Thrush - symptoms and treatment

Thrush - symptoms and treatment 25 3.8

Health of pregnant women

Thrush - symptoms and treatment

Thrush during pregnancy

Many future mothers are puzzled when they are prescribed tests for sexually transmitted infections: why be reinsured if, it seems, everything is in order?

Ekaterina Svirskaya Obstetrician-gynecologist, Minsk

Unfortunately, these diseases in our time are quite common and often occur asymptomatically. Meanwhile, among them there are those who can adversely affect the course of pregnancy, childbirth and the health of the baby. That's why these diseases deserve a special conversation.

Thrush - This is the popular name of the disease, in which vaginal discharge appears, similar to sour milk. Doctors-gynecologists and pharmaceutical companies under thrush understand a strictly defined disease caused by only one pathogen-fungus of the genus Candida. From the name of the microorganism, the scientific name of the disease is also called candidiasis, or candidal colpitis. 

Unfortunately, in recent years, candidiasis has firmly taken the lead among all diseases of pregnant women. In advertising, you can see smiling lucky beggars who bought a miracle pill and forever forgot about this unpleasant disease. All would be well, but why then at least 75% of women at least once in their life suffer from vaginal candidiasis, and many of them still do not part with this disease? Why do half of all pregnant women have candidiasis before delivery?

Thrush Is not just a term for itching and discharge. After all, similar symptoms can accompany other diseases, such as genital herpes, chlamydia, mycoplasmosis, trichomoniasis or gonorrhea. And all preparations "from a thrush" are directed on liquidation of candidiasis. Therefore, self-medication "miracle pill" during pregnancy is not only not effective, but also dangerous. If you are concerned about such symptoms thrush, it is necessary to go to the doctor and find out the true causative agent of the disease, and then choose a treatment that is safe for the baby's future.

Causes of thrush

So, the only culprit thrush are fungi of the genus Candida. Most candidiasis in pregnant women causes Candida albicans (in 95% of cases), but sometimes it is possible to kill other candidias. The risk of transmission of candidiasis during sexual intercourse has not been confirmed to date. So, only 10% of the sexual partners of women with candidiasis find Candida at the examination. It is believed that the main source of infection is the intestine of the patient herself, where in normal these fungi are present in small amounts. In the vagina their numbers are controlled by other bacteria that make up the normal microflora. Under adverse circumstances, the beneficial bacteria of our mucous membranes die, or the defenses of the body are depleted and can not prevent uncontrolled growth of fungi. 

Candidiasis Is an internal condition, the cause of which is a decrease in immunity. In the overwhelming majority of cases, a decrease in immunity is the result of an infection (including the so-called hidden infections - chlamydia, ureaplasmosis, mycoplasmosis, etc.). Infection leads to an imbalance of microflora, against which fungi are activated. The situation is exacerbated by the use of antibiotics used in treatment of these infections.

Additional factors that provoke candidiasis include the use of hormonal drugs, a change in the acidity of the vaginal environment as a result of douching, an unbalanced diet with a predominance of carbohydrates, severe emotional stress, environmental pollution. This is especially true for women who have problems with metabolism or suffering from diabetes.

The risk factor for exacerbation of candidiasis is pregnancy, especially its last three months.

thrush symptoms лечение

Symptoms of candidiasis

Symptoms of candidiasis проявляются в любом случае, однако некоторые женщины совсем не обращают на них внимание. Выраженность симптомов зависит от формы протекания thrush:

  1. Carrying. It occurs in women with sufficient immunity. Symptoms of candidiasis while there are no, however, when testing a smear, fungi of the genus Candida are found. Despite the fact that the woman herself does not feel any inconvenience, if not treated, infection can be transmitted to the child during childbirth.
  2. The acute form. Shown by the following symptoms:
  • itching and burning sensations in the vagina and in the external genital area, which is enhanced by wearing tight synthetic underwear, after a warm bath, sexual intercourse, urination;
  • white, thick, curdled discharge. Most often they are meager, without a sharp odor. The nature of the discharge may vary slightly;
  • edema and redness of the mucous membrane of the vagina and external genitalia. In colposcopy (examination of the mucosa under a microscope), changes are observed that are characteristic of the inflammatory process, with inclusions in the form of "semolina" and a pronounced vascular pattern;
  • pain during intercourse and urination.
  1. Persistent candidiasis, or chronic thrush. About 2-3% of women are observed. Characterized by the fact that symptoms заболевания длятся несколько месяцев и больше. При этом symptoms thrush могут затухать, появляется иллюзия выздоровления, однако через некоторое время все повторяется. Все symptoms могут выступать как в совокупности, так и по отдельности, обычно они появляются за 1 неделю до менструации, после полового акта.

