Bacterial vaginosis causes ways of infection. Vaginosis: causes, symptoms, diagnosis, treatment. Why is bacterial vaginosis dangerous?

Bacterial vaginosis is a violation of the natural microflora of the vagina caused by infectious diseases. In other words, a woman has vaginal dysbacteriosis. If you follow the statistics, then this disease is observed most often in young girls (18–27 years old) and in women during menopause.

Etiology

The main provoking factors in bacterial vaginosis include the following:

• long-term use of antibiotics;
• douching;
• wearing synthetic, tight underwear;
• non-compliance with personal hygiene;
• use of contraceptives of dubious quality;
• use of contraceptive suppositories.

Bacterial vaginosis develops most actively in those women who often change sexual partners. Also at risk should be attributed to women who are often in stressful situations, have hormonal imbalances and weakened immunity. In fact, there are quite a few reasons for the development of an infectious process.

Symptoms

Bacterial vaginosis has pronounced symptoms. But it is possible to start treating such a violation only after an accurate diagnosis by a gynecologist. Self-medication is unacceptable, as it can only aggravate the course of the disease.

As bacterial vaginosis progresses, the following symptoms can be observed:

• a sharp, unpleasant odor from the vagina;
• burning sensation, especially when urinating;
• itching and burning during intercourse;
• pain in the lower abdomen.

Allocations are quite plentiful (up to 30 mg per day). They have a sharp fishy smell, a grayish color and a liquid consistency. Symptoms and discharge are especially aggravated after intercourse.

It is worth noting that in some cases the disease may not show any symptoms at all, which greatly complicates the diagnosis.

At the same time, it is important to understand that the presence of such symptoms is not always a harbinger of bacterial vaginosis. Symptoms of this nature may also indicate other ailments of the genitourinary and reproductive system of a woman.

Pathogenesis

In the vagina of every woman there is a set of bacteria, which is called microflora. The main bacteria in a healthy microflora are lactobacilli.

When an extraneous infection enters the microflora, lactobacilli are replaced by anaerobic microorganisms. As a result of this, an infectious process begins to develop, that is, bacterial vaginosis or. An earlier name for this pathology is.

As official medical statistics show, today bacterial vaginosis is diagnosed in 20% of the total female population of the planet. Age group - from 18 to 50 years.

Diagnostics

For an accurate diagnosis of bacterial vaginosis, symptoms alone are not enough, even if they are pronounced. A complete diagnosis of the disease is carried out through a personal examination by a gynecologist, anamnesis, analysis of symptoms. Based on this, the doctor writes out a referral for laboratory tests. Only at the conclusion of all the above procedures, it is possible to make an accurate diagnosis and prescribe the correct treatment for vaginal dysbacteriosis.

Laboratory research methods include the following procedures:

• smear from the vagina;
• study of infectious cells.

It should be noted that the diagnosis is aimed not only at confirming the diagnosis, but also at identifying the number of infectious cells, establishing the true cause of the formation of the pathological process.

Bacterial vaginosis during pregnancy

It is essential to treat bacterial vaginosis during pregnancy. And the sooner, the better for both mother and child, because. ailment during pregnancy can lead to complications such as:

• infection of the fetus in the womb;
• premature contractions;
• premature birth;
• outpouring of amniotic fluid ahead of schedule.

pathogenesis during pregnancy

Microflora bacteria are the catalyst for the biochemical reaction between the fetus and the biological mother. As a result, the production of a substance called prostaglandin begins. Its composition is very similar to hormones, which leads to premature contractions. In addition, such a violation in the microflora can cause infection of the amniotic fluid and the fetus itself. The consequences of this can be the saddest - from severe pathology of the child to death.

Bacterial vaginosis during pregnancy requires immediate treatment and constant medical supervision. In the early stages, the treatment of vaginal dysbacteriosis is effective and if it is carried out correctly, then no complications develop.

Treatment

Before starting the treatment of bacterial vaginosis, it is necessary to accurately determine the cause of the disease. Treatment is usually carried out in two stages. First of all, therapy is carried out aimed at eliminating the pathogens that provoked the onset of the infectious process. At the second stage of treatment of bacterial vaginosis, the microflora is populated with healthy lactobacilli.

The basis of drug treatment is the use of suppositories - metronidazole and clindamycin. Such antibiotics in the form of vaginal suppositories give good results already at the first stages of use. Pain and burning almost completely disappear after the introduction of 2-3 suppositories. But this does not mean that the disease has completely receded. Under no circumstances should treatment be interrupted.

