Bacterial vaginosis is contagious. What is bacterial vaginosis, how is it manifested, how is it treated? Complications of bacterial vaginosis

Bacterial vaginosis - 8 out of 10 women of childbearing age have experienced this disease at least once in their lives. It is also diagnosed in 76% of cases of patients visiting a gynecologist. However, there are still many myths surrounding bacterial vaginosis, also known as vaginal dysbiosis or bacterial vaginosis. Let's try to figure out where truth ends and fiction begins.

Myth #1: Bacterial vaginosis is sexually transmitted.

In fact, the nature of the disease is best characterized by the term "bacterial", prudently placed in the title.

The vagina of every woman is a mobile ecosystem in which more than 300 species of bacteria coexist. Normally, lactobacilli predominate among them, protecting our body from the invasion and reproduction of pathogenic microbes. Bacterial vaginosis develops when, under the influence of certain factors, beneficial lactic acid bacteria give way to opportunistic microflora, which causes the disease only with reduced immunity. Previously, it was believed that only one type of bacteria, the so-called gardnerella (Gardnerella vaginalis), is responsible for the development of pathology, but scientists now believe that the disease occurs due to the very fact of disturbing the "microbial balance".

Anything can cause bacterial vaginosis. According to Alexander Leonidovich Tikhomirov, Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology of the Faculty of Medicine of the Moscow State Medical University, first of all, these are frequent sexual intercourses (more than 4-5 per week), intrauterine contraception, cunnilingus, uncontrolled use of antibiotics, the use of tampons and synthetic underwear, hygiene violations or, conversely, excessively frequent douching, which leads to the washing out of healthy vaginal microflora. However, like any dysbacteriosis, this disease is not sexually transmitted.

To avoid recurrence of the disease, it is extremely important to observe the rules of personal hygiene:

• Do not wear tight, synthetic underwear. It disrupts blood circulation in the pelvic organs and is poorly ventilated, creating a warm and humid environment in the perineal area - ideal conditions for the reproduction of gardnerella.
• Do not abuse the wearing of tampons and panty liners, especially those containing fragrances.
• Properly wash yourself - not from the bottom up, but from front to back.
• Use intimate hygiene products that help restore the natural pH of the vaginal environment. The best option is to use a combination of special soap and gel with Ph from 3.8 to 4.4 (this information should be indicated on the package). In addition, among the components, look for lactic acid, preferably in combination with plant extracts (calendula, chamomile, sage), moisturizing mucous membranes.

We thank Alexander Leonidovich Tikhomirov, obstetrician-gynecologist, MD, professor, and experts of the pharmaceutical company "EGIS" for their help in preparing the material.

What is the treatment for bacterial vaginosis? Gardnerellosis is considered an infectious disease and is not inflammatory in nature, often with distinct symptoms in women and blurry in men.

Today we will talk about what drugs to treat, whether it is necessary to carry out therapy for pregnant women, whether it is safe.

Both the weak half of humanity and the strong can face this disease. Moreover, bacterial vaginosis is not necessarily sexual in nature, although this is often how it is transmitted.

Vaginosis is a pathogenic microorganism that affects the epithelium of the vaginal mucosa and urethral canal.

Symptoms of the disease are abundant discharge, which has a characteristic fishy smell, itching and burning. This happens due to the multiplication of microbes, adversely affecting the conditionally pathogenic flora of the genital tract.

Many people think that PP cannot be infected, but this is not true. In an acute form, this is possible. Males have little to no symptoms initially, but are carriers.

The risk group is everyone who leads an active sex life. It is mandatory to get rid of the infection in order to exclude complications.

Therapy

The treatment regimen for bacterial vaginosis takes place in several stages.

1. Regeneration of the normal flora of the genital tract, restoration of immune forces, stabilization of hormonal balance, destruction of pathogens.
2. Reception of lactobacilli to establish a normal acid-base environment of the vagina and urethral canal. Assigned to both sexual partners.

Gardnerellosis

His treatment should be mandatory. This disease is fraught with complications that can lead to inflammation of the prostate gland, damage to the urethral canal and the genitourinary system.

Depending on the severity of the course of the disease, treatment is prescribed for a course of 3-10 days. urologist. If there is no result from therapy with one drug, it changes to another, but you should not do it yourself.

• Refuse intimate relationships during therapy.
• Drinking alcohol.
• Visiting public baths and saunas.
• Excessive physical activity.
• Prevent stressful situations and nervousness.

