Cytogram of bacterial vaginosis on the background of inflammation. Bacterial vaginosis, causes, symptoms, treatment. Treatment regimen for bacterial vaginosis

Bacterial vaginosis is a pathological condition in which the normal composition of the microflora of the female vagina is disturbed, both in terms of its quantity and quality. According to statistics, vaginosis is diagnosed in more than 15% of all women aged 17 to 45 years. Moreover, the problem does not always have a vivid clinical picture, and sometimes it is simply impossible to notice violations without the help of a doctor.

Vaginosis in women

When a woman notices the first signs of vaginosis, often the disease is already fully progressing, and the normal microflora of the vagina has already undergone numerous pathological changes. It is important to know that in the case of vaginosis, a timely visit to the gynecologist does not always help to get rid of the disease quickly. Therapy and its duration depend on many factors, including the stage of the disease, the age of the patient and the presence of chronic concomitant diseases.

The normal microflora of the vagina is a unique environment in which various types of fungi and bacteria continuously grow, develop and die. The vital activity of these microorganisms is controlled by several systems of the woman's body, including hormonal and immune systems. If this control is violated, the composition of the microflora, therefore, changes.

In women, vaginosis can occur in different ways. Often the clinical picture is blurred, there may be no symptoms of vaginosis at all, or vice versa, abundant fetid discharge, burning and discomfort during intercourse may disturb.

A pathological condition in which the normal composition of the vaginal microflora is disturbed is diagnosed in approximately every 4-5 women who bear a fetus. This fact is due to a significant decrease in the functioning of the immune system.

Vaginosis during pregnancy is treated comprehensively. Most often, medications with metronidazole are prescribed and in most cases they are recommended in the form of suppositories or a special gel, which is administered using a convenient syringe. The course of therapy is on average 6-8 days. Also, for the treatment of bacterial vaginosis during late pregnancy, doctors advise using Metrogyl, Ornidazole and Trichopolum. Up to 22 weeks of pregnancy, drugs with metronidazole in the composition are prescribed extremely rarely.

In addition to the antimicrobial treatment of vaginosis, agents with lactobacilli are recommended, which have a restorative effect on the vaginal microflora. Therapy during the period of gestation should be prescribed only to attending gynecologists.

Vaginosis in men: is it possible?

In relation to men, the diagnosis in the form of bacterial vaginosis is incorrect, because this, in fact, is a violation of the balance of the vaginal microflora. Vaginosis in men as a statement is sometimes used in practice, especially if the representative of the stronger sex received an infection that appeared in a partner against the background of an imbalance in the vaginal microflora.

Treatment of the partners of a woman diagnosed with bacterial vaginosis is not mandatory.

Risk factors

Among the existing risk factors for the development of bacterial vaginosis, it is worth highlighting:

the use of intrauterine devices for a long period of time, oral contraceptives;
gynecological diseases of an inflammatory nature in history;
uncontrolled intake of antibacterial drugs;
background pathological processes on the mucous membrane of the cervix;
operations in the pelvic area;
several abortions in history;
menstrual disorders of various nature.

The level of significance of the transmission of bacterial vaginosis through sexual intercourse has not been determined today, but one thing can be said for sure - bacterial vaginosis is not a sexually transmitted disease.

Of course, during intimacy, the pathogenic microflora that lives in the vagina can be transmitted to a partner. But, for example, the same Gardnerella vaginalis cannot cause vaginosis in a healthy woman, because this microbe is often an integral part of the normal vaginal microflora.

But, despite all the above data, protected sex plays an important role in the emergence and development of vaginosis. And the point here is not infection, but the fact that the constant change of partner contributes to the imbalance of the vaginal microflora.

Causes of vaginosis

Among the main and most significant causes of vaginosis, one should single out hormonal failure, deterioration of the immune system, and taking certain medications. The cause of vaginosis is not the presence of pathogens, but a change in the ratio of pathogens that provoke the appearance of vaginosis, and lactobacilli. Bacterial vaginosis is often referred to as vaginal dysbiosis.

It is worth considering each of the causes of vaginosis in more detail.