It is also worth paying attention that it is possible to use vaginal suppositories for vaginal dysbacteriosis only as directed by a doctor. The dosage and duration of taking tablets and suppositories is prescribed only by a gynecologist, taking into account the general condition of the patient and the severity of her illness.

Treatment of bacterial vaginosis can lead to the progression of other underlying diseases. Most often this is . Therefore, along with suppositories, against vaginal dysbacteriosis, drugs are prescribed for the prevention of thrush.

If, after a course of treatment, bacterial vaginosis again made itself felt, the symptoms became more pronounced, you should undergo a re-examination and repeat the course of treatment.

It is also important to review your diet during treatment. Proper nutrition in combination with drug therapy gives good results. The diet should include the following foods:

• biokefir;
• yogurt;
• sauerkraut.

It is also important to give the body the necessary vitamins to strengthen the immune system.

During treatment, sexual intercourse should be completely abandoned, even with a condom. If you still have sex, you should take into account the following - vaginal suppositories destroy the condom. Therefore, it is better to use birth control pills for this period.

Forecast

Violation of the microflora of the vagina is not a life-threatening disease. But if left untreated, it can lead to serious complications. Women who have had an illness are more susceptible to inflammatory processes of the genitourinary system, infections. But, if drug treatment is started in a timely manner and brought to an end, there can be no complications.

Prevention

It is almost impossible to completely eliminate a disorder of this kind. But you can minimize the risk of its formation. To do this, you need to apply in practice the following rules:

• examination by a gynecologist at least 2 times a year;
• you can not wear tight, synthetic underwear;
• you need to monitor personal hygiene;
• it is desirable to completely eliminate the frequent change of sexual partners.

For any symptoms, you should seek medical help, and not resort to the advice of friends, forums and self-medicate.

Bacterial vaginosis is one of the most common diseases of the vagina and a common cause of bad breath, vaginal discharge and itching in the intimate area.

Symptoms of bacterial vaginosis

Bacterial vaginosis often causes the following symptoms:

• Unpleasant "fishy" smell from the vagina. The smell may be constant, or it may appear during or after sex.
• , sometimes resembling mucus. Allocations can be plentiful or moderate.
• Irritation, itching, discomfort, redness of the skin in intimate areas.
• Pain and cutting during urination.
• Dryness and.

You are more likely to have bacterial vaginosis if:

• Have you recently taken antibiotics
• Have you recently changed your sexual partner?
• You have had two or more sexual partners in the previous few weeks
• You have
• Have you recently used a jacuzzi or taken a bath
• Did you douche recently
• You don't comply

All of the above factors are not the direct cause of inflammation, but they disrupt the vaginal microflora and predispose to the development of bacterial vaginosis.

When a smear indicates bacterial vaginosis

Most women learn that they have bacterial vaginosis, it is by the result. If a woman has bacterial vaginosis, then the following changes are found in the smear:

• many key cells
• many cocco-bacillary forms (bacteria that look like rods and cocci)
• abundant coccal flora
• leukocytes are elevated or within normal limits
• the presence of mobiluncus (Mobiluncus)
• excretion pH above 4.5

Bacterial vaginosis is often combined with other infections, so the smear may contain changes characteristic of other diseases, such as candidiasis (),.

Gardnerella and bacterial vaginosis

Sometimes bacterial vaginosis is erroneously called gardnerellosis, since it is most often the bacterium gardnerella (Gardnerella vaginalis) that causes inflammation in this disease.

However, gardnerella are often found in the vagina and in healthy women who do not have inflammation. That is why, if you have been diagnosed with gardnerella, but there are no signs of inflammation (there are no symptoms of inflammation and the result of a smear is normal), then there is no question of any bacterial vaginosis, and you are all right.

Why is bacterial vaginosis dangerous?

The bacteria that cause inflammation in bacterial vaginosis are very sensitive to standard antibiotic treatment, and the disease is easily treatable. But if left untreated, bacterial vaginosis can cause complications:

• - Inflammation of the uterus.
• Salpingitis is an inflammation of the fallopian tubes.
• Adnexitis - inflammation of the uterine appendages (fallopian tubes and ovaries).
• Infertility.

Bacterial vaginosis during pregnancy can lead to premature delivery.

How to treat bacterial vaginosis?

If bacterial vaginosis appears for the first time:

• Metronidazole 500mg (Trichosept): one tablet 2 times a day for a week, or
• Vaginal gel Metronidazole 0.75% (Rozex): insert one applicator into the vagina at bedtime for 5 days, or
• Clindamycin Vaginal Cream 2% (Clindamycin): insert one applicator into the vagina at bedtime for 7 days.

