The use of suppositories genferon for the treatment of ureaplasma. What candles for women are used from ureaplasma? Rectal suppositories for ureaplasma

23.01.2022

Ureaplasma affects the mucous membranes of the genitourinary organs, causing the development of cystitis, pyelonephritis, inflammation of the appendages and uterus, joint diseases. The disease often develops in women, and men in most cases are carriers. The following factors contribute to the manifestation of symptoms:

pregnancy;
dysbiosis;
long courses of hormones and antibiotics;
treatment with radiation exposure.

Candles for ureaplasmosis for vaginal and rectal use have antibacterial, antiseptic and immunomodulatory effects. The active substances of the preparations block the reproduction of bacteria and prevent the occurrence of complications caused by pathogenic microorganisms. Treatment of ureaplasmosis is almost always complex and includes the use of oral forms of medications and suppositories.

If the patient has contraindications to the use of drugs for internal administration, doctors prescribe monotherapy with antibacterial suppositories.

Benefits of treating ureaplasmosis with suppositories

The antimicrobial drug in the form of tablets has a systemic effect and has a pronounced therapeutic effect in ureaplasmosis and other sexually transmitted diseases. Currently, doctors prefer complex treatment with the use of oral forms of medicines and suppositories for local use. Many antibiotics have contraindications, which include pregnancy, lactation, disruption of the digestive tract, severe liver and kidney dysfunction. In such cases, patients are prescribed suppositories with antimicrobial action.

Candles for the treatment of ureaplasmosis have the following advantages:

Rapid elimination of symptoms of the disease. Due to the local effect on the focus of infection of the active substances of the drug, it is possible to get rid of the infection in a short time.
Minimal impact on the body. When using suppositories, their active ingredients penetrate into the bloodstream in small quantities, which avoids the development of side effects that often occur when using tablets or capsules.
Anesthetic action. When inflammatory processes occur in the genitourinary tract, many patients experience pain that causes discomfort and prevents them from living a full life. The use of suppositories helps to eliminate these unpleasant symptoms in the first days of treatment.
Efficacy in chronic disease. The local effect of antibacterial components on the genitals allows you to treat sluggish inflammatory processes caused by ureaplasma.

Suppositories have the ability to slowly dissolve in the vagina, gradually affecting the bacterial focus. Each suppository is packed in a film to prevent pathogenic microorganisms and viruses from getting into the preparation.

Varieties of candles: which is better

Ureaplasmosis can be treated with universal antibacterial suppositories containing one active ingredient.

The drug is selected depending on the symptoms, the form of the disease and the presence of other types of infections.

With ureaplasmosis, doctors prescribe suppositories containing the following substances:

antibiotics;
antimicrobial components;
immunomodulators.

Suppositories with antibiotics

Many patients suffering from ureaplasmosis are prescribed vaginal suppositories with antibacterial components. Such drugs are highly effective and quickly destroy the causative agent of the disease. Therapy of infection is carried out with the following drugs:

Terzhinan. The drug is combined and has antibacterial, antiseptic, fungicidal effects. The composition contains nystatin, prednisolone, neomycin, ternidazole. The drug is prescribed for ureaplasmosis, candidiasis and other types of infection. Candles can be used during pregnancy. The duration of therapy is 5-14 days.
Hexicon. Suppositories contain the substance chlorhexidine, which is highly effective in the combination of bacterial infections, syphilis, trichomoniasis, ureaplasmosis and other diseases of the reproductive system. A woman can use suppositories during childbearing, lactation. The course of treatment is 10 days.

Vaginal antibacterial suppositories for the treatment of ureaplasmosis can cause:

burning;
hyperemia of the mucous membranes.

If you experience any of the above symptoms, you should consult your doctor.

Antimicrobial suppositories

Candles with antiseptic action are less effective in ureaplasmosis compared to antibacterial drugs. In the presence of complications and severe course of the disease, antimicrobial suppositories are not prescribed. When ureaplasma is detected, the following can be prescribed:

Betadine. Povidone-iodine, which is part of vaginal suppositories, is a strong antiseptic. Candles help to eliminate pathogenic microorganisms and restore the microflora of the vagina. The drug is not prescribed for adolescent girls, patients with hyperthyroidism or chronic kidney disease. The drug is prescribed for pregnant women with caution. The course of therapy with suppositories is designed for 1-2 weeks.
Klion-D. Candles have a powerful antimicrobial effect and are prescribed for early detection of ureaplasmosis and for preventive purposes. The drug has contraindications and can cause the development of dyspeptic disorders, migraines, changes in blood composition. The course of treatment is 10 days.

