drop, more bad bacteria move in, and you get BV.

Any woman can get BV, but your risks are higher if you:

  • Smoke

  • Are sexually active

  • Douche

Douching upsets the natural balance of bacteria. So can scented soaps, bubble baths, and vaginal deodorants.

A new sex partner, or having more than one, makes it more likely that you’ll get BV. It isn’t clear why, but women who have female partners are most at risk. You can get BV from oral and anal sex.

The IUD birth control device, which fits inside your uterus, has been linked to BV, especially if you have irregular bleeding. But it isn’t clear whether it’s a direct cause.

You can’t get vaginal infections like BV from swimming pools or public toilet seats.

The doctor will:

  • Ask about your medical history

  • Do an overall physical exam

  • Do a pelvic exam

  • Check your vagina’s pH or acidity level

  • Take a sample of discharge from your vagina to look for cells covered with bacteria

The doctor can prescribe antibiotics (metronidazole, clindamycin, tinidazole) to treat BV. This could be a tablet you take by mouth or a cream or gel you put into your vagina. You’ll need to take most treatments for 5 to 7 days. Finish all your medicine, even if the symptoms go away. If you stop early, the infection could come back.

Since BV can be spread through sex, don’t have sexual contact until you’re done taking your medicine and your symptoms are gone. If your partner is another woman, they may want to see their doctor to find out if they need treatment.

Even after BV is treated and goes away, it often returns. If that happens, you’ll probably need to take antibiotics again for a longer time.

If you use an IUD and BV keeps coming back (recurrent BV), you may want to talk to your doctor about a different type of birth control.

Bacterial vaginosis has been tied to a higher risk of other health problems, including:

  • A bacterial infection, if you have a hysterectomy or other surgery on your female organs while you have BV

  • A premature or low birth weight baby

  • A sexually transmitted disease like herpes, chlamydia, or gonorrhea, or passing HIV to your partner

  • Less success with fertility treatments like in vitro fertilization (IVF)

  • Pelvic inflammatory disease (PID), an infection of your uterus, fallopian tubes, and ovaries

To lower your chances of getting BV, take these steps:

  • Clean sex toys after every use.

  • Don’t douche.

  • Get tested for sexually transmitted diseases, and make sure your sex partners are tested.

  • Limit your number of sex partners.

  • If your partner is male, put a condom on their penis before it touches your vagina, mouth, or anus.

  • Use only water or mild soap to wash your genitals.

  • Wipe from front to back after you use the bathroom.

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Urogenital infections: Symptoms, Diagnosis and Treatment

Attention!

The information in the article is for reference only and cannot be used for self-diagnosis and self-treatment.
If you have symptoms of the disease, contact your doctor.

Content:

  • Classification of diseases
  • Causes of
  • Symptoms
  • Sequelae if left untreated
  • Diagnostics
  • Treatment

Infectious and inflammatory diseases of bacterial, fungal and viral origin that affect the genitourinary system are now the most widespread in the human population. Approximately half of the patients endure it at least once during their lives. When symptoms appear, do not postpone a visit to the doctor. Further progression of the pathological process leads to complications.

Women are treated by gynecologist

Urogenital infections are a group of pathologies grouped according to the type of localization of the focus of inflammation. This series includes bacterial, fungal and viral lesions, leading to inflammatory changes in tissues in the organs of the urinary tract.

Pathogens cause diseases with a wide range of clinical manifestations. This group, along with pathologies that are sexually transmitted, includes numerous opportunistic infections.

In the complex of urological diseases in patients, they are registered much more often. Urogenital pathologies often recur. Over time, a chronic course of the infectious process is formed, which leads to the development of severe complications.

Infection of the urogenital tract is more common in women. This is explained by the special structure of their genitourinary system. Their urethra differs in that it is wider and shorter than in men.

The causative agent penetrates more easily into the urethra and then into the bladder. Women develop urethritis and cystitis. The proximity of the anus to the vagina and urethra also predisposes to this. The infection penetrates into the lumen of the urethra from the anus or vagina during intercourse.

Classification of diseases

Urogenital infections in women are classified according to the anatomical level of the lesion, the severity of the course. The presence of concomitant risk factors, microbiological data is important. The following levels of damage are distinguished:

  • cystitis;
  • urethritis;
  • pyelonephritis;
  • urosepsis.

According to the severity of the course, mild, moderate and severe diseases are distinguished. They are complicated by a violation of the outflow of urine and uncomplicated. According to the type of pathogen leading to inflammation in the urinary tract, urogenital diseases are divided into sexually transmitted infections. These include the following microorganisms:

  • gonorrhea;
  • chlamydia;
  • trichomoniasis;
  • syphilis;
  • genital herpes;
  • mycoplasmas.

There are also those pathologies where the causative agent of inflammation is opportunistic flora. These microorganisms are found in healthy people. When certain conditions develop, they cause inflammation. This group includes: staphylococci, Escherichia coli, Klebsiella, Enterococcus and other microorganisms.

The most common species

Many pathogens are now known to cause inflammation in the genitourinary tract. The most commonly diagnosed urogenital infections include:

  • Genital herpes . This is a viral pathology that is transmitted mainly through sexual intercourse. The characteristic external signs of the disease are the appearance of vesicles and ulcerations on the skin and mucous membranes of the reproductive organs.
  • Mycoplasmosis . This bacterial infection affects the tissues of the urethra, external and internal genital organs.
  • Gonorrhea . It refers to diseases that are transmitted through sexual intercourse. Inflammation caused by gonococci causes ectopic pregnancy and infertility.
  • Chlamydia . This pathology of a bacterial nature affects the tissues of the external and internal genital organs. Inflammation occurs in the mucous membranes of the urinary tract. Developing, pathology causes a variety of complications. Possible inflammation in the pelvic organs and arthritis.
  • Candidiasis . The disease belongs to the group of mycoses that cause yeast-like fungi. Candida is part of the normal microflora of the genitourinary organs. Fungi infect tissues under the influence of adverse factors. The most dangerous is the generalized form of the disease. It occurs when the immune system malfunctions.

