What causes bacterial vaginosis. Bacterial vaginosis: causes of the disease, effects on pregnancy, treatment. Classification of bacterial vaginosis

Bacterial vaginosis is a dysbacteriosis of the vagina, i.e. a condition in which the ratio of microorganisms that normally live in the vagina is disturbed. Those that should be more (lactic bacteria) become smaller, and vice versa, those who should normally be few multiply.

Bacterial vaginosis occurs against the background of immune disorders, inflammatory diseases of the reproductive system, menstrual irregularities, prolonged use of the intrauterine device, unsystematic use of antibiotics and hormonal drugs.

Accompanied by profuse discharge with an unpleasant odor. Sometimes it is asymptomatic. The diagnosis is established on the basis of complaints, anamnesis and data from special tests. Treatment is local and general pharmacotherapy. It is worth noting that this infectious disease is not sexually transmitted as such, but can be transmitted by a man from a partner to another partner.

Causes of bacterial vaginosis

The factors leading to the development of bacterial vaginosis include, first of all, the prolonged, sometimes uncontrolled use of antibiotics, which leads to dysbiosis not only of the vagina, but also of the gastrointestinal tract. According to a number of authors, in almost every second patient with bacterial vaginosis, violations of the intestinal microecology are detected.

Doctors also identify several factors that presumably provoke the development of the disease:

Hormonal factors: female sex hormones affect the state of the microflora of the vagina. Bacterial vaginosis is rare in adolescent girls and menopausal women, when the level of sex hormones in the blood is low.
Reception of cytostatics, antimycotic drugs and radiation therapy(weakening of the immune system).
The presence of an intrauterine device- The risk of infection is doubled.
Excessive desire for cleanliness(douching, frequent washing with soap and vaginal douches).
reduced immunity– treatment of bacterial vaginosis may be required after serious illnesses, as they lead to a weakening of the protective functions of the body and contribute to the reproduction of harmful bacteria.
Deformity of the vagina, cervix and pelvic muscles bottom after childbirth, surgery or radiation.
is a violation of the composition of the intestinal microflora and is a factor contributing to the development of bacterial vaginosis.
Pregnancy (increased progesterone synthesis causes relative estrogen deficiency, reduced immunity to prevent fetal rejection).

As a rule, with bacterial vaginosis, the following bacteria are found in the vagina: gardnerella (Gardnerella vaginalis), bacteroids, fusobacteria, Klebsiella, etc. Due to the presence of gardnerella in vaginal discharge, bacterial vaginosis is often called gardnerellosis.

During pregnancy

Vaginal dysbacteriosis is dangerous for its consequences and complications for both the woman and the unborn baby:

In the early stages, the disease can cause spontaneous abortion.
In the 2nd - 3rd trimesters, infection of the fetus and / or membranes may occur, which will lead to their premature rupture and prenatal outflow of water.
Premature birth, complications of the birth process and the occurrence of purulent-septic diseases after childbirth - this is an incomplete list of the dangers that gardnerellosis is fraught with.

Treatment of bacterial vaginosis during pregnancy is prescribed only by the attending physician and is carried out under his supervision.

Symptoms of bacterial vaginosis

In women with bacterial vaginosis, the main symptom is a copious, fishy-smelling, creamy, white or gray discharge. Itching, burning, discomfort during intercourse are possible.

In the case of bacterial vaginosis, acute or torpid, asymptomatic, monosymptomatic (only with secretions) or polysymptomatic course of the disease is distinguished. In some women, the symptoms of bacterial vaginosis persist for a long time, while in others they periodically occur under the influence of adverse factors.

When collecting an anamnesis, it turns out that more than 90% of patients with suspected bacterial vaginosis have previously consulted a gynecologist and other specialists with complaints of discharge and other symptoms. Three-quarters of the patients were repeatedly treated for non-specific vaginitis, using antibacterial suppositories and taking various oral antibacterial agents.

Diagnostics

Before determining how to treat bacterial vaginosis, it is worthwhile to undergo an examination and determine the causes of its occurrence. Diagnosis is based on the presence of three of the following four symptoms:

the specific nature of the discharge;
acidity> 4.5 (normally 3.8-4.5);
positive aminotest;
the presence of "key" cells. The so-called "key cells" are mature epithelial cells (surface
layer of the vaginal epithelium), over the entire surface of which microbes are tightly and in large numbers attached.

Depending on the severity of the course and the severity of the symptoms of bacterial vaginosis, the scheme and duration of treatment is determined.

How to treat bacterial vaginosis

Women diagnosed with bacterial vaginosis, depending on the degree and nature of the pathological process, may be prescribed local or systemic antibiotic therapy. In this situation, etiotropic agents with an antianaerobic effect are used.

The main treatment for bacterial vaginosis is the use of antibiotics (Metronidazole or Clindamycin), which inhibit the development of pathogenic bacteria in the vagina and create conditions for the restoration of normal flora.

