Streptococcus agalactiae in a smear from the vagina, urethra and cervical canal - what to do if detected. Pregnancy and streptococcal infection

Streptococcal infection during pregnancy is detected quite often in a smear. In some regions this figure is significantly higher than the statistical average of 30%. This is explained by the transmission of the disease. Streptococcus isolated in smears of a pregnant woman could enter the woman’s body through one of the following routes:

• From person to person, for example, when shaking hands, kissing.
• Sexually.
• Use of personal hygiene items by several people, one of whom is a carrier of a bacterial infection. This applies not only to towels, but even soap.

During pregnancy, women's immunity is significantly reduced. This is due to certain changes in the body.

Infection can occur both at the beginning of pregnancy and in the last weeks. Therefore, significant attention should be paid to the safety of the expectant mother. In some cases, it is even useful to limit your social circle.

At risk are women who have addictions that further suppress the functioning of the immune system. Also, negative consequences are more often recorded in those who suffer from diabetes.

In addition to its unsystematic occurrence in a latent form, detected streptococcus in the urine of a pregnant woman can lead to the development of various skin rashes. We are talking about the following diseases:

• Superficial streptoderma. They come in the following varieties - Tilbury Fox, folds, annular, periungual, slit-like, bullous, lips, mucous membranes, including the oral cavity and throat.
• Deep streptoderma has one form. The disease is called ecthyma.
• Atypical streptoderma is lichen simplex, acute diffuse streptoderma. Papular syphiloid impetigo occurs only in children under 1 year of age in the absence of proper hygienic care. Its second name is diaper dermatitis.

Often, pregnant women confuse the first manifestations of streptococcal infection with other ailments. Therefore, it is important to know what symptoms are characteristic of this disease.

Symptoms and signs of streptococcal infection in pregnant women

Streptococcus in the urine of a pregnant woman is a fairly common occurrence. In most cases, drug therapy with antibiotics is sufficient to get rid of the bacterial infection. The situation is much worse when group B streptococcus is detected in pregnant women. The influence of this strain can lead to the death of the mother after childbirth, premature onset, and infection of the child.

Doctors identify the following symptoms that are characteristic of the obvious manifestation of streptococcal infections:

• A - skin rashes in the form of streptoderma, damage to the respiratory tract, reproductive system, and urinary tract.
• B - can cause early meningitis, pneumonia, endocartitis, and septic arthritis in a newborn.
• C and G are pathogens of zoonotic diseases.
• D - just like A, it manifests itself in the form of streptoderma.

With a significant decrease in immunity, moderate growth of streptococcus during pregnancy can lead to the development of various serious diseases.

The infection can be localized to the gastrointestinal tract, respiratory tract, genitals and reproductive organs. In severe cases, the circulatory and lymphatic systems are affected, which leads to damage to the joints, heart, and brain.

Treatment of streptococcal infection during pregnancy

The methodology for influencing streptococcal infection and the choice of drugs largely depend on the manifestation of the disease. In addition to eliminating the pathogen itself, a course of immunomodulatory therapy is recommended. You can use such as rosehip decoction, pomegranate juice, tea with chamomile and lemon balm.

Streptococcus in the throat of pregnant women is quite common. In this case, Amoxicillin, Azithromycin, and Cefuroxime are prescribed. With high frequency, streptococcal infection manifests itself in the form of seizures in the corners of the lips. Antibiotic ointments are used for treatment. Also, the skin around the lesion should be wiped with a solution of levomycetin, boric or salicylic acid.

Streptococcus in the cervical canal during pregnancy must be eliminated without fail. In this case, there is a high risk of infection of the baby during childbirth. Drug therapy is prescribed individually. It is advisable to immediately use the latest generation of antibiotics.

Consequences of streptococcal infection for mother and fetus

If streptococcus is detected during pregnancy by bacterial culture, it is necessary to undergo a course of antibiotic treatment prescribed by a doctor. The importance of this is determined by the fact that there is a probability of up to 2%. Approximately 15% of infected babies die. Timely prescribed drug therapy will help to avoid death.