Candidiasis при беременности

Pregnancy contributes to the development of candidiasis, this disease is 2-3 times more common in pregnancy than in non-pregnant women. Many women first encounter candidiasis during pregnancy, кроме того, существует прямая связь между сроком беременности и частотой возникновения candidosis. Это обусловлено изменениями гормонального баланса во время беременности, который, в свою очередь, изменяет кислотную среду во влагалище и подавляет иммунитет. Candidiasis, как и любая другая инфекция, представляет собой потенциальную опасность, осложняет протекание самой беременности и повышает риск инфицирования плода и новорожденного. Поэтому, несмотря на высокую частоту встречаемости у беременных, thrush is not an inoffensive companion of this state. It must be diagnosed and treated.

For candidiasis during pregnancy characterized by alternation of asymptomatic flow and frequent relapses, that is even after лечения symptoms thrush могут появляться вновь и вновь. Candidiasis не влияет на наступление преждевременных родов, однако больная женщина может быть источником инфицирования плода. 

Transmission of the fungus from mother to newborn during labor occurs in more than 70% of cases, with the same frequency in women giving birth through natural birth canals, and in those who have had a cesarean section. Infection of the child is most often limited to the umbilical cord, cutaneous! covers, mucous membranes of the mouth and lungs, however, in preterm infants, i very serious complications are possible, up to and including death. In addition, the presence of fungi in the birth canal increases the incidence of postpartum inflammation of the uterus, despite the fact that the candidate herself does not cause these diseases.

thrush symptoms лечение

Диагноз thrush при беременности

Предварительным методом диагностики candidosis, который проводится у все; здоровых беременных,  является  микроскопическое исследование. For этого а стенки влагалища берут мазок и отправляют в лабораторию под микроскоп. При обнаружении в мазке спор или мицелия (тела) грибков ставится диагноз «кандидоз». Данное исследование  позволяет быстро поставить диагноз, однако лучшим методом диагностики является посев на специальную питательную среду – бактериологический (культуральный) метод. При этом отдельные клетки грибов, даже будучи в очень малом количестве, попадают в благоприятные условия и размножаются, образуя колонии. Этот анализ хорош тем, что можно точно определить конкретный вид грибка и выяснить, какие противогрибковые препараты способны его убить, а какие – нет.

The method of polymerase chain reaction (PCR diagnostics) is based on the detection of single molecules of DNA pathogens in the material under study. This is the most sensitive method of diagnosing infections, but often in the diagnosis candidosis it gives false positive results (a positive result in the absence of a causative agent). Similarly, the definition of antibodies to candida in the patient's blood (serological diagnosis) is not effective due to the high incidence of false negative and false positive results.

Лечение candidiasis during pregnancy

Bearing a child is the time during which all medicines are prescribed with an eye to not damaging the fetus. Preparations for лечения candidosis are divided into system and local. System treatment is taking drugs inside. Outside pregnancy, this method of treatment is the main, because the bulk of Candida is located in the intestine and from there spreads throughout the body. However, during pregnancy, the intake of systemic antifungal drugs is severely limited due to possible toxic effects on the fetus. Thus, in experiments with laboratory animals, the ability of INTROCONAZOLE (ORUNGALA) to provoke malformations of the fetus has been proved. The use of this drug is unacceptable in pregnancy. The tests of another systemic drug Fluconazole (DIFLUCAN, MICOSIST, DIFLAZON) did not show similar effects, however, data are not enough to judge the safety of the use of this drug in pregnant women. Nevertheless, in very rare cases, if it is impossible to cope with candidiasis with local forms, these drugs can be prescribed on the eve of childbirth.

The main method treatment of pregnant women women is the use of local drugs in the form of candles, cream ointments. Unlike their predecessors, modern types of such medicines are highly effective. In the first trimester of pregnancy, the most commonly used is NATAMIMIN (PIMAFUZIN). After 1 week of pregnancy, candles with Nystatin may be used, and after 20 weeks - preparations BUTOCONAZOL / (GINOFORT) or ISOCONAZOLE, (GINOTRAVOGEN).

On the eve of childbirth, preference is usually given to complex drugs that eliminate not only thrush, но и другие виды инфекций родовых путей (ТЕРЖИНАН). В схему лечения candidosis обязательно включают поливитамины, иногда требуется назначение иммуномодуляторов. Контрольное обследование проводится спустя 7-10 дней после завершения лечения. Совместно с женщиной рекомендуют также лечить и ее полового партнера (назначают таблетки и крем для местного применения), а на время лечения использовать презерватив.

Thrush during pregnancy represents a danger to the fetus only if it is not treated. If the candidiasis is detected in time, then any of its consequences are easily preventable. Therefore; you need to try at the planning stage of pregnancy to completely get rid of various foci of infections in the body, and during pregnancy to protect yourself from colds to prevent the possibility of returning the infection.