Vaginosis and where is it located. Bacterial vaginosis: causes, symptoms and treatment. What bacteria contribute to the development 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.

Bacterial vaginosis(vaginal dysbacteriosis) is a clinical syndrome caused by the replacement of lactobacilli of the vaginal flora with opportunistic anaerobic microorganisms. Currently, bacterial vaginosis is not considered a sexually transmitted infection, but rather a vaginal dysbiosis.

However, bacterial vaginosis creates the prerequisites for the occurrence of infectious processes in the vagina, so it is considered together with inflammatory diseases of the genital organs. This is a fairly common infectious disease of the vagina, found in 21-33% of patients of reproductive age. Approximately half of them also have intestinal dysbiosis.

Vaginosis can be found not only in sexually mature women, but also in adolescents who do not live sexually. Causes can be poor hygiene and chronic diseases.

Symptoms of bacterial vaginosis

Bacterial vaginosis is much more common than thrush, but only a few women are aware of the existence of this disease.

Noticing vaginal discharge and itching, many women immediately "attribute" them to thrush, which they have heard a lot about from friends, on television and on the Internet, and begin treatment with antifungal drugs, which are completely ineffective for bacterial vaginosis.

The main symptoms of bacterial vaginosis are:

These symptoms can be a sign not only of bacterial vaginosis, but also of other diseases (for example, gonorrhea, trichomoniasis, candidiasis), therefore, an accurate diagnosis cannot be made only by the presence of symptoms. To clarify the cause of the disease, you must contact and take tests.

Treatment of bacterial vaginosis

Treatment of bacterial vaginosis is carried out in two stages.

At the first stage, the number of anaerobes is reduced, local and general immunity and endocrine status are corrected; on the second - the restoration of normal microbial biocenosis in the vagina by colonizing the vagina with lactic acid bacteria.

First stage

The first stage includes the following therapeutic measures:

Already in the middle of the first stage of treatment, women feel better, the amount of whiteness decreases, itching and burning disappear.

Additionally, at this stage of treatment, antihistamines (tavegil, suprastin, pipolfen) are prescribed and, if the patient is worried about pain, non-steroidal anti-inflammatory drugs (brufen, flugalin, voltaren) to suppress the production of prostaglandins that cause pain reactions.

A prerequisite for treatment is the exclusion of sexual, including orogenital, contacts, since sperm and saliva have an alkaline reaction, which negatively affects the results of treatment.

Second phase

The second stage of treatment - the restoration of the vaginal biocenosis - is carried out using biological preparations from lactic acid bacteria:

• lactobacterin;
• bifidumbacterin;
• acylact;
• zhlemik.

Conducting complex therapy allows you to get a good result in 93-95% of patients.

Relapse or exacerbation

Relapse or exacerbation often occurs against the background of genital (acute infections, exacerbations of chronic inflammatory processes) or extragenital diseases, as well as concomitant diseases (intestinal dysbacteriosis), leading to a decrease in general and local immunity and often proceeding against the background of endocrine pathology.

Often, an exacerbation occurs during menstruation, when the pH in the vagina rises significantly, the growth of microorganisms associated with bacterial vaginosis increases.

In order to avoid repeated relapses, there is a need to stimulate the mechanisms of immunological protection of the vaginal environment; This is especially true in terms of preparing for pregnancy. For this purpose, the Solcotrichovac vaccine is currently used, obtained from weakened lactobacilli (lactic acid bacilli) of patients who have recovered from trichomoniasis.

Such lactobacilli stimulate the production of antibodies in a woman's body. The production of antibodies against the background of vaccination with Solkotrikhovak contributes to the destruction of atypical forms of lactobacilli, Trichomonas and nonspecific pathogenic bacteria, promotes the growth of lactobacilli, restores normal microflora and normalizes the physiological pH value of the vaginal mucosa.

Vaccination with Solcotrichovac reduces the risk of recurrent infection and re-infection caused by Trichomonas and other pathogenic bacteria in 80% of patients with recurrent vaginal infections.

Vaccination is carried out three times at 0.5 ml with an interval between injections of 2 weeks, the fourth injection is made a year after the first injection of the vaccine. The vaccine is well tolerated and gives a stable positive effect with no relapses in 75% of patients in the future.

Solcotrikhovac is not recommended for use during pregnancy and lactation, since there are currently no data on clinical trials of the drug in this group of patients. When using Solcotrikhovac during the period of preparation for pregnancy, it is rational to make the last injection 2-3 months before the intended conception.

