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Cystitis and urethritis in pregnant women than to treat

Urethritis during pregnancy

Urethritis is an infectious and inflammatory process that develops in the urethra. During pregnancy, this condition often occurs against the background of vulvovaginitis and other diseases of the genital area. In severe cases, urethritis can cause infection of the fetus and create many problems up to a miscarriage at any time.

Causes of urethritis

The causative agent of urethritis is most often chlamydia, mycoplasma and ureaplasma. These microorganisms prefer to live on the mucous membrane of the urethra. The cylindrical epithelium of the urethra is the optimal environment for the reproduction of these microorganisms. Inflammation of the urethra can also cause E. coli, Proteus and other representatives of the normal microflora of the vagina. Often, the examination reveals a mixed infection.

During pregnancy, all conditions are created for an inflammatory process to occur in the urethra. This is facilitated by a noticeable decrease in immunity, both local and general. For expectant mothers, this condition is quite common, otherwise the woman's body simply could not bear the child. But it is precisely the decrease in immunity that leads to the fact that all pregnant women in one way or another are at risk for developing urethritis.

Urethritis during pregnancy is usually combined with colpitis (inflammation of the vagina) and cervicitis (damage to the cervical canal). In this case, the clinical picture of the disease can be somewhat blurred, and the doctor is not always able to determine the disease at the first examination. When the infection spreads upward, damage to the bladder (cystitis) is possible. In severe cases, inflammation can move into the uterine cavity, leading to the development of endometritis.

Symptoms of urethritis

Signs of urethritis in pregnant women do not have any features:

• burning and itching when urinating;
• frequent urination;
• Frequent urge to empty the bladder.

When urethritis is combined with inflammation of the vagina and cervix, discharge from the genital tract appears. Their color and consistency will depend on the type of pathogen. A yellowish thick discharge indicates the development of gonorrhea, while a white-gray discharge occurs with bacterial vaginosis. When affected by opportunistic flora, the discharge becomes yellow-green. Chlamydial and mycoplasma infection can be almost asymptomatic, declaring itself only as urination disorders.

The general condition of expectant mothers with urethritis is usually not disturbed. As a rule, a pregnant woman is concerned only with local manifestations of the disease. Fever with fever and chills occurs only with a pronounced decrease in immunity.

During pregnancy, the typical clinical picture of urethritis is far from always observed. Inflammation of the urethra in expectant mothers is characterized by rather blurred and meager symptoms, which greatly complicates the diagnosis. Often, urethritis is detected by chance during the next examination of a pregnant woman.

Diagnosis of urethritis

The following methods are used to identify the pathogen:

• Smear from the urethra. The material is taken in the supine position on the gynecological chair. Using a special tool, the doctor takes a swab from the walls of the urethra. The procedure is not very pleasant, but it is this method that allows you to draw the first conclusions about the causative agent of the disease. The resulting material is examined under a microscope with high magnification.
• Bacteriological culture. Discharge from the urethra is sown on special nutrient media. After a few days, the doctor can find out exactly what kind of infectious agent caused the urethritis. If necessary, the sensitivity of detected microorganisms to antibiotics is determined.
• Common urinalysis. It is carried out with suspicion of inflammation of the bladder and kidneys. For analysis, it is required to collect the morning portion of urine in a sterile jar. According to indications, a bacteriological examination of urine is carried out to detect pathogens in it.

Consequences of urethritis for the fetus

The urethritis caused by chlamydia and mycoplasma is a great danger. This infection, carried in the early stages, can cause spontaneous miscarriage. There is also an opinion that it is infectious diseases of the urogenital area that lead to regression of pregnancy.

Specialists have not yet been able to find out whether urethritis causes the formation of congenital malformations of the fetus. It is assumed that infectious agents penetrate the embryo, causing various diseases. At the same time, many women who have had urethritis during pregnancy have healthy children.It is not possible to predict in advance the risk of damage to certain organs of the baby during intrauterine infection.