In rare cases, during the treatment of bacterial vaginosis, a fungal flora begins to develop in the vagina. For the prevention of vaginal candidiasis, especially in the presence of episodes of "thrush" in a patient in history, antimycotic agents may be prescribed. 1 - 2 weeks after the end of treatment, the examination and laboratory tests are repeated to evaluate the effectiveness.

After elimination of pathogenic bacteria, it is necessary to restore the normal microflora of the vagina. The restoration of the microflora of the vagina is carried out with the help of a group of drugs called probiotics.

These include the following medications:

Lactobacterin, Bifidumbacterin is recommended to be injected into the vagina one suppository at a time before bedtime, for 10 days.
Linex - is available in capsules, which are recommended to be taken after meals, two capsules 3 times a day.

Separately, it must be said about the treatment of sexual partners of women with bacterial vaginosis. In almost all cases, it is inappropriate, since the disease is not sexually transmitted. The exception is men with infectious diseases of the genitourinary system, and those who present active complaints.

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Among the many infections of the female genital organs, the most common is bacterial vaginosis (BV, vaginal dysbacteriosis, bacterial vaginosis).

According to statistics from research and educational medical institutions, this pathology is detected in almost a quarter of healthy women and over 60% of patients with clinical symptoms of vaginitis (colpitis).

According to its characteristics, it belongs to non-inflammatory diseases of connective tissues (non-inflammatory syndrome). The disease is caused by a qualitative and quantitative imbalance of the vaginal environment - a significant increase in opportunistic bacteria and a decrease in the concentration of lactic acid flora, which increases the chances of an increased spread of pathological microorganisms.

What it is? - With bacterial vaginosis of the vagina, the composition of vaginal discharge includes a mixed microflora - peptococci, peptostreptococci, bacteroids, mobilejuncus, mycoplasmas, gardnerella and a small amount of epithelium. So this pathology, according to scientists, is a pathological condition with a special distribution of the bacterial ecosystem and is not, as such, a tissue infection.

In medical practice, vaginal dysbacteriosis is classified by stages - the severity of clinical manifestations:

Compensated BV - characterized by the almost complete absence of microflora. Histological examination does not find changes in epitheliocytes. The structure of the epithelium of the organs of the reproductive system is not broken.
Subcompensated type of BV - there is an increased number of pathogens of various diseases and a decrease in the level of lactobacilli.
The uncompensated type of vaginal dysbacteriosis is characterized by the absence of lactic acid flora and an increase in the concentration of pathogenic and opportunistic microorganisms. Changes in the epithelium are noted.

The clinical picture of the disease can be expressed as an acute, torpid, erased or asymptomatic form. The form of manifestation of the pathology greatly simplifies the task of the doctor in determining how to treat bacterial vaginosis, given the species of the disease.

Etiology and genesis: causes and origin

The leading role in the microenvironment of the vagina is played by lactobacilli (the main flora of the vagina is 98%), which have:

a feature of the production of hydrogen peroxide (peroxide);
the creation of a protective acid factor - lactate;
stimulation of the body's immunity;
competitiveness for a place on the epithelial cells of the vagina, displacing and preventing other flora from developing.

It is this ability of them that ensures the balance of vaginal microorganisms. Various adverse factors (internal or external) cause a violation of the normal microcenosis of the vagina, resulting in a change in the vaginal microsystem, which is the main cause of dysbacteriosis.

to internal"Provocateurs" include:

hormonal changes caused by menopause, stress after medical abortion or after childbirth, pregnancy complications, etc.;
violations of local immunological processes;
nonspecific infections - hypo or atrophy of the upper layer of the vagina, functional failure of the cell receptors of its epithelium;
changes in the biocenosis of the gastrointestinal tract.

In more than half of the patients with signs of BV, intestinal dysbacteriosis is detected, which speaks in favor of a single dysbiotic process with a predominant lesion of the genital or digestive system. Of the concomitant infections hiding against the background of vaginal manifestations, bacteria, mycoureaplasmas, and papillomaviruses are often detected.

External provocative factors are due to a variety of reasons, including:

taking antibiotics, chemotherapy, hormonal drugs, antiviral and antifungal therapy;
radiotherapy;
lack of hygiene measures;
frequent vaginal cleansing procedures;
ruptures during childbirth, contributing to the anatomical change in the vagina;
congenital vaginal anomalies and gynecological operations;
polyps and cystic formations of the hymen (virgin fold);
spermicides (contraceptives) or vaginal tampons

Although the route of sexual transmission is not statistically proven, the issue of such transmission of bacterial vaginosis remains debatable.

The severity of the main signs and symptoms of bacterial vaginosis is due to:

prolonged or moderate discharge;
an unpleasant smell of fish tripe, intensifying during menstruation and after sexual intercourse;
in the initial period of the disease, leucorrhoea has the structure of a liquid consistency,;
with the development of the process, the structure and color of whiter change. They become thick or cheesy, the color changes to yellow or greenish;
in rare cases, discomfort manifests itself in the form of itching, irritation, burning pain during intercourse;
long-term, pronounced signs of the disease appear with recurrent vaginosis, often in the "company" of erosive pathologies of the uterus and its cervix.

