Flora in a smear is not a pathology, therefore, it is necessary to treat not the flora itself, but deviations in its composition, changes in the concentration of the existing components and the consequences of this. Since the main useful and unhealthy part of the internal environment of the vagina, urethra, mouth is bacteria, the question of how to treat flora in a smear looks trite, because the vast majority of us know that there are antibiotics for this. It would seem, go to the pharmacy, ask for an antibiotic and the problem is solved. But the question is not this, but how to determine an effective drug and its necessary dosage. In addition, it is not a fact that, together with the bacteria in the body, the fungal microflora, which is being treated with completely different medications, does not even work underground.
Before you begin to treat the microflora in the smear, you need to figure out if everything is so bad? Understand and explain what the test results show, can only be a specialist doctor, who later either offers additional research or relies on the results obtained and prescribes a specific treatment, which ideally should consist of two items:
- destruction of pathogenic or excessively multiplied conditionally pathogenic microflora,
- restoration of the normal internal environment of the body, in particular the intestine and vagina,
- restoration and maintenance of general and local immunity.
Performing only one or two of these points will not give good and lasting results, except that we are talking about dysbiosis, when they are often limited to prescribing only those drugs that normalize the microflora.
If we are talking about a bacterial infection, the treatment of which is not complete without the use of antibiotics, it is very important to do not only microbiological examination of the smear, but also to determine the type of infection, as well as its sensitivity to antibiotics (the most popular in this regard, the analysis is the PCR method or PCR -analysis).
Recently, many strains of already known bacteria have appeared, which either do not respond to antimicrobial agents, or have developed their own system of protection from them, so the treatment prescribed at random without taking into account the specific strain of the pathogen may turn out to be pointing at the sky. After all, even universally prescribed broad-spectrum antibiotics are not designed to destroy all types and strains of bacteria. Well, there is still no such universal medicine, and it is almost impossible to create it, given the fact that more and more new mutated strains appear regularly.
As for the fungal infection, at first glance it would be possible to do without a smear, because the symptoms of candidiasis are quite specific - white bloom, cheesy discharge, itching. But after all, thrush in different people can also have slightly different manifestations, and white plaque accompanied by itching or without it is characteristic not only of a fungal infection. So what is there to understand the issues of diagnosis is best to allow specialists.
If the diagnosis is finally established, then it will be necessary to carry out therapeutic procedures with the use of antifungal drugs along with hygiene measures. It should also be understood that even those infections that are not among the STIs can be sexually transmitted, especially if the partner’s integrity of the skin of the genitals or mucous membrane is compromised, so for the duration of treatment it is worth refraining from sexual contact. After all, what cannot one or two bacteria, can be under the power of their "army", especially if the sexual partner can not boast of strong immunity.
As you can see, the treatment of flora in a smear and the approach to its appointment is much more difficult than simply smearing a broken paint with green paint. At the same time, various types of infection require an individual approach to the choice of drugs, not to mention the fact that the requirements for the treatment of conditionally pathogenic microflora and STIs differ significantly.
Treatment of coccal flora in a smear and not only
Do I have to say that most of the infectious diseases of the respiratory and urogenital systems are associated with the activation of conditionally pathogenic microorganisms living on the integuments of our body? Most of them are spherical bacteria, called cocci, and among them streptococci and staphylococci come to the fore, some strains of which cause most of the known infectious diseases. Little of. The coccal flora can also be found in diseases triggered by other pathogens, so the question of how to treat the cocci flora in a smear, if necessary, is quite logical and relevant.
The site of infection in women can be external and internal genital organs. And if the removal of the infection from the surface of the genitals is not difficult, then the treatment of vaginal microflora and bacteria penetrating the uterus is more difficult, because the usual hygienic procedures and surface treatment with antiseptics will not help here.
The most optimal method of treating vaginal opportunistic coccal microflora is the use of vaginal tablets and suppositories with an antibiotic. During pregnancy, doctors may prefer rectal suppositories because of the proximity of the rectum and the female reproductive organs. In the arsenal of gynecologists, there are many drugs in this direction: Polygenz, Terzhinan, Metronidazole, Clindacin, Clarithromycin, Fluomizin, Trihopol, Sintomitsin, Klion-D, Hexicon (candles with a strong antiseptic broad-spectrum), etc.
The list of drugs is quite large and it makes no sense to list them all, because when prescribing a treatment, doctors are guided not only by the action of antimicrobial agents, but also by the nature of the infection, the characteristics of the patient’s body, its condition, therefore all appointments are purely individual. Friends and advertising in the media are not the best advisers in this matter, because the infection must be cured and not healed, as often happens with self-treatment.
Since coccal flora in a smear for diseases of the genital sphere is very rarely present in proud solitude (usually it is a mixed microflora, including a fungal infection), most drugs for the treatment of gynecological diseases are combined, i.e. Contain topical antibiotic and antifungal agent. This is a very important point, because we already know that by means of antibiotics alone, bacteria can be destroyed, but it is impossible to cope with fungi. Combined preparations are "Verzhinan", "Polygyans", "Neo-Penotral", "Klion-D", "Guinomax" and some others.