If bacterial vaginosis has not gone away with the prescribed treatment, then the gynecologist prescribes an alternative treatment:

• Tinidazole: 2g daily for 2 days, or 1g daily for 5 days or
• Clindamycin 300mg: tablet 2 times a day for a week.

Probiotics in the treatment of bacterial vaginosis

Probiotics are products that contain the same beneficial bacteria, which make up the normal microflora of the vagina, and help protect against infections.

The following probiotics are used for bacterial vaginosis:

• Gynoflor vaginal tablets
• Vagilak: tablets for oral administration

The regimen for taking probiotics for bacterial vaginosis is as follows:

• 7 days daily intake
• 7 days break
• 7 days of re-admission

This regimen of taking probiotics will avoid the return of the infection several months after the end of antibacterial treatment. According to the manufacturers, the use of these drugs is not prohibited during pregnancy and breastfeeding.

Treatment of bacterial vaginosis during pregnancy

Bacterial vaginosis during pregnancy can be the cause, so treatment is necessary. Preparations that are prescribed to pregnant women are recommended to be taken from the second trimester of pregnancy (not earlier than 13 weeks):

• Metronidazole 500mg: one tablet 2 times a day for 7 days
• Metronidazole 250mg: one tablet 3 times a day for 7 days
• Clindamycin 300mg: one tablet 2 times a day for a week

Topical treatments (vaginal ointments or creams) help relieve the symptoms of bacterial vaginosis, but do not reduce the risk of complications during pregnancy (premature birth).

Attention: The indicated regimens are indicative and may be changed by your doctor. Be sure to consult your gynecologist before using medications!

Does my husband (sexual partner) need treatment?

It is known that in 80% of men whose sexual partners suffer from bacterial vaginosis, the main causative agent of this disease is found in the urethra. Gardnerella vaginalis and other bacteria. This means that the bacterium "moves" from the vagina into the urethra of a man during unprotected sex.

And yet, men are treated no need. Numerous studies have shown that the treatment of sexual partners does not affect the recovery of women and does not reduce the chances of recurrence.

Treating your partner necessary if you have had bacterial vaginosis for the first time, or if you have been diagnosed with a sexually transmitted disease.

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 pathogens and pathogens 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 give up everything halfway, because terrible itching and discomfort begin. In general, the microflora is not restored to any. That's exactly why I'm roaming 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!

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 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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Bacterial vaginosis is a disease of the female sphere of an infectious nature, in which the normal microflora is replaced by opportunistic bacteria. Vaginosis corresponds to vaginal dysbacteriosis of the 3rd degree. This disease does not have an inflammatory reaction and thus differs from vaginitis.

With bacterial vaginosis, the normal microflora of the vagina is disturbed

Prevalence

Bacterial vaginosis is one of the most common diseases in women. About 85% of women have had symptoms of vaginosis during their lifetime. Symptoms of this disease can be in virgins. However, it is noted that the more active and disorderly sexual life, the more often a woman suffers from vaginosis.

Causes of the disease

The cause of the disease is a change in the composition of the microflora of the vagina of women, in which a significant part of lactobacilli is replaced or completely replaced by other bacteria.

Biocenosis is normal

In healthy women, many microorganisms live on the vaginal mucosa, the proportion of lactic acid bacteria of which is more than 95%. Lactobacilli live in symbiosis with the woman's body, that is, they benefit each other. They secrete lactic acid, making the vaginal secretion sour and providing a protective barrier against unwanted microbes. The normal pH of a woman's vagina is in the range of 3.8–4.5.

The composition of the flora of the remaining 5% for each woman is unique, it includes conditionally pathogenic anaerobic cocci and bacilli that are resistant to an acidic environment.

Bacterial vaginosis occurs when pathogenic bacteria enter

Provoking factors

The stability of the microecosystem can change under the influence of a cause that causes a shift in the pH of the vagina to the alkaline side and its seeding with alien flora. This is facilitated by:

• non-compliance with feminine hygiene (rare change of underwear, long wearing of tampons during menstruation);
• improper hygiene (frequent douching, use of cosmetic alkaline soap instead of special products with low pH);
• super-intense sex life without condoms (sperm pH has an alkaline characteristic);
• frequent change of sexual partners;
• damage to the vaginal mucosa and neoplasms;
• menstrual irregularities;
• hormonal changes due to pregnancy, menopause, abortion or puberty;

Frequent douching can be a trigger for the development of bacterial vaginosis

• prolonged wearing of an intrauterine device;
• frequent use of condoms with aseptic lubrication;
• contraceptive creams and suppositories, which include antimicrobials;
• antibiotic treatment;
• taking hormonal drugs, including contraceptives;
• the presence of endocrine diseases (especially diabetes mellitus);
• women's alcoholism;
• decreased immunity and allergies;
• previous sexually transmitted diseases.

