Normal discharge in women after menstruation. Why do brown discharge occur after menstruation

Discharge before or after menstruation often confuses women. Not everyone knows which discharge after menstruation is normal, and which indicate a malfunction in the body.

The vaginal secret can have a different color - from red to colorless, white and even yellow-green. In addition, the consistency may be different. You should also pay attention to the possible smell and the presence of associated symptoms in the form of irritation, redness of the external genitalia, itching or pain.

Normally, the vaginal secret does not cause any discomfort in a woman. It should not smell, be accompanied by burning or itching.

An unpleasant smell almost always indicates the presence of an infection, since pathogenic bacteria multiply in the body.

When there is pathology

The following types of vaginal secretion are possible in the presence of certain problems:

Bloody with a scarlet tint - microcracks of the vagina, cervical erosion, cervicitis, as well as the presence of pregnancy (with the threat of interruption) are possible.
after menstruation, a curdled consistency with a sour smell - candidiasis is likely or, as it is also called,.
White discharge after menstruation is odorless, mucous or transparent with white streaks - the cause is in the cervix. A similar symptom is possible with such diseases of the female reproductive system as cervicitis, erosion.
Green, yellow-green, bubbling consistency - a sign of the presence of infections that affect the genital tract.
White with a gray or green tint, having the smell of fish - most likely the development of vaginal dysbiosis.
Abundant or scanty, green or yellow - a symptom of an acute or chronic course of adnexitis, the presence of a bacterial infection, inflammation of the fallopian tubes.
Purulent with a green tint, thick, containing mucus - more often indicate the presence of purulent cervicitis.
Sucrose, watery discharge after menstruation of a pink tint, having an unpleasant odor - often a manifestation of chronic endocervicitis or chronic endometritis.
Brown spotting during pregnancy is a sign of detachment of the placenta or fetal egg.
Dark spotting some time after the end of menstruation - indicate a pathology in the uterus.
With large blood clots during menstruation - in the presence of an IUD, a violation of the processes of blood clotting, or with a pathology of the uterus such as a bend.

After intercourse

During sexual contact with a man, a woman exudes a transparent mucous secretion as a result of arousal. This is a natural lubricant, which is the norm.

With a full-fledged sexual intercourse, when the sperm enters the vagina, abundant, white, thick discharge with a not very pleasant smell appears. So the vagina is cleared of male fluid. If at the same time spotting is present, then it is worth examining for the presence of cervical erosion or microcracks.

If a yellow, white, gray or greenish discharge appears a few days after sexual intercourse, smelling unpleasant, infection with a sexual infection can be suspected. Concomitant symptoms - pain during sex, itching and burning in the vagina, as well as the urethra.

When to go to the doctor?

If a woman is concerned about discharge that seems abnormal to her, accompanied by pathological symptoms, it is better to immediately contact a gynecologist.

In such situations, an examination is prescribed in the form of blood tests, urine and smear, ultrasound, tomography and others. By the appearance of the discharge alone, no doctor can make a correct diagnosis.

If during the examination a disease or infection is detected, only then the doctor will prescribe treatment. It can be antibacterial or anti-inflammatory drugs, various physiotherapy.

Prevention measures

In order to avoid problems with the work of the female reproductive system and the appearance of pathological secretions, it is worth observing preventive measures:

observe hygiene - daily washing, direction when washing only in the direction from front to back;
have sex with one partner - the risk of sexual infections is reduced;
If symptoms are present, seek medical attention immediately.

On the video about discharge after menstruation

A woman who monitors her health may be wary of noticing light brown discharge after menstruation. There are a huge number of reasons that can cause such a phenomenon. Establishing the reason why dark or red-brown spotting occurs at the end of menstruation can only be done by a gynecologist. For review, you can consider some of the most common factors that can provoke a similar symptom.

There are both completely natural and pathological factors of this condition. It is also important on which days of the cycle the beige, light brown ointments from the genital tract began. The time at which the dark discharge began can be divided into three stages:

Before and after menstruation. When menstruation begins and their completion occurs, such a phenomenon may appear.
A few days after the critical days have passed.
2 weeks after menses.

The diagnosis also depends on which day of the cycle brown discharge appeared after menstruation. But in order to correctly establish the cause, the gynecologist prescribes a series of tests and conducts an appropriate examination. Only after that it is possible to determine the causes of the appearance of ointments from the vagina.