Immunomodulating suppositories

Vaginal suppositories with an immunomodulatory effect help prevent the development of chronic inflammatory processes and speed up the healing process. With ureaplasmosis and other infectious diseases of the genitourinary system, viferon and genferon suppositories are prescribed. The components of the preparations prevent the reproduction of pathogenic microorganisms. Suppositories can be used to treat an infectious disease in both men and women.

Topical preparations with an immunomodulatory effect are not prescribed for autoimmune pathologies, a tendency to allergic reactions to components, in the first trimester of pregnancy.

The course should not exceed 7 days. With the development of signs of intolerance to suppositories, you should consult a doctor.

How to use candles correctly

Doctors recommend using suppositories before bed. The active components of the drugs act on the focus of infection throughout the night. Before the introduction of a candle, it is desirable to treat the external genitalia with warm water with a neutral hygiene product. The suppository is carefully removed from the protective film and inserted deep into the vagina.

During the entire course of therapy, unprotected sexual intercourse is contraindicated. The use of suppositories can increase irritation and soreness during intimacy with a partner.

Side effects and their elimination

The instructions for use of suppositories with an antibacterial, antimicrobial effect indicate that the drugs can cause itching, redness of the mucous membranes, the development of allergic reactions in the form of rashes and swelling. If such phenomena occur, it is recommended to consult your doctor. Usually, after the abolition of suppositories, side effects quickly disappear.

Vaginal suppositories containing iodine can also cause itching and irritation of the genital mucosa in women. The active ingredient in rare cases causes disruption of the thyroid gland and symptoms associated with its hyperfunction.

You can eliminate signs of irritation by douching with warm boiled water or a decoction of chamomile. If severe discomfort occurs, the use of the drug should be abandoned.

In case of intolerance to drugs intended for local treatment, only oral forms of antibacterial and antimicrobial medicines are prescribed.

Treatment of allergic reactions that occur against the background of the use of suppositories is carried out with antihistamines (suprastin, cetrin, clarotadine).

Price

The pharmacy sells suppositories for the treatment of ureaplasmosis and other infections at the cost indicated in the table.

Candles for vaginal and rectal use can be purchased without a prescription. Before using medicines, a doctor's consultation is necessary.

When ureaplasmosis is detected, patients are prescribed a complex treatment consisting of oral preparations, vaginal suppositories. Men can be prescribed immunomodulating agents in the form of suppositories for rectal use. Topical preparations are usually well tolerated by patients. Side effects can manifest as itching and irritation of the mucous membranes. Therapy of ureaplasmosis is carried out under the supervision of a doctor.

- an infectious disease that affects the urethra. The causative agent of this pathology is Ureaplasma urealyticum, which refers to intracellular microbes. In women, the disease occurs much more often than in men. Pathology therapy with candles is considered an effective and popular method of getting rid of pathogenic microorganisms.

There are quite a few factors influencing the active reproduction of microorganisms in the carrier's body. These include:

Weakening of the body's defenses
stressful situations
The use of hormonal drugs
Immunodeficiency states
The period of pregnancy and childbirth
Diseases of the internal organs, which in turn affect the human immune system
Surgical interventions
promiscuity

All the factors listed above create excellent conditions for the spread of bacteria in the urinary tract.

Symptoms of pathology

This disease may not bother for a long time. The incubation period is approximately 7 to 14 days. The absence of signs of pathology increases the risk of the disease becoming chronic, and this can seriously affect human health.

The symptoms of this pathology are similar to those of other sexually transmitted diseases.

Signs of pathology in the fair sex:

Pain while going to the toilet
and during intercourse
White discharge from the vagina
Problems with conception
Bloody discharge that can be observed after sex

It's important to know! You can also become infected during oral sex. In this case, the infection will manifest itself in the form of pharyngitis, laryngitis or tonsillitis.

If you do not see a doctor in time, other pathological processes may appear, such as cystitis, colpitis or endometritis. Adhesions that occur in the fallopian tubes are considered the most dangerous. This leads to terrible and irreparable consequences:

miscarriages
ectopic pregnancy

Such complications appear in the chronic course of the disease.

