Colpitis in pregnancy: what is it and what to treat?

Inflammatory disease of the mucous membrane of the vagina, accompanied by a noticeable discomfort in the external genital area, is called colpitis or vaginitis. Inflammation often extends to the vaginal part of the cervix or vestibule (vulvovaginitis). Nevertheless, many people have never heard of him. So what is colpitis in women with pregnancy?

This is a fairly common disease of the female genital area, caused by pathogenic or conditionally pathogenic microorganisms. With colpitis, almost every woman came across her during her life, and just a few - it was during pregnancy, because the body of a future mother is partially losing the ability to resist infection.

The next question: what to do? Is colpitis dangerous during pregnancy? It is necessary to listen to the recommendations of the attending physician. The disease is accompanied not only by considerable discomfort, but can have a negative effect on the outcome of pregnancy. The danger is not so much colpitis, as the absence of his treatment.

[1], [2],

Causes of the colpitis in pregnancy

Pregnancy in itself is a predisposing condition for the development of pathogenic microorganisms. Physiological immunosuppression and decreased vaginal acidity under the influence of sex hormones are specific for this period, the causes of colpitis. Against this background, any microorganism begins to multiply almost unhindered. And there are a lot of them-gonococci, trichomonads, chlamydia, staphylococci and other microorganisms inhabiting the vaginal mucosa. The alkalinization of the vaginal environment favors the violation of its microbiocenosis and the development of candidiasis, gardnerellez, whole microbial associations.

To this are added risk factors for inflammation of the vagina, not related to pregnancy:

• damage to the integrity of the mucous membrane of the vagina - mechanical (tight underwear, jeans), chemical, thermal or a combination of them;
• dysbacteriosis of the vagina due to prolonged antibacterial therapy or adherence to douching as a hygienic procedure;
• promiscuous sex life;
• sensitization to intimate hygiene or intravaginal medicines;
• neglect of the rules of intimate hygiene;
• diseases of the endocrine system, autoimmune pathologies;
• dystrophy of the vaginal mucosa
• anatomical abnormalities;
• prevalence in the diet of spicy foods, fast carbohydrates (flour, sweet);
• the transferred diseases, an unfavorable ecological situation.

[3], [4],

Pathogenesis

Specific colpitis develops, mainly, when invading pathogenic microorganisms during coition. After their introduction, the mucous membrane of the vagina becomes inflamed - the examination reveals swelling, hyperemia, bleeding at an incautious touch.

The mechanism of development of nonspecific colpitis: serous → mucous → purulent catarrh.

In addition, inflammation can be primary when its development occurs as a result of infection of the vaginal mucosa, or secondary - descending from the uterus or ascending from the vulva.

Against the background of pregnancy and other factors mentioned above, which increase the likelihood of the development of inflammatory phenomena on the vaginal mucous membrane, pathogenic microorganisms become active and begin to multiply actively. Sex glands begin to actively produce a vaginal secret in order to remove the waste products of microorganisms. This is the reason for the secretion of abundant secretions, in which both the culprits of inflammation and the products of their metabolism are found. There is another symptomatology, corresponding to the form of colpitis.

The disease occurs in acute, subacute and chronic form. During pregnancy, an infection that has been latent can become aggravated. The diagnosis of colpitis means that the inflammation is limited by the vagina.

Statistics of morbidity states that in future mummies colpitis is diagnosed quite rarely - more than ¾ of pregnant women suffered this disease. Correlation between the period of pregnancy and the probability of getting sick is not traced. This is possible at any time, but the most dangerous is acute colpitis or exacerbation of chronic in recent months, especially before childbirth.

Studies of the etiology of the disease indicate that in almost 80% of cases of colpitis two or more microorganisms are sown, with representatives of conditionally pathogenic flora prevailing among them. Moreover, aerobes, absorbing oxygen, create favorable conditions for the reproduction of anaerobes. Thus, practically all microorganisms, except lacto- and bifidobacteria, can take part in the development of inflammation of the vaginal mucosa.