In the second half of pregnancy, urethritis often causes placental insufficiency. The infection spreads upward and, getting into the placenta, causes the development of inflammation. This process leads to the fact that the placenta cannot cope with its functions, including transporting oxygen and nutrients to the fetus. Hypoxia of the fetus develops, often combined with a delay in its intrauterine development. Fortunately, such complications are quite rare and can be successfully prevented by timely antibiotic therapy.

Consequences of urethritis for a pregnant woman

If left untreated, the infection from the urinary canal easily penetrates into the bladder and further to the kidneys. Cystitis and pyelonephritis develop - dangerous conditions that significantly interfere with the normal course of pregnancy. With kidney damage, signs of intoxication appear, accompanied by pain in the lumbar region. In some cases, pyelonephritis can cause preeclampsia - a severe complication of pregnancy.

Infection from the urinary tract can penetrate not only into the kidneys. Dangerous bacteria are in close proximity to the cervical canal, from where they can move into the uterine cavity. Endometritis (inflammation of the mucous membrane of the uterus) occurs, as a rule, in the early stages of pregnancy and often leads to spontaneous miscarriage.

Treatment of urethritis during pregnancy

Therapy of urethritis begins with the selection of antibacterial drugs. Antibiotic treatment is carried out from 16 weeks of pregnancy. By this time, the placenta is finally formed, and the likelihood of penetration of drugs to the baby is significantly reduced. Up to 16 weeks, an antibiotic is prescribed only for strict indications.

For the treatment of chlamydial, mycoplasma and ureaplasma urethritis, macrolide antibiotics are used. The most famous of them is Josamycin. This drug effectively fights the main pathogens of urethritis and is quite safe for pregnant women. Most expectant mothers tolerate this antibiotic well. In rare cases, allergic reactions are noted while taking the drug.

"Josamycin" and its analogues are prescribed in a course of 5-10 days. The dosage is selected by the doctor, taking into account the characteristics of the selected drug. Repeated treatment with macrolides during pregnancy is not carried out.

For gonorrheal urethritis, antibiotics from the cephalosporin group (cefotaxime, ceftriaxone) are prescribed. The drugs are administered intramuscularly once. If an allergy to cephalosporins is noted, these drugs are replaced with antibiotics from the macrolide group.

When urethritis is combined with colpitis and cervicitis, local therapy is performed. For this purpose, vaginal suppositories with a wide spectrum of action are used. The choice of drug will depend on the causative agents of the disease. The course of therapy is from 7 to 10 days.

The effectiveness of treatment is monitored after one month. To do this, a second smear is taken from the urethra or bacteriological seeding is done on nutrient media. In some cases, it is possible to repeat the course of therapy.

Restoration of the vaginal microflora is the final touch in the treatment of urethritis. For this, a pregnant woman is recommended to take drugs containing a large number of lactobacilli. Among them, "Vagilak" has proven itself well. This remedy is taken orally and acts on the mucous membrane of the urethra through the intestines. Alternatively, you can use the "Lactagel" tool, intended for insertion into the vagina.

Prevention of urethritis

To prevent the disease, it is recommended to follow simple rules:

• use reliable barrier methods of contraception;
• do not get cold;
• avoid stress;
• monitoring the hygiene of the genital tract;
• maintain the normal microflora of the vagina.

Following these recommendations will prevent the development of urethritis and protect a pregnant woman from the undesirable consequences of this disease.

Symptoms, diagnosis and choice of antibiotics for the treatment of urethritis in pregnant women

Urinary tract infections rank third among the diseases that accompany pregnancy, after anemia and cardiovascular pathology.

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Among them are infections of the lower (urethritis and cystitis) and upper urinary tract (pyelonephritis). What is the danger of urethritis during pregnancy, what are its main symptoms and how to properly approach the treatment of this pathology, we will consider further.

1. What is urethritis?

Urethritis is an infectious and inflammatory disease, accompanied by damage to the walls of the urethra.

Quite often during the period of gestation, inflammation of the urethra does not occur in isolation, but is accompanied by vulvovaginitis or cervicitis.

