How is bacterial vaginosis treated? Bacterial vaginosis. Causes, modern diagnostics, effective treatment and prevention of the disease. Causes of bacterial vaginosis

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

Symptoms of bacterial vaginosis

Bacterial vaginosis often causes the following symptoms:

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

You are more likely to have bacterial vaginosis if:

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

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

When a smear indicates bacterial vaginosis

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

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

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

Gardnerella and bacterial vaginosis

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

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

Why is bacterial vaginosis dangerous?

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

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

Bacterial vaginosis during pregnancy can lead to premature delivery.

How to treat bacterial vaginosis?

If bacterial vaginosis appears for the first time:

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

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

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

Probiotics in the treatment of bacterial vaginosis

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

The following probiotics are used for bacterial vaginosis:

• Gynoflor vaginal tablets
• Vagilak: tablets for oral administration

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

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

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

Treatment of bacterial vaginosis during pregnancy

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

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

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

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

Does my husband (sexual partner) need treatment?

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

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

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

Causes and symptoms of bacterial vaginosis in women, as well as methods of treatment with drugs and folk remedies.

Intimate health problems in women are always an acute issue. Even bacterial vaginosis - a disease, at first glance, not a terrible one - can cause a lot of problems and troubles. It is dangerous with complications, and therefore requires mandatory treatment.

What is bacterial vaginosis

The microflora of the vagina of a healthy woman is 95-98% composed of lactobacilli, which maintain a constant acidity. Normally, it is 3.8-4.5. This level of acidity does not allow pathogenic bacteria and microbes to multiply, which make up the remaining 2-5%.

As a result of various adverse factors, the number of lactobacilli may decrease. This entails a decrease in acidity and the growth of pathogenic microorganisms. This is the nature of the development of bacterial vaginosis.

This disease is not inflammatory, it is a violation of the qualitative and quantitative composition of the vaginal microflora. It is a purely female disease, does not apply to sexual infections. It occurs in 80% of women of reproductive age.

Causes of the disease

The causes leading to the development of the disease are divided into internal and external.

Internal:

• hormonal system disorders;
• intestinal dysbacteriosis;
• endocrine diseases;
• damage to the inner lining of the vagina;
• weakening of the immune system;
• polyps and cysts in the vagina.

External:

• long-term antibiotic treatment;
• douching abuse;
• neglect of personal hygiene;
• consequences of radiation therapy;
• long-term use of an intrauterine device, a contraceptive diaphragm, a ring;
• taking oral contraceptives for a long time without interruption.

Symptoms of the disease

Bacterial vaginosis is often asymptomatic, especially in the early stages of the disease. Sometimes, with minor violations of the microflora, the body itself is able to adjust the deviations.

A distinctive symptom of the disease is vaginal discharge - leucorrhoea. Usually they are white or with a grayish tinge, liquid with an unpleasant stale smell. Their number may be different, but in any case exceeds the amount of daily allocations.

If the symptoms of the disease do not decrease in manifestations against the background of the treatment received, chronic bacterial vaginosis occurs. In this case, periods of exacerbations are replaced by remission, and the disease becomes protracted.

In chronic bacterial vaginosis, the leucorrhea becomes more dense, sticky, with a green or yellow tint. In addition, the following symptoms are noted:

• itching, burning;
• discomfort during sex;
• pain when urinating.

Does the disease affect conception and pregnancy

Bacterial vaginosis is not sexually transmitted. The diagnosis is not a ban on sexual relations, except in cases where the disease becomes acute. In such situations, having sex can bring discomfort and discomfort.

This gynecological disease is not an obstacle to conception, but it poses a danger to future pregnancy. Pathogenic microflora from the vagina can enter the uterus and damage the fetus. The so-called intrauterine infection will provoke growth retardation, pathology in the development of the fetus.

Bacterial vaginosis increases the risk of postpartum complications, especially if the birth ended with surgery. The likelihood of such consequences is extremely low, but during pregnancy, this disease requires mandatory monitoring and treatment.