Should know! If you begin to worry about discharge, itching and burning, it is recommended to see a doctor as soon as possible in order to exclude possible infections.

Diagnostic measures

In order for the results of diagnostic measures to be as reliable as possible, it is recommended to follow certain rules. These include:

Avoid sexual contact for 48 hours
Do not douche for a few days
Do not use vaginal suppositories, ointments, tablets, sprays, unless, of course, their use has been prescribed by a doctor
In the morning before taking it, you do not need to use soap for washing, it is better to carry out the procedure with ordinary warm water.
It is undesirable to urinate two hours before coming to the doctor

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The main diagnostic methods for ureaplasmosis:

Examination by a gynecologist.
Vaginal smear for flora.
PCR (polymerase chain reaction).
ELISA (immunofluorescent analysis).

In addition, for certain medical reasons, a serological blood test or immunofluorescent test may be prescribed. Currently, it is the latter that is gaining wide popularity. This is due to the fact that the result of the analysis is ready after a small amount of time, and the price for such a procedure is not so high.

Treatment of ureaplasma

The most effective treatment for such a disease is the use of candles. However, there are other antibacterial medicines that are highly effective when exposed to pathogenic microorganisms. These include drugs in the following groups:

macrolides
Tetracyclines
Lincosamides

It's important to know! Medicines from the group of Cephalosporins and Penicillins do not have the proper effect on ureaplasma.

In addition, in the treatment of the disease, not only candles are used, but also tablets.

The treatment regimen should be prescribed only by a doctor. In case of illness, drugs, antifungal drugs, a certain diet, products that are aimed at normalizing the microflora, vitamin therapy, and temporary abstinence from sexual intercourse are prescribed.

Overview of funds

Below we will consider the most popular and effective vaginal suppositories. Remember that before buying a medicine, it is recommended to consult with your doctor.

Almost all vaginal suppositories are made on the basis of antibiotic substances. They effectively eliminate pathogenic microorganisms. Overview of the most popular antibiotic drugs for the treatment of ureaplasmosis.

Terzhinan

Active components of the drug: ternidazole, neomycin sulfate, nystatin, prednisolone sodium metasulfobenzoate. As a rule, such vaginal suppositories are well tolerated, without causing much discomfort during use. Terzhinan is also used for prophylactic purposes before surgery, childbirth, the installation of an intrauterine device, and much more. One of the most valuable properties of this medication is that by provoking the death of pathogenic microorganisms, it in no way violates the natural microflora of the vagina.

The only contraindication of Terzhinan is the individual intolerance to the components of the drug. In addition, if after using the drug observed, it is recommended to consult a doctor and stop using it. The doctor will replace Terzhinan with another medication.

Attention! This remedy is not intended for use by patients under 16 years of age. The course of therapy is 5-15 days. Terzhinan is prescribed for pregnant women in the 3rd trimester.

Hexicon D

The active substance is chlorhexidine bigluconate. Candles are used for the treatment and prevention of various pathologies. The only limitation to the use of this drug is the patient's hypersensitivity to the components of the drug. This may cause severe itching in the area of application. it is allowed to use during pregnancy and during the period of breastfeeding, but before that it is recommended to visit a doctor. The remedy is generally well tolerated by patients, it does not have a systemic effect, since the main component is not absorbed into the blood.

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In rare cases, after insertion into the vagina, itching and burning may be felt, as well as the appearance of rashes on the skin near the application area. The course of treatment with this remedy is 7-10 days. It is recommended to use candles 2 times a day.

Betadine

The product has a powerful disinfectant and antiseptic effect. It is effective against many pathogenic organisms, with the exception of Koch's bacillus. One vaginal suppository contains 200 mg of the main component povidone-iodine. After the introduction of the suppository, the active substance decomposes, releasing iodine, as a result of which bacteria are destroyed.

Restrictions: individual intolerance to iodine, various thyroid pathology, simultaneous use of other medicines containing iodine. As a rule, adults are prescribed one candle 1 time per day. It is recommended to insert it at night. The course of therapy is determined by the attending physician, depending on the severity of the pathology and other characteristics of the body. As a rule, it averages 3-14 days. For special indications, the daily dose of the drug can be increased to 2 suppositories, but they should also be administered at night. As a preventive measure, before various gynecological procedures, 1 candle is prescribed once. The course of treatment is 5 days.