This increases the risk of not only pregnancy complications in the form of intrauterine infection of the fetus and membranes, but also its unfavorable outcome (spontaneous miscarriage, premature birth).

2. Predisposing factors

Not only the hormonal system undergoes great changes during pregnancy, the anatomy and physiology of the genitourinary system also change. These changes contribute to the occurrence of infectious and inflammatory processes not only in the urinary system.

These factors include:

An important feature of inflammatory diseases during pregnancy is that their outcome is dangerous not only for the mother, but also for the fetus.

Factors predisposing to the occurrence of urethritis in a pregnant woman also include:

That is, there are a great many reasons contributing to the development of urethritis, and it is not always possible to identify one single one that provoked the disease.

One way or another, they are all factors that create a favorable environment for the development of facultative or pathogenic flora.

3. Main pathogens

In the literature there is a division of urethritis into:

In our opinion, this is an irrelevant classification, since non-infectious urethritis quickly becomes infectious after the addition of a secondary infection.

It is more logical to divide urethritis into specific and nonspecific.

Such a classification is useful in determining the management of a pregnant woman. Nonspecific urethritis is not shared in pregnant women with cystitis and is treated as a lower urinary tract infection. Urethritis against the background of STDs requires different tactics and observation of the patient.

The most common causes of specific urethritis are M. genitalium, gonococci, and chlamydia.

4. Nonspecific urethritis

It is the opportunistic flora that accounts for the vast majority of urinary tract infections during pregnancy. There is no exact epidemiological data on the frequency of urethritis in pregnant women, since the inflammatory process, as a rule, develops rapidly in the bladder (cystitis).

Next, consider the most common pathogens of nonspecific urethritis.

4.1. coli

This microorganism is found in 80% of cases of all urethritis in pregnant women, it is a representative of the normal flora that colonizes the paraurethral region.

This is a bacterial commensal, that is, a microorganism that does not normally pose a danger to the body and lives in symbiosis with it.

In urethritis, uropathogenic Escherichia coli acquires additional virulent properties, due to which the development of the disease is possible.

These include:

All these conditions, together with the state of natural immunosuppression, contribute to the development of an inflammatory process in the wall of the urethra and bladder.

4.2. Mycoplasmas and ureaplasmas

Namely, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, etc. In recent years, they are also considered to be part of the normal facultative flora, but in extremely small quantities (detected in 5-30% of women).

These microorganisms are sexually transmitted. During pregnancy, their excessive reproduction, resettlement is not excluded.

Mycoplasmas are bacteria that do not have a cell wall, carrying both DNA and RNA. Mycoplasmas carry out their pathogenic properties due to pathogenicity factors: adhesins, endotoxins, exotoxins, antigens, aggression enzymes (phospholipase A, neuraminidase, RNase, DNase, aminopeptidase, protease).

Ureaplasma is found as part of the normal flora in 60% of sexually active women. Until 1998, ureaplasmosis was considered a sexually transmitted infection.

This issue remained controversial, since ureaplasmas were also found in healthy women, without any clinical manifestations. At the moment, this microorganism is classified as a minor component of the facultative flora of a woman.

Ureaplasmas are bacteria without a cell wall, intracellular parasites belonging to the mycoplasma family. Unlike Mycoplasma hominis, ureaplasmas have the ability to break down urea to ammonia. This process underlies the formation of urate nephrolithiasis and urolithiasis.

The role of Mycoplasma hominis and Ureaplasma in the occurrence of inflammatory diseases of the genital organs and urinary system should be studied in more depth. In all likelihood, these microorganisms contribute to the chronicity of urethritis, cystitis, vulvovaginitis and cervicitis, provide frequent relapses of these diseases, which significantly reduces the quality of life of patients.

5.Specific urethritis

In the development of specific urethritis lies infection before or during pregnancy with pathogens of sexually transmitted infections. These include mycoplasmas M. genitalium, chlamydia, gonococci and Trichomonas.