When diagnosing most of the gynecological diseases and those diseases that are associated with the endocrine system, there is a violation of the hormonal background. Hormonal imbalance leads to disorders associated with the renewal of the epithelium in the vagina. But in order to eliminate the cause of vaginosis, in this case, a comprehensive and thorough diagnosis is needed under the strict guidance of a competent specialist.
If the immune system fails, an imbalance occurs in the microflora of the vagina. The activity of the process of producing secretory antibodies and immune cells decreases.
If the bacterial composition of the gastrointestinal tract (GIT) changes, then this fact also affects changes in the vaginal microflora. Therefore, intestinal dysbacteriosis can cause vaginosis.
The development of vaginosis can be affected by taking antibacterial drugs, because the effect of these drugs on certain types of bacteria in particular is not selective. So, for example, in the treatment of pneumonia, antibiotics can also destroy bacteria in the gastrointestinal tract, as well as in the vagina.

The risks of vaginosis increase in cases where a woman does not adhere to the basic rules of personal hygiene, often douches, is constantly washed away with antiseptic solutions, is promiscuous, has some malformations of the reproductive system, and often uses tampons during menstruation. Also, the risks are high after surgical interventions on the organs of the genitourinary system.

Bacterial vaginosis: symptoms

The whole clinical picture is ambiguous, and if one patient has discharge, itching, and burning, then the other does not have any symptoms at all. Signs of vaginosis depend on numerous factors, so it is wrong to make a diagnosis based on symptoms on your own.

If we consider bacterial vaginosis, then the symptoms are primarily associated with discharge. They may have an unpleasant smell, a whitish-grayish tint. Sometimes they go abundantly, and in some cases they appear extremely rarely and almost imperceptibly.

According to statistics, discharge with vaginosis appears on average in an amount of up to 20 ml in 24 hours. When the condition becomes chronic and can be traced in a woman for 2-4 years, the mucus secreted from the genital tract may become more specific - become thick, frothy, with a greenish tint.

The amount of discharge in a woman with vaginosis can be different, and this depends on numerous nuances, including age, the presence of concomitant diseases and the level of activity in the sexual sphere. Also, the discharge may be different in its consistency and volume, depending on the day of the menstrual cycle.

Sometimes a woman with vaginosis may complain to the doctor about pain during intercourse or urination. Often, the discharge is accompanied by itching.

If a woman seeks help from a competent specialist in the medical field, then with vaginosis, the inflammatory process on the vaginal mucosa is most often not traced. Even with colposcopy, tissue swelling and redness are not observed, although more than 30% of all patients are diagnosed with pathological changes in the cervix, and more precisely in its vaginal part. It can be erosion, and scars.

Also, adhesion of the labia minora can be added to the description of the clinical picture, which is caused by copious discharge from the vagina. All signs of vaginosis are: discharge, itching, burning, discomfort during intercourse and/or emptying of the bladder.

Diagnosis of vaginosis

The microbiocenosis of the vagina undergoes changes in bacterial vaginosis. The number of lactobacilli decreases, in the microflora of the vagina, bacteroids, mycoplasmas, and gardnerella begin to predominate.

Determine violations in the vaginal microflora due to the results of laboratory tests, gynecological examination on the chair and taking into account the patient's complaints. Identifying bacterial vaginosis is not difficult for a competent doctor. On a gynecological examination, discharge of a mucopurulent nature is traced, and there is no inflammation of the mucosa.

If the attending physician detects additional diseases, then, most likely, consultations of different specialists will be needed. It can be a venereologist, and a mycologist, and an endocrinologist. Perhaps ultrasound diagnostics of the small pelvis, a biochemical blood test, hormone tests, etc. will be prescribed.

It is also important to know that during the diagnosis of the patient, the doctor must differentiate vaginosis from trichomoniasis, nonspecific vaginitis and gonorrhea. It is necessary to accurately diagnose, therefore, at the slightest doubt, the specialist will prescribe a set of additional diagnostic manipulations.

If vaginosis is suspected, the doctor will make a smear for microscopic examination without fail. The effectiveness of this diagnosis is extremely high. Confirming vaginosis, if present, is not difficult.

A bacteriological laboratory test is ideal if a doctor suspects an infectious lesion associated with bacterial vaginosis. An amino test and determination of the acidity level of the vaginal secretion may also be recommended. Analyzes for vaginosis are extremely important, because without their results it is impossible to accurately determine the problem and prescribe an adequate effective solution to it.