Norm

There are several completely natural factors that can cause light brown or dark odorless discharge in the last days of menstruation or even some time after it. Normal processes in the body that can cause brown ointments or reddish, dark mucus include the following reasons:

Menstruation has not ended.
Taking hormonal contraception.
Ovulation.
Implantation bleeding.

Menstruation

It is generally accepted that discharge after menstruation, which lasts no more than three days, is quite natural. After the uterus has freed itself from the bulk of the overgrown endometrium, much less blood is already released. On the tenth day of the cycle, they should completely stop.

However, if the duration of the discharge is longer, their color is bright red, or the abundance has increased, you should immediately contact a medical specialist. These are the first signs of pathology.

Hormonal drugs

If a few days after menstruation, dark spotting, reddish mucus from the vagina appeared, a possible explanation may be the action of hormonal contraceptives. In the first three months of taking them, this is quite acceptable.

But if such a picture is repeated at 4 months, this indicates an inappropriate drug. It must be replaced or abolished by this approach of protection against pregnancy in general.

Ovulation and implantation

On the day when the egg ready for fertilization comes out of the follicle, the mucus from the vagina may contain a small amount of blood. It's quite normal. Only now it is quite difficult to determine that the cause of this phenomenon was precisely ovulation. Therefore, only a doctor should deal with the diagnosis.

If a woman had unprotected intercourse on or before ovulation, dark brown ointments may be the first sign of pregnancy. If they go for a long time, this is a pathology.

Symptoms of pathology

Discharge after menstruation should alert a woman if there is one of the following symptoms. They may be the first sign of a serious illness. In this case, the sooner the woman goes to the hospital, the better. Diagnosed at an early stage of development, the disease responds better to treatment and does not cause serious complications. The first signs of the disease are:

If menstruation is over, but beige or bloody ointments regularly appear at the end of sexual intercourse.
The discharge is accompanied by an unpleasant odor, fever, pain in the lower abdomen, in the vagina or during an intimate relationship.
In the absence of contraceptives, a brownish discharge began a few days after the end of menstruation.
Critical days last unusually long.
During the onset of menopause, one year after the last menstruation.

Brown discharge after menstruation, which appeared in the last days or a week after them, is often caused by diseases. Therefore, it is necessary to visit a gynecologist every six months. If you experience any of the above symptoms, make an appointment with your doctor as soon as possible.

Diseases

When asking her doctor why ointments from the genital tract began after menstruation, a woman can get a completely disappointing answer. The reason why bloody mucus on underwear is observed a week after menstruation is often a disease. The most common of these are the following ailments:

Endometritis.
Endometriosis.
Oncological diseases.
Hyperplasia.
Hormonal disbalance.
Ectopic pregnancy.

Inflammation of the inner lining of the uterus (endometritis) or its significant growth (endometriosis) can be the answer to the question of why menstruation does not end. These ailments can be manifested by a small daub that appears every day.

Various oncological diseases (polyps, benign, malignant neoplasms) can cause spotting a week after the end of menstruation.

Hormonal disruptions caused by various factors can also cause unpleasant phenomena on the day the regular bleeding ends or after it. Here, treatment is prescribed by a gynecologist together with an endocrinologist.

An ectopic pregnancy can also manifest itself as a discharge after menstruation. This phenomenon is accompanied by severe pain and requires immediate hospitalization.

By monitoring her health every day, a woman can identify possible diseases at an early stage. This will allow you to quickly cure the disease. Therefore, regular visits to the gynecologist and the vigilance of his patient can prevent negative consequences in the future.

Often women are faced with such a phenomenon as brown discharge after menstruation. They are different in volume and color, may have an admixture of blood.

In this regard, the weaker sex has such a question - why do brown discharges occur after menstruation, what is the reason for the appearance of postmenstrual bleeding.

Menstruation is an integral part of the functioning of a woman's body and indicates reproductive ability. Every month, a mucous membrane forms in the uterine cavity, which is necessary for the implantation of a fertilized egg. If conception does not occur, the mucosa begins to shed from the walls of the uterus and come out along with bloody discharge.

The duration of menstruation is normally from 3 days to one week. And the average duration of a woman's menstrual cycle is about 28 days.

