Sexually Transmitted Diseases - I. I. Mavrov 2005

Other bacterial urogenital infections
Gardnerellosis

Gardnerellosis holds a distinct position among Sexually Transmitted Infections. In recent years, Infections caused by Gardnerella have increasingly drawn the attention of researchers.

Etiology. The disease results from vaginal infection with Gardnerella vaginalis, formerly known as Haemophilus vaginalis. Gardnerella vaginalis is a non-motile Gram-negative rod, though Gram-variable forms may occur. It exhibits polymorphism. Recognized as a pathogenic microorganism relatively recently, it was first isolated from patients with vaginitis by Gardner and Dukes in 1955 and named Haemophilus vaginalis. Later, B. A. Teokharov (1961) described Urogenital infections caused by this Organism in both men and women. Today, it is well established that this pathogen causes inflammatory processes in the Urogenital System, infectious complications in newborns (such as meningitis and Pneumonia), and postpartum complications. Inoculation of cultures of this microorganism into the Vagina (in volunteer studies) induces nonspecific vaginitis.

In 1980, Greenwood and Pickett proposed the generic name Gardnerella for this microorganism.

Modes of Transmission. Infections caused by Gardnerella are contagious. The pathogen is sexually transmitted. Transmission to a newborn is possible during passage through the mother's birth canal, and cases of intrauterine fetal infection have also been reported.

Epidemiology. Like any infectious disease, gardnerellosis has an incubation period averaging 7–10 days, though it can last up to 5 weeks. The condition is frequently diagnosed in women with multiple sexual partners.

Gardnerella vaginalis has been isolated in 59.6% of women with inflammatory Disorders of the urogenital Organs. The detection rate of this microorganism in men suffering from non-gonococcal urogenital infections ranges from 2.5% to 3.5% (B. A. Teokharov, 1968; I. I. Mavrov, 1978; Gardner et al., 1959; Dettani et al., 1982).

Mixed infections involving Chlamydia, Mycoplasma (Ureaplasma), gonococci, Protozoa (trichomonads), Fungi, and anaerobic microorganisms are frequently noted.

The primary sites of infection are the vagina, cervix, and Urethra. There is also Evidence indicating the presence of the pathogen within the uterine cavity.

Clinical presentation. Clinical manifestations lack specific characteristic features. The main Complaints include profuse urethral and vaginal discharge, itching, and a burning sensation.

Gardnerella causes vaginitis, Endocervicitis, and urethritis in women, and prostatitis in men. Gardnerella-induced vaginitis is the most prevalent form of bacterial vaginitis. In typical cases, the discharge is scanty, gray, watery, and has an unpleasant ("fishy") odor resulting from The breakdown of amines produced by anaerobic Bacteria that proliferate actively during gardnerellosis-associated vaginitis.

Vaginitis caused by Gardnerella can lead to ascending inflammatory processes, fetal complications, neonatal infections, and postpartum complications. Cases of infant pneumonia, Postpartum Endometritis, and other Gardnerella-associated diseases have been documented.

Diagnosis. Laboratory diagnosis is performed using native (wet mount) and Gram-stained preparations, as well as cultivation on nutrient media.

Native preparations reveal flat epithelial Cells with Gardnerella attached to their surfaces, giving them a characteristic "peppered" appearance. These specific cells were termed "clue cells" (M. Borriello et al., 1974) and serve as a pathognomonic sign of gardnerellosis.

In stained smears, the cytologic picture is characterized by scattered leukocytes throughout the visual field, a significant number of small rods—predominantly Gram-negative and occasionally Gram-positive—adhering to epithelial cells, and the absence of lactobacilli and cytolysis.

The cultivation process for Gardnerella is relatively straightforward. The optimal medium is Casman's Blood Agar supplemented with 5% defibrinated rabbit blood. The culture is incubated under anaerobic conditions.

On blood agar, Gardnerella grows as small, convex, translucent colonies with a grayish sheen and zones of hemolysis. The colonies measure 0.5 mm in diameter, making them easy to miss even upon careful examination of the agar surface; therefore, using a magnifying Glass is recommended for their detection. Smears from these colonies reveal Gram-negative rods with rounded ends, arranged singly or in short chains.

Gardnerella ferments sucrose, glucose, and mannitol under anaerobic conditions; it does not produce rhamnose, xylose, or 4% lactose, nor does it form indole or hydrogen sulfide. It does not reduce nitrates, lacks catalase and oxidase activity, and is not Bile-soluble.

Treatment. Patients are prescribed ampicillin, Tetracyclines, or macrolides at standard dosages. In cases of resistance, metronidazole combined with erythromycin or ampicillin is recommended. Positive results have also been described with the intravaginal use of creams containing sulfonamides or tetracycline, as well as Clion-D vaginal tablets.

To achieve therapeutic success, both sexual partners must undergo treatment.