Urogenital infections often develop in immunocompromised patients. Their source is conditionally pathogenic microflora. Among the causative agents of nonspecific infections, the tissues of the urogenital tract are most often affected: Escherichia coli, staphylococcus saprophytic, Proteus, Klebsiella.

Causes of

Inflammatory changes are caused by viruses, fungi and bacteria. They enter the urogenital tract in the following ways:

  • Unprotected intercourse. During sexual contact, pathogens are transmitted from one partner to another. The probability of infection is determined by the pathogenicity of the causative agent of the disease, the activity of the immune system in the patient. Its ability is also affected by the condition of the mucous membranes.
  • Household transmission. The source of pathogenic microorganisms is any hygiene item (toothbrush, towel, razor). Many pathogens are long-term viable in the external environment.
  • Hematogenous route of transmission. Microorganisms from the focus of chronic infection in the body are released into the bloodstream. Then they enter the organs of the genitourinary tract.
  • Self-transfer. The patient himself transfers the pathogen from one zone to another. Infection of one’s own genitals occurs with herpetic eruptions on the skin.
  • Infection during medical procedures. This happens if manipulations in this area are accompanied by damage to the skin and mucous membranes.

    • Predisposes to infection of the genitals decreased activity of the immune system. Another predisposing factors are considered: hypothermia, SARS, alcohol abuse.

    Symptoms

    The duration of the incubation period varies from a couple of days to six months. The first to change is the appearance of the genitals. There is reddening of the skin. Vesicles, sores and other formations appear. The characteristic symptoms of lesions of the urogenital tract are the following:

    • rise in body temperature;
    • swelling and redness of the skin in the affected area;
    • painful urination;
    • cloudy discharge from the urethra;
    • urine has an unpleasant odor;
    • weakness;
    • pain in joints and muscles;
    • dizziness;
    • frequent urge to urinate;
    • feeling of incomplete emptying of the bladder;
    • pain in the lower abdomen and lower back;
    • tingling sensation;
    • itching in the genital area and urethra;
    • admixture of blood in the urine.

    There is a hidden form of urogenital infections. They are detected only during a screening examination.

    Sequelae if left untreated

    If the infection is left untreated, there are serious complications of STDs for women’s reproductive health. They lead to the development of inflammatory diseases in the pelvic organ.

    The infection causes infertility in women and ectopic pregnancies, which poses a threat to their lives. In chronic forms of STDs, the central nervous system, bones, brain, respiratory organs, intestines, cardiovascular and endocrine systems are affected. Possible development of cancer.

    Diagnostics

    For any genitourinary tract problems, first take the history of the disease and examine the patient. Then, to clarify the diagnosis, the following additional examinations are prescribed:

    • Urinalysis, Nechiporenko study. This testing is done to detect inflammation in the urinary organs.
    • Blood test. It is carried out to assess the level of inflammatory changes in the body.
    • Urethral swab. After taking the material, a microscopic examination is performed to identify the pathogen.
    • Urine culture tank. It is carried out to determine the sensitivity of the pathogen to antibiotics.
    • Serum creatinine and urea. These studies are prescribed to evaluate the work of the kidneys.
    • Intravenous urography. She evaluates the excretory function.
    • Ultrasound of the bladder and kidneys. It is produced to study the structure of tissues. Detect the presence of foci of inflammation.
    • CT scan of the pelvis. With its help, the condition of the pelvic organs and lymph nodes, blood vessels is assessed. It helps to identify foci of inflammation.

    In addition, cystoscopy is prescribed. This is an endoscopic examination that helps to examine the inside of the bladder.

    Treatment

    The volume of therapy is determined by the level of the lesion and the nature of the pathogen. Treatment is complex. The main directions and genitourinary infections are considered: reorganization of the pathogen, immune therapy, relief of individual manifestations of the disease.

    The choice of antimicrobial agent is determined by the type of pathogen that caused the inflammatory process. With mixed infections, several etiotropic drugs from different groups are prescribed – antibiotics, antifungal and antiviral.

    In addition, analgesics, antispasmodics, vascular and other symptomatic drugs are prescribed. Another important component of therapy is the correction of the body’s immune status. They increase the effectiveness of etiotropic agents and prevent the transition of the disease into a chronic form.

    The immune response to the infection is activated, the risk of the negative effects of antibiotics is reduced. With the development of a severe purulent complication, patients undergo surgery to eliminate the focus of inflammation.

    It is not worth treating these illnesses on your own. It is necessary to contact a gynecologist at the “Health” medical center and follow his appointments.

    References:

    • Rodionov A.N. Handbook of skin and venereal diseases. St. Petersburg, 2005, 464 p.
    • Akovbyan, V.A. Rational therapy of sexually transmitted infections: basic principles and reality / V.A. Akovbyan, V.G. Nesterenko // Clinical dermatology and venereology. 2005. – No. 4. – P. 151-155.
    • Gomberg, M.A. Sexually transmitted infections: a review. inform. / M.A. Gomberg, A.M. Solovyov. 2003. – No. 2. – S. 10.
    • Kosova, I.V. The role of urogenital infections in the etiology of cystitis and non-obstructive pyelonephritis in women: dis. cand. honey. Sciences / I.V. Kosovo. M., 2005, – 118 p.

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