Brown discharge after period

Discharge after menstruation brown, lasting no more than 3 days, can be attributed to normal phenomena for a woman's body. The reasons for this are that in the final days of menstruation, the volume of released blood decreases significantly, as a result, it coagulates. Hence the brown color.

If you are concerned about brown discharge a week after menstruation, an examination is required here. Probably the development of some gynecological diseases, for example, such as endometriosis or endometritis.

Is it dangerous?

After menstruation, brown discharge comes, what could it be - a question that worries many women. An excessively dark color should be a reason to see a doctor, since the natural mucus secreted by the genitals should not be black or dark brown in color, except for three days after menstruation.

Dark brown discharge after menstruation can also be a consequence. During the period of implantation of a fertilized egg in the uterine mucosa, discharge is possible, however, they are usually odorless, painless, and not thick.

What does spotting after menstruation mean? More often, this may indicate problems with hormones in the female body.

Causes

If brown discharge is observed after menstruation, the reasons may be problems with women's health.

The following diseases are characterized by similar symptoms:

This problem leads to the appearance of postmenstrual discharge. The disease occurs more often in women of reproductive age. But brown mucus in this case is not the only sign. It is accompanied by discomfort and strong. Menstruation becomes longer than usual.
Endometritis. An inflammatory disease that affects the tissues lining the uterus from the inside. The secret secreted in this case is with an unpleasant odor. The causes of the development of the disease are most often in the operations performed, which include curettage, abortion, and other operations on the organs of the reproductive system.
hyperplasia of the endometrium. If brown discharge has gone a week after menstruation, the reasons may be just in this disease. It is characterized by pathological proliferation of uterine tissues, which in some cases leads to the development of neoplasms.
Endometrial polyp. Often causes, and discharge immediately after menstruation, and 2 weeks after menstruation. In the uterine cavity, the mucous membrane grows, which is transformed into a polyp.

Not only diseases can cause a problem. The reasons include a malfunction of the hormonal system, taking birth control pills or other hormonal drugs (for example, after women often complain about daub and). An ectopic pregnancy should not be ruled out.

Mention should also be made of light brown discharge after menstruation. They occur in the presence of uterine fibroids, adenomyosis.

What to do?

Women do not immediately rush to the doctor if they find brown postmenstrual discharge, and this is a fact. Many self-medicate, which can be hazardous to health.

It is possible to take some measures without consulting a doctor only if the cause of the discharge is known, and also if:

monthly passed normally, and the daub arose for the first time;
the volume of menstruation was normal;
during menstruation there was no pathological pain;
body temperature is normal, there are no dizziness, nausea and weakness;
pregnancy is one hundred percent excluded;
the discharge is odorless, does not cause itching and other unpleasant sensations;
was taking hormonal contraceptives;
stress was experienced or heavy physical exertion took place;
there was a change in body weight: the woman lost weight or gained weight.

If the mucus of a dark color and smearing character has arisen for a non-serious reason, it is not difficult to eliminate it. In these cases, it is recommended to observe the regime of the day and sleep, proper nutrition, limiting physical activity, and avoiding stress.

You can use traditional medicine in the form of herbs, such as chamomile, shepherd's purse.

However, if the discharge continues after these measures, and other symptoms join the smear, you should immediately go to the gynecologist.

Pathological cinnamon discharge can have many causes. A woman may not understand what's wrong. Therefore, the best solution in such a situation is a visit to the doctor.

But often girls notice a daub before or after menstruation, as well as after ... In which case can brown discharge between periods be normal?

Why did light brown periods go. By the nature of the discharge from ... and after menstruation, prolonged daubing before and already after the end of menstruation.

Causes of bleeding after the end of menstruation. Doctors can give dozens of reasons...

As soon as menstruation ends, the discharge becomes slimy ... After this, the discharge begins to become a little cloudy, viscous.

Previously asked:

Anonymous

Hello, I had such a situation for the first time on the 12th day of the cycle, I did an ultrasound of the small pelvis, a suspicion of a polyp, but they can’t say for sure, on the same day in the evening there was blood discharge, then there was sexual intercourse, and the next day the same thing during the day spotting blood discharge and an unpleasant smell, can this be the norm. The first polyp was removed in June

Hello! Do you happen to have cervical erosion yet? After sexual intercourse and vaginal ultrasound, it is she who can give a slight daub. But polyps also very often give spotting, and sometimes decent discharge in the middle of the cycle. Sometimes even several days in a row. Most likely, you really have a polyp. And what is the histological answer of the last study? Have you received any treatment? Specify your age, please). A polyp, if it does not go away on its own, you will have to do a second curettage, and then prescribe treatment. In general, recurrent polyps of the uterine cavity are an indication for serious surgical treatment up to the removal of the organ, so take such a situation with full responsibility, because it is better to save the organ - there is nothing superfluous in a woman's body. All the best!

