Bacterial vaginosis 10 in 5. How to treat chronic gardnerellosis in women? Relapse or exacerbation

What is it - bacterial vaginosis is also called vaginal gardnerellosis or dysbacteriosis (dysbiosis) due to an infectious non-inflammatory syndrome due to a sharp decrease or absence of lactoflora and its replacement by polymicrobial associations of anaerobes and gardnerella.

In women, there is a special ecosystem in the vagina, consisting of lactobacilli. They protect the vagina: they secrete lactic acid, creating an acidic environment, stimulate local immunity and inhibit the growth of pathogens.

With bacterial vaginosis, the vaginal microflora (or microbiocionosis) is disturbed, which leads to an increase in the role of conditional pathogenic endogenous microflora and a sharp decrease or disappearance of lactobacilli with their replacement by other microorganisms.

With bacterial vaginosis, complications may occur during pregnancy or severe pathology of the female genital organs. Namely: premature birth at a short time and the birth of a premature baby with a small weight, the development of inflammatory processes in the genital organs, postpartum endometritis and the presence of purulent-septic complications in the mother and child.

Causes of bacterial vaginosis

1. 1) Synthetic underwear, tight-fitting and tight to the body. It does not allow oxygen to penetrate to the skin of the perineum, vulva and vaginal mucosa.
2. 2) Tampons and pads that rub and irritate the mucous membranes when worn daily and the presence of an intrauterine device.
3. 3) Long-term use of antibiotics that can kill bacteria, including dairy.
4. 4) Wrong diet and lack of fermented milk products. They are sources of essential lactic bacteria.
5. 5) Chronic bowel disease and other conditions that cause dysbacteriosis: the dislocation of lactic bacteria in the intestines that came with food.
6. 6) Immunodeficiency. At the same time, the immune system is not able to eliminate the pathology in the body.
7. 7) Consequences, which were caused by past diseases of the pelvic organs with a serious inflammatory process.
8. 8) Concomitant diseases on the cervix: endocervicitis, pseudo-erosion and endometriosis.
9. 9) Violations: hormonal and phases of menstruation.
10. 10) The use of contraceptives with the presence of 9-nonoxynol (creams, suppositories, condoms) and oral contraceptives.

Symptoms of bacterial vaginosis

In acute form, women may complain of:

• secretions: gray-white, frothy with an unpleasant smell of spoiled fish.
• itching and burning during urination in the external genital organs and in the vagina.
• urination disorders.
• pain during sexual intercourse.
• increased discharge after sex and before menstruation.
• viscous, sticky, thick yellow-green leucorrhoea in case of progression of the process.
• the appearance of irritation and inflammation of the skin of the perineum, thighs, anus and buttocks.

• inflammation in the urethra (with);
• inflammation on the skin of the head and foreskin of the penis (with);
• pain when urinating and frequent urination.

Diagnosis of bacterial vaginosis

In the laboratory, women determine another characteristic symptom of bacterial vaginosis - the pH of the contents of the vagina becomes higher - 4.5, that is, the acidity of the vagina becomes more alkaline.

Bacterial vaginosis can hide other viruses and infections and increase the risk of sexually transmitted diseases:,. Actively developing, gardnerella begins to destroy the microflora that is useful for the vagina, and create conditions favorable for the development of a sexual infection that is more dangerous for the body.

Establish a diagnosis based on:

1. 1) PCR and cytological studies.
2. 2) Amino test, in which chemicals interact with abnormal vaginal secretions, resulting in an unpleasant fishy odor.
3. 3) Culture inoculation to identify the pathogen through nutrient media.
4. 4) Microscopy of a stained smear to determine the presence or absence of the vaginal epithelium - key cells densely populated with anaerobic bacteria: Klebsiella, Fusobacterium, Bacteroid, Gardnerella, which is characteristic of dysbacteriosis (vaginosis).

Treatment of bacterial vaginosis

During the first stage, a bacterial infection (gardnerellosis) is destroyed with antibacterial and combined preparations of general and local use.

During the second stage, they restore the normal microflora of the vagina with biological preparations and topical drugs: tampons, baths, etc.