Infection of a baby with epidemic pemphigus, which is caused not only by Staphylococcus aureus, but also by some streptococci, occurs through no fault of maternity hospital staff. Often its cause is a young mother who refused to undergo “unnecessary” tests.

Beta hemolytic streptococcus in pregnant women occurs in approximately 4% of the total number of women. In the normal state of the body, its presence does not manifest itself in any way. The situation is completely different during pregnancy. Especially if the pregnant woman has streptococcus agalaticps 10 6 degrees. Often, obstetricians associate the onset of premature birth with its presence.

Alevtina Aasar, general practitioner, specially for the site

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Streptococci cause various diseases and are detected by modern diagnostic methods. A urine test during pregnancy can confirm or refute the presence of group B streptococci in a woman’s body. If the laboratory result is positive, treatment with antibiotics is carried out.

Group B streptococcus

Group B Streptococcus (GBS) is a common bacteria that causes health problems. For an adult, this microorganism is usually not dangerous. GBS discovered during pregnancy poses a serious threat to the fetus.

About 10-30% of expectant mothers are carriers of group B streptococcus. Since this bacterium is present in the body of every fourth woman in an “interesting” situation, it cannot be called rare. However, it is also unacceptable to be indifferent to GBS. The fact is that a woman can transmit this microorganism to her child during childbirth.

In most cases, it is possible to determine that streptococcus is present in the body only by the results of laboratory tests. To do this, it is necessary to conduct a detailed examination of urine or smear. In only a small number of the population infected with GBS, the bacteria's activity leads to urinary tract and bladder infections.

Types of streptococci and diagnosis of infection during pregnancy

Hemolytic streptococci are the most common pathogenic bacteria. They are divided into several groups based on various criteria.

Group A streptococci are transmitted by airborne droplets, and less commonly through contaminated dishes and food. These microorganisms are detected by examining a throat swab. To prevent infection, doctors recommend observing basic hygiene requirements.

Group B streptococci are detected in 10-30% of expectant mothers. Most carriers of the bacteria are sexually active women under 20 years of age. GBS is transmitted during sexual intercourse from an infected partner to a healthy one.

Streptococci can be found in various organs. To identify pathogenic microorganisms in the urinary tract, a urine culture test is performed. If the rules for collecting material are not followed, this diagnostic method produces false positive results.

The study requires an average portion of urine and a sterile container. It is best to use disposable containers, which are available in every pharmacy. Before collecting material, you must wash thoroughly. When urinating, it is advisable to cover the vaginal opening with a sterile tampon.

Another diagnostic method is taking a smear from the vagina. Analysis is optional. Pregnant women take it at the direction of a gynecologist.

If the expectant mother suffered a urinary tract infection caused by streptococci during the gestational period, or in the past gave birth to a child infected with these microorganisms, then at 35-37 weeks of pregnancy she needs to undergo a smear. If the result is positive, the doctor will prescribe a course of antibiotics and will closely monitor the woman’s health.

How dangerous is streptococcal infection?

Unfortunately, GBS is a dangerous bacterium that can lead to various pathologies. That is why, if group B streptococci are detected in the urine or smear, urgent treatment is necessary. Lack of timely treatment increases the risk of:

• premature birth;
• intrauterine fetal death;
• premature rupture of membranes.

In addition, GBS is a common cause of urinary tract infections. This microorganism can lead to increased body temperature, burning sensation and pain when urinating. Almost always, streptococcal infection is asymptomatic, but is detected by examining urine and smears.

If the infection is transmitted to a child, pneumonia may occur

In 1-2% of cases, infected mothers transmit group B streptococci to their children during childbirth. If this happens, the child develops the following diseases:

• meningitis;
• sepsis;
• pneumonia.

However, there is no need to despair. Modern medicine successfully combats GBS in newborns with antibiotics (penicillin, ampicillin) and intensive symptomatic therapy. Most infected children recover. In only a small number of young patients, streptococcal infection causes future pathologies, such as hearing or learning problems.