Causes of bacterial vaginosis

There are no specific causative agents of bacterial vaginosis. It is caused by polymicrobial complexes, among which there are gardnerella and mycoplasmas (opportunistic pathogens).

In bacterial vaginosis, microorganisms of the genus Lactobacillus (existing in the normal microflora of the vagina) are replaced by associations of various bacteria, including Gardnerella vaginalis, anaerobes (Bacteroides, Prevotella, Porphyromonas, Peptostreptococcus, Mobiluncus) and Mycoplasma hominis.

It was previously believed that the disease was caused by gardnerella based on the identification of the microorganism in women with bacterial vaginosis. However, it has been found that more than 50% of women without symptoms of the disease are colonized by gardnerella.

In addition to gardnerella, in the vaginal secretion of women with bacterial vaginosis, anaerobic bacteria are found in large numbers:

• bacteroids;
• peptococci;
• peptostreptococci.

Mobiluncus spp. has also been associated with bacterial vaginosis. and Mycoplasma honunis, but the exact role of these bacteria in the etiology of the disease is unknown. In the process of metabolism, gardnerella forms amino acids, from which, under the influence of anaerobes, volatile amines (putrescine, cadaverine, triethylamine) are formed. These amines are responsible for an unpleasant odor reminiscent of rotten fish.

Causes of bacterial vaginosis

Until the end, the causes of bacterial vaginosis have not been clarified.

Doctors can identify only a few factors that most often provoke the replacement of normal microorganisms by pathogens.

These include:

The household route of transmission of bacterial vaginosis has not been proven. But the disease can be "received" with a frequent change of sexual partners and sexual intercourse without barrier methods of contraception.

Complications of bacterial vaginosis

A large body of evidence has accumulated to suggest that bacterial vaginosis is a risk factor for adverse pregnancy outcomes.

In addition, the following complications are associated with bacterial vaginosis:

The presence in the vagina of women with bacterial vaginosis of large amounts of various bacteria increases the likelihood of these microorganisms entering the urethra of men during sexual intercourse, followed by infection of the urethra and the development of nonspecific urethritis.

The disease may also play a role in the development of chronic prostatitis of unknown origin in men. It is commonly referred to as abacterial chronic prostatitis, emphasizing the absence of any infection that could be the cause of the chronic inflammatory process.

Recently, using the polymerase chain reaction (PCR) method, a connection was found between such prostatitis and bacteria involved in the development of bacterial vaginosis.

With further study of this problem, however, there will certainly be difficulties associated with the characteristics of chronic prostatitis in this patient, the anamnesis of his sexual life and the often intermittent nature of bacterial vaginosis.

Bacterial vaginosis and pregnancy

Bacterial vaginosis occurs in 15-20% of pregnant women and is a serious risk factor for the development of infectious complications. A pronounced relationship of the disease with premature termination of pregnancy and untimely rupture of the amniotic membranes was noted. The risk of developing these complications compared with healthy pregnant women in patients with bacterial vaginosis increases by 2.6 times.

It has been established that many bacteria detected in bacterial vaginosis (Fusobacterium, G. vaginalis, Peptostreptococcus, Micoplasma hominis, etc.) can lead to increased synthesis of prostaglandins, the development of preterm labor and untimely rupture of the amniotic membranes.

Moreover, an increase in the pH of the vaginal environment above 4.5, which is characteristic of the disease, in itself can lead to premature rupture of the amniotic membranes. Approximately 10% of preterm women give birth to gardnerella and other microorganisms from the amniotic fluid, while normally the amniotic fluid is sterile.

It is noted that women who gave birth at a gestational age of less than 37 weeks have a high probability of having bacterial vaginosis. Chorioamnionitis, detected in 1% of pregnant women, is a severe complication that threatens the life of the mother and fetus. The development of chorioamnionitis associated with bacterial vaginosis in the mother can subsequently lead to premature termination of pregnancy or premature rupture of amniotic fluid.

The presence of chorioamnionitis in patients is histologically confirmed by the identification of relevant pathogenic microorganisms in the placental tissue, which can also be the cause of preterm labor.

When studying amniotic fluid in patients, G. vaginalis, Fusobacterium nucleatum, Prevotella melaninogenica, ureaplasma, Candida albicans, E. coli are also most often detected.

There is also a connection between the presence of the disease and the development of postpartum endometritis, including after caesarean section. The microbial flora detected in the endometrium in patients with endometritis is often similar to that in bacterial vaginosis. This is especially true for anaerobic microorganisms.