Diagnosis of the disease

An experienced gynecologist, even during examination, can put bacterial vaginosis under suspicion. Abundant discharge along the walls of the vagina in the absence of an inflammatory process, an unpleasant smell of mucus indicate this disease. To clarify the diagnosis, the following tests are performed:

1. Measuring the level of acidity using an indicator strip.
2. Reaction with potassium hydroxide solution, which enhances the smell of stale fish inherent in the secretions.
3. Smear microscopy.

It is smear microscopy that shows which bacteria and microbes predominate in the vaginal microflora, how much the number of lactobacilli has changed. This analysis allows you to establish the presence of "key" cells - elements of the exfoliated vaginal epithelium. Their presence, even in small quantities, indicates the severity of the disease and the duration of its course.

Based on laboratory tests, examination, complaints and questioning, the patient is prescribed treatment.

Treatment of a gynecological disease

In each case, the treatment regimen and dosage of drugs are individual.

Important! Self-treatment and incorrectly selected doses lead to the development of drug resistance in bacteria and the complication of further treatment.

Treatment is aimed at sanitizing the vagina from pathogenic microorganisms and increasing the number of lactobacilli. Consists of two stages.

At the first stage, antibacterial drugs are prescribed that suppress the reproduction of pathogenic microbes and bacteria. In most cases, this is . They have an advantage over tablets, as they are injected directly into the vagina and do not have side effects on the organs of the digestive system. At the second stage, probiotics with lactobacilli are prescribed to quickly restore the normal microflora of the vagina.

To relieve itching and burning, antihistamines are prescribed ( Zodak, Tsetrin). To restore the correct acidity of the vagina - lactic acid preparations ( Femilex).

Folk remedies for bacterial vaginosis

In the early stages of the disease, with mild symptoms, you can use folk remedies. These include douching and baths with decoctions of herbs. Such treatment will require perseverance and patience, since the minimum course is 2-3 weeks.

To obtain the effect of the procedure, you need to repeat 2-3 times a day. All decoctions are prepared in the same way: 2 tbsp. l. herbal collection, pour 1 liter of hot water and let it brew for 5-6 hours. For one douching procedure, 1 tbsp. (200 ml) ready-made broth. You can use the following herbs:

• oak root, geranium, chamomile, violet;
• marshmallow root, St. John's wort, calendula, dandelion and blueberry leaves,.

These recipes can be used for sitz baths. For this, 2 tbsp. the finished broth is dissolved in 10 liters of warm water. The duration of the procedure is 15-20 minutes.

Disease prevention

Bacterial vaginosis is a common disease. Compliance with simple rules will allow, if not to avoid this disease, then at least reduce the manifestation of unpleasant symptoms. For prevention, you should:

• observe personal hygiene;
• treat sexual infections in time;
• rational use of antibiotics;
• correctly use hormonal contraceptives;
• do not abuse douching;
• regularly observed in the antenatal clinic.

Many women at least once in their lives have to face the diagnosis of "bacvaginosis". What's this? This is the name given to a specific type of vaginal inflammation caused by an overabundance of bacteria. By themselves, microorganisms do not pose a danger; they always live in the vagina and perform useful functions. However, the excess of their normal amount leads to a violation of the natural balance of microflora, and then to bacterial vaginosis.

Most often, this pathology is detected, although an imbalance can be diagnosed in everyone. The causes of the violation are still not known to science; only certain ones can be distinguished - for example, unprotected intercourse or frequent douching. Certain medications can also cause bacterial vaginosis.

Symptoms

In women of all ages, the disease manifests itself in the same way. Contact your gynecologist if you are concerned about:

• watery grey, white or vaginal;
• unpleasant from the vagina;
• itching in the groin;
• burning sensation during urination.

In some cases, bacterial vaginosis is asymptomatic.