To prevent transmission of infection to your newborn, you should closely monitor your health during pregnancy. It is advisable to be tested for the presence or absence of GBS shortly before delivery. For preventive purposes, it is necessary to strengthen the immune system and lead a healthy lifestyle.

Signs of a child becoming infected with streptococcal infection

Signs of early and late infection may appear. In the first case, fever, increased drowsiness in the first week of life, and problems with the respiratory system appear. Early onset of the disease occurs in 50% of newborns and sometimes leads to sepsis, pneumonia and meningitis.

With a late onset of infection, cough, problems with eating, high body temperature, convulsions or drowsiness, and nasal congestion are observed. These symptoms occur between 7 days and 3 months after birth and often provoke meningitis and sepsis.

In 99% of cases, infected newborns have no symptoms of the disease. For this reason, doctors recommend establishing GBS colonization through laboratory diagnostics. The test material is obtained by taking samples from the baby’s throat, external auditory canal, navel, and rectum. The presence of pathogenic microorganisms can be detected by examining the amniotic fluid.

Consequences and treatment of streptococcal infection after childbirth

Sometimes GBS leads to infection of the uterus. In this case, the following symptoms arise:

• high body temperature;
• increased heart rate of mother and fetus;
• painful sensations in the abdomen.

Antibiotics are used to combat GBS. These medications are administered intramuscularly or intravenously before delivery. It is optimal to use antibiotics 4 hours before the baby is born. This will help prevent the newborn from becoming infected.

Penicillin (sometimes ampicillin) is usually prescribed to treat streptococcal infections. In some cases, these drugs cause an allergic reaction (in 1 in 25 women). This therapy is used only if natural childbirth is planned. As a rule, a cesarean section eliminates the need for the expectant mother to take antibiotics.

Despite all the negative consequences that a streptococcal infection can cause during pregnancy, there is no need to be afraid. Firstly, during the gestation period, various abnormalities are diagnosed, including the presence of GBS in the body (by examining urine and smear). Secondly, timely treatment helps to cope with a dangerous disease, preventing negative consequences for the mother and her baby.

The vaginal microflora is represented by a variety of microorganisms. Depending on their relationship, the concepts of normality and pathology are distinguished. The basis of normal flora is made up of rods - lactobacilli. They are supplemented by opportunistic microorganisms, represented by streptococci, staphylococci, gardnerella, candida, urea and mycoplasma.

As long as the number of these microorganisms is insignificant, there is no large number of leukocytes, the condition of the vagina is considered satisfactory. If one of them predominates in a smear from the cervical canal, for example, streptococcus agalactia, then nonspecific inflammation is diagnosed.

A little about the pathogen

Streptococci are a large group of microorganisms that are similar in morphological characteristics. Depending on the nature of growth on nutrient media, serogroups are divided into hemolytic, greening and non-hemolytic. Groups B, D and green are present in the vagina. Normal values ​​should not exceed 10 to 4 degrees CFU/ml.

Agalactia belongs to beta-hemolytic streptococci of group B. This means that when sown on a nutrient medium based on agar and blood, as the colony grows, a zone of complete hemolysis of red blood cells forms around it. In this case, the nutrient mixture becomes discolored.

The activity of the microorganism is accompanied by the release of various toxic substances:

• streptolysin destroys surrounding tissue;
• leukocidin destroys immune cells, allowing microbes to escape;
• necrotoxin and lethal toxin cause tissue necrosis;
• a set of enzymes that help streptococcus penetrate into surrounding tissues: hyaluronidase, proteinase, amylase, steptokinase.

The colonization of streptococci occurs with puberty and the onset of sexual activity. Possible household transmission through the use of common hygiene items. Women can self-infect themselves if they move from back to front when washing their genitals. Microbes from the anal folds enter the vagina. A pregnant woman can infect her baby during childbirth.

Men can become infected from women during oral or anal sex, through the intestinal walls during dysbacteriosis, or descending from the kidneys or nasopharynx.