To prevent the occurrence of the disease in the future, you need to follow some tips:

1. Use condoms.
2. Do not neglect hygiene.
3. Drink vitamin complexes that strengthen the immune system.
4. Seek medical attention in a timely manner if there is an unpleasant smell in intimate areas.

How to treat

Based on the symptoms, antibiotic therapy is prescribed to eliminate acute signs of the disease.
The scheme of bacvaginosis often includes the main drug "Metronidazole". Produced in various forms. Which is very convenient.

• Tablets: 0.5 g * 2 rubles / day.
• Candles: twice.
• Gel: 1 time.

The course varies from 5-10 days, is prescribed by a doctor, do not self-medicate. Analogues of the drug are "Metrogil".

It is available as a solution for intravenous use and tablets. Flagyl is also prescribed, it is available in capsules, suppositories and a solution for intravenous administration. Along with the usual regimen, suppositories and creams for vaginal use are often used.


To restore the microflora of the vagina, it is necessary during treatment and after taking drugs to increase lactobacilli - Dederlein's sticks:

1. "Lactoginal" Lactoginal.
2. "Bioselak".
3. "Lacidophilus".
4. "Vaginorm".
5. "Bifoval".
6. "Bactisubtil".

The duration of treatment and the amount of the daily norm is prescribed by the doctor. You may not guess with the dose, and the therapy will not bring results. In the treatment of gardnerellosis, it is necessary to strengthen the immune system, therefore, vitamin complexes are prescribed among them:

• "Viferon".
• "Ruferon".
• "Genferon".
• "Interal".
• "Altevir".

The doctor prescribes antifungal drugs for candidiasis, specific pathologies of the genital area. These include gonorrhea, chlamydial infection, gonorrhea. Therapy will be with the use of etiotropic drugs.

Pregnancy

If the disease is detected in the first term, treatment is not carried out, it starts from the second trimester.

Bactaginosis tablets:

• "Metronidazole" Metronidazole: 2 rubles / day * 3-5 days.
• "Clindamycin" Clindamycin: 2 p./d - 3-5.

Candles and gels are successfully used in the treatment of vaginosis in pregnant women. They are safer and non-toxic to the fetus. The course of therapy and the amount of medication is prescribed by the gynecologist who leads the pregnancy.

Candles and ointments:

1. "Betadine" or "Povidone-iodine";
2. "Hexion";
3. "Chlorhexidine";
4. "Terzhinan";
5. "Polygynax".

It is contraindicated to take drugs without the supervision of a gynecologist. The instruction is indicated for a general idea of ​​​​the treatment of the disease.

Preparations

These remedies for bacterial vaginosis are used after the main one and should be prescribed by a specialist.

• "Baktisubtil" Bactisubti: 1 tab. * 4 p. / Day before meals.
• Linnex or Probifor.
• Bifidumbacterin Forte.
• "Immunal".

Suppositories to combat vaginal discharge:

• "Ecofemin" vaginal capsules.
• "Hexicon".

At home

Use healing herbs in the initial stages of the disease in combination with basic antibacterial drugs, as an alternative to expensive suppositories and ointments for vaginal administration.

Some believe that with bacterial vaginosis, if you douche with lactic acid products, you can get rid of unpleasant symptoms on your own and improve the vaginal flora.

But this is not so, in no case can not be done. In addition to important lactobacilli, you can pick up harmful ones. Throughout the course of treatment, use one of the recipes below.

You can do douching or tampons based on tinctures and decoctions. For procedures such as baths and douching, you need to devote at least 10 minutes of your time. It is advisable to put tampons at night.

Folk remedies

Recipe #1

1. Chamomile pharmacy: 1.0 tablespoons
2. Goose foot: 1.0 tablespoons

Mix everything, cook in a water bath with 1.0 liters of boiling water, cool, strain, refrigerate, use warm.

Recipe #2

1. Oak bark: 1.0 tbsp.
2. Pour boiling water (1 glass), let it brew, strain, apply warm, consume within a day.

Recipe #3

1. Common bird cherry: 1.0 tablespoons

Pour (2 cups.), Cook in a water bath for up to 8 minutes, let it brew and cool.

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, which entails a change in the vaginal microsystem, which is the main cause of the development 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, hidden, asymptomatic forms of pathology that occur for a long time in women can manifest themselves precisely during pregnancy “in all its glory”, favorable factors have this. Delay in the treatment of bacterial vaginosis in pregnant women threatens with dangerous complications:

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

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

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

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.

• Bacterial vaginosis or bacvaginosis, vaginal dysbacteriosis, vaginal dysbiosis is a polymicrobial infectious non-inflammatory syndrome of the lower genitalia, which occurs against the background of a violation of the healthy balance of the vaginal microflora and a decrease in the acidity of the vaginal environment.