Daria Shirochina (obstetrician-gynecologist)

Hello! This may be normal as well. But in such situations, pregnancy should always be ruled out first - take a test or take a blood test for hCG (the latter is preferable, as it is more informative). If such a daub appears again, you should undergo a complete examination by a gynecologist for pathology. Such a daub is typical for many diseases - endometriosis, cervical pathology and others. All the best!

Good evening! Menstruation goes on for about 5 days, then the daubing of day 3 begins! The daub has turned brown and smells terrible! Is this something wrong?

Daria Shirochina (obstetrician-gynecologist)

Hello Julia! This happens, but you should be examined more thoroughly, at least an ultrasound of the small pelvis, perhaps hormones and something else. Smell is a normal phenomenon at the end of menstruation, perhaps you are a little biased towards them. The most common disease that provokes such a daub is endometriosis and polyps in the uterine cavity, on the cervix. You should undergo an examination and an ultrasound to begin with. It may be possible to try oral contraceptives for a while, if the symptoms go away, this is another confirmation of endometriosis. All the best!

Anonymous

Hello, such a situation, there was a delay, I took a pregnancy test, it showed a faint pale pink second strip, I decided to repeat the test in two days, the result is the same. I decided to wait a bit, because. it was too early to go to the hospital. As a result, a week after the delay, she began to bleed like during menstruation, then clots. It was a miscarriage, right? As a result, all the discharge passed after 7 days, the duration was like my usual menstruation, and on the 10th day brown discharge appeared, that is, no ... What is it?

Daria Shirochina (obstetrician-gynecologist)

Hello! Usually, even if the pregnancy was in such a short period, spontaneous miscarriage occurs independently and in full. Now you should visit a gynecologist for an examination, and you also need to perform an ultrasound of the pelvis. After that, it will be clear what is happening to you, what treatment to prescribe. The sooner you seek medical help, the better. All the best!

Nastenabalkonskaya

Hello. I have such a problem. There was a delay of a month, I went to the gynecologist for an examination and ultrasound. They said it was a follicular cyst. That she is in regression. Menstruation went as usual and a week later brown spotting appeared. What does this mean?

Bayana

Hello. After PMS, after 7 days, I started to have brown discharge, or rather anointed a little with blood. But after that, I started to get pain in the lower abdomen and back pain. But as if there is pain but not so often. That's just in the heat throws and headaches torment. Haven't contacted a gynecologist yet. Looking forward to next month. Such doubtful at first. What could it be?

Every time after menstruation, thrush: (I drank and pills, and put candles, and took pimafucin cream, and it doesn’t help. Now they tell me to try metrogil plus, and if it doesn’t help, then put betadine during menstruation. Do you really have to suffer all your life? "The doctor says that I have discharge due to erosion, I started to be treated with metrogil plus, so that I can do cauterization later. But there are such difficulties - you need to get to the doctor on a specific day of the cycle, and my cycle is unstable, despite the fact that I need to see a doctor for 3 weeks record.And how to be treated?

Daria Shirochina (obstetrician-gynecologist)

Hello! As for how to be treated like this)), I will not tell you)). You can use the services of paid centers, I think there is no such record. Regarding the discharge, indeed, they may be due to erosion. Then they will pass only after her final treatment. As for recurrent thrush, it’s worth “digging deeper”, there is definitely a reason for it. For example, increased blood glucose, intestinal dysbiosis, periodically aggravated hemorrhoids, sexual infections. The minimum list of tests for you is blood glucose, testing for STIs, sowing on the vaginal flora (preferably with sensitivity to drugs). And the treatment of recurrent forms is not a 7-10-day course, but at least six months of periodic treatment, usually before menstruation. All the best!