Before inserting a candle, the patient should wash her hands well with soap and water. After that, it is recommended to take a supine position and carefully introduce the agent. In addition, during suppository therapy, the fair sex is recommended to use panty liners, since the remnants of the drug may remain on the underwear.

Klion D

The tool is intended for the treatment of diseases of the female genital organs of an infectious nature. The drug has antibacterial and antimicrobial action. The active ingredients are metronidazole and miconazole.

In the first trimester of pregnancy, the drug is contraindicated, because the metronidazole contained in it can be absorbed into the blood and seep through the placenta to the fetus. In the second and third trimester of pregnancy, Klion D is used, but only for special indications.

Possible negative manifestations after using the product: burning, pain, itching, irritation of the vaginal mucosa,

As a rule, the remedy is used in conjunction with antibiotics. Genferon increases their effectiveness and reduces the risk of negative effects. The course of therapy is 7 days. The tool has antiviral and immunomodulatory effects. During therapy, active substances increase the body's immune defenses, block the reproduction of pathogenic microorganisms.

Suppositories are not recommended for use in case of individual intolerance to the components of the drug, autoimmune disorders, as well as in early pregnancy. After application, there may be a burning sensation, rarely, rashes on the skin, excessive sweating, refusal to eat, pain in the muscles.

Hexicon

It refers to antiviral drugs that fight against various pathogenic microorganisms. The tool not only relieves signs of inflammation, but also increases the body's defenses. With regular use of Hexicon, pain and itching are reduced. The remedy, although it destroys ureaplasma bacteria, does not affect the natural microflora of the vagina.

During pregnancy and lactation, Hexicon is used only after a doctor's recommendation. Candles are administered twice a day. The course of therapy is 1 week. Restrictions: individual intolerance to the components of the drug. Patients using Hexicon often complain of itching and burning in the vagina. All of them disappear on their own after the drug is discontinued.

Often a recurrent disease indicates. In this case, the patient is prescribed Viferon - these are rectal suppositories that have an immunomodulatory effect. The main component of the drug is human recombinant interferon alfa-2.

Candles are contraindicated in case of individual intolerance to the components and in the first trimester of pregnancy. Pregnant women in the 2nd and 3rd trimesters, nursing mothers, children, and the elderly should use Viferon only after the doctor's approval.

Suppositories (candles) from ureaplasma for women contain substances that have a detrimental effect on pathogens that provoke the development of a pathological process in the genitals. The therapeutic effect of their use is achieved with intravaginal (less often - with rectal) administration. Suppositories act locally, due to which they practically do not have a systemic effect on the body. This allows them to be used in the treatment of ureaplasmosis in different categories of patients.

When prescribing therapy for ureaplasma to women, specialists often include broad-spectrum vaginal suppositories in the treatment regimen, the components of which are active against bacteria:

Ureaplasma parvum;
Ureaplasma urealyticum.

Most often, these drugs are antibiotics, but for women who are contraindicated in this group of drugs, the treatment of the disease can be carried out using local immunomodulators and suppositories with antimicrobial properties.

Antibacterial candles Terzhinan

Ureaplasmosis is a disease of bacterial etiology, so there is nothing surprising in the fact that in the fight against it, doctors most often use vaginal suppositories with antibacterial action. Among the most effective means of this group is a combination drug produced on the basis of:

ternidazole;
nystatin;
neomycin;
prednisolone.

The use of Terzhinan allows a woman to get rid not only of ureaplasmosis, provoked by the microorganisms Ureaplasma parvum and Ureaplasma urealiktum, but also of gynecological diseases caused by a large number of pathogenic bacteria and fungi. For this reason, it is advisable to prescribe the drug to patients in whom ureaplasma is combined with other diseases of the genital organs.

Candles for the treatment of ureaplasma Terzhinan, when used correctly, do not affect the integrity of the vaginal mucosa and do not violate its microflora. Their components have a local antibacterial, antiseptic, anti-inflammatory and antifungal effect. The indisputable advantage of Trezhinan is that it can be used during pregnancy and lactation. The drug has no age restrictions for use, does not affect the functioning of the heart, liver and kidneys. Contraindications to it are limited to individual intolerance to the components from which it is produced.