5.1. Gonococci

The causative agent of gonorrhea is the gram-negative diplococcus Neisseria gonorrhoeae. When it enters the urinary tract, it causes a violent inflammatory reaction that can spread to the overlying organs of the genitourinary system.

The inflammatory process is accompanied by the formation of a cellular infiltrate, followed by its replacement with connective tissue.

Gonococcal urethritis in pregnant women does not occur in isolation, but in combination with colpitis and cervicitis.

5.2. Trichomonas

The causative agent of urogenital trichomoniasis is Trichomonas vaginalis, a unicellular protozoan microorganism with 3-5 flagella.

Infection is possible not only through sexual contact, but also through dirty bed linen, a towel, a toilet seat, washcloths (contact household route).

Trichomonas can serve as a reservoir for other pathogenic microorganisms, which aggravates the course and therapy of the infectious process.

5.3. Chlamydia

The leading role in the occurrence of urethritis and other diseases of the urogenital tract is played by the microorganism Chlamidia trachomatis.

Chlamydia are intracellular parasites that are unable to generate energy on their own; for these purposes, they use the energy potential of the host cell.

Their life cycle consists of 2 stages (forms):

• elementary bodies - an inactive infectious form that is transmitted from one host to another, adapted to survive in the external environment;
• Reticular bodies are an active reproductive form located intracellularly.

Chlamidia trachomatis is not normally found in the body. Infection through unprotected sexual contact (including anal and oral).

Chlamydial infections are often asymptomatic or have few symptoms.

In case of chlamydia in a pregnant woman, a miscarriage is possible in the early stages, in later periods - intrauterine infection and fetal death, premature birth, complications in the newborn (for example, chlamydial pneumonia, conjunctivitis, sepsis, etc.).

6. Symptoms of the disease

Symptoms of urethritis during pregnancy do not differ much from those in other categories of patients.

The main clinical manifestations include:

It should be remembered that during pregnancy, inflammation of the urethra quickly turns into cystitis, and then into pyelonephritis.

Urethritis is often combined with inflammatory diseases of the genital organs due to their proximity and high probability of contamination.

During pregnancy, the clinical picture may be erased, while the general condition of the patient is not disturbed, only local symptoms are disturbing.

7. Possible complications of pregnancy and childbirth

Urethritis in combination with cystitis in a pregnant woman can lead to the following complications:

The risk of complications is much higher with urethritis associated with STDs. Nonspecific urethritis is dangerous by the spread of infection higher, the occurrence of gestational pyelonephritis and urosepsis.

8. Diagnostic methods

The pregnant woman herself, and then her attending physician, can suspect urethritis based on complaints and symptoms, anamnesis and visual examination. To confirm the diagnosis, laboratory and instrumental diagnostic methods are used.

8.1. Urinalysis

For analysis, a morning portion of urine is used, in which an increase in the content of leukocytes (leukocyturia), bacteria (bacteriuria), and mucus is possible.

8.2. Urethral smear microscopy

This is a routine method, cost-effective, clinically reliable, although not for all types of infections that can cause urethritis during pregnancy.

Microscopy of a smear easily reveals gonococci and Trichomonas, which are the cause of specific urethritis.

The non-specific nature of urethritis can be indicated by "markers" of the inflammatory reaction - more than 10 leukocytes and 10 epithelial cells in the field of view, a change in the nature of the flora (coccal forms predominate), the presence of mucus.

A swab from the urethra in women is taken, as a rule, during a gynecological examination on the chair by carefully inserting a special applicator into the urethra for a length of no more than 4 cm. The applicator is removed with rotational movements for better collection of the material. The resulting substrate is applied to a glass slide, dried, stained and examined under a microscope.

8.3. Bacteriological examination

Bacteriological examination (bakposev) reveals the pathogenic flora that caused the disease, at the same time assesses its sensitivity to antibacterial drugs.

The material is taken for examination in the same way as for simple microscopy, but with the obligatory observance of sterility. After sampling, the resulting material is sown on a nutrient medium in one of the ways.