Menstruation is the main indicator of the health of the female reproductive system. The cyclicity, color, volume and consistency of discharge can tell a gynecologist a lot about the problems that bother a girl. Based on the statistical data, we can conclude that at least once every representative of the beautiful half of humanity diagnosed herself with brown discharge after menstruation.

The stories that abound on thematic forums are full of questions about whether such smearing clots of various color pigmentation are a physiological norm. Does this symptomatology refer to a sign of pathology in the work of the organs of the reproductive system? Let's figure it out together.

Why do brown discharge occur after menstruation? Gynecologists identify several factors that provoke the appearance of such secretions. Conventionally, the symptom can be attributed both to the manifestation of the physiological norm, and to evidence of the pathology that has arisen in the work of the reproductive organs. Based on the comments of experts, it is problematic to independently identify the cause of the appearance of spotting discharges. Consider the most common causes of brown discharge at the end of menstruation.

Experts say that such a daub should end within one to three days after menstruation. Based on the information received, it can be concluded that this case should not give serious cause for concern and does not require medical intervention with subsequent treatment. After all, what is happening is due solely to the rejection of blood clots that have had time to curl up before leaving the uterine cavity.

Taking hormonal contraceptives

The start of taking hormonal contraceptives makes its own, acceptable, adjustments to the work of the woman's reproductive system. Experts say that the presence of abundant brown discharge after menstruation within one to three months after the introduction of a new drug is a physiological norm, which can only indicate the effectiveness of contraception.

Please note that prolonged similar discharge at the end of menstruation, associated with the intake of these drugs, means rejection of the drug by the body.

In this case, you should immediately contact a specialist to choose another hormonal contraceptive or stop using it yourself.

Ovulation

At the time of maturation of the egg, completely ready for fertilization, the appearance is possible. This process is not a violation in the work of the reproductive organs, on the contrary, it indicates their complete health.

Note that if a woman had intercourse on the day of ovulation or a few days before it without using contraceptives, dark brown secretion not associated with menstruation may be the first evidence of pregnancy.

But the presence of mucous clots of similar pigmentation for a long time can indicate a disease that has affected the reproductive organs. In this case, you should immediately contact a specialist.

Symptom as a sign of pathology

There are a number of signs that force us to consider in the context of the symptoms of pathological processes occurring in the reproductive organs of a woman. According to gynecologists, one should be wary if the rejection of brown mucous clots is accompanied by:

an increase in body temperature;
unpleasant musty smell.

You should also pay attention to the symptom of increased attention under such conditions:

Sexual intercourse is accompanied by unpleasant, painful sensations.
The patient does not take hormonal contraceptives, but dark brown discharge continues after menstruation.
More than a year passed from the onset of menopause before the appearance of clots with blood pigment.
The described symptom is accompanied by a sharp pain in the lower abdomen or in the groin area.
There are sharp failures of the menstrual cycle.

Brownish discharge after menstruation may indicate the possible presence of inflammatory processes in the uterus, an ectopic pregnancy, or sexually transmitted diseases.

Diagnosis of the true cause of what is happening is carried out by a specialist after examination in the gynecological chair and interpretation of the test results obtained as a result of the study of physiological fluids in the laboratory. The following are the diseases that most often provoke the described symptom.

endometriosis

Omitting medical terminology, endometriosis is a sharp increase in endometrial cells outside the uterine cavity. Statistics show that most often this disease affects women under the age of 30. Endometriosis can begin not only with abundant brown discharge that continues after the end of menstruation, but also with sudden pain in the groin area. undergo changes: or become abundant; or scarce; or absent altogether. Gynecologists say that this pathology cannot go away on its own, but the lack of timely treatment can result in infertility.

endometritis

The second most common disease that provokes brown discharge a week after menstruation. This disease is an acute inflammatory process on the mucous membrane of the uterus. Endometritis, at an early stage, can also reveal chronic fatigue in combination with aching, “dull” pain in the lower abdomen. But the acute form of the disease can pass without the appearance of its characteristic symptoms. is a chronic course of the disease.

Sexually transmitted diseases

The attached pathogenic microorganisms: chlamydia, herpes virus, ureaplasma and mycoplasma, change the composition of normal mucus and postmenstrual secretions. That is why after menstruation there is a brown discharge with an unpleasant odor. Find out more about the article at the link.

In addition to the rejected mucous clots, which have a dark shade and a thick consistency, sexually transmitted diseases denote themselves by severe itching and burning in the perineum during urination. Many patients who encountered this problem noted that they were rejected.