Terzhinan can be used during menstruation. Its active ingredients do not penetrate into the systemic circulation, so adverse reactions are unlikely when it is used. Sometimes women may experience complaints of allergic reactions in the form of burning, tingling and other unpleasant sensations inside the vagina while using the remedy. It is extremely rare for a drug to cause hives and a skin rash in a patient. Prolonged use of suppositories can slow down the healing process of wounds on the body and lead to atrophy of the vaginal mucosa.

Macmirror Complex for ureaplasma

What suppositories can still be used for ureaplasmosis? For women who have an increased sensitivity to Terzhinan, doctors prescribe combined vaginal suppositories with antimicrobial and antiseptic effects Macmiror Complex. They include the active components nifuratel and nystatin, which have a detrimental effect on ureaplasma and other pathogenic microorganisms that provoke the occurrence of vulvovaginal infections.

Before starting treatment, a woman should take into account that Macmirror Complex is contraindicated in:

hypersensitivity to its components;
pregnancy;
lactation.

If the dosage recommended by the doctor is observed, Macmiror Complex does not cause a negative effect on the body. Side effects from its use are rare and manifest as contact dermatitis, skin rash, urticaria, vaginal itching and burning.

Application of Hexicon candles

For the treatment of ureaplasmosis and other sexually transmitted diseases, women are prescribed vaginal. Their main component is chlorhexidine, a substance with a pronounced antiseptic effect. In gynecological practice, Hexicon is used not only for medicinal purposes, but also for the prevention of sexually transmitted diseases. The drug in the form of suppositories has a limited list of contraindications. It is not recommended for women who have hypersensitivity to chlorhexidine. Pregnant and breastfeeding patients can use this remedy after consulting a doctor.

Hexicon does not cause side effects, except for discomfort in the vaginal area and allergic reactions. Before inserting it into the vagina, a woman should wash the external genitalia with warm water, without using detergents, as they can reduce the effectiveness of chlorhexidine.

Rectal suppositories Viferon

Often recurrent ureaplasmosis indicates a decrease in the body's defenses. In this case, the woman is prescribed Viferon - rectal suppositories with an immunomodulating effect. Their main component is human recombinant interferon alpha-2, the action of which is aimed at increasing the body's resistance to infectious agents.

Do not use when:

hypersensitivity to their substances;
I trimester of pregnancy.

Expectant mothers who are in the II and III trimesters of pregnancy, breastfeeding women, children, the elderly and patients suffering from various chronic diseases, the drug should be taken with the permission of a specialist. Viferon is well tolerated by patients and has no side effects on the body. In rare cases, it can cause allergic reactions that disappear after its withdrawal. With ureaplasma, Viferon is often prescribed as part of complex therapy. This approach allows you to enhance the effect of other medications and provide a woman with the final deliverance from the disease.

During the treatment of ureaplasmosis, the fair sex must remember that even the most effective remedies will not help her recover if she self-medicates.

The use of local drugs to combat this disease must be agreed with a specialist, strictly following the scheme prescribed by him. It should be borne in mind that treatment for ureaplasmosis should be carried out not only by a sick woman, but also by her sexual partner. If this requirement is not met, the patient will re-infect the infection after some time and will need a second course of treatment.

The use of suppositories in the treatment of ureaplasma in women is one of the most important parts of therapy, since it makes it possible to act on the problem directly at the site of its formation. Due to this, their effectiveness is at a much higher level compared to other drugs.

Based on this, it is a prerequisite, designed to eliminate any discomfort and prepare the body for bearing a child. Therapy consists in the use of a complex effect, consisting of several parallel directions. One of them is the use of vaginal and rectal suppositories, which has a versatile positive effect on the female body.

The manifestations of ureaplasma are mixed, similar in structure to various viral, bacterial or fungal agents. Such extensive symptoms require appropriate treatment. Most often, not one specific drug is used to overcome the problem, but a whole complex of different means.

Treatment of ureaplasma should be carried out exclusively under the supervision of a specialist who, based on the results of the tests and the existing symptoms, will determine its components and general direction.

At the same time, self-medication is strictly prohibited, since it can give a diametrically opposite to the expected result and lead to the development of complications.

Most often, therapy for ureaplasma is based on the use of the following groups of suppositories:

immunomodulators;
antibacterial agents;
lactobacilli.