In the normal course of the postpartum period on the 3rd day, the number of anaerobes decreases in a logarithmic progression. However, this does not happen in patients, since the contamination of the vagina with anaerobic bacteria in them many times exceeds normal values ​​long before childbirth.

It has been established that the risk of developing postpartum endometritis in pregnant women with BV is several times higher than in healthy women. Mixed microflora can lead to the development of other inflammatory complications, such as breast abscess, inflammation of the umbilical wound, etc.

Thus, patients with bacterial vaginosis are at increased risk of developing:

• inflammatory diseases of the pelvic organs;
• premature termination of pregnancy;
• untimely discharge of amniotic fluid;
• occurrence of chorioamnionitis;
• postpartum and postoperative endometritis.

A high concentration of virulent microorganisms in the vagina of patients is a risk factor for the penetration of bacteria into the higher parts of the genitourinary system.

Classification of bacterial vaginosis

There are several types of bacterial vaginosis that vary in severity:

In addition, along the course of bacterial vaginosis, there are:

• spicy;
• torpid;
• erased (asymptomatic).

Diagnosis of bacterial vaginosis

A diagnosis of bacterial vaginosis is certain if a woman has at least three of the following four features:

In order to detect gardnerella and anaerobic microorganisms in a vaginal discharge smear for the diagnosis of bacterial vaginosis, staining with different colors is used according to special methods. Tissue culture is rarely used for this.

In recent years, patients with bacterial vaginosis are increasingly being given a sensitive and highly specific oligonucleotide test. Special reagent kits are available for this test.

Bacterial vaginosis in men

Bacterial vaginosis, by definition, is a dysbiosis of the vagina in women. Therefore, it is wrong to make such a diagnosis for men. The carriage of transient microflora is the most common option for them.

According to different authors, 50-70% of male sexual partners of women with bacterial vaginosis have colonization of the urethra by G.vaginalis and other pathogens. At the same time, the man is absolutely not worried about anything, and carriage is detected only when examined by high-precision laboratory methods.

These men are carriers of transient microflora and, with frequent casual sexual contacts, they are, as it were, the main reservoir and distributors of transient microorganisms among women.

The male urethra, unlike a healthy female vagina, has an alkaline environment, which is a favorable factor for the habitat and reproduction of transient vaginal microflora. However, not all of the strong half are susceptible to infection.

Men who have previously had venereal diseases, patients with chronic prostatitis and abusing the use of local antiseptics for the prevention of genital infections are at the greatest risk. Often, with bacterial inflammation of the head and inner leaf of the foreskin of the penis, representatives of the woman's vaginal flora are found.

Prognosis for bacterial vaginosis

Very often the disease acquires a chronic character, it can constantly recur. Gynecologists attribute this to the fact that antibiotics only kill pathogenic microflora, but at the same time do not provide a full restoration of beneficial microflora, which is necessary.

Therefore, it is very important after the completed course of therapy, for another 10 days to use drugs, which include bifidobacteria:

• Bificol;
• Bifidumbacterin;
• Acylact;
• Lactobacterin.

Bacterial vaginosis is not a serious disease if it is treated on time and correctly. It is very important to adhere to the rules of hygiene, for the purpose of prevention, be constantly observed by a gynecologist, especially after a long course of antibiotic treatment.

If you notice an unpleasant smell of discharge in yourself, you must definitely pass all the necessary smears. If bacterial vaginosis is not treated, it can cause the development of various diseases, it is especially dangerous during pregnancy and can affect the baby.

Prevention of bacterial vaginosis

In order to prevent bacterial vaginosis, a woman needs:

• avoid promiscuity;
• carefully observe personal hygiene;
• visit a gynecologist at least once a year.

Questions and answers on the topic "Bacterial vaginosis"

Question:Hello. The husband has already been treated, because. in my femoflor analysis, they found gardnerella vaginalis and streptococcus. Now I am being treated. I was prescribed a 10 day treatment for ciprolet, pimafucin, bion3 and gynoflor e suppositories. I drank it for 6 days, but it so happened that I caught a cold, had a temperature and stopped treatment for 2 days. There was itching, discharge, but no smell. Your gynecologist does not have the opportunity to ask, on vacation. Is treatment worth it?