In a quarter of patients who become ill, clinical symptoms of bacterial vaginosis may not appear at all. Despite the general signs of BV, the clinic of the disease in each patient is individual.

Bacterial vaginosis during pregnancy

The manifestation of bacterial vaginosis during pregnancy is due to changes in the woman's body that occur during this period. The balance of bacteria in the vagina is disturbed, as the production of lactic acid by bacteria, which maintains the balance of the vaginal flora, is reduced. Decreased immunity opens up the possibility for pathogenic microbes to develop intensively and increase their number.

In addition, latent, asymptomatic forms of pathology that occur for a long time in women can manifest themselves precisely during pregnancy “in all its glory”, favorable factors have this. Delay in the treatment of bacterial vaginosis in pregnant women threatens with dangerous complications:

the development of diseases of organs located in the space of the lower pelvis;
infect the internal organs of the reproductive system, the fetal membrane or the placenta;
migration of the infection leads to the development of inflammation in the fetal membrane, to their purulent melting and rupture, which ultimately ends in premature birth or spontaneous miscarriages;
the infection can affect the child, cause functional disorders in the placenta and blood vessels, which provokes prolonged oxygen starvation in the fetus;
after birth, such children, as a rule, have low weight, pneumonia, pathologies of the nervous system.

With timely therapy, neither the mother nor the child is in danger.

Before starting the treatment of vaginosis, it is necessary to undergo a number of diagnostic procedures. Specific tests are prescribed by the attending physician, the main ones are:

Examination of secretions to determine acidity.
Detection of vaginosis by the amine test.
Study of a vaginal smear to determine the ratio of bacterial flora;
Diffusion method and dilution method, which determine the degree of sensitivity of harmful bacteria to antibiotic preparations;
In disputable situations, an analysis is carried out on the quantitative ratio of succinic and lactic acid.

Tactics for the treatment of bacterial vaginosis - phased.

In the first stage treatment provides for the destruction of microflora that damages the vaginal flora. Local drugs are prescribed that suppress the reproduction and growth of the main pathogens:

candles or tampons;
drugs containing antibiotics - "Trichopolum", "Clindamycin", "Metrogil", "Metronidazole", etc.;
drugs that restore the intestinal microflora (side effects of antibiotics).

The choice of drugs is carried out in accordance with the indicators of analyzes for the sensitivity of bacterial microflora to antibiotics.

Second phase due to the restoration of microflora and the colonization of the vaginal environment with lactobacilli. Probiotic preparations containing live strains of beneficial microflora are prescribed: Bifidumbacterin, Lactobacterin, Linex, etc.

After a week's course of treatment, a gynecologist's examination and a control sampling of tests are carried out. The final stage is a control examination after one and a half months.

Preventive measures for BV

The main measure for the prevention of the bacterial form of vaginosis and its recurrence is the exclusion of provoking factors.

Prudent use of antibiotics.
Maintaining the intestinal microflora at the proper level.
Timely treatment of gynecological and hormonal pathologies.
Maintenance of normal functions of the immune system.
In most cases, the use of contraceptives and the use of vaginal hygiene products are excluded.

It should be remembered that an alternative to dubious self-treatment, even at first glance, minor disorders in the body, is a high-quality examination and well-chosen treatment by a specialist.

Vaginosis- This is a condition in which there is a violation of the microflora of the vagina. The average age of patients with vaginosis is 20-45 years. The incidence of the disease in this group is 80%. Based on these data, we can conclude that eight out of ten women suffer from vaginosis at least once in their lives.

The disease does not pose a danger to a woman's life, but can adversely affect her reproductive function. Often, even after the onset of pregnancy, patients with vaginosis have miscarriages. If she bears a child, then the disease threatens with intrauterine infection of the fetus, complications after delivery. Therefore, you need to know the main causes and symptoms of the disease, as well as be able to cope with it.

Man and microbial flora exist in indivisible tandem. There are microbes that, in the process of evolution, have adapted to live in the human body and even benefit it. This process is called biocenosis. Such flora is represented by a stable bacterial composition. Some bacteria inhabit exclusively the dermis, others live in the mouth, and others in the gastrointestinal tract. Such bacteria benefit the human body by destroying the harmful flora, producing vitamins and stimulating the work of its immunity.

Lactobacilli live in the vagina. They look like small thick sticks. The bacteria break down glycogen, which is found in the epithelium that lines the vagina. During this process, lactic acid is released. Due to which the acidic environment is maintained in the vagina. Pathogenic microorganisms die in it, which is the norm. In the biocenosis of the vagina, lactobacilli account for 95-98% of all beneficial microflora.

Sometimes it happens that lactobacilli are destroyed. Then other microbes take their place. The acidic environment of the vagina changes, which creates favorable conditions for pathogenic microorganisms to enter it. They can be sexually transmitted, or they can reproduce on their own. In the latter case, they speak of nonspecific vaginosis. Lactobacilli are replaced by flora, which inhabits the perineum, urethra, perianal folds. Microbes begin to multiply rapidly, but such flora is not able to perform the functions of lactobacilli.