[5], [6], [7], [8], [9]

Symptoms of the colpitis in pregnancy

The first signs that draw attention to themselves are the emissions that pollute the underwear and cause uncomfortable sensations. They are quite abundant, the color and smell depends on the type of pathogen. Getting on the genitals, cause their irritation - itching, swelling, flushing. The genitals cheshutsya outside and inside, in addition, patients often complain of pain, burning and rubbing during the emptying of the bladder, discomfort during intercourse. The mucous membrane is covered with a grayish coating, which when removed reveals a bleeding surface. Over time, the epithelium of the vagina is covered with bright red spots or tubercles. Women complain of pain in the lower abdomen, giving in the lower back. In general, the symptomatology of pregnant and non-pregnant women is no different.

Acute colpitis begins suddenly and is characterized by severe symptoms, sometimes a woman can get body temperature, which is accompanied by common signs of intoxication. In the absence of treatment, the symptoms become less pronounced, the condition improves, the amount of secretions decreases and the disease becomes chronic. During examination, widespread dilations of blood vessels or their foci are detected. The vaginal epithelial surface undergoes significant changes due to degenerative processes and may be absent in some areas, visually it looks as if pus oozes directly from the rough and densified walls. Chronic colpitis occurs with periodic exacerbations, which can be caused even by a change in diet.

Types of colpitis differ depending on the pathogen. The most common are inflammatory processes caused by:

1. Nonspecific pathogens (E. Coli, staphylococci, streptococci and other bacteria, in small amounts present in the microbiocenosis of the vagina or getting there from the anus and with normal acidity and immunity without the ability to develop). This inflammation occurs most often. Colpitis in the early stages of pregnancy belongs, in essence, to this species. It shows mild secretions without an odor, the color of which varies from transparent-whitish to brownish, with weak itching. Long-term non-specific colpitis during pregnancy can cause a feeling of heaviness, sometimes heat, in the lower abdomen, giving back.
2. Fungi of the genus Candida - the reason for their distribution is similar to the previous one, as well as the frequency of occurrence. Candida, yeast colpitis during pregnancy is accompanied by white dense secretions of the consistency of slightly wrung cottage cheese. Cottage cheese pieces are collected in the folds of the external genital organs, causing severe itching, irritating the epithelium, which is manifested by swelling and redness. Characterized by a sharp sour smell of discharge, emptying the bladder can be accompanied by burning or cutting.
3. Bacterial vaginosis (gardnerellez) - allocation abundant, grayish-white, viscous, with the smell of foul fish, sometimes foam. Virtually do not cause itching, pain over the pubis occur in neglected cases.
4. Trichomonas colpitis during pregnancy is also not uncommon. This is a fairly common venereal parasitic infection. Sent by sexual contact. Vaginal secret - abundant, foaming, yellowish-gray or greenish in color, with an unpleasant odor. Itching from mild to severe, burning during the emptying of the bladder is also possible.
5. Gonorrheal colpitis - liquid copious purulent discharge without odor, emptying of the bladder is accompanied by cuts, there is a pain over the pubis. External genitalia are itchy not much, sometimes itching may be absent. Often there are periodic bleeding (bleeding) and pain above the pubic area, pressure in the lower abdomen. The acute form of the disease is accompanied by severe symptoms, pain and fever, swelling and hyperemia of the external genitalia. Gonorrhea in women is often asymptomatic, so during pregnancy, the symptoms of the disease can not be bothered too much. However, gonorrhea colpitis in a pregnant woman can have the most unpleasant consequences for her and the baby.

Colpitis in most cases is caused by microbial associations, so the symptoms are mixed, for example, the discharge may have a curdiness and a gray-green color, since fungi develop well against the background of colonization by the pathogenic flora. Trichomonads perfectly coexist with gonococci and this symbiosis leads to difficult diagnosis and unpleasant consequences. Therefore, when there is a discharge of any kind and consistency, itching or moderate tolerable pain in the lower abdomen of a pregnant woman, it is imperative to inform your gynecologist about it.