If a woman suspects vaginosis, then you should immediately go to the gynecologist. Unfortunately, the symptoms of such an imbalance in the vaginal microflora are nonspecific, so the signs can be confused with other diseases, including those of an infectious nature.

Vaginosis: treatment

Therapy for bacterial vaginosis is carried out in stages. Therefore, all causes of the development of imbalances in the balance of the vaginal microflora are initially eliminated. Perhaps they will stimulate the immune system, correct the hormonal background, etc. Next, the stage of using antibacterial agents and restoring the balance of the vaginal microflora is carried out. But the patient does not always need treatment for bacterial vaginosis. Sometimes the doctor can make a bias towards expectant management, especially if the woman does not experience any discomfort and does not speak of pronounced symptoms of vaginosis.

Preventive therapy for vaginosis is necessary before abdominal surgery or invasive gynecological procedures.

Combination therapy for vaginosis may be:

Tablets with metronidazole for 5-7 days.
Metronidazole in the form of a gel for intravaginal use.

The effectiveness of therapy is determined by several factors, including the results of repeated laboratory tests. Dynamic changes in the signs of vaginosis are taken into account.

After the start of treatment for bacterial vaginosis, after about 2 weeks, the patient must undergo a control laboratory examination.

Treatment of vaginosis during pregnancy

During the period of gestation, vaginosis is quite insidious, and even if the results of smears indicate an increased number of pathogenic microorganisms, a woman may not complain of any symptoms. The attending physician in this case, most likely, will not prescribe medication, but will only monitor the dynamics of the development of the condition.

If vaginosis during pregnancy is clinically pronounced, then therapy is selected on an individual basis and may include antibacterial drugs and eubiotics. Accurately and unambiguously at the first appointment, more than one specialist will not be able to say how to treat bacterial vaginosis. In any case, a comprehensive diagnosis is needed.

Vaginosis is treated with complex therapy aimed at eliminating the causes of disturbances in the vaginal microflora, as well as antimicrobials and eubiotics.

Particular attention requires the final stage of treatment of bacterial vaginosis - this is the restoration of the balance of the vaginal microflora. In addition, this is one of the most difficult therapeutic stages, and it is not so easy to achieve positive results even for a competent doctor.

You need to know that the use of only eubiotic vaginal suppositories is rarely considered by the attending physician. The advantage is given to complex treatment with the use of both inside and locally. Thus, a specialist may recommend Linex, Hilak forte or, for example, Baktisubtil.

Antibiotics for vaginosis

In the treatment of vaginosis, antibacterial drugs are prescribed.

It can be Metronidazole - an antiprotozoal and antimicrobial agent. Moreover, in the treatment of bacterial vaginosis, as a rule, this drug is prescribed 0.5 g several times a day for 1 week.
Suppositories Povidone-iodine is a good antibiotic that is prescribed for vaginitis. Apply suppositories several times a day for 1 week.
Ornidazole is one of the most common drugs for vaginosis. Take an antibiotic several times a day for 5 days.
Another effective antibacterial drug is clindamycin. Use the drug for vaginosis for 1 week several times a day.

Candles for bacterial vaginosis

Suppositories are one of the common dosage forms successfully used in the treatment of bacterial vaginosis. The doctor may prescribe different suppositories, depending on the clinical picture and the age of the patient.

Neo-penotran is an excellent drug with antibacterial and antifungal effects. This medication can be prescribed even during the period of gestation, mainly after 20 weeks. The course of treatment of vaginosis with Neo-penotran is 10 days.
Hexicon - candles from bacterial vaginosis with an excellent antibacterial effect, and this medication does not affect the vital activity of lactic acid bacteria.
Metronidazole is a well-established drug in the treatment of vaginosis. In addition, this remedy is also effective for vaginosis, the development of which is due to the reproduction of Trichomonas in the vaginal environment. The average course of treatment is 6 days.
Clindamycin is an antibacterial drug. These are good suppositories for bacterial vaginosis, used at different stages of the development of the condition.
Bifidumbacterin is a good drug that helps restore the vaginal microflora. Assign these suppositories 1 per day for 7-10 days.
Ecofemin - this remedy restores the microflora of the vagina. The therapeutic course is about 7-10 days.

All presented suppositories from bacterial vaginosis should not be used without consulting a doctor. Only a competent specialist will determine the causes of violations of the vaginal microflora and select medications on an individual basis.