When to See a Doctor

Sign up for a consultation at a polyclinic or medical center if:

• Vaginal discharge looks new or unusual, smells bad, or is accompanied by fever. A gynecologist will help identify the cause and diagnose the disease by signs and symptoms.
• You have treated vaginal infections before, but this time the discharge has a different color and consistency.
• You have had sexual relations with several partners or have recently changed partners. Sometimes the symptoms of sexually transmitted diseases are similar to those of bacterial vaginosis.
• You tried to treat a yeast infection yourself with over-the-counter medications, but the result was bacterial vaginosis that won't go away.

The reasons

The inflammatory process in the vagina begins as a result of the overgrowth of several types of bacteria that live in the female body. In a normal state of microflora, beneficial lactobacilli outnumber "harmful" microorganisms (anaerobes). But if there are more anaerobes, the natural balance is disturbed and leads to a disease called "bacvaginosis". What is it an accident or a pattern generated by non-compliance with personal hygiene? Unfortunately, medicine is not yet able to give an unambiguous answer to this question.

Risk factors

There are circumstances that increase the risk of developing pathology. These include:

• Frequent change of sexual partners or relationship with a new sexual partner. Doctors do not fully understand the relationship between sexual activity and bacterial vaginosis, but the disease is more often diagnosed in women who have entered into a relationship with a new man. Representatives of non-traditional sexual orientation are at even greater risk.
• Douching. The practice of washing the vagina with water or detergent (douching) upsets the natural balance of the vagina. This can lead to the growth of anaerobic bacteria, which, in turn, threatens the development of pathology. Since the vagina is self-cleansing, douching is not necessary.
• The lack of lactobacilli as an individual feature of the body. Sometimes perfectly healthy women who do not change sexual partners and do not douche are found to have bacvaginosis. What kind of misfortune is this and why does it develop, it would seem, from scratch? In fact, there are times when a woman's vagina is naturally unable to produce enough lactobacilli. The lack of "good" microorganisms eventually leads to the appearance of unpleasant symptoms.

Complications

Usually this inflammatory process does not entail complications. In rare cases, there are:

• premature birth. Bacvaginosis during pregnancy can lead to premature delivery and the birth of a child with low weight and height.
• Infectious diseases, sexually transmitted. If a woman does not take any measures to alleviate her condition, her body becomes more vulnerable to the list includes HIV, herpes simplex virus, chlamydia and gonorrhea. If the patient has HIV, it increases the risk of passing the virus to a partner.
• Risk of infection after surgery. Untreated disease increases the risk of postoperative infection after procedures such as removal of the uterus or expansion and curettage of the uterine cavity.
• Inflammatory diseases of the pelvic organs. Bacvaginosis, the causes of which have remained a mystery, in some cases causes inflammatory processes in the small pelvis (as a rule, the uterus and fallopian tubes suffer), which, in turn, can lead to infertility.

Diagnostics

To make an accurate diagnosis, the doctor:

• Ask questions about your medical history. The specialist will ask if you have had a vaginal infection or sexually transmitted disease before.
• During this examination, the doctor examines the vagina for signs of infection and places two fingers inside while pressing on the abdomen with the other hand to check if the pelvic organs are healthy.
• Take a sample of vaginal discharge for analysis (smear). This procedure is performed to detect an excess of anaerobic bacteria in the microflora of the vagina. The specialist will examine the discharge under a microscope, looking for "clue cells" - vaginal cells covered with rod-shaped microbes.
• Check the pH level in the vagina. The acidity of the vagina is checked by placing a special test strip inside. If the pH reaches 4.5 or higher, the doctor diagnoses bacterial vaginosis (photo).