Answer: Hello! Probably, the husband was undergoing treatment for another reason. Gardnerella is a symptom of bacterial vaginosis. This is not an inflammatory process of the vagina against the background of a violation of the vaginal microflora. Therefore, there must be indications for the treatment of a sexual partner. However, if there are reasons for joint treatment, then it is carried out simultaneously. Continue the treatment prescribed by the gynecologist. But in parallel, interferon preparations with antioxidants C, E (Viferon) and local sanitation of the vagina (tantum rose, epigen intima) can also be used. A control examination is carried out 4 weeks after the end of treatment.

Question:Hello. Periodically, signs of bacterial vaginosis appear. There are many leukocytes in the smear. According to the results of the analysis for the biogenocenosis of the vagina, there are very few lactobacteria - from 31 to 53 percent. There are many enterobacteria - 43-58 percent. Everything else is normal (analysis for 23 groups of microorganisms). The analysis for sexual infections is negative (IFA and PCR method). Candida and gardnerella were never found. Torment periodically (once every few months) curdled discharge without an unpleasant odor, severe itching and burning. The doctor constantly prescribes pimafucin or something else antifungal, although candida is never found in smears. The rest of the time, the discharge is pale greenish, not abundant, and does not torment you in any way. How to kill these opportunistic bacteria (enterobacteria) and increase lactobacilli in the vagina? How to prevent the normal content of lactobacilli? I have erosion and a polyp in the uterine cavity. The sexual partner is permanent. As I understand it, first you need to restore the microflora in the vagina, then cauterize the erosion and remove the polyp.

Answer: Hello! With so many white blood cells in a smear, antibiotics are usually prescribed both to drink and in the vagina. It is possible to connect more and metronidazole. After treatment, pass a control smear, and if it is good, then then remove the polyp and treat erosion.

Question:Hello. My husband and I are planning a pregnancy. In this regard, I turned to a gynecologist to advise on tests for preparation. Of the complaints, there were only not very abundant discharges and there is a slight erosion, which so far they said not to touch. A microscopic examination of the smear was carried out, as a result of which vaginosis was found (increased levels of leukocytes, coccobacilli, blastospores and g.vaginalis). The gynecologist prescribed terzhinan and vagilak. After the treatment, menstruation began, and after them an unbearable itching, burning sensation and copious discharge appeared. Has addressed to other doctor. Appointed or nominated research femoflora. She was also diagnosed with cervical erosion, bacterial vaginosis and urogenital vaginosis. (Lactobacilli below normal, g.vaginalis + prevotella bivia + porphyromonas spp. 10 in 6.8, candida spp 10 in 5 and ureaplasma 10 in 5.6). Ornidazole, neo-penotran (itching gone), then femilex, bifiform, unidox solutab and fluconazole were prescribed. Plus treatment for her husband. A smear in a month. Everything was done as prescribed by the doctor. Menstruation passed, after them 2 days everything was perfect. Now the discharge began again, dense, white, cheesy. There is no itch. Is it normal to have such discharge again? Or is it a process? Should I wait a month before a smear?

Answer: Hello! Yes, just wait for the next analysis. Now you can conduct a second course to restore the vaginal microflora. These are immunocorrectors (Viferon) and probiotics (Acipol). Since you are planning a pregnancy, you should donate blood for the extended TORCH complex and homocysteine. It is also advisable to visit an endocrinologist and discuss the intake of iodine and folic acid preparations. Check the condition of your teeth.

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

The development of gardnerellosis affects women of reproductive age. Therefore, the cause of the development of the disease is often associated with sexual transmission. The physiological environment of the vagina is acidic. It is with such a microflora that pathogenic pathogens, having penetrated the genital canals, cannot have a negative impact on health.

The natural environment of the vagina is represented by lactobacilli - short thick rods that dissolve glycogen. Cells are not visible visually - their number can only be determined using a microscope. To maintain a stable pH level, the concentration of lactobacilli must be at least 98%. Bacterial vaginosis is one of the polymicrobial diseases.

The spontaneous reduction in vaginal acidity and lactobacilli is not caused by a single pathogen, but by a combination of them. The definition of "bacterial vaginosis" is explained by the peculiarities of the development of the disease. The pathogenic process proceeds with the participation of a large number of aerobic and anaerobic microflora. A feature of the pathology is the absence of leukocytes (cells that are elevated only during inflammation).

How does it develop

The replacement of the physiological environment of the vagina with pathogenic microorganisms occurs under the influence of a wide range of adverse factors. They are associated with previous interventions on the organs of the reproductive system, lifestyle, and nutritional habits.