For the treatment of vaginosis, folk remedies are used quite often, since they can be used to supplement effective drug therapy. It is important not to change the treatment regimen prescribed by the doctor and continue therapy until the problem is completely eliminated, which must be confirmed by appropriate tests.

Additionally, bacterial vaginosis can be treated with tinctures of medicinal plants that should be taken orally. Among them, the most effective are the following: leuzea root, sweet clover, cudweed, lavender color, elecampane root, birch leaves, licorice, thyme, geranium leaves, meadowsweet, etc.

Tinctures from all these mixtures are prepared and used according to the same principle. You need to mix certain ingredients in equal parts. Then 2 tbsp. spoons of the resulting mixture are steamed with boiling water (1 liter). After 5-7 hours, the tincture can be drunk 1/2 cup 3 times a day, always before meals. The course lasts 2-3 months, which the attending physician will definitely tell.

In addition to internal use for vaginosis, folk remedies (decoctions of medicinal plants) are used for baths. In addition, the doctor may prescribe douching. To do this, you may need such mixtures:

blueberry (berry), birch leaves, tansy color, Greek;
oak bark, geranium leaves, mugwort, chamomile blossom, violet blossom, etc.

These mixtures are prepared and used as follows. The necessary ingredients are taken in equal proportions. The resulting mixture (2 tablespoons) is steamed with boiling water (1000 ml) and infused for approximately 7-8 hours. Then the tincture is filtered and used for douching. For one douching, you need 1 glass of decoction.

But before taking into account information about douching, it is important to take into account the fact that such therapy is acceptable for use only on the strict recommendations of a specialist. The fact is that incorrect or frequent douching changes the level of acidity and further disrupts the balance of the vaginal microflora.

Washing with infusions of herbs is also practiced for vaginosis. It can be a prepared solution of walnut and sage leaves, chamomile flowers, oak bark. Also a common recipe is a mixture of coltsfoot leaves and juniper (fruits).

In the treatment of vaginosis, folk remedies are sometimes recommended for baths. To do this, pour 2 cups of a pre-prepared decoction of specific medicinal herbs into water at a comfortable temperature (10 liters) and mix. The procedure lasts from 15 to 25 minutes. It should be noted that such baths bring a very good result in cases where bacterial vaginosis is accompanied by severe itching.

Before treating bacterial vaginosis with tinctures for internal use, you should think about individual intolerance to one or another ingredient. If this is not available, it will not be difficult to cure vaginosis with folk remedies and medicines with their correct and regular use, but only under the guidance of a doctor.

Traditional medicine requires a serious attitude. Self-medication or correction of the treatment regimen prescribed by the doctor is unacceptable. It is important to know that improperly selected or applied infusions and decoctions of herbs can aggravate the situation with vaginosis, provoke the development of side effects, allergies.

An imbalance in the microflora of the vagina increases the risk of developing various diseases of the genitourinary system, including inflammatory processes associated with the uterus and appendages. Bacterial vaginosis can cause premature birth, provoke the appearance of complications during the period of gestation.

Vaginosis and vaginitis: the difference

As mentioned in the above information, vaginosis is not accompanied by an inflammatory process on the vaginal mucosa, which cannot be said about vaginitis.

With vaginitis, a vivid clinical picture is traced: liquid discharge, itching and burning, as well as pain during intercourse. Anti-inflammatory drugs are prescribed. It can be a medicated antiseptic or / and some traditional medicine recipes with sage and chamomile. Antibacterial agents are recommended for recurrent disease. In addition, vaginitis can be different - gonorrheal, trichomonas, mycoplasma, chlamydia, candidiasis.

It can be said with certainty that the prevention of a disease such as vaginosis is aimed at achieving one goal: to eliminate as much as possible all the factors that can provoke a problem. Based on this, preventive measures for bacterial vaginosis are as follows:

It is necessary to maintain immunity at a high level, and, therefore, to eat correctly, fully and balancedly and adhere to a healthy lifestyle.
It is necessary to provide a comprehensive and complete treatment of all concomitant diseases (among other things, they reduce immunity, as a result of which bacterial vaginosis may develop).
It is necessary to maintain the intestinal microflora at the proper level in order to prevent intestinal dysbacteriosis (especially while taking antibiotics, which destroy not only harmful, but also beneficial microorganisms and can thus provoke their deficiency in vaginosis).
To normalize the hormonal background, it is necessary to comprehensively treat gynecological and endocrine diseases, if any.
Be sure to observe personal hygiene. It's not just about keeping your body clean and changing your underwear every day. People should not use towels, washcloths and other bath and toilet accessories at the same time. Each person should have their own personal body care products! In no case should you wear someone else's underwear, and in public baths or toilets, never sit on the surface without protection. Experts strongly do not recommend the use of cosmetic soap: it should be replaced with special care products with an appropriate pH value. Also, do not douche without first consulting with your doctor.
Alcoholic drinks should not be abused (the best thing is to minimize their use or refuse them altogether). Any bad habits - smoking, taking drugs - are unacceptable. They can lead not only to vaginosis, but also to many other, sometimes very serious problems.
Women who are actively sexually active need to be extremely careful when choosing a sexual partner. It is necessary to avoid indiscriminate relationships and contacts with several men. The best solution is an intimate relationship with only one partner.
When changing partners, do not forget about condoms. This method of contraception will not only protect against infection, but also prevent unwanted pregnancy. Meanwhile, it is worth knowing that in some cases the use of condoms and other means of vaginal contraception is not allowed (you should consult your doctor about this).
If there is a problem, you can not self-medicate by taking antibiotics and any antimicrobial medications. Before treating bacterial vaginosis and using any drugs, you should consult with your doctor.
If a doctor has prescribed hormonal medications against the background of diabetes mellitus, it is necessary to undergo a gynecological examination at least twice a year and take appropriate tests.

By following all preventive measures, you can avoid the disease and never know how to treat bacterial vaginosis. Health is the most important thing, and you should always follow it.

Bacterial vaginosis

general information

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

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

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

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

What is meant by bacterial vaginosis?

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

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

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

Causes and risk factors

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

What are the causes of bacterial vaginosis?

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

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

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

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

Predisposing and/or aggravating factors

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

- Unprotected intercourse and a large number of sexual partners.

Bacterial vaginosis is more common in sexually active women.

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

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

- Other risk factors.

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

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

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

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

Bacterial vaginosis in pregnancy

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

Symptoms and signs

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

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

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

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

Possible Complications

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

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

endometritis;
parametritis.

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

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

Diagnostics

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

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

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

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

Diagnosis can also be confirmed:

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

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

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

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

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

Treatment of bacterial vaginosis

Sometimes vaginosis spontaneously regresses, but if symptoms or complications are present, a specific therapeutic protocol established by a general practitioner or reference gynecologist is always indicated.

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

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

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

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

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

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

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

Forecast

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

Prevention

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

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

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

Specialty: Cardiologist, Therapist, Doctor of Functional Diagnostics.

Bacterial vaginosis is a violation of the microecology of the vagina. This is the most common condition in women of childbearing age.

Predisposing factors leading to the development of bacterial vaginosis include the following:

the use of antibacterial drugs;
prolonged use of intrauterine contraceptives;
the use of tableted contraceptives;
previous inflammatory diseases of the urogenital tract;
violation of the hormonal status, accompanied by a violation of the menstrual cycle;
changes in the state of local immunity;
exposure to low doses of ionizing radiation;
stressful effects on the body.

In 60% of women suffering from bacterial vaginosis, violations of the microecology of the colon (intestinal dysbacteriosis) are detected.

Manifestations of bacterial vaginosis

The main symptom is complaints of discharge with an unpleasant odor, which are noted by only 50% of women. Allocations are often moderate, less often - abundant, in some cases they may be completely absent. Discharge from bacterial vaginosis is grayish-white in color, homogeneous, without lumps, has a specific "fishy smell", which can be permanent, absent, appear during menstruation and sexual intercourse.

The duration of the existence of these symptoms can be calculated for years. With a long-term process, the discharge becomes yellowish-green in color, becomes thicker, often resembles a curdled mass, has the property of foaming, slightly viscous and sticky, evenly distributed along the walls of the vagina.

Other complaints, mainly itching and urination disorders, are rare: they may be completely absent or appear intermittently. Often, women with bacterial vaginosis complain of heavy menstrual bleeding, pain in the lower abdomen, adnexitis.

At the same time, in some cases, some patients do not reveal any manifestations of the disease.

Irritation of the vulva and vagina is rare, which distinguishes bacterial vaginosis from candidiasis and trichomoniasis, which are usually accompanied by severe itching.

Diagnostics

A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After examination, a discharge from the posterior lower vaginal fornix is taken.

The diagnosis can be made in the presence of 3 of the 4 listed signs:

the specific nature of the discharge;
acidity> 4.5 (normally 3.8-4.5);
positive aminotest;
the presence of "key" cells. The so-called "key cells" are mature epithelial cells (the surface layer of the vaginal epithelium), over the entire surface of which microbes are tightly and in large numbers attached.

Performing one of the 4 tests is not enough to make a diagnosis.

Treatment of bacterial vaginosis

With bacterial vaginosis, local therapeutic measures are considered optimal. A good therapeutic effect is shown for drugs from the group of nitroimidazoles (metronidazole, trichopolum, metrogil, etc.), which are administered intravaginally in the form of tablets, tampons or suppositories.

There are various schemes for the complex treatment of bacterial vaginosis, consisting in the use of nitroimidazoles, prescribed in tablets and topical agents (1% hydrogen peroxide, tomicid antiseptic solution, benzalkonium chloride compounds, etc.), which irrigate the vagina.

When prescribing tablets of nitroimidazoles, it is necessary to take into account the possibility of side effects in the form of dysfunction of the gastrointestinal tract, dizziness and headache.

In severe cases of bacterial vaginosis, the fundamental principle of treatment is the use of broad-spectrum antibiotics for the purpose of general sanitation of the vaginal mucosa (clindamycin, oleandomycin, cephalosporins).

When prescribing broad-spectrum antibacterial drugs, a large number of side effects may occur, including dysbacteriosis of other cavities (intestines, etc.).

The effectiveness of the treatment of bacterial vaginosis is assessed by the disappearance of subjective manifestations, the dynamics of the clinical symptoms of the disease, and the normalization of laboratory parameters. The first follow-up clinical and laboratory examination should be carried out one week after the completion of therapy, the second - after 4-6 weeks.

During treatment and follow-up, the use of barrier methods of contraception (condoms) should be recommended.

Currently, one of the effective drugs for the treatment of bacterial vaginosis is dalacin vaginal cream, applied once a day for 3 days. The course of treatment is 3 days. One full applicator corresponds to a single dose of the drug.

Vaginal candidiasis should be noted among the most frequent complications in the use of the above drugs. For its prevention, it is necessary to prescribe antifungal drugs - nystatin 2000 mg per day orally, simultaneously with the start of treatment. The most effective drug for non-pregnant women is fluconazole. At the same time, for the treatment of vaginal candidiasis during pregnancy, drugs such as clotrimazole, pimafucin, gyno-pevaril, dafnedzhin, etc. are widely used.

Another effective treatment for bacterial vaginosis is the antiseptic drug povidone-iodine (Betadine).

Forecast

With all of the above methods of treatment, relapses can occur at various times after treatment. Apparently, this is due to the fact that antibiotic therapy, while eliminating pathogens, often does not create conditions for a sufficiently rapid recovery of beneficial bacteria.

In this regard, within 10 days after the main course of treatment, it is necessary to include such biological preparations as acilact, bifikol, bifidum- and lactobacterin in the complex of therapy, due to their specific action aimed at restoring the normal ratio of lactobacilli in the vagina, and thereby preventing the frequency of relapses of this diseases.

Update: October 2018

Probably, every representative of the weaker sex at least once during her life met with such a disease as bacterial vaginosis of the vagina. This unpleasant companion is not so much dangerous for its manifestations as for complications, the appearance of which can provoke.

But this disease acquires the greatest danger during pregnancy, therefore, it requires maximum rehabilitation of the vaginal microflora and the restoration of normal microbiocenosis.

What is this disease?

Speaking of a similar disease - bacterial vaginosis, they mean a nonspecific inflammatory syndrome, in which the microbiocenosis of the vagina changes significantly in quantitative terms towards an increase in opportunistic microflora due to anaerobic bacteria and a decrease in lactic acid bacteria or Doderlein sticks.

Other names for the disease are gardnerellosis, vaginal dysbacteriosis, or anaerobic vaginosis. Considering that a variety of microorganisms is observed in this process, the name "bacterial" is quite justified. However, the absence of signs of an inflammatory reaction (leukocytes) in smears, the term "vaginitis" has changed to "vaginosis". The disease occurs in 15 - 80% of cases.

Classification of vaginal dysbacteriosis

According to the severity in vaginal dysbacteriosis, there are:

compensated or 1 degree(there are no microflora in the smear, epithelial cells are present without changes and the possibility of infection with other pathogenic microorganisms remains);
subcompensated or 2 degree(the content of Doderlein sticks decreases, gram-negative and gram-positive flora increases, there are from 1 to 5 "key" cells, a slight increase in leukocytes - up to 15 - 25);
decompensated or 3 degree(there are no lactic acid bacteria, there is a clinical picture of the disease, “key” cells are completely, various pathogenic and facultative or conditionally pathogenic microorganisms).

Along the course, acute, torpid or erased and asymptomatic vaginal dysbacteriosis is isolated.

Causes and mechanism of development of vaginal dysbacteriosis

It is known that the vagina is inhabited by lactobacilli or lactic acid bacteria (Doderlein sticks), whose function is to process glycogen and synthesize lactic acid from it, which creates an acidic environment, thus inhibiting the reproduction of facultative and pathogenic microflora.

Among other things, Doderlein sticks also produce hydrogen peroxide, providing a disinfecting effect. In the case of a decrease in the content of Doderlein sticks, the acidic environment (3.8 - 4.5) of the vagina shifts to the alkaline side, thus provoking the growth of opportunistic microorganisms.

If in the normal vaginal microflora lactic acid bacteria are in the amount of 95% or more of all microorganisms, then the remaining percentages are opportunistic flora (bacteroids, peptococci, staphylococcus and others).

The causes of bacterial vaginosis are not the reproduction of any one opportunistic microorganism, but the association of microbes. These include primarily gardnerella, mobilincus and mycoplasma. With this disease, the number of anaerobic (not requiring oxygen) bacteria mainly increases.

Provoking factors

All factors that contribute to the occurrence of the disease can be divided into 2 groups:

Endogenous or acting from within

Vitamin C

At the same time, vitamin C is prescribed (1 tablet three times a day), which not only stimulates the immune system, but also improves tissue regeneration, reduces the permeability of vascular walls, resulting in a decrease in fluid transudation into the vagina.

Vaginal instillations

Also, the first stage of therapy includes vaginal instillations of 2% lactic or boric acid once a day for a week. Such manipulations contribute to the creation of an acidic environment, which is unfavorable for the reproduction of anaerobes.

You should also take antiallergic drugs (suprastin, tavegil, see).

Restoration of microflora

At the second stage, the use of biological preparations (intravaginal administration) begins. Apply apilak, acylact, bifidumbacterin, lactobacterin and others. To do this, 2-3 doses are diluted with 5 ml of boiled water, a swab is soaked with the resulting solution and administered intravaginally twice a day (after 10-12 hours). The duration of treatment is 7 - 10 days.

You can use candles:

Bifidumbacterin (live bifidobacteria) 1 suppository 2 r / day for 5-10 days.
Bifikol (dried bifidobacteria) 7-10 days.
Atsilakt 10 days (110 rubles).
Laktozhinal (450 rubles), Vagilak (500 rubles) lactobacilli, 1 vaginal capsule for 10 days in the morning and evening.

Treatment of bacterial vaginosis during pregnancy

How to treat bacterial vaginosis in case of pregnancy? In the first trimester of gestation, systemic therapy for the disease is not performed (metronidazole and other drugs are toxic to the embryo). Local administration of etiotropic drugs in the early stages is used with caution.

Metronidazole or clindamycin is started from the second trimester and is carried out in short courses. Metronidazole 0.5 gr. (2 tablets) twice a day for 3-5 days, and clindamycin is prescribed at a dosage of 0.3 g. 2 times a day for 5 days.

Prevention measures

To prevent frequent relapses of the disease, promiscuous sexual intercourse should be excluded, and condoms should be used in case of casual sexual intercourse. It is also necessary to strengthen the immune system, correct hormonal imbalance and endocrine diseases, undergo medical examinations by a gynecologist at least 2 times a year.

To strengthen local immunity, the Solco-Trichovac vaccine has been used, the introduction of which is carried out intramuscularly, 3 times in 2 weeks. A year later, a single revaccination is carried out. The introduction of the vaccine creates immunity from vaginal dysbacteriosis for 2 years.