What are the signs of infection?

Until the amount of the pathogen is at a minimum level, there are enough lactobacilli in the vagina that suppress the growth of opportunistic flora. In men, streptococcus agalactia appears after unprotected sexual intercourse. In the future, they become carriers of the infection and are able to transmit the pathogen to other partners.

Activation of streptococcus occurs when the balance of normal microflora is disturbed. The following reasons lead to this:

• changes in hormonal levels;
• decreased immunity;
• violation of hygiene procedures;
• use of douching for personal hygiene;
• diabetes mellitus and severe pathologies.

During pregnancy, the first two factors are especially relevant. , which gradually increases, inhibits local immunity. This process is aimed at preserving pregnancy, but it has negative consequences: latent infections of the genitourinary organs often worsen in pregnant women, and colpitis also develops.

There are no symptoms of agalactia. These pathogens do not cause an inflammatory reaction in the vagina. Detection of a high concentration of the pathogen occurs accidentally during a routine examination. In pregnant women, signs of infection activation appear in the form of urethritis or cystitis.

Initially, the pathogen appears in the urethra, and then rises higher. Characteristic symptoms of cystitis are pain and burning when urinating, followed by a feeling of incomplete emptying of the bladder, frequent urges that are not accompanied by the release of a large amount of urine.

Acute cystitis is accompanied by a deterioration in general condition, weakness, and headache. Temperature increases are rare.

What is the danger of infection?

Streptococcus agalactia is detected in 20% of women during pregnancy. Lack of timely treatment can lead to the development of the following complications:

• urinary tract infection;
• postpartum endometritis;
• sepsis of the neonatal period;
• pneumonia of the newborn;
• endocarditis;
• meningitis.

For a woman, in most cases, the infection will be hidden; in a newborn, it often causes complications.

In what cases is examination necessary?

There are certain risk groups for developing streptococcal infection:

• long water-free period of more than 18 hours;
• rise in body temperature in a woman during childbirth;
• bacteria in urine;
• birth of a premature baby;
• low birth weight of the newborn;
• childbirth by means of .

If a woman has had a child with streptococcus agalacia in previous pregnancies, then examination in the second birth is mandatory.

Laboratory diagnostic methods

Routinely, pregnant women undergo smears from the cervical canal. This research method allows you to determine the degree of vaginal cleanliness and establish the first deviations from the norm. If coccal flora predominates in the smear, a culture test is necessary, which is the main method for diagnosing the infection.

For sowing, liquid or solid nutrient media are used. In some laboratories they add substances that inhibit the growth of other microorganisms. This increases the excretion of streptococcus by 50%.

For sowing, material is taken from the vagina and anorectal area. It is recommended to take discharge from several areas of the mucous membrane at the same time. This also increases the likelihood of identifying the pathogen. Detection of 10 to 3 CFU/ml is a normal variant.

Since the role of streptococcus agalactia in infection of a newborn is very large, a system of screening tests has been developed to detect agalactia. To do this, they use the determination of microorganism antigens in latex agglutination, ELISA, and coagglutination. These methods are fast but have some disadvantages. If the examination is carried out during labor, vaginal discharge may be mixed with amniotic fluid and blood. This reduces the sensitivity of the tests.

PCR diagnostics is also used. With its help, you can isolate Streptococcus agalactia in urine discharged from the vagina and from the skin of a newborn. During the study, the DNA of the pathogen is determined. Recent developments in this area make it possible to study virulence genes. Identification of such a genetic composition indicates a high probability of infection of a newborn with a severe form of the disease.

For pregnant women, the study is carried out at 35-37 weeks. The PCR method allows you to identify qualitatively and quantitatively streptococcus in the material under study. Identifying the number of microorganisms allows us to judge the contamination of the area under study. The disadvantage of this method is that it is impossible to identify living representatives of the genus and determine their resistance to antibiotics.

What is streptococcus? How to treat this infection? Isn't it dangerous for the unborn child? We will try to answer these and other questions in our article.

