Cystitis or urethritis during pregnancy

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, quickly develops 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), and 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, and 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.

Urethritis treatment during pregnancy

Inflammation of the urinary system, called urethritis, can occur in women during pregnancy. This usually happens suddenly and is manifested by characteristic signs. For the correct treatment of urethritis, pregnant women need to consult a doctor, as self-medication can be ineffective and even dangerous.

Features of the disease in pregnant women

The signs of this disease during pregnancy are often confused with another disorder called cystitis, although these diseases are very different. Depending on the form of urethritis, the doctor determines the appropriate therapy using special medications. Urethritis during pregnancy always belongs to one of the groups:

What is the danger of the disease?

Early and late urethritis can affect the development of the fetus. The level of risk is affected by the form of the disease and the infection that caused the disease. The non-infectious form is less dangerous, since the risk of infection of the developing baby with pathogenic parasites is excluded in this case, but the disease cannot be ignored. Otherwise, urethritis will develop into other pathologies of the urinary system.

There is even a risk of infection of the baby at the time of birth, when he passes through the birth canal. In this case, the development of conjunctivitis in an infant, gonococcal infection, and even pneumonia is possible. In this regard, it is better to take care of the treatment of urethritis during pregnancy, preventing the disease from developing.

What are the symptoms of the disease?

The symptoms of urethritis in women in position are similar to the manifestations of the disease in ordinary people. The main distinguishing features of the disease in pregnant women is the muffling of pain, because of which a woman may not notice them. Despite this, at the first visit to the gynecologist, the disease will be detected.

Indicate urethritis, especially in the early stages, can be frequent urination, accompanied by itching, burning and other uncomfortable sensations. Along with this, discharge comes out of the urinary canal. Their appearance and abundance depends on the pathogen.

According to the symptoms, urethritis in pregnant women is often confused with cystitis, but the diseases are different. With cystitis, pain occurs after going to the toilet, and with urethritis, they accompany urination and do not disappear after it.

Why does the disease develop?

There are many reasons for the appearance of urethritis at different stages of pregnancy. Often they are associated with a weakening of the protective mechanisms in the body and hormonal disruptions. A weakened body is always vulnerable to infections, so pathogenic parasites that provoke urethritis can immediately become active after conception. Also, experts identify a number of factors that contribute to the emergence and development of urethritis:

• injury to the urethra from stones coming out of the kidneys;
• hypothermia;
• drinking little water;
• neglect of personal hygiene;
• sexually transmitted infections (you can get infected even before pregnancy);
• pressure of a developing fetus;
• disturbances in the urinary system;
• overwork;
• pathology of the genitourinary system;
• impaired circulation.

Is urethritis in pregnant women treated?

Doctors prescribing treatment for urethritis during pregnancy are guided by the stage of the course of the disease. The main goal is not to harm the baby. The disease is especially dangerous in the early stages in the first trimester, when the main systems and organs are laid in the fetus.

When diagnosing bacterial urethritis, local preparations are needed, which include special urological suppositories, ointments, gels and creams. Antibiotics are practically not prescribed, and to speed up the fight against infection, you need to take care of the diet.

It is impossible to say exactly how to treat urethritis during pregnancy. The approach should be comprehensive and include:

• restoration of the microflora in the vagina;
• strengthening immunity;
• use of aids.

To normalize the microflora, you need to populate the vagina with microorganisms that should live in it. The choice of drug for this doctors choose individually. Immunomodulators and vitamins are required to strengthen and maintain immunity.

As ancillary measures for the treatment of urethritis in pregnant women, folk remedies are isolated. When used correctly, they are very useful. Especially recommended are lingonberry and cranberry fruit drinks, linden tea, cornflower blue infusion. Parsley juice, which has anti-inflammatory and diuretic effects, is also suitable.

In the advanced stages of urethritis during pregnancy, emergency measures are needed. These include quenching of the urethra, that is, cauterization of the affected mucosa. The essence of the procedure is to prevent irreversible pathologies in complex chronic forms of the disease.