From the moment the microflora of the vagina changes (after gardnerella gets into it) and until the first signs appear, it can take from several days to 2-3 months and even six months. In extremely rare cases, the incubation period took more than 1 year. In this matter, the determining factor is the state of the woman's immunity. The weaker the protective properties of the body, the more pronounced the symptoms of the pathology and the earlier it manifests itself.

Risk factors

With a high degree of probability, bacterial vaginosis develops in women for whom the following are relevant:

1. Frequent stress, psycho-emotional state problems
2. Recent surgical interventions or instrumental diagnostic procedures on the organs of the urogenital tract
3. Cystic neoplasms in the organs of the genitourinary system (regardless of the number, size, location, cause of development)
4. The use of drugs containing nonoxynol-9 (for example, Patentex oval, Nonoxynol)
5. Condition after recent childbirth (especially burdened)
6. Wearing underwear made from synthetic fabrics
7. The formation of the menstrual cycle (the period of hormonal changes negatively affects the condition of the vaginal mucosa, making it vulnerable)
8. Uncontrolled or unreasonably long-term use of hormonal, anti-inflammatory, antifungal drugs. This is especially true for the use of antibiotics.
9. Transferred radiation or chemotherapy (for tumor diseases)
10. Poor nutrition, obsessive diets
11. Using low quality detergents

The risk group for the development of gardnerellosis includes women who douche excessively often, do not perform hygiene procedures, and supercool. Latex intolerance, hypersensitivity to lubricants, spermicidal creams adversely affect the condition of the vaginal mucosa.

Symptoms

The main signs of the development of bacterial vaginosis:

1. Vaginal discharge. They are characterized by a sharp fishy smell, green-yellow hue, abundance (their number is 20 times higher than the norm). The consistency is thick, sticky, foamy. Secretion increases after intercourse, douching, menstruation.
2. Severe pain during intercourse, which prompts to stop it. Discomfort has an acute, burning character, persists for a certain time after intimacy.
3. Unpleasant sensations during urination (stinging, irritation inside the urethra).
4. Insomnia, discomfort in the lower abdomen during menstruation, not related to the cycle.
5. A sharp, putrid-fishy smell from urine, a change in its shade.

During the examination, the color of the mucous membranes of the vagina characteristic signs of the inflammatory process (edema, redness) is not observed. The body temperature remains within the normal range, and there are no complaints about the typical signs of intoxication (chills, weakness). Therefore, not suspecting the presence of the disease, the woman does not go to the doctor or does it late.

The reasons

Experts identify the following causes of bacterial vaginosis:

• Change in hormonal background. It is observed during puberty, pregnancy, menopause, after an abortion.
• Intestinal dysbacteriosis (violation of its natural microflora). It develops as a result of inflammation of the large or small intestine, intoxication. Violation of the microflora contributes to the observance of an exhausting diet, starvation.
• Atrophic changes in the mucous membrane of the vagina (occur mainly during menopause).
• Constant use during menstruation only tampons. They contribute to intravaginal stagnation of blood, create a favorable condition for inflammation.
• The presence of diabetes mellitus decompensated form. Pathology contributes to regular irritation of the vaginal mucosa.

The risk of developing gardnerellosis increases if a woman is sexually promiscuous, uses an intrauterine device for an excessively long time. The source of inflammation present in the body increases the likelihood of an infectious pathology.

Degrees

In gynecology, a certain classification of bacterial vaginosis is used. According to this, according to the severity of symptomatic manifestations, the disease is divided into compensated, subcompensated and clinically pronounced type.

Compensated

It is characterized by the absence of lactobacilli in the vagina, which creates the risk of replacing the natural microflora with pathogens. Such indicators do not apply to a pathological condition. Often they are associated with overly thorough hygienic treatment of the genital tract before a visit to the gynecologist. In particular, if a woman used antiseptic preparations or highly concentrated detergents to cleanse the intimate area. Also, bacterial vaginosis of this type occurs with oncological neoplasms - due to radiation and chemotherapy.

Subcompensated

It is characterized by a decrease in the number of lactobacilli, which indicates a violation of the natural microflora of the vagina. Edema and redness of the mucous membrane of the genital tract is not observed. Therefore, changes can only be detected in the laboratory. Leukocytes - 15-20 in the field of view, which refers to a moderate degree. There is an increase in other microbial flora.