It is important for a woman to receive appropriate therapy in a timely manner. With a long course of the disease, inflammatory processes in the uterus and appendages can occur, which leads to endometritis, salpingitis (infectious inflammation of the fallopian - fallopian tubes), complications during pregnancy and childbirth: chorioamnionitis - inflammation of the walls of the fetal bladder (fetal membranes) and infection of the amniotic fluid, premature birth, intrauterine infection of the child and weight loss.

And also to pneumonia, pathological uterine bleeding, postoperative infectious complications, impaired reproductive and sexual function of a woman, decreased performance and neuropsychiatric disorders.

Stage one - antibiotic therapy

1. 1) Metronidazole (Trichopolum), Tinidazole, Clindamycyte, Miramistin, Polycresulen (Vagotil), Chlorhexidine, Metrogyl, Betadine, Terzhinan in tablets orally.
2. 2) Candles, gels, ointments or creams with the presence of the above drugs (except Tinidazole) and introduce them into the vagina.
3. 3) Immunocorrectors - Viferon or Kipferon.
4. 4) Estrogens and antihistamines.

• nausea and vomiting, accompanied by pain in the lower abdomen;
• anorexia - the drug is used with a strong desire to lose weight;
• constipation or diarrhea, allergic reactions;
• dryness or metallic taste in the mouth;
• glossitis, stomatitis, pancreatitis, candidiasis;
• irritation and irritability, peripheral neuropathy;
• convulsions, weakness, hallucinations, insomnia;
• polyuria, cystitis, urinary incontinence and staining it in a brownish-red color.

Persons under 18 years of age are not prescribed the drug in combination with Amoxicillin. For pregnant women, the doctor selects a course of treatment with approved drugs for a given gestational age (fetal age).

Stage two - restoration of microflora

Treatment according to the system (scheme) is performed in the presence of particularly severe cases.

Prevention

• visit a gynecologist and conduct an examination at least once a year;
• do not douche with hygiene products with an antiseptic;
• do not take hormonal and antibacterial drugs without a doctor's prescription;
• monitor the state of the microflora of the digestive tract due to the relationship of intestinal and vaginal dysbacteriosis;
• monitor the hygiene of the genital organs, not abusing douching, use protective equipment during intercourse;
• switch to a nutritious and healthy diet;
• do not use antibiotics for a long time in the treatment of diseases.

Which doctor should I contact for treatment?

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

causative agents of the disease

What is bacterial vaginosis?

How does the disease develop?

Factors predisposing to the development of bacterial vaginosis include:
Long-term treatment with antibacterial drugs, including antibiotics
Postponed inflammatory diseases of the genital organs
Oral and intrauterine contraception
Frequent change of sexual partners
Hormonal disorders
Decreased immunity
Chronic bowel disease and other diseases that can cause dysbacteriosis
Irrational nutrition - lack of dairy products in the diet
Excessive use of panty liners and tampons
Frequent wearing of tight-fitting, tight-fitting synthetic underwear and trousers.

If the balance of the vaginal microflora is disturbed, the pH of the vaginal contents changes from 4.5 to 7.0 - 7.5. As a result of the vital activity of pathogenic microorganisms, complex chemical compounds (volatile amines) are formed in the vagina, which contributes to the release of the unpleasant smell of "rotten fish". These pathological mechanisms disrupt the normal functioning of the natural biological barriers in the vagina and favor the development of various inflammatory diseases of the genital organs, postoperative infectious complications.

Clinical manifestations

• The main complaint is numerous homogeneous creamy grayish-white frothy vaginal discharge, slightly viscous. Allocations stick to the walls of the vagina and are evenly distributed along its walls. The discharge is accompanied by an unpleasant smell of "rotten fish"


• Itching and burning in the vaginal area


• Dyspareunia - discomfort and pain during intercourse


• Urination disorder

How is bacterial vaginosis diagnosed?

• The bacterioscopic method can also detect a small number of leukocytes in the field of view, a reduced number or the complete absence of Dederlein sticks.