What is this infection?

Streptococci are pathogenic bacteria that are found in the human body. A pregnant girl has streptococci in her vagina, which are usually divided into 3 groups:

1. "green" appearance;
2. serological group B;
3. enterococci.

Experts usually identify the 2 most dangerous pathogens:

1. hemolytic serological group A, which arose due to many cases of bacterial sepsis;
2. serological group B, which began to often appear in infants.

Main spreaders of infection

Group A streptococci

Consider infections caused by group A streptococci.

The causative agent is hemolytic streptococcus. In pregnant girls, the nasopharynx, vagina and perianal areas are mainly affected. To identify it, they take a smear from the vagina, a urine test, and examine it in a laboratory. Most often, a girl gets sick with tonsillitis, pharyngitis; infections of the genitourinary system, endometritis and postpartum sepsis appear. A doctor can make a diagnosis using the cultural method (the breathing diaphragm is examined). This disease can affect the fetus in such a way that it may develop diseases related to the respiratory system.

For the purpose of prevention, doctors advise promptly identifying the risk factor, observing the rules of hygiene at the time of birth, taking antibiotics and taking a general urine and blood test 2 times a month.

Treatment is usually carried out with the drug " Novotsin" And " Procaines-Benzyl penicillin", in two weeks.

Diagnosis of streptococcal infections can be achieved by culturing, in which the material is examined under aerobic conditions.

Group A streptococci should be treated in a pregnant girl with penicillin therapy for approximately two weeks, and you can also use the drugs “Fortazim” and “Vilprafen”.

If bacterial sepsis occurs, the doctor administers a large dose of procainepenecillin intravenously. Infants with such an infectious disease may also be prescribed a large dose of procainepenecillin.

To prevent such a disease from appearing again, you must follow special rules that your doctor should tell you about.

Group B streptococci

Now let's look at those infectious diseases that are caused by group B streptococci.

Pregnant women are susceptible to this disease much more often than others. To identify it, it is necessary to take a smear and examine it in a laboratory. Also, additional urine and blood tests are taken.

In a pregnant woman, the disease may occur without pronounced symptoms. But sometimes it happens that a genitourinary tract infection can occur. To identify these diseases, you need to take a general urine test. The disease is diagnosed by culturing. It can affect the fetus in this way: the child subsequently develops meningitis and severe diseases of the nervous system.

Treatment is carried out using the drug " Sumamed ».

Streptococci of this type contribute to the appearance of meningitis and septicemia, which can often lead to death. Statistics show that a premature baby gets an infection 3 times more often than other children.

The main distribution medium for group B streptococci is the presence of a girl’s normal microflora.

I was diagnosed with such an infection at 29 weeks. The doctor immediately prescribed me the following treatment: the antibiotic Cephalexin and douching. After taking a course of cephalexin and doing 5 douches, I came for a re-examination. After I passed a general urine and blood test, the doctor said that everything was normal and no infection was detected.

How should it be treated?

Streptococcal infection can only be cured with antibiotics. Your doctor must prescribe a course of treatment; you usually take the tablets for two weeks. It is recommended to take medications such as:

Finally, we would like to say that only a timely visit to a specialist will help you avoid the development of such an unpleasant disease.

Carriers of class B streptococcus (the most common) can be women who have never complained of infectious and inflammatory diseases of the genital organs. And in the period before the discovery of pathogenic organisms, they did not even suspect their presence. This is why streptococcal infection is dangerous - its inconspicuousness. And it is dangerous not for a woman, whose immune system is able to cope with bacteria that have entered the body, but for a defenseless baby, whose intrauterine and extrauterine development can be jeopardized by harmful organisms.

Causes of streptococci in the body of a pregnant woman

The actual reason is the constant presence of few or numerous colonies in the gastrointestinal tract, on the back wall of the nasopharynx or in the female genital organs. Streptococcal bacteria, as a rule, do not manifest themselves in any way, but are actively transmitted from person to person during a handshake, kiss, or sexual intercourse.