Sanitized colpitis during pregnancy is perhaps the most dangerous. This is an inflammation that was not treated in due time and proceeds in a latent form without expressed symptoms. It can be detected only when passing the smear, and this procedure is carried out twice for pregnant women. If a leukocytosis is found in the smear, a small number of Dodderlyna sticks, cocci flora, E. Coli, and specific pathogens are necessary, without refusing to be treated, despite the absence of symptoms, since colpitis during childbirth, aggravated in the last days of gestation, can infect a child at the time of passage by birth.

[10], [11]

Complications and consequences

Pregnant women should not ignore the symptoms of colpitis, since the consequences of such an irresponsible attitude can be dangerous for the future mother and her unborn child.

First, it is necessary to take into account the ability of pathogens to ascendant infection. In the absence of treatment, they migrate with a current of blood and lymph, into the uterus and appendages, the urinary organs, colonizing all the larger spaces and causing an inflammatory process.

Secondly, much depends on the type of infectious agent. Such pathogens as trichomonads are very mobile themselves, moreover, gonococci use them as a vehicle, so the combined infection with these microorganisms, which is not an exceptional rarity, is especially dangerous.

Third, the presence of colpitis during labor (open uterus) at times increases the likelihood of infection of the uterus and appendages and the appearance of diseases such as endometritis, salpingoophoritis, leading to the development of adhesions, tubal obstruction, ectopic pregnancy and persistent infertility. This, of course, the long-term consequences.

Closer in time are complications during childbirth in the form of ruptures of the walls of the vagina and cervix, as edematous, ulcerated mucous lose elasticity. There is a possibility of significant trauma to the birth canal and the development of massive hemorrhages.

Colpitis is a hotbed of infection, and after birth, sutures can stagnate for a long time, secondary inflammatory processes develop with suppuration and necrosis. Purulent inflammation is often complicated by the formation of an infiltrate in the vaginal wall and extends to the adjacent tissues (paracolphitis), occasionally an abscess.

In general, the long-term inflammation is chronic and manifests itself as frequent exacerbations with the likelihood of development in ascending and generalized inflammation.

According to medical statistics, enough colpitis is the cause of a stagnant pregnancy. The probability of miscarriage in expectant mothers with colpitis, especially specific, increases by 1.2-1.4 times compared with those who do not have it.

The presence of an inflammatory process in the vagina can have other negative consequences for the child.

Some pathogens cross the placental barrier and infect the amniotic fluid and the placenta, which can entail in the early stages - the development of vascular and brain abnormalities in the embryo, chorioamnionitis, placental insufficiency, infection of the fetus. All this can result in the birth of a child with developmental anomalies, congenital pneumonia, immunodeficiency, and also his death.

A child may become infected during labor, which causes a number of complications in the newborn, for example, blennorea.

[12], [13], [14], [15]

Diagnostics of the colpitis in pregnancy

The diagnosis of colpitis is quite obvious, and the gynecologist fixes it at visual examination on specific signs: the presence of noticeable vaginal discharge, the appearance and smell of which allows one to assume the appearance of colpitis, edema and redness of the genitals, often to the detection of erosion of the cervix (as colpitis complication) and also - by the presence of the patient's complaints about a certain discomfort.

A swab of vaginal discharge is mandatory for the definition of the pathogen. This can be microscopic studies, culture tests, which also allow to determine the sensitivity of the microorganism to certain antibiotics. If the laboratory is able to do an analysis of PCR, which allows in a short time to determine the DNA of the pathogen.

Instrumental diagnosis is designed to identify the probability of miscarriage, fetal development anomalies, placental insufficiency. Pregnant women are prescribed ultrasound, from the second trimester - with dopplerography. If necessary, a colposcopic examination is performed.

[16]

Differential diagnosis

Differential diagnosis is carried out on the basis of gynecological examination, laboratory and instrumental studies. Colpitis is differentiated according to the form of the disease, the origin and type of pathogen, and also assess the degree of damage to the walls of the vagina and its transition to other layers of tissues. Excludes parametritis, vaginal hematoma.