Despite the presence of provoking factors, the immunity of women is of greater importance. That is, in healthy women with good immunity, age-related hormonal changes, pregnancy and frequent sexual intercourse will not cause vaginosis. The weaker the immune system, and this is usually associated with the presence of concomitant pathology, the greater the risk of developing the disease. And the more difficult it is to treat.

Taking antibiotics provokes violations of the normal microflora of the vagina

Bacteria that cause vaginosis

What is conditional pathogenicity? Unlike pathogenic bacteria (syphilis, gonorrhea), these microorganisms do not harm a person, provided they are small in number. However, with the growth of colonies above the maximum permissible norm, they begin to show their pathogenicity - they harm the body of women.

Most often, with vaginosis, they are found in excess of the norm:

• gardnerella;
• clostridia;
• klebsiella;
• coli;
• streptococci;
• staphylococci;
• corynebacteria;

Mycoplasma - the bacterium that causes bacterial vaginosis

• mycoplasmas;
• fusobacteria and others.

Vaginosis is caused not by one type of bacilli, but by the colonization of various species of anaerobes, many of which are not identified in the laboratory. In fact, the biocenosis of each woman with vaginosis is unique.

Symptoms

Due to the absence of a local and general inflammatory reaction, the symptoms of dysbacteriosis are poor. Clinical signs of vaginosis:

• profuse, homogeneous and thick discharge from the vagina of a white or grayish color, aggravated before menstruation and after intercourse;
• possible unpleasant odor (sometimes up to the “stink of rotting fish”);
• brief and unexpressed episodes of itching or burning (these symptoms may appear only when urinating);
• there may be pain during intercourse.

Bacterial vaginosis causes profuse vaginal discharge

More pronounced clinical signs rather indicate vaginitis - an infectious inflammatory process. Vaginosis often has a sluggish, chronic, relapsing course. In the absence of smell and discomfort, when vaginosis is manifested only by abundant "whiteness", many women perceive this as the norm, and therefore do not go to the doctor. This circumstance contributes to the chronization of the process.

Vaginosis during pregnancy

Bacterial vaginosis is rarely caused by hormonal changes alone. More often, a woman already suffered from dysbacteriosis, and pregnancy increased its degree to vaginosis. The question remains whether or not to treat bacterial vaginosis during pregnancy. The decision is made by the obstetrician-gynecologist, depending on the ratio of possible benefits and harms for the unborn baby. When deciding the issue, the duration of pregnancy and the presence of possible threats to its course are taken into account.

In the treatment of pregnant women, standard drugs are prescribed, but mostly locally. A possible complication of vaginosis is vaginitis. And then there may be an ascending infection of the uterus, placenta, membranes and amniotic fluid. And as a result, miscarriage or premature birth. But the risk of developing such an outcome is minimal. The best prevention of vaginosis in pregnant women is to plan pregnancy and treat it before it occurs.

The treatment regimen for bacterial vaginosis during pregnancy is standard

Classification

There is no separate official classification of vaginosis. Many authors use the classification of dysbacteriosis, but vaginosis corresponds to it only in stages 3-4.

Dysbacteriosis means any imbalance of the biocenosis:

• I degree - the absence of microflora. The state of the epithelium is normal. There is a possibility of colonization by alien microbes. The causes of this condition are the consequences of a long and powerful course of antibiotic treatment or chemotherapy.
• II degree - the proportion of opportunistic bacilli exceeds 5%, but less than 50%. The smear will show the detection of a negligible number of "clue cells". Normal condition of the vaginal mucosa.
• III degree - this is vaginosis. A diverse microflora dominates over lactic acid bacteria and makes up more than 50%. In addition to the violation of the balance of ratios, the total contamination increases due to conditionally pathogenic species. Smear - detection of "key cells" in large numbers. Mucous membrane without signs of inflammation.

Bacterial vaginosis is a grade 3 vaginal dysbacteriosis.

• IV degree - morphologically mixed flora completely displaces lactobacilli from the vagina. At this stage, for some time there may still be no inflammatory reaction - this corresponds to vaginosis.