So they would remain unnoticed and harmless if, under certain conditions, they did not exhibit hemolytic properties and begin to absorb red blood cells, releasing toxins in return.

To protect yourself and your baby from a “safe” infection, a woman should:

• carefully maintain intimate hygiene;
• avoid the use of aggressive agents (even ordinary soap in this case can serve as a “conductor” for streptococci), maintaining an acidic environment in the vagina at a certain level.

Statistics: the number of bacteria carriers and successful births with streptococcal infection

From 10 to 30% of pregnant women are carriers of streptococci. Moreover, the majority experience asymptomatic infection. The only thing that may indicate the presence of bacteria is yellowish discharge, which is inconsistent in nature, but quite abundant.

Only sometimes streptococcus B can cause a fatal disease in a woman. It manifests itself immediately after childbirth and consists in the ability of bacteria to harm blood cells.

Newborn babies are susceptible to the harmful effects of streptococci somewhat more often, but mass deaths of babies born from carrier mothers have not been observed.

British pediatricians, observing the outcome of the births of infected women, compiled statistics using the results of observations as a basis: out of 700,000 newborns, streptococcal infection manifests itself in 700. 100 babies die from it, in percentage terms this is 15%.

As a result of research, it was also revealed that some children very easily become infected with streptococci, while others are born completely healthy. Apparently, the reason is the difference in the power of the immune system, thanks to which some babies can resist diseases while in the womb.

Russian doctors state the probability of fetal infection at 1-2%. Fortunately, the rate is low, but there are factors that can increase a child’s risk of infection.

Risk factors

1. Bursted amniotic sac: the time from the moment of rupture to the moment of birth is 18 hours or more.

2. Premature contractions.

3. An increase in the mother’s temperature to 38 degrees or more.

4. Previous births with streptococcal infection.

Fear of getting pregnant

Among women who have already had a sad or not so bad experience of childbirth with streptococcal infection, 30% are afraid of the possibility of becoming pregnant again and repeating this experience again.

Streptococcus B is a natural component of the human flora and if it is present, then you cannot escape it.
In some cases, bacteria pose a danger to the baby during the birth canal. To protect the baby, doctors cover the bacteria with antibiotics directly during labor - they put the mother on an IV no later than 4 hours before the start of active labor.

Treatment and prevention during pregnancy

The truth is: there are no reliable preventive methods that guarantee complete elimination of streptococcal infection. The most accessible and effective way is to constantly work on strengthening the immune system: adequate sleep and rest, proper nutrition, spending time in the fresh air, and, if possible, doing physical exercise (gymnastics for pregnant women).

If the streptococcal infection bothers you too much and intrusively, you should seek medical help. The most suitable and safest drugs for mother and child are penicillin and ampicillin. They are usually prescribed to pregnant women.

The course of treatment is up to 10 days.

If a woman is at risk and has already given birth while infected, she needs to be tested for streptococci between 35 and 37 weeks of gestation. Based on the results, the doctor prescribes antibiotics during childbirth and constant monitoring of the newborn during the first three months of life.

If not treated

The impact of streptococcal infection on the course of pregnancy and childbirth cannot be underestimated, despite the tiny percentage of deaths for the baby. Bacteria behave differently in different organisms, and there is no guarantee that “if you don’t touch them, then they won’t be touched.”

If streptococcal infection is left untreated, there is a real risk of premature rupture of membranes, premature birth and intrauterine fetal death.

Complications in newborns

If, at first glance, everything ended well, the birth took place and the baby is alive, do not rush to refuse the close attention of doctors - the consequences of a streptococcal infection do not appear in the first five minutes. The problem matures over weeks and months, and as a result, the diagnosis shows one or more dangerous diseases: meningitis, pneumonia, sepsis, each of which poses a mortal threat to the child’s life.

The “operation” to save the baby must begin long before birth at the slightest suspicion of bacteria. The responsibility of the mother and the professionalism of doctors usually bring excellent results: the baby is alive, healthy and happy.