Against the background of leukocytosis, the so-called "key" cells appear. Their number is up to 5 in the field of view. The main symptoms of this degree of vaginal candidiasis are itching, soreness during intimacy. Additionally, there is an increase in vaginal discharge, the appearance of an unpleasant odor from them.

clinically pronounced

It is characterized by the complete absence of lactobacilli and the presence of anaerobes. When examining a smear under a microscope, "key" cells occupy the entire field of view of the laboratory assistant. The main manifestations of the condition are a large amount of vaginal discharge, itching inside the genital tract. Pathogenic secretion, the volume of which increases after intercourse, glues the walls of the vagina.

Features in pregnant women

Bacterial vaginosis is one of the diseases, given the danger to the fetus, gynecologists recommend undergoing a detailed preliminary study. The main consequences of the disease for the child and the expectant mother:

1. Intrauterine fetal injury. The consequences of exposure to pathogenic flora on a child are anomalies in his development. There is an incorrect laying of organs - in particular, the heart, neural tube, musculoskeletal system, skull bones.
2. Miscarriage. The infectious process stimulates uterine spasms, which contributes to the rejection of the fetal egg. The first signs of the condition are pain in the lower abdomen, the appearance of bloody discharge from the genital tract.
3. Freezing fetus. Bacterial vaginosis is a pathological process that has an extremely negative effect on the developing fetus. The infection contributes to disruption of the blood supply to the child, causes its intoxication, which leads to intrauterine death. The first signs of the condition are dark spotting from the genital tract, an increase in body temperature to high numbers. During a gynecological examination, a discrepancy between the size of the uterus and the gestational age is established.

Often, bacterial vaginosis can cause polyhydramnios or oligohydramnios, isthmic-cervical insufficiency, placental insufficiency. Also, complications of gardnerellosis are premature onset of labor or infection of the child during its passage through the birth canal. In 2% of cases, the presence of bacterial vaginosis is associated with the development of preeclampsia during pregnancy and premature rupture of the membranes.

If the pathology occurs during pregnancy, the condition becomes more complicated due to problems with the selection of treatment. The difficulty lies in the fact that antibiotics and other anti-inflammatory drugs are contraindicated during gestation.

Possible Complications

Bacterial vaginosis can cause urethritis, cystitis, colpitis, cervicitis, and in the most severe cases, endometritis. Listed inflammation of the bladder, urethra, vagina, cervical canal, the inner layer of the uterus. Due to chronic and often latent inflammation of these organs, infertility develops, but the risk of ectopic pregnancy is also high. Violation of the vaginal environment that occurs during gestation increases the risk of serious complications.

Which doctor to contact

Bacterial vaginosis is treated by a gynecologist. But the determining factor is the root cause of the pathology. If the disease is caused by diabetes mellitus, an additional appeal to the endocrinologist will be required. With the relationship of bacterial vaginosis with genital infections, it is necessary to contact a venereologist. If gardnerellosis is a consequence of intestinal dysbacteriosis, you need to consult a gastroenterologist.

Diagnostics

Initially, the doctor conducts a survey and examination of the patient. From the anamnesis, she learns about the presence of problems with digestion, the change of sexual partner, the use of new intimate products. An obstetric history is also of no small importance - you need to inform the doctor if complications occurred during pregnancy or labor. During the examination on the gynecological chair, no signs of inflammation are detected.

The purpose of the examination is to exclude the presence of diseases with similar symptoms, and then to determine the degree of organ damage and the presence of complications. Similar signs in the course of ureaplasmosis, thrush (vaginal candidiasis), trichomoniasis. Examination of the patient makes it easy to differentiate infectious pathology. Standard set of diagnostic procedures:

1. Microscopic examination of a smear from the vagina. The most revealing type of examination. Detects all changes in the vaginal microflora.
2. Blood test for glucose, general clinical and biochemical parameters.
3. Urinalysis is general (a large number of leukocytes are detected in the sample).
4. Bacteriological examination of urine (sowing).
5. PCR diagnostics (detection of the causative agent of pathology - gardnerella).

Already on the basis of the results of the smear, it becomes clear that the microflora of the vagina is disturbed. It is established that lactic acid bacteria are almost absent, the level of leukocytes corresponds to the norm or slightly exceeds it, the pH of the secretions is more than 4.5. In 95% of cases, the listed types of examination are enough to clarify the clinical picture.

Additional types of diagnostics depend on the characteristics of the underlying cause of bacterial vaginosis. It is possible that an ultrasound of the abdominal cavity and small pelvis will be required. Diagnosis is carried out on the eve of treatment, 2 weeks after its start, and 1 month after its completion.

Treatment

Gardnerellosis is not treated in an operative way - a fairly comprehensive, but conservative approach. In addition to eliminating the infectious agent, you need to restore the pH of the vagina. In the long term recovery is of no small importance strengthening the body's immune abilities.