Treatment

Use only those medicines that your gynecologist has prescribed for you. For the treatment of the inflammatory process in the vagina is usually used:

• Metronidazole. This medicine is convenient in that it is produced in tablets - you can just drink the tablets with water. It is also available as a topical gel, a small amount of which is placed in the vagina. To avoid side effects from taking the pills (they can manifest as indigestion, abdominal pain or nausea), avoid drinking alcohol during therapy. It is also advisable to refrain from drinking alcohol during the day after the completion of the course of treatment.
• Clindamycin. This remedy is available in the form of a vaginal cream. It should be borne in mind that this drug has a destructive effect on latex condoms - both during treatment and for at least three days after the end of therapy.
• Tinidazole. This drug is presented in the form of tablets and has properties similar to those of metronidazole, the most common medication used to treat bacterial vaginosis. What does it mean? Follow the instructions for use and remember that you should also not drink alcohol during the course of tinidazole.

If the sexual partner of an infected patient is a man, he usually does not require treatment. Things are different with representatives of non-traditional sexual orientation; they are advised to undergo diagnostic examinations and, if inflammation is detected, begin a course of therapy. Timely treatment is of particular importance for pregnant women, as bacterial vaginosis can lead to premature birth.

Take medications or use a cream or gel strictly for the period prescribed by your gynecologist, even if the symptoms disappear sooner. Premature termination of therapy may increase the risk of relapse.

relapse

Even if you learned exactly from the doctor how to treat bacterial vaginosis and strictly followed his recommendations, the disease can recur after a period of three months to a year. Research is currently underway to prevent recurrent vaginal inflammation. Be sure to consult a doctor if the symptoms of the infection reappear; you may be given an additional course of metronidazole.

There is a scientifically unsubstantiated but widespread belief that eating foods rich in lactobacilli helps restore natural balance. Proponents of this point of view suggest that women suffering from relapses of bacterial vaginosis add more natural yogurt and other products containing probiotics to their daily diet. Although this assumption may have a rational basis, scientists cannot yet give an unequivocal answer to the question of the usefulness of changes in the menu.

Prevention

It is better not to treat, but to prevent bacvaginosis. Reviews of special intimate hygiene products will help you make the right choice - get a mild non-perfumed liquid soap and tampons or pads without fragrances.

It is not recommended to resort to douching, since the vagina does not need special cleaning - just take a bath or a familiar shower. Frequent douching upsets the balance of the microflora in the vagina and increases the risk of developing infectious diseases. In addition, the deliberate "cleansing" of the vagina will not help to calm the inflammatory process that has already begun.

Avoid contracting sexually transmitted infections. Use male latex condoms, limit the number of sexual partners, or temporarily abstain from sexual activity to minimize the risk of contracting a sexually transmitted disease.

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.

Bacterial vaginosis is a non-inflammatory disease of the vagina associated with changes in its microflora. This condition is extremely widespread among women of childbearing age (20-45 years), its occurrence in this group reaches 80%. That is, out of ten women, 8 suffer from bacterial vaginosis at least once in their lives. The disease does not pose a danger to the patient herself, but may adversely affect her reproductive function. Bacvaginosis often causes miscarriages, intrauterine infection of the fetus, complications after childbirth, abortions and invasive interventions on the genitals. How the disease is transmitted and how to get rid of it, read on.

How does bacterial vaginosis develop?

Human existence is inseparable from the activities of various microorganisms. Those of them that in the process of evolution have adapted to productive cooperation with people are called normal microflora / biocenosis. Its composition is permanent: some microorganisms are found only on the skin, others - in the oral cavity, in the intestines. In their habitat, they perform the most important functions: they protect the host body from pathogenic bacteria, produce vitamins, and stimulate the immune response.

Normally, the vagina is inhabited by lactobacilli - short thick sticks. They break down glycogen, which is rich in vaginal epithelial cells with the formation of lactic acid. Thus, in the lower genital tract of a woman, an acidic environment is constantly maintained, which prevents the fixation and growth of pathogenic microflora. To maintain normal conditions and the protective function of the vagina, a large number of lactobacilli are needed, so their share in its biocenosis is 95-98%.