Having found this symptom in yourself, you should immediately seek help from a specialist, and not wait until the disease passes into a chronic, sometimes incurable, stage.

Ectopic pregnancy

Not the physiological location of the fetus is fraught with the appearance of spotting brown clots. Gynecologists note that late diagnosis of the location of the embryo in the fallopian tube or abdominal cavity is extremely dangerous for a woman. This pathology is fraught with heavy bleeding, which can begin at any time. If there are suspicions that indicate the development of an ectopic pregnancy, it is urgent to consult a doctor.

Hypothyroidism

This anomaly is characterized by malfunctions in the thyroid gland, resulting in an imbalance in the production of hormones. One of the main signs of hypothyroidism is brown discharge, which disturbs a woman for 7 days after the end of critical days.

Myoma

Uterine fibroids are benign. Symptomatically, the tumor manifests itself as bleeding or dark brown discharge after menstruation or throughout the entire intermenstrual period. Sometimes, fibroids prompt anemia in the patient's history caused by significant blood loss. Needless to say, at the first signs indicating the presence of a tumor, you should immediately contact a specialist.

anovulation

Pathological condition, the opposite of the process of ovulation. It is rather a consequence of other diseases that provoke the absence of menstruation. Anovulation is characterized by the inability of the body to create favorable conditions for the formation of an egg. Symptoms of this disease are brown spotting clots, rejected a week after the expected critical days. Such a pathology can only go through a long, complex treatment aimed at restoring all the functions of the reproductive system involved.

Cystic formations

Cysts that affect the surface of the ovaries make themselves felt with secretions that have a bright "black" pigment and manifest themselves two to three days after menstruation. Such symptoms cannot appear “accidentally” and require immediate consultation with a specialist with subsequent treatment.

polyps

The growth of the glandular part of the endometrium is fraught with the release of abundant black clots both after the end of critical days and in the intermenstrual period. Often, polyps in the uterus are the result of acute inflammatory processes that have affected the organs of the woman's reproductive system. It is possible to eliminate the cause of the discharge associated with the growth of a part of the endometrium only with the help of complex therapy.

Light postmenstrual discharge

Plunging into the consideration of causal relationships in the context of the rejection of brown mucous substances by the vagina, it is impossible not to mention the discharge of light brown color in women after menstruation, disturbing many women. A similar secret, weighed down by additional symptoms, can stand out with the diseases listed below.

Salpingitis

This disease is characterized by a strong inflammatory process in the fallopian tubes. Educational materials on gynecology say that in addition to the active release of a light secret, the disease is characterized by a pungent odor. Also in the anamnesis of patients there are references to cutting pain in the groin area, weakness and high fever.

Vulvovaginitis

A disease that, in equal measure, can cause both a lack and an overabundance of hygiene procedures. One of the most effective means of preventing and treating this disease is the rejection of personal hygiene products containing artificial fragrances, and the daily washing of the intimate area with herbal infusions.

Cervical erosion

A pathological condition characterized by damage to the epithelial lining of the vagina. "Visually" erosion is manifested in the appearance of rich red formations on the outer surface of the cervix. It is impossible to identify such a deviation on your own, because diagnosis with subsequent approval of the diagnosis is carried out using special gynecological mirrors used in the examination process. Based on the symptoms, cervical erosion refers to a number of diseases of the "hidden" type, occurring without disturbing manifestations. Many of the women learn about the presence of this disease during a routine examination by a specialist. Despite the absence of pronounced symptoms, it is worth remembering that spotting, disturbing after the end of menstruation, may indicate the occurrence of neoplasms characteristic of this pathological process.

Briefly about the main

Rejection of mucus-like clots that have both brown and white pigmentation can be equally related to both the physiological norm and the symptoms of pathological processes. It is not possible to independently identify the root cause of this. It is possible to draw up a complete picture reflecting the processes taking place with a woman solely on the basis of the results of tests, ultrasound data and gynecological examination.

A patient who notices brown, supplemented by pain or a sharp, unpleasant odor should immediately contact a specialist. It is possible that in this situation we are talking about an acute inflammatory process or a sexually transmitted infection. The presence of such deviations requires the immediate start of a course of antibiotics in conjunction with maintenance and strengthening therapy.