The prevalence of bacvaginosis is very high. The disease was noted in 55.8% of women of childbearing age who applied to a gynecologist; in 60-70% of patients with inflammatory diseases of the genitals and 35% of pregnant women. The combination of intestinal dysbacteriosis with bacterial vaginosis is observed in 71% of cases.

Bacterial vaginosis. ICD-10 code:

N89 Other non-inflammatory diseases of the vagina
Clarification:
There is no diagnosis of bacterial vaginosis in the ICD-10. Over the years, this syndrome was repeatedly renamed: until 1955, the disease was called nonspecific vaginitis; since 1980 - gardnerellosis.

Later it was found that the conditionally pathogenic bacterium gardnerella (Gardnerella vaginalis), which was considered the causative agent of bacvaginosis, is found in the vaginal discharge in 47-75% of healthy women without any clinical symptoms and is not the only "culprit" of the disease. Therefore, in 1981, gardnerellosis was renamed anaerobic vaginosis, and in 1984 the modern name appeared: bacterial vaginosis.

To identify the prevailing infectious agent, an additional ICD-10 code is used:
B96 Other bacterial agents listed as the cause of diseases classified elsewhere.

Healthy vaginal flora

The determining factor in the normal microflora of the vagina is the Doderlein flora. At 90-98% it is represented by lactobacilli (Doderlein sticks), bifidobacteria and, to a small extent, strict anaerobes (in particular, peptostreptococci).

The share of other (more than 40 species) microorganisms that inhabit the vaginal space of a woman normally accounts for only 3-5%.

/the most clinically significant microbial communities are indicated/

• A sharp decrease or disappearance of peroxide- and acid-forming lactobacilli (lactobacilli). As a result, an increase in the pH of the vaginal environment.
• Massive reproduction of strict (obligate) anaerobes: Peptostreptococcus spp., Mobiluncus spp., Bacteroides spp., Prevotella spp., etc.

These microorganisms belong to the normal vaginal microflora. But their excessive growth, against the background of a deficiency of lactobacilli, leads to a decrease in the content of acids in the vaginal contents and creates a favorable environment for the rapid development of opportunistic and pathogenic infections.

• Colonization of the vagina with gardnerella.
• An increase in the total concentration of bacteria in the vaginal discharge to 10 9 - 10 11 microorganisms in 1 ml (CFU / ml).

Representatives of the Doderlein flora

In the vaginal contents of various women, more than 10 types of unequal lactobacilli are isolated. They produce lactic acid (as a result of the destruction of glycogen accumulated by the vaginal epithelium), hydrogen peroxide, lysozyme, and stimulate local immunity.

By blocking the receptors of the cells of the surface epithelium, lactobacilli prevent the adhesion of pathogenic agents. Colonizing the mucous membrane, they participate in the formation of a protective ecological film and provide colonization resistance of the vaginal biotope.

The pronounced acidic environment created by lactobacilli suppresses the reproduction of acidophobic opportunistic and transient pathogenic microorganisms.

The second representatives of the useful flora of Doderlein also belong to acid-forming microorganisms. They play an important role in maintaining low pH values ​​of the vaginal environment, produce alcohols, lysozyme, bacteriocins, amino acids, vitamins, and stimulate the immune system.

propionic acid bacteria- useful representatives of anaerobes. Actively processing glycogen, they secrete acetic and propionic acids, inhibit the growth of opportunistic microflora.

Causes of bacterial vaginosis

The mechanisms of development of vaginal dysbiosis are still not entirely clear.

An important role in the pathogenesis of the disease is played by:

• Change in hormonal status.
• Changes in general and / or local immunity, a decrease in the body's resistance.
• Decompensated diabetes.
• Taking antibiotics, cytostatics, radiation therapy, ionizing radiation.

Risk factors for bacterial vaginosis:

- Puberty, menopause, pathology of pregnancy, postpartum, post-abortion period, menstrual disorders (amenorrhea, oligomenorrhea).
- Hypotrophy and atrophy of the vaginal mucosa.
- Violation of the sensitivity of the vaginal mucosa to sex hormones.
- Sexually transmitted infections.
- Inflammatory processes of the urogenital tract.
- Taking glucocorticosteroids, antibacterial, antiviral, chemotherapeutic drugs.
- Long-term, uncontrolled use of oral and intrauterine contraceptives.
- Foreign bodies in the vagina and uterus (tampons, IUDs, etc.)
- Cysts, polyps of the genital tract.
— Surgical gynecological operations.
- Violation of the hygiene of the genital organs.
- Inadequate use of douches, vaginal douches, deep washing.
- The use of condoms, uterine caps, diaphragms treated with spermicide (nonoxynol -9).
- Frequent change of sexual partners.
- Chronic stress.