To stop bacterial vaginosis, the patient is prescribed:

1. Use of an anti-inflammatory drug (of the options listed below, 1 or 2 is prescribed). Metronidazole (Trichopol) 1 tab. 2 p. per day, the duration of the therapeutic course is 10 days. Clindamycin (150 mg) - 1 tab. 4 p. per day. The duration of treatment is 1-1.5 weeks. Tiberal (500 mg) - 1 tab. twice a day, up to 5 days in a row.
2. The use of vaginal suppositories with anti-inflammatory, antifungal, antibacterial action. These include Vagisept, Terzhinan, Vagiferon. Assign the introduction of 1 candle 1 p. per day, after careful intimate hygiene. The therapeutic course is 10 days.
3. Restoration of intestinal microflora. Assign Linex (2 capsules 3 rubles a day, 3 weeks in a row) or Hilak Forte (1 teaspoon per 100 ml of water 3 rubles a day, 3 weeks).
4. Vitamin therapy. Group B drugs are administered individually or in the form of complexes (these include Neurobex, Neurorubin). The therapeutic course, subject to intramuscular administration of drugs, is 10 days.
5. Diet food. Refusal to eat sweets, sour, spicy, salty, smoked foods, dishes. Alcohol and caffeine are prohibited. If bacterial vaginosis is caused by intestinal dysbacteriosis, undesirable foods include fried and fatty foods, legumes.

After stopping pathogenic microorganisms, the normalization of the vaginal microflora is shown through the use of drugs such as Laktonorm, Bifidumbacterin, Acilact. Vaginally administered Vaginorm, Laktogel or their analogues.

At the time of treatment, it is necessary to observe sexual rest. It is equally important to carry out hygiene measures in full (especially after going to the toilet and during menstruation). It should be remembered that bacterial vaginitis can infect a man during intimacy, cause complications for the sexual health of a partner. Therefore, he needs to simultaneously undergo treatment by contacting a urologist.

Forecast

If you eliminate not only gardnerellosis, but also the cause of its development, the prospect of restoring health is favorable. When the pathology takes a protracted course, the reproductive function of a woman is threatened. In general, the disease lends itself well to elimination, but on condition that the treatment is made by a doctor, and the patient follows all his recommendations.

Prevention

To avoid the development of bacterial vaginosis, the following recommendations will help:

• The use of vitamins (especially during the off-season)
• Cold protection
• Maintaining a decent sex life
• Restriction from stress
• Exclusion of the use of abortion as the optimal method of birth control
• Prevention of constipation - refusal to eat dry food, fractional nutrition
• Selection of an alternative method of contraception (for latex intolerance)
• Timely correction of the state of intestinal microflora
• Full implementation of hygiene measures
• Normalization of blood glucose levels, regular visits to the endocrinologist (with a hereditary predisposition to diabetes)
• A healthy approach to the use of intimate products
• Refusal of the experimental attitude to the selection of hygiene products

Excessive use of tampons during menstruation causes irritation of the vaginal mucosa. Therefore, it is recommended to periodically apply gaskets. It is equally important to timely eliminate diseases of the organs of the urogenital tract, preventing the transition of pathologies into a chronic form. You should also adequately approach the issue of douching, taking medications.

Bacterial vaginosis is a gynecological pathology of polymorphic origin, which is eliminated without surgery. Even with a conservative approach, treatment should be comprehensive - in addition to medication, include diet, hygiene, and sexual rest. Pathology causes complications only in case of prolonged neglect of one's health. In particular, when a woman does not visit a gynecologist for a long time and does not know about the presence of the disease. If the pathology is caused by endocrine or gastrointestinal disorders, you will need to visit doctors of these profiles.

Video: How to cure bacterial vaginosis

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

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

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

What is bacterial vaginosis

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

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

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

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

Causes of vaginosis

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

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

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

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

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

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

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

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

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

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

Types of bacterial vaginosis

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

• asymptomatic;
• monosymptomatic;
• polysymptomatic.

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

• sharp;
• chronic;
• recurrent.

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

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

Bacterial vaginosis during pregnancy

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

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

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

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

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

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

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

Forecast

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

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

Diagnostics

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

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

Bacterial vaginosis in men

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

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

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

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

How is bacterial vaginosis transmitted?

Bacterial vaginosis is not a sexually transmitted disease!

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

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

When should you see a doctor?

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

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

What is the treatment for bacterial vaginosis?