Usually, topical application of antibiotics helps to kill two birds with one stone: destroy the infection and relieve inflammation. But if the inflammatory process is strongly expressed, it makes sense to prescribe drugs containing steroids (the same "Terzhinan" in addition to two strong antibiotics neomycin and ternidazole contains the antifungal component nystatin and glucocorticosteroid prednisolone). If the inflammation does not subside, doctors additionally prescribe systemic antibiotic therapy with topical drugs in each case.
Most of the antimicrobial drugs used in gynecology have a wide spectrum of action, therefore, they are used to treat a mixed infection in which there are cocci, unhealthy sticks, coccobacilli, fungi, and even STI pathogens, including the Trichomonas parasite. But the predominance of one or another form of microorganisms requires the doctors to select the appropriate treatment regimen, and sometimes combinations of various drugs.
If we are talking only about the activation of a fungal infection, and other indicators of conditionally pathogenic and pathogenic microflora remain normal, there is no sense in prescribing drugs with an antibiotic that, along with pathogens, are capable of destroying beneficial lactobacilli. In this case, it is more logical to refer to simple antifungal agents, such as Pimafucin, Clotrimazole, Fluconazole, Flucostat, which are also available in vaginal forms and tablets.
A very important role in the treatment of vaginal infections is given to medical and hygienic procedures. It is not enough to maintain the purity of the external genital organs, it is also very important to carry out the cleaning of the vagina as well, which is most convenient to do through douching. This procedure helps to remove microorganisms from the vagina that have already died under the influence of antibiotics and antimycotics and to reduce the livestock population. Especially if for this purpose you use not only anti-inflammatory alternatives (extracts of chamomile, St. John's wort, calendula, yarrow, etc.) and soda solution, but also pharmacy antiseptics (Chlorhexidine, Miramistin, Chlorophyllipt, a weak solution potassium permanganate, etc.).
How many things need to be considered only for the appointment of the first point of complex treatment, which aims to destroy pathogens. But this is not enough. Destroying pests, potent drugs significantly thin out a number of beneficial lactobacilli, and if their volume does not return to the required 95%, the results of treatment will be short-lived. After all, it is not for nothing that alternative wisdom says that a holy place is never empty, and the conditionally pathogenic microflora, which multiplies actively, will soon take over the place of lactobacilli.
After antibiotic or antifungal therapy, the gynecologist takes a second smear to evaluate the effectiveness of the treatment. If the patient has not taken any measures to restore the beneficial microflora of the vagina, it may not be comforting at all.
To avoid this, even during antibiotic therapy, which usually lasts 5-7 days, or immediately after it, care should be taken to restore the microflora by introducing lactobacilli in the vagina in the form of vaginal preparations and creating conditions for their normal functioning and reproduction.
There are various preparations for the restoration of the vaginal microflora: "Acilak", "Laktozhinal", "Biosporin Femina", "Ginoflor", "Lactonorm", "Vaginorm", "Vagilak" and others. But if the patient was prescribed systemic antibiotic therapy, then most likely it is necessary to restore the intestinal microflora by taking appropriate medications (Bifidumbacterin, Lactobacterin, Laktovit, Narine, etc.).
Considering the question of how to restore the flora in a smear, we must not forget that any infection is a blow to the body’s immune system. And with a weakened immunity, even a sufficient amount of lactobacilli can not always cope with disease-related competitors. If the conditionally pathogenic microflora of lactobacilli is somehow able to keep within, then to combat the pathogens, a joint effort is required between the local (lactobacilli) and the general immunity.
Thus, we come to the need for the third point of treatment of gynecological infections, i.e. Restoration of the body's defenses through plant and synthetic immunostimulants and systemic probiotics, which take care of general immunity, while vaginal preparations for microflora restoration provide local immunity.
As for the treatment of urogenital infections in men, the treatment regimen may have noticeable differences depending on the location of the infection. If we are talking about infectious balanitis or balanoposthitis, which affects the open parts of the reproductive system in men (head and foreskin), preference is given to local preparations (antiseptics and ointments / gels with antibiotics). Systemic antibiotic therapy is prescribed only for severe inflammation, which does not go away, despite ongoing local treatment.
With a urethral infection, access to the place of its dislocation is limited, therefore, internal antibiotics are necessary in most cases. But this treatment is not limited. In addition, uterine lavage with local antiseptics is used to remove pathogens from the focus of inflammation, for which special tips are provided.
The item on the restoration of beneficial microflora of the genital organs for men for obvious reasons is not relevant, but it is still worth raising the body's resistance to infections. And here there are no especially male or female preparations.
The otolaryngologist is engaged in the treatment of ENT infections, who must prescribe effective drugs for the treatment of diseases of the ear, nose and throat, based on the localization of the lesion, the causative agent, ie detected flora in the smear, the characteristics of the patient. The fact that bacterial infections are treated with antibiotics and fungal infections with antifungal agents remains unchanged. Antiseptics can be used in any case for rinsing or irrigating the throat, rinsing the nose and ear, and treating wounds in the skin and mucous membranes.