Development of bacterial vaginosis

Under the influence of external and / or internal factors that disrupt the healthy balance of the vaginal microecosystem, the number of H 2 O 2 -producing pool of lactobacilli decreases, the production of lactic acid decreases, the pH of the vaginal contents increases.

The growth of the pool of strict anaerobes is increasing. The waste products of these bacteria decompose to volatile amines, with a characteristic smell of "rotten fish".

Hormonal imbalance "progesterone / estrogens" accelerates the proliferation (reproduction) of the vaginal epithelium. Activation of the receptors of these cells to bacteria stimulates the adhesion (adhesion) of strict anaerobes to the vaginal mucosa and the formation of "key" cells.

• "Key" cells are desquamated cells of the vaginal epithelium, covered with gram-negative bacilli (rod-shaped bacteria, not lactobacilli).

Abundant exfoliation of the "key" epithelium is accompanied by increased production of vaginal discharge up to 20 ml per day (at a rate of 2 ml).

Symptoms of bacterial vaginosis

1. Whitish-gray, creamy vaginal discharge, usually with a "fishy" smell of varying intensity. The unpleasant odor either disappears or intensifies after intercourse, menstruation, douching, washing.

It is the characteristic discharge that is the main complaint of patients with bacterial vaginosis. Liquid secretions can subsequently acquire a yellowish-greenish color, become sticky, thick, foamy.

2. Often patients feel discomfort in the external genital area, painful sexual contact (dyspareunia).

3. Very rarely there is itching and burning of the genital organs or painful urination (dysuria).

Objective clinical symptoms of bacterial vaginosis
Amsel criteria
1. Abundant, homogeneous whitish-gray discharge from the vagina.
2. "Key" cells in vaginal smears.
3. Acidity of vaginal content: pH>4.5.
4. Positive amino test.

The presence of 3 out of 4 possible signs confirms the diagnosis of bacterial vaginosis.

Diagnosis of bacterial vaginosis

1. Inspection of the walls of the vagina with a mirror.
In favor of bacvaginosis testify:
- The presence of abundant secretions (whites), evenly covering the vaginal mucosa.
- The usual pink color of the walls of the vagina no signs of inflammation.

2. Calposcopy.
Confirms the absence of inflammation of the vaginal mucosa.

3. Microscopy: bacterioscopic examination vaginal smears are the main, most accessible and reliable method for diagnosing bacterial vaginosis.

Microscopy of smears of patients with bacvaginosis reveals:
- Reduction or disappearance of lactobacilli (gram-positive rods of various sizes).
- Increased mixed non-lactobacillary microflora.
- "Key" cells. The edges of the "key" epithelial cells are uneven, indistinct due to the adherence of gram-variable rods and cocci, including Gardnerella vaginalis, Mobiluncus, etc., to them; it is often difficult to distinguish microorganisms from each other.
- In most cases: a small number of leukocytes.

Not characteristic of isolated bacterial vaginosis.

4. Determination of acidity (pH) of the vaginal secretion using indicators.

5. Aminotest.
When mixed on a glass slide of vaginal discharge from a patient with bacvaginosis with an equal amount of potassium hydroxide solution (solution KOH 10%), an unpleasant smell of rotten fish appears.

Additional methods for diagnosing bacterial vaginosis

They are used according to indications, in cases of frequent recurrence of the disease.

1. Cultural study.
It consists in determining the species and quantitative composition of the vaginal microflora: isolation and identification of Gardnerella v., other facultative and obligate anaerobes, lactobacilli (with a sharp decrease in their number

2. Molecular biological methods: PCR, etc.
Test systems detect specific fragments of DNA and/or RNA of microorganisms (A. vaginae, G. vaginalis, M. hominis and Ureaplasma spp., etc.), including difficult-to-cultivate bacteria.

Differential Diagnosis

The diagnosis of bacvaginosis requires the exclusion of urogenital microbial-viral sexually transmitted infections (gonococcal, trichomonas, chlamydial, and other STIs). It is also important to differentiate infections caused by opportunistic agents and fungi (genital mycoplasmas, facultative anaerobic and aerobic microorganisms, candida).

Degrees of bacterial vaginosis

/Microscopic characteristics of smears according to Mavzyutov A.R./

1 degree

It is characterized by a meager amount of any microbial, including lacto-flora in a vaginal smear.