Treatment of the colpitis in pregnancy

Trying to cure colpitis at home is not worth it. It is from the timeliness of treatment that a favorable outcome of treatment and pregnancy itself will depend.

In the process of treatment a woman must observe several conditions. Restrictions are introduced into the diet - the patient should exclude spicy dishes, pickles, smoked products, sweets and buns. Sexual life for the period of treatment is excluded, if the causative agents of sexually transmitted diseases are found, then both partners should be treated.

Medicines are prescribed depending on the type of infectious agents identified. Systemic therapy for pregnant women is undesirable, therefore, if possible, try to dispense with topical preparations. Most often used candles from colpitis during pregnancy.

Suppositories vaginal  Hexicon  (active component - antiseptic chlorhexidine bigluconate) are active against the causative agents of fairly common sexual infections - trichomonas, gonorrhea, chlamydia, mycoplasmal, yeast fungi and dermatophytes. They have a local effect and do not enter the systemic circulation. Allowed for use in pregnant women, even at the earliest. The only contraindication is individual intolerance.

Soap and means containing an anionic group neutralize the activity of chlorhexidine, however, this does not apply to external washouts, since candles are inserted deep into the vagina. For therapeutic purposes, one candle is used every 12 or 24 hours from five to ten days. As part of complex therapy, not simultaneously with local preparations containing iodine, are not appointed.

Intravaginal tablets  Terzhinan  - a combined drug, the active components of which are:

• Ternidazole - is active against trichomonads, gardnerella and some other anaerobes;
• Neomycin sulfate - disrupts the functions of RNA of bacteria that may be present in microbial associations that cause inflammation of the vaginal mucosa: corynebacteria, listeria, golden staphylococcus, intestinal and hemophilic rod, proteas, salmonella, shigella, Yersinia, Klebsiella and many others;
• Nystatin - a known fungicide, is especially active towards yeast fungi of the genus Candida;
• Prednisolone is a corticosteroid, an anti-inflammatory and an anti-allergic component.

The drug is the widest spectrum of action, suitable for treating the most common colpitis species.

May cause local sensitization reactions. During pregnancy - only as prescribed by the doctor. One tablet is administered intravaginally every 12 or 24 hours. Before the introduction of the tablet moistened with clean water, and after - it is necessary to lie down for a quarter of an hour. The duration of treatment is determined by the doctor.

Pimafucin  - vaginal suppositories are considered one of the safest and are not contraindicated in pregnant women. The main component of the drug - antibiotic Natamycin, is active against pathogens of candidiasis, disrupting the integrity of the cell membranes of fungi. There are no known cases of development of resistance and allergic reactions to this substance. The most sensitive to the drug Candida ablicans, causing the vast majority of candida colpitis, however, in cases of mixed infections, the suppositories may not be effective. Assign one candle per day for three to six days.

Polizinaks  - a combined preparation in the form of vaginal suppositories of the widest spectrum of action, contains three antibiotics:

• Neomycin sulfate - disrupts the functions of RNA of bacteria that may be present in microbial associations that cause inflammation of the vaginal mucosa: corynebacteria, listeria, golden staphylococcus, intestinal and hemophilic rod, proteas, salmonella, shigella, Yersinia, Klebsiella and many others;
• Polimexin B sulfate is a polypeptide antibiotic that is active mainly in gram-negative bacteria; violates the osmotic resistance of bacterial walls, inhibits the growth of pathogenic microorganisms;
• Nystatin is a known antimycotic, to which Candida yeast fungi are particularly sensitive.

The active ingredients do not affect the activity of Doderlein sticks. It is used for mixed infections, nonspecific bacterial vaginosis, candidiasis.

Contraindicated in patients who do not tolerate the active ingredients of the drug, as well as with allergy to soy and peanuts. During pregnancy is used only as prescribed by the doctor.

Sometimes, pregnant women can not do without the appointment of systemic drugs, especially for gonorrhea colpitis. In this case, the woman is placed in a hospital, prescribing both local drugs and antibiotics inside. Safe in the period of bearing a child are Erythromycin and Josamycin.

