“Bad smear”: how to understand when the microflora is out of control and requires treatment

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Opportunistic pathogens: what are they?

To begin with, let’s figure out what the term “opportunistic flora” means. A pathogen is a microorganism or foreign protein that can cause disease. The phrase “conditionally pathogenic” means that this protein can cause disease only under certain conditions – for example, if the pathogen enters another environment: from the intestine to the vagina or when the acid-base balance of the environment changes, bacteria or fungi begin to multiply intensively. Conditionally pathogenic flora is in all people. Only good bacteria cannot be present on the skin and mucous membranes. The balance between good microorganisms and pathogens is dynamic: today the result is one, and tomorrow it may be different. In gynecology, we often encounter such conditionally pathogenic microorganisms as E. coli, staphylococcus aureus, gardnerella, fungi (candida), mycoplasma: ureaplasma parvum, ureaplasma urealiticum, mycoplasma hominis.

Treatment of opportunistic flora only “according to analyzes” is not carried out. It is necessary to treat the conditionally pathogenic microflora, which has multiplied, got out of control and caused an inflammatory process.

According to some reports, opportunistic microflora is found in the genitourinary tract in 75-80% of healthy women. However, only those who are carriers of ureaplasma, gardnerella or candida are accompanied by symptoms and complaints (abnormal discharge from the genital tract, itching, burning, pain during urination, discomfort or pain in the lower abdomen), and in the case when all other most likely causative agents of the inflammatory process are excluded (for example, chlamydia, trichomonas, gonorrhea, mycoplasma genitalium).

Thus, the decision on the appropriateness of treatment is made individually in each case, taking into account the data of the examination, the examination, a carefully collected anamnesis and analysis of the patient’s complaints.

Where do opportunistic pathogens appear in tests?

Obstetrician-gynecologist Alena Mintz (@alena.mintz) often raises this topic on her Instagram account. As a rule, after she was once again bombarded with questions about what to do with a “bad” smear. That’s what she tries to convey to subscribers over and over again.

Where do opportunistic pathogens appear in tests? ⠀ From the formation of comfortable conditions for them, and not because of contact with a partner and infection. After all, conditional pathogens are also living beings. Is there a comfortable environment? This is where they breed. ⠀

What causes bacteria to multiply:

  • douching (don’t do them!); ⠀
  • past illnesses, when the body as a whole is weak and needs to be restored. Particularly affected by the use of antibiotics; ⠀
  • hormonal changes during pregnancy; ⠀
  • non-observance of hygiene rules; ⠀
  • non-compliance with the diet; ⠀
  • use of spermicides (contraceptive suppositories). ⠀ Not every bad smear is treated. Maybe you need to retake the test because the swab was taken incorrectly. Or you were sick and have not yet recovered. Treat the root cause and obvious complaints that will not pass you by.

Is it necessary to treat the microflora of pregnant women

It turns out that it is not necessary to treat conditionally pathogenic flora at all?

⠀ Not really. There are cases when treatment is still applied. But when does it happen? Only in the presence of manifestations and complaints from the patient! For example, if a candida is found, but the discharge is normal and there is no itching, then this does not mean thrush. If there are manifestations, of course, the patient is treated. The same is true for other opportunistic pathogens. ⠀

And what should pregnant women do, is it necessary to determine the flora and be treated?

If pathogens are found in the expectant mother, but there are no complaints and symptoms, then they do not need to be treated. The opportunistic sphere is not the cause of problems with the fetus and pregnancy, miscarriages, etc. However, at the 36-37th week of pregnancy, you need to take a bacteriological test for group B streptococcus. During childbirth, it can be dangerous for the baby, but only during childbirth. During pregnancy, the baby is safe.

The subject of bakposev is extensive, this analysis is justified in the presence of complaints and the search for other pathogens that are not conditionally pathogenic (gonorrhea, Trichomonas).

Photo: Pexels.com

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