Such a smear is not considered a pathology. Often it is due to excessive preparation of the patient for a visit to the gynecologist (deep washing with disinfectants), previous antibacterial treatment (taking broad-spectrum antibiotics) or intensive chemotherapy.

2 degree

Subcompensated bacterial vaginosis:- decrease in the number of lactobacilli;
— a commensurate increase in other microbial flora;
- the appearance in the smear of single (1-5) "key" cells.

3 degree

Clinical bacterial vaginosis:- almost complete absence of lactobacilli;
- the field of view is filled with "key" cells;
- the bacterial flora is represented by various (except for lactobacilli) cultures in various species combinations.

How to treat bacterial vaginosis

The first stage of treatment of the disease is carried out with antibacterial agents of the 5-nitroimidazole or clindamycin group, to which anaerobic bacteria and gardnerella are most highly sensitive.

• Metronidazole
  Trade names: Trichopolum, Metrogil, Flagyl, Klion
• Tinidazole
  Trade names: Fazizhin, Tiniba (500 mg)
• Ornidazole
  Trade names: Tiberal, Dazolik, Gyro, Ornisid, etc.
• Clindamycin
  Trade names: Dalacin, Clindamin

Vaginal tablets and suppositories for bacterial vaginosis:

In recent years, local combined vaginal agents with antibacterial, antifungal, anti-inflammatory effects have been considered a promising method for treating bacvaginosis:

• Polygynax
• Terzhinan
• Vagisept
• Vagiferon
• Elzhina

Apply: one suppository (tablet) in the vagina for 10 days.

The second stage of treatment is carried out after the complete eradication of anaerobic and conditionally pathogenic microflora. Restoration of the normocenosis of the vagina is carried out by local administration of biological preparations:

• Lactoginal
• Acylact
• Floragin Gel
• Laktonorm
• Lactobacterin
• Bifidumbacterin
• and etc.

The effectiveness of bottom biopreparations, unfortunately, is limited by the low survival rate of "foreign" strains of lactobacilli in the vagina.

To restore normal vaginal microflora, intravaginal agents are also recommended:

• Lactogel (lactic acid + glycogen)
• Multi-Gyn Actigel
• Vaginorm

They are used both for the treatment and prevention of bacterial vaginosis.

In cases of atrophic changes in the vaginal mucosa, local estrogens (estriol preparations) are used:

• Trioginal
• Orniona vaginal cream 1%

According to indications, antiallergic drugs and vitamins A, E, C are prescribed.

Recommended Antibacterial Treatments for Bacterial Vaginosis

Metronidazole 500mg tablets. 1 tablet 2 times a day, orally (by mouth).
Course of treatment: 7-10 days.

Tinidazole 2.0 g (4 tablets of 500 mg) at a time, by mouth orally, once a day.
Course of treatment: 3 days.

Given the local nature of the infection, many specialists prefer topical treatment for bacterial vaginosis. The best therapeutic effect was shown by intravaginal suppositories and gels with Metronidazole or Clindamycin.

3.1 Vaginal suppositories with Metronidazole 500 mg (Flagyl, vaginal suppositories)
Apply once a day, intravaginally, at night.
Course: 7-10 days.

3.2 Metrogyl (Metronidazole), gel 1%
Apply intravaginally at 5.0 g (one full applicator) 1 time per day, at night.
Course: 5 days.

3.3 Metronidazole gel 0.75%. Apply 5.0 g intravaginally (one full applicator) 1 time per day, at night.
Course: from 5 days to 2 weeks.

Dalacin (Clindamycin, Clindamycin), cream 2%
1 full applicator (5.0 g cream = 100 mg clindamycin) deeply intravaginally 1 time per day, at night.
Course: 7 days

Alternative Treatments for Bacterial Vaginosis

Metronidazole 2.0 g (8 tablets of 250 mg or 4 tablets of 500 mg) at a time, once, inside, orally.
Treatment result:
closest is good
remote - not good enough

Scheme 2A Tiberal (Ornidazole) 500 mg, 1 tablet orally 2 times a day.
Course: 5 days.

The effectiveness of the drugs Metronidazole and Clindamycin is approximately the same. But taking Clindamycin is less likely to cause unwanted side effects.

During treatment and within 24 hours after the end of taking Metronidazole it is forbidden to take alcohol.

Bacterial vaginosis during pregnancy - treatment features

Treatment of bacvaginosis in pregnant women requires an individual approach in the choice of dosages and therapeutic regimens. Taking oral antibiotics is possible only from the 2nd trimester of pregnancy under the strict control of laboratory diagnostics in a specialized medical facility.