Bacterial vaginosis in women is treated in two main steps:

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

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

Medicines for bacterial vaginosis

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

Eubiotics

Consider a treatment regimen with effective eubiotics:

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

Candles from bacterial vaginosis

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

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

Treatment regimen for bacterial vaginosis

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

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

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

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

How to treat vaginosis at home

Consider several ways to treat the disease at home:

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

Folk remedies for bacterial vaginosis

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

Consider the most effective recipes:

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

Prevention

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

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

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

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

Bacterial vaginosis (or gardnerellosis) is a common disease of women, and women of young, reproductive age. The disease develops against the background of an imbalance of bacteria in the vagina.

The vagina of a healthy woman is a balanced environment where more than 1000 types of microorganisms coexist, each of which has its own role; they form a normal vaginal microflora. A special role in it is played by lactobacilli, or lactobacilli (Lactobacillus spp.), As well as bifidobacteria and propionic acid bacteria.

Lactobacilli (they are normal - almost 90%) - lactic acid bacteria, perform a primary task - produce hydrogen peroxide, creating an acidic environment in the vagina (pH 3.8 - 4.5). It is this environment that restrains and balances the aggressive activity of other (anaerobic) representatives living in the vagina.

The “trigger” of bacterial vaginosis is always a decrease in the number of beneficial lactobacilli in the vaginal environment (or their disappearance altogether), which reduces the concentration of lactic acid in the vagina. Conditionally pathogenic (not dangerous under normal conditions) anaerobic microorganisms are activated, primarily gardnerella (Gardnerella vaginalis), which occupy the vacant niche. Their number increases by 5-6 times. Gardnerella colonize the vagina in the form of colonies, and the volatile compounds they form - amines - have a characteristic smell (rotten fish).

Symptoms of bacterial vaginosis in women

Bacterial vaginosis has 2 variants of the course: with characteristic symptoms of the disease and without symptoms. Women pay attention to abundant, sometimes foaming, vaginal discharge, reminiscent of the smell of rotten fish. The smell can intensify before and after menstruation, during intercourse.

During the course of the disease, the viscosity and color of the discharge may change. So, at the beginning of garnerellosis, the symptoms are reduced to the appearance of leucorrhoea of ​​a liquid-mucous consistency, with a protracted course they become thick and viscous. The color of the discharge may become yellowish-green. As a rule, the process is delayed for 2-3 years.

Often the only sign of gardnerellosis in women is the appearance of gray-whitish discharge (whites) from the genital tract. Pays attention to the smell of whites, similar to the smell of rotten fish. But quite often, bacterial vaginosis does not manifest itself at all. Approximately 45% of cases of bacterial vaginosis in women are asymptomatic, and this complicates the process of diagnosis.

Other symptoms can be added to the discharge: pain and discomfort in the genital area that occurs during intercourse - dyspareunia, itching and burning in the vulva.

With these symptoms, bacterial vaginosis is easy to suspect. However, approximately half of the patients are asymptomatic with positive laboratory findings for bacterial vaginosis and no clinical symptoms. In this case, the idea of ​​a possible bacterial vaginosis is suggested by frequent and severe inflammatory diseases and regularly occurring relapses after the treatment.

Why are the symptoms of gardnerellosis in men often erased?

The "strong half" receives the bacterium Gardnerella vaginalis, the causative agent of gardnerellosis, from an infected woman during intercourse. But, unlike a woman, gardnerellosis in a man is more often observed in a carrier format. This is explained by the features of the urogenital tract, in the lower sections of which gardnerella gets and where it lingers. During this period, without knowing it (since there are no symptoms), a man is dangerous for his partners, because he infects them through sexual contact.

If, against the background of Gardnerella vaginalis, inflammation develops in the genitourinary system of a man, the symptoms become brighter: urethritis (painful urination, pain and burning in the urethra), and then inflammation of the glans penis (swelling, pain, discharge with an unpleasant odor). Symptoms of gardnerellosis in a man in the form of non-specific inflammation help the doctor quickly diagnose and prescribe treatment.

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

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

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

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

Causes of bacterial vaginosis

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

Symptoms of bacterial vaginosis

In acute form, women may complain of:

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

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

Diagnosis of bacterial vaginosis

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

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

Establish a diagnosis based on:

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

Treatment of bacterial vaginosis

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

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

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

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

Stage one - antibiotic therapy

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

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

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

Stage two - restoration of microflora

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

Prevention

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

Which doctor should I contact for treatment?