• Sowing on the microflora of the vagina


• Antibiogram - determination of the sensitivity of the pathogen to antibiotics


• Polymerase chain reaction - to determine the genetic material of Gardnerella vaginalis

Complications of the disease

How to treat bacterial vaginosis?

The first direction is to destroy pathogenic and pathogenic microorganisms and restore the balance of the normal microflora of the vagina. For this, vaginal suppositories and gels are used, which include antibiotics and antiseptics - Metronidazole, Ornidazole, Clindamycin. Use drugs such as Macmiror and Terzhinan in the form of vaginal suppositories or tablets.

The second direction involves the use of eubiotics - preparations containing lactobacilli (Lactobacterin, Bifidum-bacterin, Acylact). Apply inside or locally - in the vagina. Recommended yogurt, biokefir.
Vitamin therapy and biogenic stimulation - to increase the overall resistance of the body.
Immunotherapy and immunoprophylaxis - Solko Trikhovak vaccine containing special strains of lactobacilli. As a result of the introduction of the vaccine, antibodies are formed that successfully destroy pathogens, normalize the microflora of the vagina and create immunity that prevents the development of relapses of bacterial vaginosis.

The main drugs used to treat bacterial vaginosis:
Metronidazole (Metrogil, Trichopolum, Flagyl) helps stop the growth of harmful bacteria. This kind of drugs are prescribed five hundred milligrams in the morning and evening. The course of treatment is seven days. Against the background of the use of these medications, such side effects as: allergic reactions, digestive disorders, vomiting, nausea and others can make themselves known.

Clindamycin is an antibiotic drug that tends to inhibit both the growth and reproduction of pathogenic bacteria. You can buy this medicine both in the form of capsules, and in the form of a vaginal cream or vaginal suppositories. As for the vaginal cream, it should be inserted into the vagina using a special applicator once a day before going to bed. The course of therapy is six days.

Prevention

• Compliance with the hygiene of the genital organs


• Proper and nutritious nutrition


• Timely treatment of inflammatory diseases of the urinary-genital organs


• Exclusion of abuse in antibiotic treatment


• Wearing comfortable underwear made from natural fabrics

Reviews

I "brought" bacvaginosis from the sea, not the first time, by the way, such nonsense. Treatment was prescribed in two stages: first, vaginal tablets, and then lactose capsules. Everything went without consequences, otherwise it happened that then the thrush still got out. I think this is thanks to dlaktozhinal, tk. he restores the flora.

I have treated vaginosis several times, I know firsthand what kind of muck it is. At first, courses were prescribed for ten days, but there were still relapses. The most successful treatment was the last time, only salvagin gel was prescribed, but there was no relapse after this appointment, although almost a year had passed

Vaginosis is of course a tin, especially when you do not have time to be treated, and after a couple of months it reappears. Salvagin helped me get rid of it, it is an intravaginal gel. Five tubes were enough to completely restore the flora, the immune system got stronger quite well, it apparently copes with bacteria and there are no more relapses.

I treated vaginosis with Metronidazole, it helped a lot, though it still needs a good probiotic, because it kills all the microflora indiscriminately.

Tell me, please, passed medical examination revealed bac.vaginosis. Are they allowed to work with such a diagnosis? Or only after treatment?

Hello! Tell me please! Can bacterial vaginosis contribute to the development of ovarian cysts?

Julia,
Vaginosis is NOT sexually transmitted! This is a natural disease (infection) of the vagina, or rather, vaginal dysbacteriosis. And yet, a man can NOT get sick with vaginosis, vaginosis and the name from "vagi" - vagina, vagina. The man doesn't have it.

Pauline,
In my observation, the patients did not experience chest pain. Go to a mammologist or gynecologist about breasts. There may be a seal.

Hello! I am a gynecologist. Write questions, I will answer. About vaginosis! My daughter (11 years old) has a whitish discharge and is clear, without gas bubbles, not foamy, there is no itching, no burning, urination is normal according to my observations. She put her finger in there and let me smell it. Silly, of course ... I didn’t smell like anything! And she says either some kind of onion, or garlic, or she already stinks of iron. Who knows what it is, tell me please!! Although I myself am a gynecologist, but I can’t figure it out until the end. I think it's normocenosis.