1. Metronidazole, tablets 500 mg.
Take 1 tablet 2 times a day orally. Course of treatment: 7 days.

2. Metronidazole, tablets 250 mg.
Take 1 tablet 3 times a day orally. Course: 7 days.

3. Clindamycin 300 mg capsules.
Take 1 capsule orally 2 times a day. Course: 7 days.

Prognosis for bacterial vaginosis

The disease does not pose a direct threat to the life of the patient. Treatment takes place at home (there are no indications for hospitalization).

The control of the therapeutic effect is carried out 14 days after the end of treatment: examination by a gynecologist + repeated smear.

If the result is insufficient, the doctor chooses alternative drugs or methods.

Despite the "harmlessness" of the disease, it is important to carry out its timely treatment and prevention.

Possible complications of bacterial vaginosis:

- Spontaneous abortion (miscarriage).
- Pathology of pregnancy: intra-amniotic infection.
- Pathology of childbirth and the postpartum period: premature rupture of amniotic fluid, premature birth, endometritis and / or sepsis after caesarean section.
- The risk of having children with low body weight.
- The risk of developing infectious complications after gynecological operations or abortions.
- The risk of developing inflammatory diseases of the pelvic organs: peritonitis, abscesses of the pelvic organs after the introduction of intrauterine contraceptives, after invasive manipulations.
- The risk of developing dysplasia (neoplasia) of the cervix. Read in detail:.
- Increased susceptibility to sexually transmitted infections, including HIV, genital herpes.

Risks of recurrence of bacterial vaginosis

Frequent recurrence of bacvaginosis is observed in women with impaired immune and/or endocrine status. Such patients need advice:
– gynecologist-endocrinologist,
— endocrinologist,
- gastroenterologist.

Practice shows that prophylactic treatment of the sexual partner has little effect on the recurrence of episodes of bacvaginosis in the patient. Examination and treatment of a sexual partner is mandatory in the presence of clinical symptoms of balanoposthitis, urethritis or other urogenital diseases.

Alternative methods of treatment of bacterial vaginosis

Among the non-traditional methods of treating gynecological diseases, douching with solutions of medicinal herbs remains the "favorite" means of traditional healers.

In the case of bacterial vaginosis, such procedures are undesirable and even dangerous. They provoke the washing out of useful vaginal lactoflora, the introduction of pathogenic and opportunistic microorganisms into the cervical canal, allergic reactions and inflammation of the mucous membranes.

Permitted procedures:

Dissolve 1 teaspoon of Boric acid pharmaceutical powder (sold in bags) in 1 cup of boiling water. Cool down. With a sterile syringe, inject 100 ml of a freshly prepared tepid solution into the vagina. The procedure is carried out 1 time per day for a week.

Prepare a weakly concentrated (barely noticeable pinkish color) solution of potassium permanganate. Wash and douche once a day for a week.

Dilute 1 tablespoon of hydrogen peroxide solution for external use 3% (hydrogen peroxide 3%, sold in a pharmacy) in 500 ml of freshly boiled tepid water. Wash and douche once a day for a week.

Prevention of bacterial vaginosis

• Controlled intake of antibacterial and other drugs.
• Adequate diagnosis and therapy of gynecological (including age-related dyshormonal) diseases.

Thanks to the correct treatment of gynecological and endocrine pathology, the content of glycogen (the main nutritional component of lactobacilli) in the vaginal epithelium normalizes, normal vaginal microflora develops.

• Hygiene of the genitals.
• Hygiene of sexual life, fidelity to one partner.
• Giving up bad habits (smoking, etc.)
• Normalization of immune and neuroendocrine status.
• Physical activity: the fight against congestion in the pelvic area.

Save the article!

Bacterial vaginosis

general information

Bacterial vaginosis - an infectious non-inflammatory disease characterized by a change in the normal ecosystem and pH of the vagina in women. In particular, there is an imbalance of microorganisms that, under physiological conditions, colonize and protect the vaginal environment (the so-called saprophytic microflora).

The result is a polymicrobial infection that affects the vagina, in which various types of bacteria are involved, able to synergistically create suitable conditions for the development of others. Thus, there is a change in the microflora of the vagina with a decrease in the number lactobacilli(usually protective and responsible for maintaining the slightly acidic environment of the vagina) and the reproduction of pathogenic microorganisms.

Indication of bacterial vaginosis itching, intimate burning and increase (homogeneous grayish-white discharge, characterized by a bad smell), but in about half of the cases it is asymptomatic.

If ignored, the disease can cause gynecological complications, as well as promote sexual transmission of sexually transmitted diseases.