Clinical symptoms: pain, pain, burning, itching, subfebrile condition. And signs of local inflammation: swelling, redness, leukocytosis. Indicate a complication of vaginitis.

Diagnostics

To establish a diagnosis, you need to contact a specialist - a gynecologist. He will appoint the necessary list of studies, correctly interpret the results, establish the cause of vaginosis, conduct a differential diagnosis with other pathological conditions, and prescribe treatment.

Survey

Diagnostic scheme for bacterial vaginosis includes:

• questioning and collecting anamnesis;

Diagnosis of bacterial vaginosis includes a gynecological examination of the vagina

• examination of the vaginal mucosa;
• gynecological palpation;
• a smear of vaginal secretion and its microscopic examination to determine the flora and "key cells";
• determination of the pH of the vagina;
• aminotest;
• sowing the vaginal secretion for microflora with the determination of sensitivity to antibiotics (according to indications);
• detailed analysis of blood and urine;
• colposcopy (according to indications);
• examination of the sexual partner (according to indications).

If necessary, colposcopy may be performed to clarify the diagnosis.

Differential Diagnosis

Differential diagnosis is carried out with similar pathological conditions:

• With dysbacteriosis of 1-2 degrees.
• With nonspecific vaginitis.
• With milkmaid. Candidiasis can have a picture of vaginosis or vaginitis, but is not caused by bacteria, but by fungi. At the same time, vaginal discharge takes on a curdled character (with dense flakes), and with vaginosis they are homogeneous. The difference is also constant itching.
• with venereal diseases.

These diseases are characterized by their own characteristics. However, often gonorrhea, trichomoniasis, chlamydia and even syphilis in women have erased symptoms. Sometimes they are discovered incidentally during examinations for other diseases.

Differential diagnosis is necessary to distinguish bacterial vaginosis from other diseases with similar symptoms.

This pathology needs specific therapy and, if left untreated, causes significant complications.

Complications

Vaginosis does not bring much concern to women, but its treatment is necessary, since the lack of a local protective reaction contributes to the development of inflammation and the penetration of foreign pathogenic microbes.

• With vaginosis, the risk of getting venereal diseases increases by 2 times.
• The possibility of developing candidiasis increases, which will only increase the alkalinity of the environment.
• The lack of protection in case of damage to the mucosa (erosion) also contributes to the degeneration of the epithelium and the development of malignant diseases.

Bacterial vaginosis increases risk of miscarriage during pregnancy

• Bacterial vaginosis during pregnancy, complicated by ascending infection, is a common cause of threatened miscarriage or premature birth.

This disease does not apply to sexually transmitted diseases, that is, it is not transmitted through a sexual partner. Naturally, men cannot suffer from vaginosis, since they do not have such an organ. However, men also have their own microflora on the mucous membranes of the urethra, the exchange of which is inevitable during sexual intercourse with a woman. Thus, if a partner suffers from vaginosis for a long time and has bacteria to which a man's immunity is reduced, he may gradually develop urethritis.

Treatment

The treatment regimen for vaginosis includes 2 stages:

• Stage 1 - antibiotic therapy. It pursues the goal - the suppression of unnecessary flora. The standard includes antimicrobial drugs: Metronidazole, Tinidazole, Clindamycin, Ornidazole. Antibiotics are used more often topically (vaginal suppositories, creams, gels), less often in the form of tablets inside. For douching, drugs are used: Chlorhexidine or Miramistin. Use combined candles Hexicon or Flagyl. The course of treatment lasts 7 days.

Antibacterial agents are prescribed to treat bacterial vaginosis

• Stage 2 - the use of probiotics. The goal is to create conditions for increasing the intensity of reproduction of lactobacilli and their colonization of the vagina to the required concentration. Probiotics are prescribed after antibiotics are discontinued. Apply suppositories containing lactic acid bacteria: Atsilakt, Acipol, Lactobacterin. Or combined candles: Bifiform, Lineks.

During treatment, it will be necessary to temporarily change lifestyle and some habits:

• Abstinence from sexual intimacy to prevent reinfection.
• Refusal to drink alcohol. Firstly, alcohol itself shifts the pH to the alkaline side, reduces local immunity and provokes vaginosis. Secondly, against the background of taking antiprotozoal drugs, ethanol tolerance decreases and withdrawal increases.

Treatment for bacterial vaginosis includes taking probiotics

• Restriction of spicy food (can also affect the pH level).

Prevention

Prevention of vaginosis is the maximum possible elimination of provoking factors. For this you need:

Detailed information about bacterial vaginosis is presented in the video: