Vaginosis causes and treatment. All about bacterial vaginosis and its treatment. Candles from bacterial vaginosis

Bacterial vaginosis- a disease with characteristic abundant and prolonged discharge from the vagina, often with an unpleasant odor. They do not detect gonococci, Trichomonas and fungi. The use of the term "bacterial" is due to the fact that the disease is caused by polymicrobial microflora; vaginosis - since, unlike vaginitis, there are no signs of an inflammatory reaction of the vaginal mucosa.

SYNONYMS OF BACTERIAL VAGINOSIS

Nonspecific vaginosis, anaerobic vaginosis, vaginal bacteriosis, vaginal lactobacillosis, aminocolpitis, gardnerellosis, mobiluncosis, vaginal discharge with key cells, "lactobacterium deficiency syndrome" and etc.

ICD-10 CODE In ICD-10, this disease is not registered, since the term " bacterial vaginosis” arose after the publication of this classification.

EPIDEMIOLOGY OF BACTERIAL VAGINOSIS

Bacterial vaginosis- the most common infectious disease of the female reproductive system. The prevalence of bacterial vaginosis in different populations of women and in different countries ranges from 15 to 80% or more. According to official medical statistics in Western countries, the symptoms of vaginosis, mainly discharge, are found annually in more than 10 million women. Bacterial vaginosis is common with equal frequency among women of different racial groups. Data on the incidence of bacterial vaginosis is variable, which is due to different populations of examined women, the use of non-standard diagnostic methods, an ambiguous interpretation of the disease, and ignoring social and demographic factors.

Bacterial vaginosis is not sexually transmitted. However, it has been established that there is a certain correlation between the occurrence of bacterial vaginosis and sexual behavior: the early onset of sexual activity, its characteristics, the number of sexual partners, etc. The number of sexual partners is a more significant factor for the development of bacterial vaginosis than the number of sexual contacts. Sexual activity in bacterial vaginosis is higher than in the group of healthy women.

PREVENTION OF BACTERIAL VAGINOSIS

For the prevention of bacterial vaginosis, it is necessary to normalize the hormonal status, limit the intake of broad-spectrum antibiotics, maintain personal hygiene, exclude promiscuity, timely treatment of sexually transmitted diseases and intestinal dysbacteriosis. An important aspect of the problem of dysbiotic diseases of the vagina, bacterial vaginosis is preventive measures, such as sex education, training in the proper use of contraceptives and antibacterial drugs.

SCREENING

All patients with complaints of leucorrhea with an unpleasant odor, itching, burning in the vagina and perineum, dyspareunia are subject to examination. All pregnant women are subject to mandatory examination during the initial visit to the antenatal clinic, as well as in each trimester and before childbirth.

CLASSIFICATION OF BACTERIAL VAGINOSIS

There are currently several classifications of vaginal dysbiosis taken for classification of bacterial vaginosis(Table 20-4).

Table 20-4. Classification of vaginal dysbacteriosis (VDD)

As can be seen from the table, most classifications reflect certain aspects of the clinical course of bacterial vaginosis. So, if the clinical classifications of Zhukova G.I. (1992), Ankirskaya A.S. (1995) and Bayramova G.R. (1996) are very similar and almost identical, then the classification of Mavzyutov A.R. et al. (1998) reflects the severity of PAD. according to this classification.

• I degree of severity (compensated WBP):
  - complete absence of microflora in the material;
  - unchanged epitheliocytes;
  - the possibility of settling an ecological niche with microorganisms entering from outside.
• II degree (subcompensated DBA):
  - quantitative reduction of lactobacilli;
  - increase in gram-variable bacterial microflora;
  - 1-5 "key" cells in the field of view, moderate leukocytosis 15-25 in the field of view.
• III degree (decompensated DBP):
  - severe clinical symptoms of bacterial vaginosis;
  - complete absence of lactobacilli;
  - the entire field of vision is filled with QC;
  - microflora - various microorganisms in different morphological and species combinations, except for lactobacilli.

Reasons for the development of bacterial vaginosis I degree of severity:

excessive preparation of the patient for a visit to the doctor, improper sampling of material, intensive chemotherapy with broad-spectrum antibacterial drugs.

Dermatovenereologists (Yu.K. Skripkin), by analogy with venereal diseases, distinguish three phases of bacterial vaginosis: fresh, torpid and chronic bacterial vaginosis with an incubation period of 5 days to 3 weeks. In the acute period, hyperemia of the mucous membrane of the cervix and vagina is possible. However, it should be noted that none of the existing classifications is indisputable. This highlights the need for further clinical and laboratory research on bacterial vaginosis.

ETIOLOGY (CAUSES) OF BACTERIAL VAGINOSIS

It is generally accepted that there are no specific causative agents of bacterial vaginosis. In the role of the etiological factor of bacterial vaginosis is the association of anaerobic and facultative anaerobic microorganisms. Among the microorganisms associated with bacterial vaginosis, Mobiluncus spp., Bacteroides spp., peptococci, peptostreptococci, etc. are more common. Gardnerella and mycoplasmas are also found in polymicrobial complexes. For such polymicrobial processes (mixed infections), it is characteristic that the etiological factor is not one of any microorganism, but their association with its inherent biological properties. An important circumstance is that against the background of a sharp decrease or complete disappearance of lactic acid bacteria, primarily lactobacilli that produce hydrogen peroxide, in quantitative terms, the total vaginal contamination increases to 1010 CFU / ml of vaginal fluid. The share of strict non-spore-forming anaerobic microorganisms mainly increases.

PATHOGENESIS OF BACTERIAL VAGINOSIS

The explanation of violations of the microecology of the vagina and the development of a characteristic symptom complex of bacterial vaginosis is one of the complex issues of the pathogenesis of the ongoing processes. The disappearance of lactomicroflora and excessive growth of anaerobic bacteria in bacterial vaginosis is the main (but not the only) pathogenetic consequence of the complex of preceding processes. Obviously, bacterial vaginosis is a disease caused by numerous factors. Such changes in microbiocenosis occur both under the influence of exogenous and endogenous influences (Table 20-5).

Table 20-5. External and internal factors affecting changes in the vaginal microflora and contributing to the development of bacterial vaginosis

Under the influence of endogenous and exogenous factors, the balance of the vaginal microecosystem occurs with a characteristic cascade of changes. An increased level of progesterone enhances the proliferation of cells of the vaginal epithelium, activates their receptors for bacteria. Adhesion of strict anaerobic microorganisms to the outer membrane forms "key cells". Cellular destruction along with an increase in extravasation leads to an increase in vaginal discharge.

Lower concentrations of estrogens compared to progesterone reduce the amount of glycogen in epithelial cells, as a result of which the concentration of monosaccharides and disaccharides is reduced. At the same time, the number of the pool of lactobacilli was reduced and the growth of strict anaerobes was increased. Such a mechanism is likely in some cases. Proof of this is the occurrence of bacterial vaginosis in menopause or in women after bilateral removal of the ovaries. An increase in the concentration of estrogens also has pathogenetic significance, as it contributes to an increase in antibodies in the blood, but most importantly, it leads to hyperproliferation of the vaginal epithelium, which explains the increase in vaginal discharge.

Anaerobes produce volatile fatty acids and amino acids, which are degraded by enzymes to volatile amines. The decrease or disappearance of lactobacilli, mainly H2O2-producing, leads to a decrease in the concentration of lactic acid and an increase in the pH of the vaginal environment over 4.5. A neutral or slightly alkaline environment is more favorable for the growth of anaerobes and is not very suitable for acidophilic microorganisms. A significant place in the pathogenesis of bacterial vaginosis is occupied by the state of local immunity, which maintains the constancy of the vaginal environment. Local factors are conditionally divided into non-specific and specific. They play a leading role in protecting the genital tract from infectious diseases. The local protection of the female reproductive system is due to its anatomical and physiological features, the presence of normal microflora, the presence of lysozyme, complement, transferrin, immunoglobulins and related antibodies. Nonspecific local protection factors of the vagina are diverse and combined into a system that includes a whole range of protection factors, such as chemical elements (zinc, copper, iron, etc.), organic substances (lysozyme, transferrin, glycoproteins, etc.), as well as a cascade the reactions they carry out.

An increase in the concentration of Na and Cl ions indicates a violation of the reabsorption function of the epithelium. It should be noted that an increase in the concentration of Na ions is also a compensatory mechanism, since a decrease in the concentration of osmotic substances (glucose and urea) is observed in bacterial vaginosis. A compensatory increase in the concentration of Na ions increases hydration, which causes profuse liquid discharge is a typical clinical sign of bacterial vaginosis. Another important factor due to an increase in the pH of the vaginal secretion is an increase in the activity of proteolytic enzymes, such as proline aminopeptidase, sialase, and mucinase, during BV. As a result, hydrolytic cleavage of protein macromolecules, including collagen, occurs, which leads to the disintegration of epithelial cells, disruption of their function and an increase in the concentration of free viable cells in the vaginal secretion.

These cells become a substrate for the vital activity of the anaerobes associated with bacterial vaginosis. Activation of the enzymes sialase and mucinase disrupts mucus formation, facilitating the accessibility of epithelial cells for microorganisms. An increase in the adhesive ability of microorganisms occurs due to the modification of cellular receptors by microbial proteases, an increase in the pH of the VJ, and a decrease in the redox potential of the vaginal epithelium. In ensuring the metabolism of anaerobes associated with bacterial vaginosis, enzymes - decarboxylases are of great importance. Their action is aimed at the decarboxylation of amino acids. The resulting carbon dioxide creates an anoxic environment. With an increase in its partial pressure, a corresponding decrease in the partial pressure of oxygen occurs. This creates the conditions necessary for the reproduction and vital activity of anaerobic microflora.

Amine test for bacterial vaginosis

One of the clinical symptoms of bacterial vaginosis is an unpleasant smell of discharge., reminiscent of the smell of "rotten fish", or a positive amine test. To conduct the test, a 10% KOH solution is added to the vaginal fluid. With a positive result, a similar unpleasant odor is determined due to the presence of volatile amines, such as: methylamine, dimethylamine, trimethylamine, cadaverine, putrescine, formed during the decarboxylation of amino acids.

The obtained data on biochemical changes in bacterial vaginosis indicate that the pathogenesis of this disease is largely determined by the imbalance between the functional activity of the vaginal epithelium, the ratio of acidophilic and other indigenous microflora and their metabolic processes. Such mechanisms are different from true inflammatory processes. This is additional confirmation of the dysbiotic nature of bacterial vaginosis.

CLINICAL PICTURE (SYMPTOMS) OF BACTERIAL VAGINOSIS

Leading and often the only symptom of bacterial vaginosis- an increased amount of whiteness, in 87% of women with an unpleasant odor, disturbing patients for a long time (on average 2 years or more).

ANAMNESIS

Examination of women begins with the collection of anamnesis. Scrupulous questioning, detailed awareness of the onset and first signs of the disease, the nature of complaints, previous treatment determine the correct diagnosis. Itching in the external genital area is noted by 26% of patients, burning - 28%, dyspareunia - 23%. Dysuric disorders are observed only in 15% of women, pain in the vagina or perineum in 21%. Regarding these complaints, 97% of women have previously repeatedly contacted a gynecologist or urologist, mycologist, endocrinologist, neuropathologist. At the same time, 95% of them were diagnosed with nonspecific vaginitis, 75% of women had previously been repeatedly and unsuccessfully treated for suspected vaginitis, while often using a variety of antibacterial drugs, both locally and orally or parenterally.

PHYSICAL EXAMINATION

During an objective examination, it is necessary to pay attention to the condition of the external genital organs, the external opening of the urethra, the mucous membrane of the vagina, the cervix, the nature of the discharge. Vaginal discharge in bacterial vaginosis, as a rule, plentiful, homogeneous, white in color, with a sharp unpleasant smell of "stale fish". Depending on the duration of the disease, the nature of the discharge is different. At the beginning of the development of the disease, leucorrhoea is of a liquid consistency, white or with a grayish tint. With prolonged bacterial vaginosis (2 years or more), the discharge is yellowish-greenish in color, thicker, resembles a curdled mass, foamy, viscous and sticky, evenly distributed along the walls of the vagina. The amount of whiteness varies from moderate to profuse, but on average their volume is about 20 ml per day (about 10 times higher than normal). A feature of bacterial vaginosis is the absence of signs of inflammation (edema, hyperemia) of the vaginal walls.

Mucous membrane with bacterial vaginosis of the usual pink color. In rare cases, in older women (in menopause), small reddish spots are found. pH measurement is carried out using indicator strips with a division scale of not more than 0.2 during the inspection. Bacterial vaginosis is characterized by a shift to the alkaline side (average 6.0). In parallel, put the reaction with a 10% solution of KOH. When mixing vaginal discharge and a few drops of alkali, the characteristic smell of “rotten fish” intensifies or appears - a positive amino test. Colposcopic picture of bacterial vaginosis characterizes the absence of diffuse or focal hyperemia, pinpoint hemorrhages, swelling and infiltration of the vaginal mucosa. In 39% of patients, pathology of the vaginal part of the cervix is ​​found (cervicitis, ectropion, simple erosion, cicatricial deformities, etc.).

LABORATORY RESEARCH

The main laboratory research method is Gram-stained microscopy of vaginal smears from the region of the posterior fornix. Conduct microscopy of native wet smears under immersion to detect mobile microorganisms Mobiluncus spp. Microscopy evaluates various morphotypes (cocci, rods, vibrios, filamentous) of microorganisms, their gram-bearing, the presence of "key" cells, the number of leukocytes (Table 20-6) Typical symptom of bacterial vaginosis- detection in Gram-stained vaginal smears of key cells (CC). They are represented by cells of the vaginal epithelium, with gram-variable rods and cocci adhered to the membrane.

Cultural, enzyme-linked immunosorbent, serological studies, as well as DNA diagnostics, have exclusively scientific priority. Thus, it is obvious that according to a number of clinical symptoms of the disease, bacterial vaginosis can be suspected at the stage of the initial examination. Particular attention should be paid to patients who have been treated for bacterial vaginosis for a long time, but unsuccessfully, using traditional methods (soda douches, herbal medicine, antibiotic therapy, etc.). Persistent leucorrhea against the background of long-term antibacterial and anti-inflammatory therapy is an important diagnostic criterion for bacterial vaginosis.

DIFFERENTIAL DIAGNOSIS OF BACTERIAL VAGINOSIS

Differential diagnosis of bacterial vaginosis is presented in Table. 20-6.

The principal goal of therapy is to resolve vaginal symptoms. All women with symptoms of bacterial vaginosis need treatment. The use of metronidazole in bacterial vaginosis significantly reduces the incidence of PID after abortion. Therefore, treatment of bacterial vaginosis (symptomatic or asymptomatic bacterial vaginosis) is necessary before performing surgical abortions.

MEDICAL TREATMENT OF BACTERIAL VAGINOSIS

To date, a two-stage method for the treatment of bacterial vaginosis is generally recognized. Its principle is the creation of optimal physiological conditions for the vaginal environment and the restoration of microbiocenosis. At the first stage of treatment, local antibiotic therapy is carried out (clindamycin vaginal cream 2%, metronidazole, chlorhexidine, etc.), lactic acid is prescribed to lower the pH, immunocorrectors (if indicated), estrogens, prostaglandin inhibitors and antihistamines. In the presence of itching, burning, pain, local anesthetics are used.

• Treatment regimens recommended by the US STS Control Board(1998) and adapted to the conditions of our country for the treatment of non-pregnant women (stage 1):

Chlorhexidine (hexicon ©) 1 vaginal suppository 1-2 times a day for 7-10 days
- clindamycin - vaginal cream 2% one full applicator (5 g) intravaginally at night for 7 days;
- or clindamycin - vaginal suppositories, 1 vaginal suppository 1 time per day for 3-6 days;
- or metronidazolegel 0.75% one full applicator (5 g) intravaginally - 1-2 times a day for 5 days;
- or metronidazole 500 mg orally 2 times a day for 7 days;
-or tinidazole 500 mg orally 2 times a day for 5 days;
-or ornidazole 500 mg orally 2 times a day for 5 days.

Patients should be warned that they should avoid drinking alcohol during treatment with metronidazole and its analogues, as well as within 24 hours after the end of treatment. Clindamycincrem is oil based and can damage the structure of latex condoms and diaphragms.

In 2006, at the RSMC. N.I. Pirogov under the guidance of Professor E.F. Kira conducted an open randomized comparative study of the efficacy and safety of Hexicon © (chlorhexidine bigluconate 16 mg), vaginal suppositories and Flagyl © (metronidazole 500 mg), vaginal suppositories in the treatment of bacterial vaginosis.

A primary evaluation of the effectiveness (on the 8th and 12th day after completion of treatment) and a secondary evaluation were carried out. Particular attention was paid to the effect of Hexicon© and Flagyl© on lactobacilli. The drugs were prescribed according to the schemes: Hexicon© 1 suppository 2 times a day for 7–10 days and Flagyl© 1 suppository 2 times a day for 10 days. The effectiveness of Hexicon © in the treatment of bacterial vaginosis was 97% of patients immediately after treatment with Hexicon ©, Flagyl © - 83%. A month after treatment, clinical and laboratory recovery occurred in 97% of patients treated with Hexicon, and in 93% of patients using Flagyl©. Unlike Flagyl ©, Hexicon © helps to improve the species composition and quantity of lactic acid bacteria. Inoculation of lactobacilli in the treatment with Hexicon © increased from 31% to 51%, for bifidobacteria from 10% to 19%.

Hexicon© was well tolerated by the patients, no adverse events were registered.

• Alternative treatment regimens for bacterial vaginosis (first stage): -metronidazole 2 g orally once or -tinidazole 2 g orally once or -ornidazole 2 g orally once or - clindamycin 300 mg orally 2 times a day for 7 days.

Relapses of bacterial vaginosis are quite common. Alternative regimens are used to treat relapses of BV. There is currently no regimen for the treatment of bacterial vaginosis using any drug for long-term maintenance therapy. Clinical trials have shown that treatment of sexual partners does not affect either the success of treatment in a woman or the frequency of relapses, therefore routine treatment of sexual partners is not recommended.

If you are allergic to metronidazole (and analogues) or intolerant to it, clindamycin cream can be used for treatment. Metronidazole gel is prescribed for patients with intolerance to systemic metronidazole, however, patients with an allergy to oral metronidazole should not be given intravaginally.

The second stage of treatment of bacterial vaginosis involves the use of bacterial biological preparations: lactobacillus acidophilus, acylacta, bifidobacterium bifidum, bifidine, etc. locally or lactogen inside to restore the vaginal microflora. The appointment of these drugs without a preliminary first stage is futile due to the pronounced competition between vaginal microorganisms. When carrying out complex etiotropic and pathogenetic therapy of bacterial vaginosis, a positive result is achieved in 90%. There are currently no standards for the restoration of the vaginal biocenosis. Below in table. 20-7 shows the main eubiotics and probiotics used to correct the vaginal microflora.

Table 20-7. Eubiotics and probiotics used to correct the vaginal biocenosis

* Not produced commercially. Has historical significance.

** Capsules for oral use.

Bacterial vaginosis therapy with eubiotics usually begins 2-3 days after the end of the first (antibacterial) treatment. During this time, elimination from the vagina or the body of antibacterial agents introduced at the first stage occurs. This excludes the so-called "post-antibiotic effect", that is, a decrease in the effectiveness of eubiotics due to exposure to trace concentrations of antibacterial drugs.

INFORMATION FOR THE PATIENT

The patient is informed about the adverse effects of bacterial vaginosis. Regular gynecological examinations are recommended.

FORECAST

With timely diagnosis and adequate treatment of bacterial vaginosis, the prognosis is usually favorable.

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

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

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

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

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

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

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

Etiology and genesis: causes and origin

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

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

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

to internal"Provocateurs" include:

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

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

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

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

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

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

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

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

Bacterial vaginosis during pregnancy

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

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

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

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

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

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

Tactics for the treatment of bacterial vaginosis - phased.

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

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

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

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

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

Preventive measures for BV

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

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

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

What natural means and methods can be effectively and safely treat bacterial vaginosis at home.

Probably it will seem strange to someone (and to be honest, it’s hard for me to believe), but I only learned about the term Bacterial Vaginosis when I was pregnant. And not even because I had it. Because it had to be prevented.

I have a rather complicated pregnancy, the cervix could not stand it and they put stitches on it (I already). And the sutures are a foreign body, and doctors feared that BV could occur and further complicate the course of pregnancy. But everything went well and I did not develop Bacterial Vaginosis.

When I started reading what it is and how often the beautiful half of humanity suffers from it, as well as the drugs that doctors prescribe for treatment (antibiotics), I decided that I should write a post about how you can and should treat BV with natural remedies. Effective and safe, without harm to its microflora and without side effects.

What is Bacterial Vaginosis?

Bacterial Vaginosis is a common gynecological disease. Usually among women of young and middle age. And in terms of frequency, according to statistics, 1 out of 5 definitely suffered from it or will suffer from it.

Particularly susceptible to BV:

• having an active sex life
• pregnant
• immunocompromised women

Women with BV also have a higher risk of:

• sexually transmitted diseases
• other pathological conditions of the vagina
• complications during pregnancy and childbirth

Cause of Bacterial Vaginosis

BV occurs due to a violation of the normal microflora of the vagina. Yes, sometimes it's hard to believe, but our vagina is its own ecosystem. With its own bacteria and yeast.

The overgrowth of any microorganisms or imbalance of bacteria just leads to Bacterial Vaginosis. The main culprit in this case is Gardnerella vaginalis, which has the ability to change the pH of the vagina. But it is important to understand that BV does not always develop because of it. Less commonly, but it may be other microorganisms.

Symptoms

So the symptoms (and they may not be - more on that below) of Bacterial Vaginosis begin to appear when the pH of the vaginal environment changes. The normal pH inside is slightly acidic 3.8-4.2. Anything above 4.5 is already BV, that is, too alkaline.

Many simply do not have any symptoms. But if it is, then usually it is:

• white or grayish discharge
• an increase in the amount of discharge with an unpleasant odor
• sometimes pain when urinating, during or after intercourse
• red and inflamed, sensitive skin around the vagina

Causes of Bacterial Vaginosis

As with any other condition, BV can be caused by a variety of causes.

The most common:

• dysbacteriosis / disturbed intestinal microflora
• excess sugar in the diet
• synthetic chemicals and fragrances
• reception
• stress

On my own behalf, I can add that Bacterial Vaginosis is a systematic disease of the whole ecosystem of a woman. Doctors often prescribe antibiotics, but this does not help with the real problem and cause! It only relieves the symptoms. BV should be treated comprehensively.

How to Treat Bacterial Vaginosis

Avoid and use soaps and intimate hygiene products

Yes, I understand that this sounds like very strange advice. But! Ordinary soap aka unnatural soap has an alkaline pH, which, as we already know, is not suitable for our vagina.

For the same reason, you should avoid all sorts of foams, sprays and other products that are advertised for feminine hygiene. The best hygiene for this delicate area is minimal with natural type soap. And no more than once a day. We do not want to disturb the microflora. And soap does just that.

Apple vinegar

Apple cider vinegar helps detoxify and fight bacteria. And restore the normal acidity of the vagina.

It is very effective to sit in a basin - 1/2 cup of apple cider vinegar in a medium basin of warm water. We sit for about 20 minutes. And also use it inside. But for this you need only (cloudy) - 1 teaspoon per glass of water, 2 times a day 30 minutes before meals.

Soda

Another effective remedy is simple soda.

Take a bath, add 1/2 cup of baking soda to it and lie down in it for 15-20 minutes.

Tea tree oil

Tea tree essential oil has a strong antifungal, antiseptic effect. Helps to get rid of unnecessary bad bacteria.

The most effective way to apply in this case is to dip the swab in any liquid oil (ideally coconut as it has antibacterial activity) and then apply 3 drops of tea tree essential oil to the swab. We insert at night and repeat the week.

Do not douche

In general, douching our intimate place is not a useful thing. For those who may be in doubt, the vagina has the ability to cleanse itself. And douching simply disrupts the normal bacterial balance.

Do not use scented pads or tampons during your period. Better switch to organic natural options. You can buy these on iHerb, or for example, I bought Naty pads (I needed them after giving birth). Ideally, it is better to refuse tampons altogether and switch to a silicone cap, for example.

Probiotics

Yes, without them. Since the main cause of BV is also in the intestines, it will be necessary to increase the beneficial bacteria there as well. Especially for the vaginal environment, logs Lactobacillus reuteri and rhamonosus. Here is a good probiotic containing these strains.

Garlic

Or as I like to call it - (and also very cheap and safe!). I even found a study stating that taking garlic tablets can be successfully used to treat BV. During pregnancy, I took this garlic.

Blood sugar balance

It may be a secret for someone, but the sugar that we consume completely destroys our microflora. And intestines and vagina. The fact is that pathogenic organisms (as well as cancer cells) simply adore, bloom on it and smell. Therefore, it is necessary to reduce the consumption of sugar as much as possible!

Bacterial vaginosis- symptoms and treatment

What is bacterial vaginosis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article by Dr. Yu.A. Chursina, a gynecologist with an experience of 6 years.

Definition of disease. Causes of the disease

Bacterial vaginosis- This is an infectious non-inflammatory disease in which an abundant growth of certain microorganisms occurs in the vagina and a sharp decrease in lactic acid bacteria with protective properties.

This pathology is one of the most common diseases of the female genital area. According to various estimates, it is found in approximately 70% of women of reproductive age.

Let's take a look at the name of the disease. The term "bacterial" emphasizes a significant increase in the number of aerobic and especially anaerobic bacteria that obtain energy from a minimum amount of oxygen. The meaning of the word "vaginosis" indicates that there are no signs of inflammation in this disease.

Previously, it was mistakenly called "gardnerellosis", since it was believed that bacteria were the cause of the pathology. Gardnerella vaginalis. However, it was found that these microorganisms are found not only in patients with symptoms of the disease, but also in 40% of women who do not have complaints. Therefore, the diagnosis of Gardnerellosis is incorrect and incorrect: it does not reflect either the etiology or pathogenesis of the disease, and in some cases leads to a false positive diagnosis and the appointment of unreasonable treatment.

The causes of bacterial vaginosis are very diverse. These include both banal violations of intimate hygiene, and more complex situations.

Factors contributing to the onset of the disease include:

• trauma during childbirth;
• various operations on the perineum;
• surgical abortion;
• menstrual irregularities;
• irrational use of antibiotics and even local antiseptics.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of bacterial vaginosis

The main symptom of bacterial vaginosis is a copious liquid homogeneous discharge from the genital tract with an unpleasant odor. They can be gray or white.

The smell of secretions is often compared to the smell of fish. It is especially strongly felt when the vaginal environment is alkalized - after intercourse and during menstruation.

Approximately 50% of women, that is, every second woman, have no complaints about vaginal discharge, so the disease may be asymptomatic.

Sometimes with bacterial vaginosis, patients are concerned about discomfort, itching or burning in the vagina and in the rectal area, urination disorders and pain during or after intercourse.

A burning sensation and itching are also characteristic of vaginitis, an inflammatory process in the vagina. It is distinguished from bacterial vaginosis by a feeling of vaginal dryness, as well as redness and swelling of its membrane.

The pathogenesis of bacterial vaginosis

Bacterial vaginosis does not have one specific pathogen - it can be caused by various microorganisms. The most frequent include not only the mentioned G.vaginalis, but also fusobacteria, peptostreptococci, veillonella, vaginal atopobium, as well as bacteria Peptoniphilus, Prevotella, P. bivia and M. mulieris. Most often, the development of the disease provokes a combination of 2-3 microorganisms or more.

In the presence of risk factors, these pathogens begin to actively multiply in the course of their life, alkalizing the vaginal environment (normally, the pH of vaginal discharge is 3.5-4.5). Only lactobacilli that secrete lactic acid can prevent the growth of pathogenic bacteria, but due to an increase in the pH of the medium, their number decreases.

According to modern ideas, the bacteria that cause bacterial vaginosis are able to create biofilms that attach to the vaginal epithelium. Inside these films, microorganisms become less vulnerable to exposure, including drugs. It is the formation of biofilms that is the cause of frequent recurrence and unsuccessful treatment of the disease.

Bacterial vaginosis is not a sexually transmitted disease, as it also occurs in girls who have never had sex. Although it is difficult to unequivocally state that the disease is not related to its sexual transmission: numerous studies confirm that the change of sexual partner, the presence of numerous sexual partners, and non-traditional sex significantly increase the number of relapses of bacterial vaginosis.

Classification and stages of development of bacterial vaginosis

At the moment, there is no classification and division into stages of the disease. There is also no code in the ICD-10 (International Classification of Diseases) that would correspond to the diagnosis of "Bacterial vaginosis". Other codes are used to encode this state. Most often it is referred to as "N86. Other inflammatory diseases of the vagina", which is incorrect and not always correct.

Previously, the classification proposed by E.F. Kira in 1995. According to her, four types of vaginal microbiocenosis were distinguished - a combination of microorganisms that live in the vagina:

• Normocenosis - the predominance of lactobacilli. is a sign of the normal microflora of the vagina.
• Intermediate type - a moderate or reduced number of lactobacilli, the presence of gram-positive cocci and gram-negative rods. Often observed in healthy women, it can rarely be accompanied by complaints of discharge from the genital tract.
• Dysbiosis - almost complete absence of lactobacilli, abundant polymorphic gram-negative and gram-positive rod and coccal microflora. This condition has been associated with bacterial vaginosis.
• Vaginitis - an increase in the number of leukocytes in smears. This condition has been associated with nonspecific vaginitis.

Today, this classification is not used due to a significant expansion of knowledge about the microbiocenosis of the vagina and the emergence of modern methods of laboratory diagnostics.

Complications of bacterial vaginosis

Unpleasant discharge from the genital tract significantly reduces a woman's quality of life and her self-esteem, causes sexual behavior disorders, and can even lead to.

In general, bacterial vaginosis can cause a number of fairly serious complications. Scientists have proven the impact of the disease on the course of pregnancy: it doubles the risk of preterm birth, especially if it is detected at the beginning of the second trimester. Complications can also occur after the birth of a child: postpartum endometritis, wound infection after a cesarean section. Some researchers suggest that the toxins of vaginosis pathogens can affect the fetus, penetrating the placenta, which in the future may become one of the causes of the child.

More recently, bacterial vaginosis has also been shown to be associated with: in patients with this non-inflammatory disease of the vagina, the risk of infection with the human papillomavirus is higher than in healthy women. It also speaks to an increased risk of cervical neoplasia.

In addition, at the moment, the possible relationship of bacterial vaginosis with an increased risk of infection and other sexually transmitted diseases is being actively discussed (,). In particular, one study noted that an HIV-infected woman with bacterial vaginosis was more likely to transmit HIV to a sexual partner than an HIV-infected woman without vaginosis.

Diagnosis of bacterial vaginosis

Diagnosis of bacterial vaginosis usually does not present significant difficulties. Nevertheless, when making a diagnosis, one can often encounter errors: both overdiagnosis (when a patient is attributed a disease that she does not actually have), and underdiagnosis.

Most often, it is possible to correctly determine the disease already at the first visit of a woman to a doctor. In such cases, the diagnosis is made on the basis of characteristic complaints, examination data and pH-metry of vaginal discharge. Sometimes a fairly extensive clinical and laboratory examination may be required.

R. Amsel criteria are used in the diagnosis of bacterial vaginosis. These include:

• the presence of homogeneous whitish-gray discharge from the genital tract (on examination, one can note their uniform distribution along the walls of the vagina);
• increase in Ph in the vagina - more than 4.5;
• positive test with 10% potassium hydroxide solution - determination of volatile amines;
• detection in native smears and / or in Gram smears of "key cells", i.e. cells of the vaginal epithelium with gram-variable microorganisms tightly attached to their surface. Leukocytes in these smears are not detected or are contained within the normal range, which indicates the absence of inflammation, and lactobacilli are reduced to the point of complete absence.

The diagnosis of "Bacterial vaginosis" is established in the presence of at least three signs.

There is also a semi-quantitative assessment of smears of vaginal fluid, Gram-stained, on a scale of 0 to 10. Now this method is practically not used.

For laboratory diagnosis of bacterial vaginosis, the Real Time PCR method is used as part of a comprehensive analysis of the vaginal microflora. There are a number of test systems, the most common of which are Femoflor 16+KVM and Femoflor screen. These test systems allow you to get a fairly complete picture of the characteristics of the microbiocenosis of the woman's vagina and prescribe a reasonable treatment.

Clinical diagnostic methods include various rapid tests: Fem-exam, BVBlue, Pip-activity TestCard. However, all of them are not widely used in clinical practice. This is mainly due to their lack of sensitivity.

In addition, it must be remembered that any woman who is sexually active and goes to the doctor with complaints of discharge from the genital tract must be screened for causative agents of trichomoniasis, gonorrhea, due to the wide spread of these infections and the high frequency of complications.

Treatment of bacterial vaginosis

In no case should you self-medicate - it must be prescribed by a doctor, otherwise it may adversely affect the woman's health.

Treatment of bacterial vaginosis is carried out in the presence of clinical and laboratory signs. Pregnant women deserve special attention. Discussions about the appropriateness of their treatment have already been closed: it is mandatory for all pregnant patients, including those with a low risk of preterm birth (cases where there was no preterm birth in the past). Treatment of pregnant women with asymptomatic bacterial vaginosis and a high risk of preterm birth (if the children were already born before the due date) can significantly reduce the risk of early termination of pregnancy.

To eliminate bacterial vaginosis, antiseptic agents and various combined preparations are used. At present, the effectiveness of a two-stage treatment regimen has been proven: the first stage consists in the use of antiseptic agents, and the second - in the restoration of the vaginal microflora.

There are quite a lot of both foreign and Russian recommendations and treatment regimens for this disease. In accordance with the Eurasian clinical guidelines for the rational use of antimicrobial agents in outpatient practice, the following drugs should be used when eliminating bacterial vaginosis:

First line therapies:

• cream "Clindamycin" 2%;
• gel "Metronidazole" 0.75%;
• "Metronidazole" 0.5 g (for oral administration);
• "Ornidazole" 0.5 g (for oral administration).

Second line therapies:

• candles "Clindamycin" 0.1 g;
• "Clindamycin" 0.3 g (for oral administration);
• "Metronidazole" 2.0 g (for oral administration).

The duration and frequency of taking these drugs is determined by the doctor individually. In addition, there are a significant number of combined drugs.

To restore the vaginal microflora, vaginal capsules with live lactobacilli, ascorbic acid for vaginal use, and lactic acid gel can be used.

A promising method for the treatment of bacterial vaginosis at the moment is the treatment of the vagina with ultrasound-cavitated antiseptic solutions. This method is being actively studied and great hopes are placed on it in the treatment of not only bacterial vaginosis, but also various inflammatory diseases of the skin and mucous membranes.

Forecast. Prevention

The prognosis for timely treatment is favorable in most cases. Sometimes relapses of the disease are possible. When they occur, a comprehensive approach to the patient is required, a complete clinical and laboratory examination and the exclusion of concomitant diseases that may increase the risk of recurrence of bacterial vaginosis. You also need to consult on nutrition and lifestyle issues.