Erythromycin  - the first representative of the macrolide group, is considered the most non-toxic, has a natural origin. It is considered an alternative, since many microorganisms have already acquired resistance to this drug and its effectiveness is considered to be lower than that of the later macrolides. It has bacteriostatic action in therapeutic doses, like all representatives of this group, penetrating through the cell wall and binding to the fragmentary part of the bacterial ribosome, prevents the normal synthesis of its protein, inhibiting the transfer of peptides from the acceptor site to the donor. In addition to the fact that macrolides can stop the growth and reproduction of bacteria, they have some immunomodulating and anti-inflammatory ability.

Josamycin, a  natural, however, more modern representative of the same class of antibiotics, is characterized by a higher activity than Erythromycin. Unlike other macrolides, practically does not depress the beneficial microflora of the gastrointestinal tract. Resistance to it develops less often than to other representatives of this group.

To support the immunity of a pregnant woman during the treatment will help vitamins and nutrition. The doctor usually recommends the intake of vitamin-mineral complexes intended for expectant mothers, Elevit, Prenatal, Femibion.

Folk treatment

Colpitis in folk medicine is treated with douches of various compositions, including infusions and herbal medicinal herbs. However, it is better for pregnant women from douching to refuse and replace this procedure with therapeutic sedentary baths or by washing (irrigation) of the external genitalia with therapeutic solutions.

Such procedures will help reduce itching and burning, faster cope with flushing and swelling of the labia vulva.

Local treatment of herbs colpitis during pregnancy is not contraindicated, even if the decoction of this medicinal plant is not applied during pregnancy inwards.

Most preferred is chamomile, it contains chamazulene, which has the ability to relieve inflammation and pain, and from all herbs the daisy is most hypoallergenic.

For the bath take six tablespoons of dried and crushed flowers, brew them in a glass three-liter jar. They do not boil, because the chamazulen is afraid of boiling, and they languish in a water bath for ten minutes. Cool down to body temperature (36-38 ℃), filter into the basin and take a bath, sitting in it for a quarter of an hour.

For such baths, you can use the infusion of calendula (antifungal activity), St. John's wort, yarrow, mother-and-stepmother.

For irrigation and watering, such infusions are made:

• oak bark - steamed boiling water with a volume of 300ml a tablespoon of oak bark, pressed for a quarter of an hour in a water bath, allowed to cool to 36-38 ℃, filtered and used at once everything;
• anti-edematous properties has an infusion of dogrose, in a thermos for the night pour boiling water (500ml) dry shredded fruits (100g), filtered in the morning and make the procedure, then they also prepare infusion, which is used before bedtime.

Local treatment is carried out until the symptoms disappear.

[17], [18], [19]

Homeopathy

Professional homeopaths can successfully cure a nonspecific or candidal colpitis in a pregnant woman, homeopathic medicines have a milder effect. In cases of infection with venereal infections, the effectiveness of homeopathy raises doubts, except that it can mitigate the negative consequences of treatment.

Appointments should be made by a homeopathic doctor. In Candida colpitis, Kalium muriaticum, Thuja occidentalis are considered as symptomatic agents. Abundant discharge with an unpleasant odor and discomfort requires the appointment of Alumina or Berberis, a violation of the integrity of the vaginal epithelium suggests the appointment of Cantharis or Lachesis. The preparations of sulfur (Sulfur) and sulfuric acid (Sulfuricum acidum) are widely used.