If active opportunistic flora in a smear is considered the result of a decrease in general and / or local immunity, then sexually transmitted infections (STIs) are most often the result of non-selectivity in sexual contact. At the same time, innocent people (wives, husbands, lovers), who, although they came into contact with only one sexual partner, could get an infection from their wrong half.
It must be said that in case of an STI, immunity is not a decisive factor, because this type of infection has the ability to survive in difficult conditions and at the same time have a destructive effect on immune cells. The survival of the species is also promoted by the high infectivity of the infection, which easily changes its location, moving from one person to another. In connection with the latter fact, it is necessary to understand that seeking the help of one patient should be accompanied by examination and treatment of all his sexual partners, as well as preventive treatment of those who have been in close everyday contact with the infected.
When prescribing optimal treatment regimens, doctors necessarily rely on the nature of the causative agent. After all, it was experimentally proved that not all antibiotics are equally effective in gonorrhea, trichomoniasis, chlamydia and syphilis, the causative agent of which is treponema pallidum (it can be detected by examining the scrape from the surface of a specific rash). Chlamydia, gonococci, and Trichomonas are detected in the usual smear with subsequent analysis of the causative agent, and various therapeutic regimens are used to combat it.
Thus, cephalosporins (ceftriaxone) and fluoroquinolones (ciprofloxacin, ofloxacin) are considered the drugs of choice for treating gonorrhea. Spectinomycin, cefotaxime, ceruroxime, lomefloxacin and norfloxacin can be used as alternative drugs, but the effectiveness of treatment may be somewhat lower, which is very undesirable.
For the treatment of urogenital chlamydia, they use the macrolide preparation azithromycin and the tetracycline antibiotic doxycycline. An alternative can be erythromycin, ofloxacin, roxithromycin, spiramycin.
Metronidazole is usually used to treat trichomoniasis. Alternative drugs, which should be prescribed in the event of the ineffectiveness of metronidazole, then representatives of the same group (imidazole derivatives): tinidazole and ornidazole.
At the same time, various treatment regimens can be prescribed, from a single dose of high doses of antibiotics, which is practiced in the treatment of gonorrhea and trichomoniasis, to a 7-day course (for chlamydia and trichomoniasis). Treatment and dosage regimens are prescribed individually, taking into account the severity of the disease, the characteristics of the patient and his condition. In addition to antibiotic therapy, they also include the restoration of the vaginal microflora for women and the strengthening of immunity for patients of any gender.
Recall once again that the treatment of STIs involves the examination and treatment (if necessary) of all sexual partners of the patient. It is very important at the time of treatment to refuse sex, to prevent the spread of infection and infection of other people.
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Treatment of unusual infections and leukocytosis
As we have already mentioned, the contents of a smear can include microorganisms, which many people have heard little or did not even know about their existence. It may even scare more than the mention of streptococcal, staphylococcal and other common infections. In fact, everything is not so scary and completely treatable.
If the flora in a smear contains such microorganisms as leptotriks or leprotrichia, the need for treatment is determined primarily by the presence of inflammation. In the absence of it, doctors can only suggest drinking a course of immunostimulants, which should prevent the development and spread of infection. It is very important to pay attention to other components of the internal environment, for example, the presence of a co-infection (usually candida or STI).
Treatment of elevated leukocytes in a smear on the flora against the background of an existing infection, which indicates the nature of the inflammatory process, implies the appointment of:
- penicillin or cephalosporin antibiotics, macrolides, aminoglycosides (topically and / or systemically),
- antifungal agents (or complex drugs) to prevent candidiasis as the consequences of antibiotic therapy,
- immunostimulants and immunomodulators,
- means to restore normal microflora.
That is, the treatment regimen is no different from the treatment of other infections. At the same time, treatment of leptotrichosis does not cause any particular difficulties and has a favorable prognosis if the disease is not started.
Unlike leptotrichosis, actinomycosis, provoked by actinomycetes, presents certain difficulties both in diagnosis, because these unusual bacteria are quite often found in smears (especially from the nose and throat), without causing symptoms of the disease, or in treatment. To make a final diagnosis, the doctor has to prescribe additional studies (scrapings, punctures, sowing of pus, etc.) that last more than one day, although in only 2-3 days single actinomycetes are able to create whole colonies.
A special approach is needed to treat this disease. The most important thing in the treatment of the disease is to increase the body's defenses by intramuscular injection of a special drug (actinolysate), which stimulates phagocytosis and the production of antibodies to fight infection. It is almost impossible to cope with actinomycetes with the help of antibiotics alone; therefore, they are prescribed mainly for the elimination of co-infections. If necessary, conduct a surgical opening of the fistula.
The particular danger of actinomycosis is seen in the fact that the infection can spread to other organs and, if there is no appropriate treatment, can be fatal.