What is meant by bacterial vaginosis?

Bacterial vaginosis is one of the most common vaginal infections among women.

The most important aspect is that the disease is characterized by severe change in the vaginal ecosystem, i.e. various populations of microorganisms that usually inhabit this region of the body and acquire a state of mutual equilibrium ( flora or vaginal microbiota).

The most important bacteria in the vaginal ecosystem are lactobacilli(Dederlein rods), and like the organism itself, these protective microorganisms benefit from this symbiosis. The lactobacillus flora feeds on essentially the glycogen present in vaginal secretions and synthesizes lactic acid, helping to keep the vaginal environment slightly acidic, while pH around 3.8-4.5. This acidity is especially important for the body, as it inhibits the growth of other harmful pathogens that can cause infections.

Causes and risk factors

Usually, in women of reproductive age, lactobacilli (or Dederlein sticks) are the predominant components of the vaginal microflora. Colonization with these bacteria is usually protective as it maintains the vaginal pH at normal values ​​(between 3.8 and 4.2) and prevents overgrowth of pathogens. However, in the presence of situations that change the vaginal ecosystem, the sexual organ becomes vulnerable.

What are the causes of bacterial vaginosis?

The causes of bacterial vaginosis are still being studied and researched medically. The etiological picture is actually quite complex: the occurrence of the disease seems to depend on simultaneous interaction of various factors rather than from a single microorganism or factor.

In any case, certain circumstances create an imbalance in the vaginal flora, where microorganisms predominate, which, as a rule, should not be present or should be present only in limited quantities. All this affects the microflora of the vagina.

Thus, some microbes can find favorable conditions and multiply abnormally, becoming dangerous and causing bacterial vaginosis.

Microorganisms that play a leading role in pathogenesis include: Gardnerella vaginalis, Mobiluncus spp. and Prevotella spp..

Predisposing and/or aggravating factors

Any woman can get bacterial vaginosis, but certain activities and behaviors can greatly increase this risk.

- Unprotected intercourse and a large number of sexual partners.

Bacterial vaginosis is more common in sexually active women.

Failure to use condoms during intercourse is a possible cause of vaginosis. In particular, vaginal dysmicrobiosis may be associated with a period of greater frequency of unprotected intercourse. In fact, sperm cells raise the pH of the vagina to create a more favorable environment for sperm to live; however, this condition may encourage the growth of certain bacteria.

Frequent change of sexual partner is also considered an important risk factor for the disease.

- Other risk factors.

Other conditions that disrupt the normal balance of the bacterial flora of the vagina and predispose to the development of bacterial vaginosis:

• topical or systemic antibiotic therapy;
• use of intrauterine mechanical contraceptives, for example, spirals;
• intimate hygiene with too aggressive detergents or insufficient pH.

Factors such as psychophysical stress can also affect the immune system, thus predisposing to bacterial vaginosis.

When defining vaginal dysmicrobiosis, which sets the ideal conditions for an increase in pathogenic bacteria and genital infections, the patient's medical history and age also contribute, in particular, it has been noted that bacterial vaginosis is rarer in prepubertal women than in postmenopausal women. probably due to the lower number of relationships and sexual partners in these two age groups and the characteristic hormonal pattern that distinguishes them from the period of fertility.

Bacterial vaginosis in pregnancy

During pregnancy vitamin D deficiency, seems to play a role in the occurrence of vaginosis, and also correlates with , preeclampsia and the need to resort to caesarean section. Vitamin D is involved in the modulation of the immune system and the regulation of cell proliferation, so an adequate supply of the vitamin is essential for the health of the pregnant woman and the fetus. If the supply of a vitamin is insufficient, it is necessary to supplement it (after consulting a doctor) to reduce the risk of these gestational complications.

Symptoms and signs

Bacterial vaginosis is not always symptomatic (it can be asymptomatic in 50% of cases), but it is usually indicated by plentiful greyish-white, rather thin and foul-smelling vaginal discharge.

Some women with vaginosis compare bad smell secretions from smell fish and report it, especially after intercourse, soap use, or menstruation. This foul-smelling leucorrhea due to the production by some microbes of certain substances obtained as a result of the decomposition of amino acids, called aromatic amines (putrescine, cadaverine, tyramine).

In some cases, the presence of the disease may signal:

• itching in an intimate place;
• burning sensation when urinating;
• pain during intercourse.

Possible Complications

In most cases, bacterial vaginosis does not cause serious complications, but the characteristic increase in vaginal pH increases the risk of infection with various sexually transmitted diseases, such as and .