From pharmaceutical preparations prepared in homeopathic dilutions, can be prescribed by a doctor in acute or chronic inflammation of the vaginal mucosa, and also by the vertical spread of the  gynecochele. Its components exert a comprehensive influence on the sexual sphere of women:

Apis mellifica (venom of honey bee) - swelling of the genital organs, traces of blood in the secretions, general malaise;

Naja tripudians (venom of Indian cobra) - normalizes the functions of the left ovary, eliminates pain;

Vespa crabro (Hornet ordinary) - used for cervical erosions and ovarian pathologies (discomfort on the left side);

Chamaelirium luteum (Yellow chamelirium) - prevention of miscarriage, normalizes the hormonal background;

Lilium lancifolium (lily tiger) - heaviness and pressure in the lower abdomen, back pain, emotional disorders;

Melilotus officinalis (leucorrhoea) - abundant leucorrhoea, accompanied by cuts, pain and sore sensations in the lumbar region

Viburnum opulus (Kalina vulgaris) - suprapubic pain;

Ammonium bromatum (Ammonium bromide) - is used in cases of inflammatory processes affecting the ovaries and fallopian tubes;

Aurum jodatum (Aurum iodatum) - normalizes the work of the endocrine system;

Palladium metallicum (Metallic palladium) - inflammatory processes of female genital organs, manifested by abundant pathological secretion;

Platinum metallicum (Metallic platinum) - bleeding, hormonal failures, neoplasm of genital organs.

The doctor decides on the possibility of treating a pregnant woman. With caution appoint patients with chronic diseases of the thyroid and liver, after the bruises of the head. Take three times a day for a quarter of an hour before a meal as follows: drip ten drops into 100ml of water and drink the solution, holding the liquid in the mouth.

Combinations with any drugs are possible, to achieve a greater therapeutic effect, it is recommended to combine the Ginekohel gel drops with oral administration of Traumeel C.

Acute candidal or mixed colpitis, accompanied by severe symptoms, can be treated with homeopathic tablets for resorption under the language of  Bioline Candida  (Walsh Pharma, USA). It is also used to prevent relapses in the chronic form of the disease. The drug has an immunomodulatory effect and contains ten components in different dilutions:

Baptisia tinctoria (Baptisia) - is indicated for acute conditions, one of the symptoms of which is the putrid odor of secretions;

Bryonia (Bryonia) - is indicated for acute conditions and pains, including in the ovaries;

Echinacea angustifolia (Echinacea angustifolia) - discharge in women, more abundant in the evenings, pain when urinating;

Eupatorium perfoliatum (Eupatorium perfoliatum) - itching in the clitoral area;

Helonias dioica (Hamelirium yellow) - vulvovaginitis with abundant whites and pains in the uterus;

Thuja occidentalis (Tuy) - urethritis, cervicitis, oophoritis, hormonal disorders; acts on the mucosa of the urinary organs;

Viscum album (mistletoe white) - used to treat diseases of the genital area;

Kreosotum (Creosoteum) - edema and itching of the genitals, itching in the urethra during the emptying of the bladder;

Nodes Candida albicans, Candida parapsilosus - revitalize the defense mechanisms.

Tablets are kept under the tongue until complete dissolution, in acute conditions - one unit in two hours, then two weeks - one tablet four times a day.

Prevention

To prevent the appearance of colpitis symptoms during pregnancy is not too difficult. The greatest danger is the inflammatory process caused by venereal infections. Therefore, when a couple plans to become parents, it is necessary to be examined by both partners for the presence of hidden STDs. If pathologies are detected, it is necessary to be treated beforehand, and also - to observe monogamy. A pragmatic attitude towards one's health can save many problems. This includes a full-fledged diet, a healthy lifestyle and a lack of bad habits, which will significantly strengthen immunity.

Nonspecific colpitis, which has arisen in a pregnant woman against a background of physiological causes, is still less dangerous and easier to treat, and sometimes even completely without treatment, when the condition stabilizes.

It is also necessary to observe intimate hygiene, but without fanaticism. Violation of the microflora of the vagina is sometimes observed in women, "crazy" on the purity. It must be remembered that douching is a therapeutic, not a hygienic procedure.

Wear comfortable panties made of natural fabrics, refuse from strings, lacy synthetic products and tight trousers.

[20], [21], [22], [23], [24]

Forecast

Timely diagnosis and compliance with the recommendations of a doctor significantly increases the favorable prognosis of colpitis during pregnancy, caused by any reasons.

[25], [26]