A change in the biocenosis of the vagina leads to the fact that not only metabolic, but also immune processes fail in it. The production of immunoglobulin A decreases. It is this substance that prevents pathogens from attaching and penetrating deep into the epithelial wall of the organ. The epithelium itself tries to cope with bacteria, which leads to excessive desquamation of its particles. This explains the increase in the volume of vaginal discharge in vaginosis. Lactobacilli are replaced by anaerobic bacteria. This is the name of microorganisms that are able to maintain their vital activity in an oxygen-free environment. Some of them produce amino acids and volatile fatty acids. They are broken down in the vagina to volatile amines. These amines have an unpleasant odor that resembles the smell of fish.

The vaginal environment changes from acidic to alkaline. The metabolism of fats, proteins, minerals and carbohydrates is disturbed, the epithelium produces more mucus. This is the first sign of developing vaginosis. At the same time, the walls of the vagina themselves are not inflamed. All changes are purely physiological in nature.

Bacterial vaginosis cannot be called a sexual infection, since there are no infectious representatives of the flora in the vagina. This disease is called nonspecific vaginosis. The main reason for its development is a change in the vaginal environment, which further leads to an imbalance in the microflora.

A wide variety of microbes are capable of replacing lactobacilli.

Microorganisms such as:

Peptococcus.

Bacteroids.

Megaspheres.

Peptostreptococci.

Aptopobium.

Leptotrichi.

Mycoplasmas.

Gardnerella.

Bacteria with disturbed microbiocenosis of the vagina begin to multiply rapidly, in 1 ml of secretion their number can reach 10 10 . In this case, for the development of bacterial vaginosis, there must be appropriate conditions. Therefore, there are 2 groups of causes that can become an impetus for the development of the disease. They are divided into internal and external.

Internal factors include:

Hormonal imbalance in the body of a woman with excessive production of progesterone.

Atrophy of the vaginal mucosa.

Deterioration of immunity.

External factors that affect the development of the disease:

Long-term use of antibiotics.

Treatment with drugs that adversely affect the immune system. First of all, this applies to cytostatics and immunosuppressants.

Radiation therapy for cancer.

The presence of a foreign object in the vagina, such as a tampon, pessary, diaphragm to prevent unwanted pregnancy.

Use of spermicides.

Douching that is done too often.

Errors in intimate hygiene.

Any of these reasons leads to the fact that the microbiocenosis of the vagina is disturbed. In the future, this can provoke vaginosis.

During pregnancy, vaginosis develops mainly due to hormonal imbalance. In order for a woman to be able to bear a child, the level of progesterone in her body rises. This hormone helps to reduce the level of glycogen in epithelial cells. Lactobacilli will have nothing to eat, they begin to die, which provokes a change in the acidic environment of the vagina to alkaline. Another effect of progesterone is that it creates a favorable environment for the reproduction of pathogenic microflora.

Vaginosis is not a sexual infection, but its symptoms often resemble STDs. In addition, vaginosis often occurs after a change of sexual partner. About a day after intimacy, a woman has the first signs of discomfort. This happens on the condition that intimacy occurred without the use of a condom.

When the cause of vaginosis is taking antibacterial drugs, or another factor, then sexual life does not have any effect on its development.

Symptoms of acute vaginosis can be identified as follows:

Increased volume of secretions from the genital tract. They become grayish in color, have a uniform consistency. They start to smell bad. The discharge becomes more after intimacy, after menstruation, after using irritating intimate hygiene products.

Pain that occurs during intimacy.

Itching and burning in the vulva. Sometimes this symptom is absent altogether.

Some patients complain of pain during bladder emptying.

Also, pain can occur in the pubic area.

If vaginosis haunts women for 60 days or more, and the treatment does not bring the desired relief, then they talk about the chronic form of the disease. In this case, a woman is most often diagnosed with a hormonal imbalance. A complication of sluggish vaginosis is atrophy of the mucous membranes of the vagina.

To confirm the diagnosis, you need to visit a gynecologist. The doctor will take an anamnesis, find out the main complaints of the woman. The next stage of diagnosis is an examination on the gynecological chair. In the course of its conduct, the doctor collects mucus.

Facts that allow you to make a preliminary diagnosis of "vaginosis":

The age of the patient. Vaginosis most often develops in women 20-45 years old.

Recent change of sexual partner or surgery.

Recent use of antibiotics.

The presence of symptoms characteristic of vaginosis.

During a gynecological examination, the doctor evaluates the external and internal genital organs. If the disease develops due to the reproduction of opportunistic flora, then the color of the vagina does not change, its walls remain of a uniform tone, there are no signs of inflammation.

Allocations are distributed unevenly along the inner wall of the vagina. If the disease is in the acute phase, then the color of the discharge is grayish, an unpleasant odor emanates from them.

Chronic vaginosis is characterized by yellow or green discharge. They are thick, viscous and can form into curd lumps or clots. Sometimes the discharge foams.

During the examination, the doctor evaluates the acidity of the vagina. He does this with the help of an indicator strip. If a woman has vaginosis, then the indicator exceeds 6.

To confirm the diagnosis, the doctor performs a rapid test. A smear from the vagina is applied to the glass and mixed with caustic potassium at a concentration of 10%. At the same time, a sharp fishy smell begins to emanate from the collected mucus. In this case, the test is considered positive.

Another swab from the vagina is sent to the laboratory. Epitheliocytes will be found in it. These are cells of the vaginal mucosa that contain gram-variable microbes. The cells themselves do not have a clear outline, they become granular. The level of lactobacilli in the smear is significantly reduced. At the same time, streptococci, bacilli and other pathogenic flora in significant quantities will be found in it.

Bacterial sowing of a smear with suspected vaginosis is rarely performed, only when it is necessary to find out exactly which representatives of the pathogenic flora inhabit the vagina.

If there is a suspicion of sexual infections, a PCR test is performed.

Differential diagnosis of vaginosis is carried out with such diseases as: trichomonas colpitis, candidiasis,.

The effect of vaginosis on the process of conception and pregnancy

With bacterial vaginosis, a woman can become pregnant, since the disease does not cause any pathological changes in the genital tract. Male sperm itself is alkaline. Once in the vagina with vaginosis, nothing happens to the spermatozoa.

After pregnancy, opportunistic microflora can enter the uterine cavity and lead to infection of the fetus. In this case, the child will lag behind in development, will not gain the desired body weight.

Sometimes vaginosis causes miscarriage, early rupture of amniotic fluid, the birth of a premature baby.

There is also an increased risk of blood poisoning during childbirth. The danger is especially high for those women who have undergone a caesarean section.

Vaginosis is treated by a gynecologist. However, if a woman has diseases of other organ systems, she may be referred for a consultation with an endocrinologist or gastroenterologist. Treatment is carried out at home, the patient is not placed in the hospital.

Therapy is aimed at destroying the pathogenic flora in the vagina and restoring normal microflora in it, that is, lactobacilli. It is important not only to eliminate the symptoms of vaginitis, but also to get rid of the cause that provoked its development. As practice shows, the passage of one-stage treatment leads to the fact that in 35-50% of cases the disease recurs. To prevent this from happening, you must strictly adhere to the timing of therapy, which should be phased.

First, the patient is prescribed antibiotics. They allow you to destroy the pathogenic flora that inhabited the vagina. For this purpose, drugs such as: Metronidazole, Clindamycin, Tinidazole can be used. All these agents are destructive to anaerobes.

Doctors point out that with an uncomplicated course of the disease, it is better to give preference to local antibiotic therapy. This will avoid many of the side effects that such drugs have on the body as a whole. Local therapy of infectious vulvovaginitis involves the use of drugs in the form of vaginal tablets, suppositories or capsules, such as Macmiror Complex (vaginal capsules / cream), which is intended for the local treatment of vulvovaginitis. The active substance nifuratel, which is part of it, has antibacterial, antifungal and antiprotozoal activity, and nystatin is added to enhance antifungal activity. In clinical studies, Macmiror Complex has proven to be highly effective against fungi, bacteria, Trichomonas and their associations with other pathogens. Macmiror Complex creates favorable conditions for maintaining a healthy vaginal biocenosis, as it does not affect lactobacilli.

Therapy is selected by the doctor on an individual basis:

Metronidazole. The drug is used in the form of a gel with a concentration of 0.75%. It is inserted into the vagina once every 24 hours. The course of treatment should last no more than 5 days.

Clindamycin gel with a concentration of the main active ingredient of 2%. The drug is injected into the vagina 1 time in 24 hours. The course of therapy is a week.

Tablets Tinidazole 2 g. They are taken 1 time in 24 hours. The course of treatment is 3 days.

Clindamycin suppositories 100 mg. They are inserted into the vagina once every 24 hours. The course of treatment should last 3 days.

Tablets Metronidazole 2 g. The drug is taken orally once.

If vaginosis develops in a pregnant woman, then antibiotics are prescribed to her no earlier than the 2nd trimester. They are used in tablet form. Treatment should last 7 days, but no longer.

During the course of therapy, it is important to exclude any alcoholic beverages. This applies even to small doses of alcohol. Drugs that are used to treat vaginosis react with ethyl alcohol and cause severe intoxication of the body. Its symptoms are similar to those of a hangover. The woman's weakness increases, there is a tremor of the arms and legs, blood pressure rises, intense headaches occur. The patient is nauseated and vomits.

The composition of the drug Clindamycin contains fat, which can damage the integrity of the condom. You need to enter any means into the vagina before going to bed. This will allow the drug to remain inside the woman's body for a long time and not leak out.

If a woman has an individual intolerance to antibacterial agents, then antiseptics are prescribed for the first-stage therapy.

These can be tools such as:

Hexicon. It will be necessary to enter 1 candle every 12 hours. The course of treatment is 10 days.

Miramistin. Irrigate the vagina with this solution once a day. The course of treatment lasts a week.

The second stage of treatment of vaginosis is reduced to the use of drugs containing lactobacilli. They allow you to normalize the microflora of the vagina. They begin to be used 2-3 days after antibiotic therapy is completed.

For this purpose, drugs such as:

Candles Acilact. They are inserted into the vagina 1 piece 2 times a day. The course of therapy lasts 5-10 days.

Bifiliz drug. It is taken orally 5 doses 2 times a day. The course of treatment lasts 5-10 days.

Experts strongly do not recommend self-medication. If you choose the wrong dose, this can lead to resistance of pathogenic microflora. It will be more difficult to cope with such a disease, as well as with a chronic form of the disease. Therefore, at the first symptoms of vaginosis, you need to go to an appointment with a gynecologist.

Video: gynecologist Yulia Fakhradinova Balatskaya about bacterial vaginosis:

Prevention of vaginosis

The disease is not sexually transmitted, however, changing the sexual partner can lead to the development of vaginosis. The same applies to unprotected intimacy. Therefore, in order to prevent the development of the disease, you need to use condoms.

If unprotected intercourse occurs, then it is necessary to rinse the vagina with Miramistin.

It is important to treat chronic diseases in a timely manner. If the use of antibiotics is required, then they are taken according to the scheme indicated by the doctor.

Any hormonal changes need to be corrected under the supervision of a specialist.

There are contraindications. Before use, consult your doctor.

Education: Diploma "Obstetrics and Gynecology" received at the Russian State Medical University of the Federal Agency for Health and Social Development (2010). In 2013, she completed her postgraduate studies at the NMU. N. I. Pirogov.

Many of the fair sex at least once in their lives faced with such a problem as bacterial vaginosis (or bacterial vaginosis). This is an unpleasant disease that threatens not only with its clinical manifestations, but also with possible complications. What is this disease, what leads to its appearance, how does it manifest itself and is it possible to fight it?

Almost ninety percent of the microflora are lactobacillus bacilli, which prevent the colonization of pathogenic microorganisms and monitor the amount of opportunistic microflora. In addition, bacilli produce the production of substances with antibacterial activity.

If the acidity of the vaginal environment changes towards alkalization, favorable conditions are created for the active reproduction of conditionally pathogenic microorganisms. In general, our body strictly controls the microflora of the vagina and does this using the following mechanisms:

hormonal system. If the hormonal background changes, then the number of receptors that are on the surface of the cells changes accordingly, and it is to these receptors that harmful bacteria attach. Also, it is the hormonal system that controls the process of updating the vaginal mucosa;
immunity. This protective system controls the number of opportunistic microflora, and immunoglobulins prevent harmful bacteria from attaching to cells and penetrating deeper;
lactobacilli. These beneficial microorganisms create an acidic environment in which pathogenic bacteria simply cannot actively multiply.

What is bacterial vaginosis

This is a disease of the female genital organs with specific vaginal discharge that has an unpleasant odor. In simple terms, this is vaginal dysbacteriosis. Unlike, with bacterial vaginosis there are no inflammatory signs.

Although the disease itself is not a sexually transmitted infection, early sexual activity, promiscuity and unprotected sex can significantly contribute to the occurrence of bacterial vaginosis.

The basis of this disease is a change in the quantitative composition of the microflora of the vagina. The number of beneficial bacteria decreases, while the conditionally pathogenic microflora begins to multiply actively.

In each case, the clinical picture of the disease may differ, ranging from an asymptomatic course to a pronounced clinical picture with severe discomfort, itching and discharge.

Causes of vaginosis

As for the specific pathogen, it simply does not exist. Entire polymicrobial complexes lead to the appearance of the disease, among which mycoplasmas and gardnerella can be noted.

The causes of vaginal dysbacteriosis can be very many. Consider the most important provoking factors:

hormonal changes, for example, after an abortion, during menopause or pregnancy;
weakening of general or local immunity;
endocrine disruption;
poor observance of the rules of intimate hygiene;
deformation of the vagina or cervix;
frequent use of soap when washing and the abuse of douching;
the presence of foreign bodies in the vagina;
the use of hormonal agents, as well as immunosuppressants;
use of oral contraceptives or long-term use of intrauterine contraceptives;
severe stressful situations;
inflammatory processes of the urinary and reproductive systems;
prolonged or uncontrolled use of antibiotics.

Symptoms of bacterial vaginosis

Immediately it should be noted that the disease has no characteristic signs. Often, its only symptom is profuse vaginal discharge with an unpleasant fishy odor.

At the very beginning of the development of the pathological process, the discharge has a white or grayish color. With a long course of that ailment, they can acquire a thick consistency with a yellow-green tint. In their appearance, they resemble cottage cheese, foam, become sticky and viscous.

There are no such signs of the inflammatory process as edema and hyperemia with vaginosis, this is a hallmark of vaginitis. Often the disease is accompanied by such pathological processes: cervicitis, erosion, scarring. Approximately in fifty percent of cases, patients experience the addition of vaginitis.

The most common signs of the disease are the following symptoms:

abundant grayish-white discharge of a homogeneous creamy consistency, which is evenly distributed along the walls of the vagina;
discomfort with intimacy;
pain in the perineum;
urination disorders.