Due to various reasons listed below, lactic acid bacilli are displaced and replaced by other microorganisms. This situation facilitates the colonization of the vagina by pathogenic microorganisms - the causative agents of sexually transmitted infections, but in most cases there is a change to nonspecific microflora. It includes bacteria that live on the skin of the perineum, perianal folds, in the lower urethra. They freely occupy a new habitat, multiply intensively, but cannot perform the functions of normal microflora. Their enzyme system differs from that of lactobacilli and does not break down glycogen to form lactic acid.

Nonspecific microflora causes a number of disorders in the metabolic and immune processes of the vagina as a whole. The level of production of protective immunoglobulin A decreases, which prevents pathogenic agents from attaching to the vaginal epithelium. Epithelial cells partially adsorb opportunistic bacteria on their surface and exfoliate intensively, which is associated with the appearance of secretions in bacterial vaginosis. Lactobacilli are replaced mainly by anaerobes - bacteria that function without oxygen. Some of their metabolic products - volatile fatty acids and amino acids - are broken down in the vagina into volatile amines, which have a characteristic fishy odor.

These changes lead to a shift in vaginal pH from acidic to alkaline. This entails progressive changes in the protein, carbohydrate, mineral and lipid metabolism of epithelial cells. Their production and mucus production increase, which is clinically manifested as abundant discharge - the main symptom of bacterial vaginosis. It should be noted that there is no inflammatory reaction in the walls of the vagina and all changes are only functional.

What causes disease?

Bacterial vaginosis does not belong to sexual infections and does not have a single pathogen, so it is also called nonspecific vaginosis. The root cause is a change in the vaginal environment, which entails disturbances in the microbiocenosis. The microflora that replaces lactobacilli can be very different and is most often represented by associations of opportunistic bacteria. Among them there are:

• bacteroids;
• peptococci;
• peptostreptococci;
• megaspheres;
• leptotrichous;
• atopobium;
• gardnerella;

Their growth, as a rule, is excessive and the number of bacteria in the vaginal secretion reaches 10 10 per 1 ml. However, comfortable conditions for their reproduction arise only after the influence of certain factors of the external or internal environment of the body.

The main causes of bacterial vaginosis are divided into 2 large groups:

Internal (endogenous):

1. hormonal imbalance with a predominance of progesterone;
2. atrophy of the vaginal mucosa;
3. intestinal dysbiosis;
4. immune disorders in the body.

External (exogenous):

1. long-term antibiotic treatment;
2. drug immunosuppression - taking cytostatics, glucocorticoids;
3. radiation therapy of tumors;
4. foreign objects in the vagina (hygienic tampons, pessary, contraceptive diaphragm, ring);
5. use of spermicides, frequent douching;
6. non-compliance with the rules of personal hygiene.

All of these factors in one way or another disrupt the normal functioning of the vaginal mucosa or cause the death of a large number of lactobacilli. Thus, a niche is vacated for opportunistic microflora and it immediately occupies it.

Bacterial vaginosis during pregnancy among the main causes is a change in the hormonal status of a woman: for the normal bearing of a child, high doses of progesterone are required, which reduces the glycogen content in epithelial cells. The lack of a nutrient substrate for lactobacilli leads to alkalization of the vaginal environment and the reproduction of nonspecific microflora. In addition, progesterone reduces the activity of the immune defense, which facilitates the growth of bacterial colonies.

How does bacterial vaginosis manifest itself?

Despite the fact that the disease does not apply to sexual infections, often its occurrence is associated with sexual intercourse, especially when changing partners. Signs of bacterial vaginosis in women develop on average one day after intercourse if it occurred without a condom. If the cause of the disease was the intake of antibiotics and other drugs, a change in the hormonal background (climax), then the symptoms of bacterial vaginosis develop regardless of sexual activity.

Acute vaginosis manifests itself:

• secretions from the genital tract: they have a grayish-white color, a homogeneous consistency, an unpleasant "fishy smell". Their number can be different, as a rule, they become more abundant after menstruation, intercourse, the use of irritating detergents;
• pain during intercourse;
• discomfort, itching and burning in the genitals. These signs are usually mild or absent;
• rarely, a woman has pain, pain when urinating, a stomach ache in the suprapubic region.

Chronic bacterial vaginosis is a continuous course of the disease for more than 2 months, despite ongoing treatment. As a rule, it is combined with hormonal imbalance and atrophy of the vaginal mucosa.

Diagnostics

The diagnosis is established by a gynecologist after collecting the patient's history, studying her complaints, examining her on the gynecological chair and obtaining laboratory data. In favor of bacterial vaginosis they say:

• age - sexually active women of reproductive age are most often ill;
• relationship with a change of partner, treatment of other diseases, surgery;
• moderate or mild severity of clinical signs of the disease.

On examination, the doctor evaluates the condition of the vagina, cervix, and external genitalia. With nonspecific changes, the mucous membrane is pink, not inflamed, unevenly covered with secretions. In acute bacvaginosis, they are white-gray, with an unpleasant odor. If the disease has passed into the chronic stage and lasts for several years, then the discharge changes its color to yellowish-green, becomes thicker, viscous, resembles cottage cheese or has a frothy appearance. During the examination, the gynecologist measures the pH of the vagina with an indicator strip: with bacterial vaginosis, its value is above 6.

There is a simple but informative test for the rapid diagnosis of bacterial vaginosis. The doctor places a small amount of secretions on a glass slide and mixes it with a 10% solution of caustic potassium. With a positive reaction, the unpleasant odor intensifies and resembles rotten fish.

Laboratory diagnosis of bacterial vaginosis consists of microscopy of stained smears from the vagina. Key cells are found in them - epithelial cells of the mucous membrane with microbial bodies adhered to their surface. The cell acquires a granular appearance, its boundaries become fuzzy, dotted. Also, under microscopy, a sharp decrease in the number of lactobacilli is established, up to complete disappearance from the population. Instead, nonspecific microflora is found: single cocci, streptococci, small rods.

Bacteriological culture of secretions is carried out in rare cases when it is necessary to accurately determine the composition of the altered microflora. The PCR method searches for the most common pathogens of sexual infections (mycoplasma,), as they often join the opportunistic microflora.

How does the disease affect conception and pregnancy?

Since bacterial vaginosis is a pathology of women of childbearing age, many of them are concerned about the question: is it possible to get pregnant with a similar diagnosis? A change in the microflora of the vagina does not entail inflammatory changes in the genital tract, therefore, it does not pose a problem for conceiving a child. Sperm normally has an alkaline environment and when it enters the vagina, with a changed pH upwards, the spermatozoa are in comfortable conditions for them.

What is the danger of bacterial vaginosis in this case? Nonspecific microflora often penetrates the pregnant uterus and affects the developing child. This condition is called intrauterine infection of the fetus and entails consequences in the form of a lack of body weight, its developmental delay. In some cases, the infection leads to spontaneous miscarriage, premature rupture of amniotic fluid, and the birth of a premature baby. With bacvaginosis, the risk of sepsis and purulent complications in parturient women increases, especially after cesarean section.

Treatment

Treatment of bacterial vaginosis is carried out by a gynecologist, if necessary, the patient is additionally observed by an endocrinologist and a gastroenterologist. Hospitalization for this disease is not required, since it does not disturb the woman's well-being, does not threaten her life and is not contagious to others. The therapy is aimed at sanitizing the vagina from opportunistic microflora, colonizing it with lactobacilli and correcting the provoking factors of the disease. Acute bacterial vaginosis recurs in 35-50% of women in the first six months after one-stage treatment, so it must be carried out in stages, observing the timing of each stage.

Initially, a woman is prescribed antibiotics: they have a detrimental effect on non-specific bacteria and cleanse the vaginal mucosa from them. The drugs of choice are Metronidazole, Tinidazole, Clindamycin, as they are active against anaerobes. Local use of antibiotics is preferable to avoid systemic side effects, but in some cases the gynecologist is forced to resort to tablet forms. The treatment regimen is selected individually:

• Metronidazole in the form of a 0.75% gel is injected into the vagina once a day for 5 days;
• cream with 2% content of Clindamycin is injected into the vagina 1 time per day for 7 days;
• Tinidazole 2.0 in the form of tablets is taken orally 1 time per day for 3 days;
• suppositories with Clindamycin 100 mg are injected into the vagina 1 time per day for 3 days;
• Metronidazole 2.0 tablets is taken orally once.

In pregnant women with bacterial vaginosis, the use of antibiotics is possible starting from the second trimester. They are prescribed in the form of tablets, the course of treatment lasts no more than 7 days.

For the duration of antibiotic therapy and the day after its completion, it is necessary to exclude alcohol intake, even in minimal doses. The drugs disrupt the metabolism of ethyl alcohol in the body, due to which the accumulation of toxic metabolites occurs and severe intoxication develops. In its course, it resembles a severe hangover: a woman experiences severe weakness, limbs tremble, blood pressure rises, a severe throbbing headache occurs, excruciating nausea and vomiting develop.

Clindamycin cream contains fat and may damage condoms or latex contraceptive membranes. All local forms of drugs are administered immediately before bedtime to prevent them from running down the walls of the vagina.

In case of intolerance to antibiotics or the presence of contraindications to their use, the first stage of treatment is carried out with local antiseptics:

• Hexicon 1 suppository is administered 2 times a day for 7-10 days;
• Miramistin in the form of a solution irrigates the vagina once a day for 7 days.

The preparations used in the second stage of treatment contain lactobacilli and create favorable conditions for the restoration of the vaginal microflora. They are used 2-3 days after the completion of antibiotic therapy:

• Atsilakt 1 suppository 2 times a day is injected into the vagina for 5-10 days;
• Bifiliz 5 doses are taken orally 2 times a day for 5-10 days.

Lactobacilli, which make up up to 98% of the biocenosis of the intimate zone, can normally exist only under certain conditions, for example, at a pH of 3.8 to 4.5. In order to maintain this pH level, it is necessary to use products with lactic acid.

Among the means of this group, Biofam stands out. It contains in its composition lactic acid, which maintains the necessary conditions for the existence of lactobacilli, and glycogen - for their successful nutrition and reproduction. The most important component of Biofam is also thyme oil, which, due to the content of thymol and carvacrol in its composition, has a pronounced antiseptic effect on 120 strains of microorganisms, including Candida. Thyme oil prevents pathogenic microflora from adhering to the surface of the vaginal epithelium and creating biofilms, which reduces the likelihood of recurrence of bacterial vaginosis.

Antifungal suppositories are usually not prescribed. The need for them arises if a fungal infection joins the conditionally pathogenic microflora. In this case, clotrimazole suppositories are prescribed 1 time per day intravaginally for 6 days.

Self-treatment at home is not recommended, since an incorrectly selected dose of the drug or the duration of the course leads to the development of resistance in bacteria. In the future, it will be extremely difficult to cure such an infection and there will be a high risk of its chronic course. How to treat bacterial vaginosis in each case is best determined only by a specialist - a gynecologist.

How to prevent?

Despite the negative answer to the question “is bacterial vaginosis transmitted sexually”, the influence of changing sexual partners and unprotected sex on the development of the disease is clearly seen. Therefore, the main prevention is the use of barrier contraception - a condom, which can be supplemented with local antiseptics. Douching with Miramistin should be carried out no later than 2 hours after sexual intercourse. In addition, preventive measures include the timely treatment of chronic diseases, the use of antibiotics strictly according to the doctor's prescription, and the correction of hormonal disorders.