Overview of the most effective suppositories for the treatment of ureaplasma

A decrease in the immune characteristics of the body contributes to the development of pathogenic microflora and leads to the appearance of symptoms of the disease. Based on this, the use of immunomodulatory suppositories is a necessary direction of treatment, designed to raise the protective properties of the body.

Compared to oral preparations, vaginal suppositories have much fewer side effects and contraindications. The only restriction to their use is the individual intolerance of the components, which is extremely rare.

One of the most popular suppositories for stimulating immune activity are Genferon and Viferon. Their action is based on human recombinant alpha-2 interferon, which has pronounced antibacterial, antiviral, anti-inflammatory and immunostimulatory effects. The use of the drug helps to quickly overcome the symptoms of the problem and strengthen the body as a whole.

Based on this, therapy is carried out on the basis of broad-spectrum antibiotics aimed at eliminating genital infections. At the same time, antiseptic and antimicrobial drugs are prescribed in the presence of foci of inflammation caused by the action of the bacterial environment.

Among the most effective means to eliminate the manifestations of ureaplasma are the following:

tetracyclines;
aminoglycosides;
lincosamides;
fluoroquinolones;
macrolides.

Sometimes there are situations when the use of other antibiotics does not bring the expected effect. With this development of events, their cancellation and reorientation of therapy to other means is the most appropriate solution.

Most often they are replaced with antibacterial drugs of synthetic properties, which have a more narrowly focused effect on ureaplasma. These drugs include Hexicon and Macmirror, which have proven their effectiveness and help to overcome the problem as soon as possible.

The main difference between suppositories and probiotics, which enter the body orally, through the digestive system, is a much higher efficiency, due to which the consequences of the action of pathogenic organisms and antibiotics are eliminated as soon as possible.

Conclusion

How does it manifest ureaplasma in women how is the treatment of women from ureaplasma, what drugs and means to prescribe to the female sex from ureaplasmosis, including pills, suppositories and folk remedies?

Ureaplasma in women manifests itself with the following features:

the active stage of the disease sometimes proceeds not so pronounced, like men ;
possible transmission of the disease, or rather, its carriers child at birth;
identifying ureaplasma as a cause is sometimes difficult without tests, since symptoms such as burning, itching and pain in the lower abdomen characteristic of various female disorders and diseases(for example, for cystitis).

However, inflammation is dangerous because complications can lead to consequences up to ectopic pregnancy and infertility.

We strongly do not recommend self-medication, especially without passing special tests and without seeing a doctor. Nevertheless, we will give an overview of the main discussed means of treating ureaplasma. There are also forums about the treatment of ureaplasma.

Candles against ureaplasma in women

Candles can hardly be called an independent medicine against ureaplasma, because in order to fight it, an integrated approach is needed to restore the balance of microflora. However, in many cases, suppositories help smooth out the manifestation of inflammation, and their action is rather antiseptic and has a local character. But there are also suppositories intended for treatment (suppositories).

Among the suppositories from ureaplasmosis, you can find the following:

Panavir- a drug known for the treatment of herpes is also available in the form of suppositories. The price of the drug is quite high, the specific and current cost can be found by requests like: “candles panavir price”.

Genferon- antiviral, immunomodulatory action. The course of active therapy for ureaplasma in women is 10 days.

Viferon- one of the analogues;

Hexicon D- a preparation based on chlorhexidine in the form of suppositories. It can also be used for diagnostics. Released without a prescription. Prices for the drug: 180-250 rubles.

Reviews of candles can be searched on various pharmacy sites.

Tablets and antibiotics against ureaplasma

Almost all tablets from ureaplasma are antibiotics at the same time. But before you eat antibiotics, be sure to think about whether you will harm the microflora even more.

Wilprafen- used for various infections, not only the genitourinary system. Is an antibiotic. The duration of treatment is determined by the doctor.

Trichopolum- Available in the form of tablets. Read the instructions for details.

Treatment of ureaplasma with folk remedies

Among the methods of treating ureaplasma with folk remedies, you can find the use of garlic, goldenrod, as well as herbs such as wintergreen, winter love.

Often, various decoctions are used to relieve burning sensation, including on oak bark.

But ureaplasma in women is a rather dangerous inflammation to fight it without consulting a specialist..