As a prevention of the occurrence of bacterial vaginosis, first of all, it is necessary to exclude such risk factors as:

• violation of the integrity and anatomy of the external genital organs of a woman (may occur with injuries during childbirth, various surgical interventions);
• alkalization of the vaginal environment (possible with the use of certain lubricants, shower gels, douching);
• surgical abortions, some gynecological operations, accompanied by the removal of the mucous plug from the cervical canal;
• menstrual disorders, hypoestrogenic state in the period before menopause;
• irrational use of antimicrobial agents and antiseptics.

A significant contribution to the development and recurrence of the disease is made by frequent changes of sexual partners, severe concomitant diseases, alcohol abuse, and smoking. All this should be avoided.

An important role in prevention is played by a healthy lifestyle, adequate physical activity and adherence to proper nutrition - a vegetarian diet and increased consumption of "fast" carbohydrates increase the risk of relapse.

To prevent bacterial vaginosis, you need to follow the recommendations for intimate hygiene:

• Wash at least twice a day. To wash the genitals, use only warm water or special compositions for intimate hygiene, which contain substances that do not violate the acidity of the vaginal environment.
• Washing should only be done with cleanly washed hands, do not use washcloths. When washing, the water jet should be directed from front to back.
• After washing, it is necessary to blot moisture with a towel for intimate hygiene. It should be soft, clean and strictly individual. You can not use them for hands, face and other parts of the body.
• During menstruation, it is not recommended to take a bath, swim in the pool or ponds. It is preferable to take a shower in the morning and in the evening. It is better to avoid sexual intercourse, especially in the first days of menstruation.
• Sanitary pads during menstruation must be changed at least four to five times a day, tampons - every two hours.
• Daily sanitary napkins should not be used regularly.
• Do not apply vaginal douching for regular hygiene. They are possible only if they are prescribed by a doctor.
• Give preference to underwear made of natural fabrics with a wide gusset. It should be changed daily, in some cases twice a day. Wash underwear separately from other clothes, towels and bed linen.

How to cure chronic bacterial vaginosis in women can be determined by a gynecologist, depending on the symptoms and provoking factors. The disease is a long-term process, accompanied by vaginal dysbacteriosis. The chronic type of pathology is characterized by a violation of the vaginal microflora, while the number of opportunistic microorganisms prevails over lactobacilli.

Reasons for the development of chronic gardnerellosis

The causes of chronic gardnerellosis may be different, the appearance of vaginal dysbacteriosis is due to the influence of a number of factors, the main of which are:

Signs of illness

The symptoms that characterize chronic gardnerellosis are as follows:

The chronic form of the disease does not cause any particular inconvenience, but as immunity decreases, the symptoms may become more pronounced.

Diagnostics

If a chronic type of gardnerellosis is suspected, the gynecologist takes a smear, with the help of which it is possible to identify conditionally pathogenic microflora. It is important to change the pH, with an increase in which a favorable environment is created for the reproduction of bacteria.

The presence of gardnerella in a smear does not make it possible to make an accurate diagnosis, since these representatives of opportunistic microflora are also present in healthy women. The doctor takes into account the ratio of bacteria and lactobacilli. If the former prevail over the latter, additional tests are prescribed:

As an additional diagnostic method, ultrasound is used to determine the presence of an inflammatory process in the ovaries, bladder and uterus, which is due to the advanced form of the disease.

Treatment of chronic bacterial vaginosis

The chronic form of the disease is amenable to complex treatment. For therapy, drugs are used for oral administration, as well as suppositories and ointments. Groups of drugs that are prescribed for the treatment of gardnerellosis:

In the treatment of chronic gardnerellosis, it is important to follow a diet. It is necessary to include in the menu as many vegetables, fruits and dairy products as possible. Alcohol, coffee and soda should be avoided. It is required to exclude fats and smoked meats. It is recommended to consume more freshly squeezed juices.

During treatment, it is important to refrain from sexual intercourse. In the presence of a concomitant infection, therapy is required in both partners. If there is a chronic type of pathology, then it is necessary to wash at least 2 times a day, while it is advisable to use a decoction of chamomile, which will help get rid of discomfort in the vagina. Soap should be used without fragrance. Useful will be economic or tar. During treatment, it is forbidden to use panty liners.

Prevention

Prevention of chronic gardnerellosis comes down to following the rules, the main of which are:

To prevent the chronic form of gardnerellosis, it is important to be examined by a gynecologist at least once a year and take a smear for microflora. If you experience heavy discharge with an unpleasant odor, you should immediately consult a doctor.

Possible Complications

With an untimely approach to treatment, chronic gardnerellosis often gives complications, the main of which are:

• the occurrence of endocervicitis;
• the spread of the inflammatory process to the ovaries;
• adhesive processes in the pelvic organs;
• accession of other types of pathogenic microflora;
• the appearance of cervical erosion.

If, in addition to gardnerella, there are Trichomonas, chlamydia, fungi and other pathogens, then the risk of developing cystitis in the chronic form of the disease increases.