Hello, I would like to know if there are chest pains and bloating in the lower abdomen with vaginosis? (Other symptoms of vaginosis are present)

Not true microflora can be restored! I drank Laktofiltrum + Terzhinan vaginal suppositories. and everything will be fine! I advise...

Girls, for the most part, you are advised to consult a doctor without fail. Like, the doctor will definitely help to competently cure this very vaginosis. Doctors have not been able to cure me for three years now. Prescribe different antibiotics, then probiotics. And that's all. The same scheme with the difference only in the names of the drugs. Atsilakt in my case, on the contrary, provokes thrush (although, in theory, it should prevent it), sometimes I have to quit everything halfway, because terrible itching and discomfort begin. In general, the microflora is not restored to any. That's exactly why I roam around the forums in order to subtract at least some other options for possible treatment (and healing, without relapses), because the schemes prescribed by doctors do not bring any benefit.

Vaginosis is a very nasty thing, she got sick herself =(((Oh, how I suffered with it ... I ran to the doctors until Vaginorm-S was prescribed. It was my savior! Discharges with an unpleasant odor were already tired, and vaginorm eliminated them in just 6 days! I recommend it to everyone!

Vaginosis is a terrible attack!! I had it several times in my life, there were, so to speak, relapses, I was treated with Vagilak. Until one fine day I went to the doctor and they prescribed Vaginorm there for a week - it doesn’t cause any inconvenience, nothing interferes “there”)) A week later I was terribly glad that it was all over !! Six months have already passed, but for now, pah-pah, no relapses ... I recommend it in general))

Thanks to the authors for the article! In vain, they just didn’t mention oral probiotics, which restore the microflora of the vagina. Because yogurts and kefirs are certainly good, but from the stomach they enter the intestines and affect the intestinal microflora, and not the vagina. There are modern drugs (for example, vagilak) that restore the female microflora!

What is bacterial vaginosis

Abnormal vaginal discharge is the most common symptom, occurring in about 1/3 of gynecological patients. It is known that among women with complaints of copious discharge from the genital tract the most common diseases are bacterial vaginosis, trichomonas vulvovaginitis, vaginal candidiasis, cervicitis due to chlamydial infection, herpes simplex virus, gonorrheal infection, and increased cervical secretion. The observed increase in vaginal infections, in particular bacterial vaginosis, which occupies a leading place in the structure of obstetric and gynecological morbidity, is largely due to economic, environmental reasons, immunological disorders, changes in hormonal homeostasis, massive and irrational use of various drugs, especially antibiotics.

It is important to note that at present, bacterial vaginosis has not been included in the ICD-X revision, apparently due to the fact that the role and place of bacterial vaginosis in the structure of infectious diseases of the lower genitalia has not been finally established. In the ICD-X, it can be found under the code N89.5 "White, unspecified as infectious" or under the code N76 - "Other types of inflammation of the vagina and vulva." Nevertheless, much attention is still paid to this problem, not only due to the widespread occurrence of bacterial vaginosis, but also the occurrence of severe pathology of the female genital organs and complications of pregnancy and childbirth. Studies by a number of authors have shown that bacterial vaginosis can lead to the development of chorioamnionitis, postpartum endometritis, premature birth and the birth of children with low body weight, inflammatory processes of the genital organs, purulent-septic complications in the mother and child in the postpartum period, etc., which affects the frequency of obstetric and neonatal pathology.

According to various authors, incidence of bacterial vaginosis varies from 30 to 60-80% in the structure of inflammatory diseases of the genital organs. So, according to Cyrus E.F., bacterial vaginosis occurs in 19.2% of women of reproductive age in the general population and in 86.6% of women with pathological whites. Bleker O.P. et al. found bacterial vaginosis in 38.1% of women, Von U.B. Houme diagnosed bacterial vaginosis in 62% of women. According to the Scientific Center of AG&P RAMS, bacterial vaginosis is detected in 24% of practically healthy non-pregnant women and in 61% of patients with complaints of abundant discharge from the genital tract. Among pregnant women, bacterial vaginosis occurs in 10-46% of cases. Thus, the literature review data indicate a significant prevalence of bacterial vaginosis, mainly in women of reproductive age.

Currently, bacterial vaginosis is considered as condition of vaginal dysbiosis, in which the elimination of lactobacilli and the colonization of the vagina by strict anaerobes and gardnerella occur. In some cases, against the background of the absolute predominance of microorganisms associated with bacterial vaginosis, lactobacilli may be present in low titer and, as a rule, these are anaerobic lactobacilli that are unable to produce hydrogen peroxide. At the same time, the level of anaerobic microorganisms can increase by 1000 times. Studies have shown that the proportion of lactobacilli is reduced to 30% of the total number of microorganisms.

Causes of bacterial vaginosis

Factors leading to the development of bacterial vaginosis First of all, prolonged, sometimes uncontrolled use of antibiotics should be attributed, 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. Thus, we can assume the presence of a single dysbiotic process in the body with its pronounced manifestation either in the reproductive or in the digestive system. In addition, as our studies have shown, bacterial vaginosis often occurs against the background of menstrual irregularities, mainly by the type of oligomenorrhea or an inferior luteal phase, and in women who use IUDs for a long time (more than 5 years). The occurrence of bacterial vaginosis may also be due to past or concomitant inflammatory diseases of the female genital organs. According to our data, among the transferred gynecological diseases in patients with bacterial vaginosis, vaginitis is the most common (63.9%). In addition, a high incidence of benign diseases of the cervix is ​​revealed.

In recent years, there have been reports in the literature about the presence of an epidemiological relationship between bacterial vaginosis and neoplastic processes of the cervix. It has been shown that nitrosamines, which are metabolic products of obligate anaerobes, serve as coenzymes of carcinogenesis and may be one of the causes of the development of dysplastic processes and even cervical cancer.

We examined 128 women of reproductive age with complaints of copious discharge from the genital tract (mean age 24.3+0.9 years). Newly diagnosed bacterial vaginosis was noted in 59.4% of women (Group 1), while recurrent bacterial vaginosis for 2 or more years was detected in 40.6% of women (Group 2). An analysis of the state of the cervix showed that in the 1st group of patients with bacterial vaginosis, a normal transformation zone (NRT) was detected in 64.3%, while in the 2nd group - in 29.3% of women; ectopia of the cervix with NRT was detected in 21.4% in the 1st group and in 31.7% in the 2nd group; atypical transformation zone (AZT) - in 7.1% and 19.5%, respectively; leukoplakia of the cervix - in 7.1% and 14.6%; centraepithelial neoplasia (CIN) I-II stage was detected in the 2nd group of patients.

On the basis of the conducted studies, it can be assumed that long-term bacterial vaginosis with frequent relapses leads to the development of dystrophic processes in the cervix, as a result of which prerequisites are created for the development of pathological conditions in it.

Bacterial vaginosis in the form of a monoinfection occurs without signs of an inflammatory reaction and leukocytes in the vaginal discharge. Some authors attribute the absence of a leukocyte reaction to the metabolic product of bacteria of the genus Bacteroides - succinate, which is present in high concentrations in vaginal samples from women with bacterial vaginosis, and to gardnerella hemolysin, which disrupt the functional activity of leukocytes and thereby prevent a pronounced inflammatory reaction.

Clinic and diagnosis of bacterial vaginosis

Patients with bacterial vaginosis usually complain profuse discharge from the genital tract, white or gray, often with an unpleasant odor, especially after intercourse or during menstruation. The duration of the existence of these symptoms can be calculated for years. With the progressive process of discharge, they acquire a yellowish-greenish color, become thicker, slightly viscous and sticky, have the property of foaming, and are evenly distributed along the walls of the vagina. The amount of whiteness varies from moderate to very abundant. Other complaints, such as itching, dysuric disorders, dyspareunia, are less common and may be completely absent or appear intermittently. However, it should be noted that in 24-50% of cases, bacterial vaginosis can be asymptomatic, without any clinical manifestations of the disease, and the diagnosis of bacterial vaginosis can only be made on the basis of laboratory research methods.

To date diagnosis of bacterial vaginosis is not difficult: the diagnosis of bacterial vaginosis can be made on the basis of 3 of the 4 diagnostic tests proposed by Amsel R. et al.:

1. pathological nature of vaginal discharge;
2. pH of the vaginal discharge more than 4.5;
3. positive amine test;
4. identification of "key" cells by microscopy of wet, unstained preparations of vaginal discharge and Gram-stained smears.

Carrying out the cultural method of research, which is widely used in the practice of obstetrician-gynecologists, has no diagnostic value for the diagnosis of bacterial vaginosis, and at present, priority is given to microscopy of Gram-stained smears. The presence in the smears of "key cells" - mature epithelial cells with adherent microorganisms associated with bacterial vaginosis (gardnerella, mobiluncus, gram-positive cocci) is an important diagnostic sign of bacterial vaginosis. The sensitivity and specificity of this method are close to 100%.

Bacterial vaginosis is characterized by a positive aminotest. The vaginal contents often have a rotten fish odor, which is the result of the formation of diamines (putrescine, cadaverine, trimethylamine) in the reaction of decarboxylation of amino acids by obligate anaerobes. The salts of these compounds are converted to volatile amines at alkaline pH values. As mentioned above, gardnerella, which is isolated with high frequency in bacterial vaginosis, does not produce these compounds. Therefore, in cases of complete dominance of gardnerella in the vaginal microcenosis, the aminotest will be negative. According to our data, the sensitivity and specificity of this diagnostic test is 79% and 97%, respectively.

pH value of vaginal discharge in bacterial vaginosis exceeds the standard values ​​(> 4.5), which is caused by the elimination of lactoflora or a sharp decrease in its content. To perform pH measurements, you can use universal indicator paper with a reference scale or various modifications of pH meters. The material for the study can be either vaginal discharge or washing of the contents of the vagina with a sterile saline solution with a neutral pH value. The sensitivity and specificity of the test is 89% and 85%, respectively.

It should be remembered that for correct diagnosis of bacterial vaginosis when taking material for research, it is necessary to follow the basic rules: the sampling of material must be carried out before the start of antibiotic therapy; the day before, the patient should not have an intimate toilet or have sexual intercourse; microbiological examination should be carried out as quickly as possible in order to avoid the death of bacteria.

Treatment of bacterial vaginosis

Currently, obstetrician-gynecologists have in their arsenal a wide range of different drugs for the treatment of bacterial vaginosis, with anti-anaerobic activity. It should be noted that many clinicians today prefer vaginal route of administration of drugs in the treatment of bacterial vaginosis, which is not inferior in effectiveness to oral therapy. It is more preferable, since local drugs are injected directly into the focus, while there is less likelihood of adverse reactions. Topical drugs can be given pregnant and lactating women, as well as in extragenital pathology, when systemic drugs are contraindicated.

Among the drugs of local action, Dalacin vaginal cream (2% clindamycin phosphate) has found wide application. A distinctive feature of this broad-spectrum antibiotic is the effect on the anaerobic component of the vaginal microflora. The drug is available in tubes of 20 g with three single applicators attached. Its effectiveness is, according to various authors, from 86 to 92%.

Currently, practitioners also have Dalacin vaginal suppositories in their arsenal, with an applicator attached to it (1 suppository contains 100 mg of clindamycin phosphate). The drug is used 1 suppository in the vagina at night for 3 consecutive days. J. Paavonen et al. conducted a randomized study on the comparative study of the effectiveness of the use of dalacin (for 3 days intravaginally in the form of suppositories) and metronidazole (peros at a dose of 500 mg 2 times a day for 7 days). The effectiveness of dalacin in the form of suppositories was 68%, metronidazole - 67%. Studies by other authors (J.A. McGregor) showed that the use of dalacin vaginal suppositories for 3 days is not inferior in effectiveness to the use of dalacin vaginal cream for 7 days, amounting to 95%. Thus, dalacin in the form of suppositories has high efficacy and compliance (a three-day course as opposed to a 7-day course of metronidazole and dalacin vaginal cream), as well as good tolerability with a small percentage of side effects.

Another drug that is widely used in the treatment of bacterial vaginosis is flagyl (metronidazole), which has a high activity against anaerobic microorganisms. The drug is prescribed for 1 vaginal suppository in the vagina for 10 days.

Among the drugs of systemic action for the etiotropic therapy of bacterial vaginosis, metronidazole and clindamycin, which have an antianaerobic spectrum of action, should be mentioned. Metronidazole is an effective drug for the treatment of bacterial vaginosis. The drug for bacterial vaginosis is prescribed 500 mg 2 times a day for 7 days or 2 g once. It has been shown that a single oral administration of metronidazole at a dose of 2 g is as effective as a 5-7-day oral administration. It should be noted that oral administration of the drug often causes side effects, such as a metallic taste in the mouth, dyspeptic disorders, and allergic reactions.

wide use in the treatment of infectious diseases of the genitals found clindamycin, which is a chlorinated derivative of lincomycin and has an advantage over the latter, because it has greater antibacterial activity and is more easily absorbed from the intestine. The drug binds to ribosomes and inhibits protein synthesis. It is active against obligate anaerobes. The drug is prescribed 300 mg 2 times a day per os for 7 days. It is important to note that oral administration of the drug may be complicated by diarrhea.

Ornidazole is also used to treat bacterial vaginosis. The drug is prescribed 1 tablet (500 mg) 2 times a day after meals for 5 days.

In 6-18% of cases against the background treatment of bacterial vaginosis with antibacterial drugs, vaginal candidiasis may occur. In this regard, for the prevention of vaginal candidiasis, it is advisable to prescribe antimycotic agents. It should be emphasized that antibacterial agents, having eliminated opportunistic microorganisms, are not able to create conditions for the rapid restoration of the normal microflora of the vagina. Therefore, it is necessary to prescribe biological preparations (acylactobacterin, bifidumbacterin, acilact, etc.), which stimulate the growth of the vagina's own lactoflora and help reduce the number of relapses of the disease by increasing the protective properties of the vagina. It is important to emphasize that the appointment of biological products is advisable after a control microbiological study confirming the absence of fungal flora.

In conclusion, I would like to note that treatment of patients should be individualized in each specific case. In this case, mandatory examination and treatment of the partner is necessary. Therapy can be considered successful with the complete elimination of the symptoms of the disease.

Errors in the diagnosis of bacterial vaginosis and its inadequate treatment often lead to serious consequences.

There is also the question of the need for treatment of bacterial vaginosis with its asymptomatic course. Treatment of bacterial vaginosis is advisable for asymptomatic course both outside and during pregnancy in order to prevent infectious and inflammatory diseases associated with bacterial vaginosis, as well as those complications during pregnancy that this disease can lead to.

Professor V.N. Prilepskaya, Ph.D. G.R. Bayramova

"Treatment of bacterial vaginosis, drugs, treatment regimens, diagnostics" - section

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:

1. Restoration of the physiological properties of the vagina, strengthening the body's defenses, normalization of hormonal levels and the fight against pathogens.
2. 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 with the help of 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 copious 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!

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:

1. 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.
2. Reception of cytostatics, antimycotic drugs and radiation therapy(weakening of the immune system).
3. The presence of an intrauterine device- The risk of infection is doubled.
4. Excessive desire for cleanliness(douching, frequent washing with soap and vaginal douches).
5. 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.
6. Deformity of the vagina, cervix and pelvic muscles bottom after childbirth, surgery or radiation.
7. is a violation of the composition of the intestinal microflora and is a factor contributing to the development of bacterial vaginosis.
8. 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 profuse, fishy-smelling, creamy, white or gray discharge. Itching, burning, discomfort during intercourse are possible.

In the case of bacterial vaginosis, an acute or torpid, asymptomatic, monosymptomatic (only with discharge) 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.

(Visited 6 281 times, 1 visits today)