Bacterial vaginosis can also contribute to pelvic inflammatory disease (PID)) :

• endometritis;
• parametritis.

If not treated promptly and correctly, the condition can damage the tubes, increasing the risk of ectopic pregnancy and even infertility.

In addition, in the case of vaginosis during pregnancy and if not properly treated, there is a chance of preterm labor because the infection can spread to the amniotic membrane, causing early rupture. During pregnancy, there is a risk of developing fetal-placental infections and postpartum endometritis.

Diagnostics

Bacterial vaginosis is diagnosed when gynecological examination. The doctor examines the vagina and measures the pH level. In the case of bacterial vaginosis, the pH level is usually above 4.5.

During a gynecological examination, the vulva and vagina have a normal appearance, but there is a homogeneous milky-grayish leucorrhea adhering to the walls of the vaginal canal.

During the examination, a sample of vaginal secretions is also taken for microscopic examination to look for bacteria associated with bacterial vaginosis. When in contact with an alkaline substance such as potassium hydroxide (KOH), the sample releases a fishy odor suggestive of vaginosis.

Microscopic examination of a vaginal secretion sample reveals the classic " clue cells”, i.e. epithelial cells of the vagina, covered with numerous bacteria, which give the cells a granular appearance. Presence white blood cells(leukocytes) on microscopic glass indicates co-infection such as gonorrhea or chlamydia and requires test cultures. However, cultural studies on ( Gardnerella vaginalis) are weakly specific (this bacterium can be isolated from 50% of healthy women).

Diagnosis can also be confirmed:

• the Gram stain method (a relatively fast test used to detect the presence of bacteria);
• analysis of the ratio of lactobacilli and other bacteria (Nugent criteria).

But the Pap smear is unlikely to be useful, because it is not very sensitive to the diagnosis of bacterial vaginosis.

- Clinical criteria (Amsel criteria) for the diagnostic definition of bacterial vaginosis.

The diagnosis of the disease is established when 3 of the 4 following clinical criteria are met:

• copious discharge from the vagina of a grayish-white, homogeneous consistency (leukorrhea), evenly covering the walls of the vagina;
• vaginal pH >4.5;
• positive fishy odor test (10% KOH);
• presence on re-examination of cue cells (vaginal epithelial cells [at least 20% of epithelial cells]).

Treatment of bacterial vaginosis

Sometimes vaginosis spontaneously regresses, but in the presence of symptoms or complications, a specific therapeutic protocol is always indicated, established by a general practitioner or reference gynecologist.

The first drug of choice for the treatment of bacterial vaginosis is metronidazole(tablets of 500 mg 2 times a day for a week).

Intravaginal therapy using 2% clindamycin cream(applied every night for a week) or 0.75% metronidazole gel(applied 2 times a day for 5 days) is also effective.

Treatment with a single dose of 2 g of metronidazole usually gives good clinical results, but is characterized by an increased rate of recurrence of infection.

Topical treatments based on creams or gels are preferred for pregnant women because they are less likely to develop systemic side effects.

These drugs have the advantage of providing a quick response, but they should be combined with foods that can stimulate the proliferation of lactobacilli: in the presence of vaginosis, it is important to restore the normal ecosystem by taking probiotics. A diet high in fiber and low in simple sugars may also be beneficial. various sweets, candies and drinks with sugar.

Finally, it should be remembered that during treatment it is always important to avoid contact or sexual intercourse in order to reduce the risk of reinfection.

Attention! The topical drug clindamycin, used to treat bacterial vaginosis, reduces the effectiveness of latex condoms and diaphragms. Therefore, women using them cannot rely on these methods of contraception during therapy.

Forecast

The prognosis is favorable. Bacterial vaginosis usually clears up after a few days but often recurs. If it recurs often, you may need to take antibiotics for a long time.

Prevention

To prevent vaginosis and an imbalance in the vaginal bacterial flora, it is important to follow a few simple tips. First of all, it is important to take care of intimate hygiene.

An intimate cleanser should be selected so as not to damage the acid-base balance (pH level) of the vagina. Also, excessive vaginal washing, vaginal cleansing, intimate hygiene sprays, and overly harsh or perfumed soaps should be avoided.

Additionally, when washing intimate places, it is recommended to perform a movement starting from the vulva to the anus, and not vice versa; thus, the spread of fecal bacteria from the anal area to the vagina is prevented. After completing intimate hygiene procedures, dry the area well and gently. Finally, another important tip - avoid wearing synthetic and too tight underwear.

Specialty: Cardiologist, Therapist, Doctor of Functional Diagnostics.