If the disease lasts more than two years, the following symptoms are characteristic:

discharges change their color and consistency, resembling a curdled mass;
whites become dark green;
pathogenic flora joins the infectious process, which leads to inflammation of the vagina, manifested as swelling and redness;
whites are easily removed from the walls of the vagina with a cotton swab;
frequent and painful urination;
itching around the vulva.

Types of bacterial vaginosis

There are several classifications of bacterial vaginosis. Depending on the clinical manifestations, the disease is divided into the following groups:

asymptomatic;
monosymptomatic;
polysymptomatic.

By the nature of the pathological process, the disease is:

sharp;
chronic;
recurrent.

Depending on the severity, bacterial vaginosis occurs in the following forms, namely:

compensation stage. The compensated type manifests itself in the form of a slight decrease in the number of lactobacilli. At this stage, the colonization of microorganisms that have entered the body from the outside takes place;
subcompensated stage. The reduction of lactobacilli occurs in a significant form and the activation of conditionally pathogenic microorganisms occurs;
stage of decompensation. Lactobacilli are completely absent. There is a pronounced clinical symptomatology and such a pathological process requires long-term therapeutic therapy.

Bacterial vaginosis during pregnancy

Often the disease is diagnosed during pregnancy. According to statistics, the disease occurs in every fifth woman.

In pregnant women, the hormonal background changes, the immune system weakens, thus creating favorable conditions for the development of the disease. In its manifestations during pregnancy, the disease is no different, and a woman is also worried about thick foamy discharge with an unpleasant smell of stale fish.

Bacterial vaginosis poses a risk to both the mother and the developing fetus:

in the early stages, spontaneous abortion may occur;
a disease that develops in the second or third trimester threatens to infect the fetus, which can lead to premature outflow of water;
premature birth;
complications during labor;
purulent-septic complications in the postpartum period.

For the treatment of pregnant women, it is preferable to use local rather than systemic drugs. Means that include metronidazole are usually prescribed. Such drugs are used in the form of vaginal pills or gels. Doctors also prescribe to pregnant women such remedies: Trichopolum, Metrogil, Tiberal.

The above funds are prescribed from the second trimester of pregnancy, so in the first there is a laying of vital organs and systems. If there is a real threat to the mother or child, then the doctor may decide to prescribe antimicrobial agents at an earlier date.

Women are also prescribed drugs containing lactobacilli for. They can be used both inside and in the form of douching. Treatment is carried out under the strict supervision of a doctor.

Forecast

Despite treatment, in some cases, relapses may occur at any stage after the end of therapy. This is most likely due to the fact that antibiotics that affect pathogenic microflora interfere with the rapid creation of favorable conditions for the active reproduction of beneficial bacteria.

For this reason, complex therapy should include. Their action is aimed at restoring the natural balance of microflora, which will serve as a good prevention of relapse.

Diagnostics

The most informative diagnostic method is a microscopic examination of a gynecological smear. Under a microscope, a specialist detects key cells - a clear sign of gardnerellosis. A bacteriological study is also carried out, which will help identify the pathogen.

Already on the basis of clinical symptoms alone, a specialist may suspect the presence of vaginosis, but an accurate diagnosis is made on the basis of laboratory data. The gynecologist conducts an examination, during which he detects a discharge characteristic of the disease.

Bacterial vaginosis in men

Many experts consider it incorrect to use the very expression "bacterial vaginosis" in relation to men, because this is vaginal dysbacteriosis. Nevertheless, the causative agents of this disorder - gardnerella - can provoke the development of the pathological process in the male body.

The causative agents of gardnerellosis can penetrate through sexual contact. Unlike the female body, gardnerella are not natural inhabitants of the male body. It is for this reason that the disease in men is treated as a sexual infection.

In most cases, the causative agent of the disease easily penetrates the male body and is just as quickly excreted after two or three days. Sometimes there may be a chronic carriage, in which there are no clinical manifestations. The danger lies only in the fact that a man may not know about the carriage, but at the same time pass gardnerella to his partner.

Sometimes these microorganisms during sexual intercourse can penetrate the urethra and cause a sluggish current inflammatory process. In this situation, green discharge appears from the penis. Which practically do not disturb the man. And sometimes this can lead to development with the appearance of pain and burning during urination, this of course requires medical therapy.

How is bacterial vaginosis transmitted?

Bacterial vaginosis is not a sexually transmitted disease!

In general, pathogens, in particular gardnerella, can be sexually transmitted, but this will not cause the development of dysbacteriosis, because these microorganisms are part of the natural microflora in small quantities. If immunity is normal, then the body's defense mechanisms simply will not allow the opportunistic pathogen to attach to the surface of the cell, and even more so to penetrate deeper.

Then what role do unprotected sex play in the onset of the disease? Here the point is not at all in infection, but in the fact that the frequent change of sexual partner violates the natural balance of microflora.

When should you see a doctor?