After that, Petri dishes are placed in a thermostat for 72 hours. Over time, the growth of the flora is assessed with the determination of sensitivity to antibiotics.

The disadvantage of this method is the duration, which does not allow promptly prescribing adequate therapy. A reliable result can be issued only 72 hours after the sampling of the material. As a rule, by this time, antibiotic therapy has already been prescribed to the pregnant woman empirically.

8.4. Serological reactions

Serological tests for urethritis are used quite rarely, usually with chlamydial or mycoplasmal infection. Simple and enzyme-linked immunosorbent assay (ELISA), immunofluorescence reaction (RIF) and less often other types of reactions are used. The principle of these reactions is based on the antigen-antibody interaction.

More often, ELISA is used to detect different classes of antibodies that the human body produces in response to an infection. This helps in diagnosing the severity of the infectious process.

8.5. PCR diagnostics

Based on the detection of bacterial DNA in a smear, discharge or other substrate, their amplification (increase in the number of their copies) to verify the suspected pathogen.

This is the most reliable research method, although quite expensive. It simplifies the diagnosis of genital infections (mycoplasma, ureaplasma, chlamydia, trichomonas, gonococci).

If a specific urethritis is suspected in a pregnant woman, it is advisable to perform a simple microscopy of a smear from the urethra and exclude genital infections by PCR. These two methods will allow you to choose the right treatment tactics.

9. Preparations for treatment

The crucial moment is the selection of therapy for urethritis in a pregnant woman. It is important to take into account all possible risks for both the woman and the fetus.

As a rule, the treatment of genital infections and the appointment of antibacterial drugs are carried out after 16 weeks of gestation, when the placenta is already formed and embryogenesis is completed. This avoids the formation of various malformations in the fetus.

Treatment of nonspecific urethritis (cystitis) is carried out at any stage of pregnancy, this is necessary to prevent gestational pyelonephritis and urosepsis.

The choice of an antibacterial drug depends on the type of urethritis pathogen. In pregnant women, the range of antibacterial drugs is also limited by the current status.

The table below shows the main regimens for the use of antibiotics for the treatment of urethritis during pregnancy.

Table 1 Treatment regimens for urethritis during pregnancy, depending on the etiology of the disease. Click on the table to view

To alleviate local symptoms, it is possible to treat the external genital organs and the urethra with ready-made, pharmacy solutions of furacillin, miramistin, chlorhexidine. You can also use slightly warm (37 degrees) baths with chamomile decoction.

It is important to remember that antiseptics in the treatment of urethritis during pregnancy are of secondary (auxiliary) importance.

Symptomatic treatment for urethritis includes:

10. Monitoring the effectiveness of therapy

The success of the therapy is assessed after 72 hours. If the patient notes the subsidence of local symptoms, improvement of health, treatment is continued until the end of the course. If no improvement is observed, therapy should be reviewed.

Recovery is confirmed by laboratory methods.

After recovery, it is possible to carry out therapy aimed at restoring the vaginal flora ("Laktgel", "Laktozhinal", Vagilak in a course of 14 days). However, full-fledged clinical studies on this subject have not been conducted.

Urethritis during pregnancy

Pregnancy is a time when the body works to the limit of its capabilities. The immune system of a woman is very weakened, since all her forces are directed to the development of a new organism. There is also a strong hormonal imbalance. All this leads to vulnerability to various diseases. One of these diseases is urethritis.

What is urethritis

Urethritis is an inflammation of the urethra. It is often confused with cystitis, but these are different diseases.

Depending on the type of urethritis that occurs during pregnancy, treatment is prescribed and the degree of danger to the fetus is determined.

Infectious urethritis - inflammatory processes that are caused by any infection. Chlamydia, ureaplasma, gonococci can cause urethritis. All these and many others are pathogens of infectious diseases that can live in a woman's body before pregnancy, but appear only after conception.