Consider the reasons that may serve as a reason for contacting a specialist:

infectious process arose for the first time. The doctor will help identify the etiological factor and talk about the characteristic symptoms, as well as tell you how to deal with them;
the disease did not occur for the first time, but the symptoms this time are different;
you have a new sexual partner. Signs of sexually transmitted diseases are similar in their manifestations to bacterial vaginosis;
fever and unpleasant odor from the vagina;
despite self-treatment, recovery never came.

What is the treatment for bacterial vaginosis?

Bacterial vaginosis in women is treated in two main steps:

Restoration of the physiological properties of the vagina, strengthening the body's defenses, normalization of hormonal levels and the fight against pathogens.
Restoration of the natural balance of the microflora of the vagina.

In addition to the main treatment, the patient is prescribed immunocorrective and desensitizing agents. It is not advisable to treat a sexual partner.

Medicines for bacterial vaginosis

Medicines are used after medical prescription. Self-medication is unacceptable.

Eubiotics

Consider a treatment regimen with effective eubiotics:

Baktisubtil. One capsule is drunk one hour before meals three to four times a day;
Khilak forte. Fifty drops three times a day;
Linex. It is taken two tablets three times a day.

Candles from bacterial vaginosis

Vaginal suppositories act directly in the focus of the pathological process. The active substance is practically not absorbed into the blood, which means it causes a minimum of side effects.

Ecofemin. The composition of the drug includes live lactobacilli. Suppositories are administered for ten days two to three times a day;
Bifidumbacterin. Contains bifidobacteria. It is enough to introduce one candle at bedtime for ten days;
. Contains chlorhexidine. A feature of Hexicon is that it has a detrimental effect on pathogenic microorganisms, while not affecting lactic acid bacteria. One or two suppositories are introduced for 10 days.

Treatment regimen for bacterial vaginosis

To begin with, consider the standard treatment regimen with systemic drugs:

Ornidazole. A single dosage is 500 mg. The remedy should be taken twice a day for one week;
Metronidazole. The usage pattern is exactly the same;
Clindamycin. Single dosage - 300 mg. Take the tablets twice a day for seven days.

Now let's talk about the scheme of using local drugs:

Neo-penotran. For seven days, a suppository is injected intravaginally twice a day;
Terzhinan. One suppository is inserted deep into the vagina twice a day for five days;
Clindamycin cream. The full applicator is administered at bedtime for seven days.

How to treat vaginosis at home

Consider several ways to treat the disease at home:

if the disease has just begun to develop, douching can be of good help. Lactic or boric acid is suitable as a solution. The liquid for the procedure should be warm, but in no case hot. One or two douches per day are enough;
You can use tampons intravaginally. They are wetted in ascorbic or lactic acid. Tampons are also lubricated with metronidazole ointments. The tampon is left in the vagina for twenty minutes, after which it should not be washed away. It is necessary to do ten such procedures, but the effect is already visible after the third application.

Folk remedies for bacterial vaginosis

Treatment using non-traditional methods is longer, but the safest. But this is provided that they are correctly used. Folk remedies are not an alternative to medical treatment, but only auxiliary help. You can use them with the permission of the doctor.

Consider the most effective recipes:

sitz baths. The duration of this procedure is fifteen minutes. They quickly remove the itch. For their implementation, you will need two glasses of herbal infusion, which are mixed with ten liters of warm water. Infusions can be prepared from the following medicinal plants: oak bark, chamomile, wormwood, St. John's wort, calendula, dandelion, etc.;
infusions for oral administration. Take the following ingredients in equal proportions: elecampane root, birch leaves, mint, chamomile, licorice, thyme. One tablespoon of crushed raw materials is poured with half a liter of boiling water. The remedy must be infused for six hours. After it has been filtered, the infusion is ready for use. Treatment lasts for three months. Half a glass is drunk half an hour before a meal;
cotton swabs are soaked in the infusion and inserted into the vagina. To prepare the medicine you will need: marshmallow root, St. John's wort, meadowsweet, dandelion leaves, blueberries and calendula. The components are taken in equal proportions, poured with boiling water and the remedy should be infused for several hours.

Prevention

It is important for every woman, especially those who have already been treated for gardnerellosis, to follow simple but effective preventive measures:

proper observance of the rules of intimate and sexual hygiene;
in case of casual sexual intercourse, the use of barrier methods of contraception;
timely treatment of inflammatory processes of the genitourinary system;
full sleep and the fight against stressful situations;
balanced diet;
rational use of antibiotics;
normalization of hormonal levels;
prevention of the development of intestinal dysbacteriosis;
regular visits to the gynecologist.

So, bacterial vaginosis is a disease in which there is a violation in the natural balance of the microflora of the vaginal mucosa. A number of reasons can lead to its appearance, among which we can distinguish a change in the hormonal background and weakening of the immune system. One of the main signs of the disease is abundant discharge from the vagina of a white-gray color with a fishy smell.

Bacterial vaginosis should be treated by a doctor. It all starts with a diagnostic examination and an accurate diagnosis. Accurate adherence to the treatment regimen, preventive measures, as well as the elimination of provoking factors will help get rid of the disease once and for all!