Non-infectious urethritis can be a consequence of allergies, trauma.During pregnancy, it appears due to the growing fetus, which presses on the urinary canal.

Symptoms of urethritis during pregnancy

The symptoms of urethritis in pregnant women do not differ from the symptoms of the disease in non-pregnant women. A feature of the signs of this disease is the likelihood of muffled pain, which a woman may not pay attention to. But on examination by a gynecologist, urethritis is diagnosed immediately.

An alarm signal should be frequent urination, which is accompanied by pain, itching and burning. Together with these signs, discharge from the urethra appears, the abundance and appearance of which depends on the causative agent of urethritis.

In terms of symptoms, urethritis is similar to cystitis, but the differences are as follows: during cystitis, pain appears after urination, and with urethritis, it accompanies this process and does not stop after it is completed.

What is the danger of urethritis during pregnancy

Any infection that affects the female body can seriously affect the course of pregnancy and the development of the fetus. The degree of risk of fetal pathologies depends on what type of urethritis the pregnant woman suffers from, and what type of infection gave rise to urethritis.

The most dangerous is urethritis, which occurs when you have chlamydia or ureaplasmosis. The fact is that these infections are able to penetrate into the amniotic fluid, through which they easily infect the fetus. As a result, developmental pathologies may occur.

There is a high probability of infection of the child during childbirth, when he is already moving through the birth canal. With such infection, the newborn may suffer from conjunctivitis, pneumonia, gonococcal infection.

Non-infectious urethritis during pregnancy is less dangerous, since there is no chance of infection of the fetus with dangerous microbes. But it requires treatment, since with advanced forms, non-infectious urethritis can develop into other more serious diseases of the genitourinary system.

How is urethritis diagnosed

During pregnancy, a woman visits a gynecologist once a month in the early stages and once a week or two in the later ones. Before each visit, certain tests are given, according to which the state of health of the expectant mother is determined. Also, at each visit, the doctor conducts a survey about the well-being of the pregnant woman. The beginning of the diagnosis of urethritis is a woman's complaints about feeling unwell and discomfort when urinating.

Based on complaints, an examination of the external genital organs is carried out and a swab is taken from the urethra, sowing for sensitivity to antibiotics. During pregnancy, the inflammatory processes that accompany urethritis quickly spread to the vaginal mucosa. Taking a smear from this area, it becomes immediately clear that inflammation of the urethra occurs.

Treatment of urethritis during pregnancy

The treatment of urethritis during pregnancy depends entirely on its nature. If the cause is an infection, then the woman is immediately sent to the hospital. Here, the most conservative antibiotics are selected, which will affect the development of the fetus as little as possible. Local preparations and a course of immunotherapy are also prescribed.

Non-infectious urethritis is treated at home after a doctor's prescription. Prescribed drugs should relieve inflammation and eliminate the cause of the disease.

There are also methods of traditional medicine, but they are only additions to drug treatment, and are used after consultation with a doctor. Douching with infusions of chamomile, linden can be practiced. It is also recommended to drink sour juices, fruit drinks and eat more leafy vegetables.

The goal of treatment for any type of urethritis is to restore the properties of the walls of the urethra, restore the microflora of the vagina and enhance the protective functions of the immune system.

Prevention of urethritis

The occurrence of urethritis in women during pregnancy can be associated with both infection and other adverse factors that disrupt the vaginal microflora. A woman always, and especially during pregnancy, must protect her body from these factors:

• avoid hypothermia;
• do not expose the body to stressful situations;
• observe the rules of personal hygiene;
• have a regular sexual partner or use protection in casual relationships;
• Eat right to maintain immunity;
• ensure proper rest;
• visit the gynecologist regularly.

Following precautions will reduce the likelihood of this disease.

Self-treatment in any case can only lead to an aggravation of the problem. Remember, now you are responsible for two lives: yours and the baby. Urethritis during pregnancy can lead to irreversible consequences, so if you have the slightest ailment, consult a specialist. Only he will be able to make the correct diagnosis and choose a gentle treatment.