Vaginosis symptoms and treatment. Bacterial vaginosis - symptoms, treatment, causes and complications, classification, diagnosis, prognosis and prevention. Additional methods for diagnosing bacterial vaginosis

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

SYNONYMS OF BACTERIAL VAGINOSIS

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

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

EPIDEMIOLOGY OF BACTERIAL VAGINOSIS

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

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

PREVENTION OF BACTERIAL VAGINOSIS

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

SCREENING

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

CLASSIFICATION OF BACTERIAL VAGINOSIS

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

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

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

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

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

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

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

ETIOLOGY (CAUSES) OF BACTERIAL VAGINOSIS

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

PATHOGENESIS OF BACTERIAL VAGINOSIS

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

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

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

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

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

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

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

Amine test for bacterial vaginosis

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

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

CLINICAL PICTURE (SYMPTOMS) OF BACTERIAL VAGINOSIS

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

ANAMNESIS

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

PHYSICAL EXAMINATION

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

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

LABORATORY RESEARCH

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

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

DIFFERENTIAL DIAGNOSIS OF BACTERIAL VAGINOSIS

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

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

MEDICAL TREATMENT OF BACTERIAL VAGINOSIS

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

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

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

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

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

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

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

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

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

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

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

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

* Not produced commercially. Has historical significance.

** Capsules for oral use.

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

INFORMATION FOR THE PATIENT

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

FORECAST

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

Many women experience bacterial vaginosis during their lifetime. A synonym for this pathological condition is vaginal dysbacteriosis. The greatest danger of vaginosis is during the bearing of the baby.

The development of vaginal dysbacteriosis

Bacterial vaginosis is a microbial lesion of the vagina that is not associated with inflammation. At the heart of its development is a change in the acidity of the vagina and an imbalance in the microflora. The prevalence of dysbacteriosis among women reaches 80%. Its share in the general gynecological pathology is about 30%. Clinical manifestations of bacterial vaginosis are not always pronounced.

It can proceed in a latent (latent) form. Bactaginosis should not be confused with vaginitis. In the latter case, there are pronounced signs of inflammation. In healthy women, the microflora of the vagina is constant. 95% of all microorganisms in it are lactobacilli. The remaining 5% contains many other bacteria.

Lactobacilli maintain the constancy of the environment through the production of lactic acid and the formation of hydrogen peroxide. These substances inhibit the activity of pathogenic flora. There are 3 degrees of severity of bacterial vaginosis. At grade 1, there is no pathogenic microflora in the studied smears, but there are epithelial cells.

In this case, there is a possibility of infection with various pathogenic bacteria. For bacterial vaginosis of the 2nd degree, a decrease in the number of Doderlein sticks is characteristic. This increases the number of gram-negative and gram-positive flora. The most severe is decompensated vaginosis of the 3rd degree. Lactic acid bacteria are not found in it. Pathogenic and opportunistic microbes predominate.

Main etiological factors

The reasons for the development of vaginosis are different. The main risk factors for microbial imbalance in the vagina are shown in photo 1. The following reasons for the development of this condition are distinguished:

• hormonal changes (decrease in estrogen production);
• a shift in the acidity of the vagina to the alkaline side;
• abortion;
• stress;
• menopause and pregnancy;
• intestinal dysbacteriosis;
• atrophic processes in the vagina;
• the presence of endocrine diseases;
• treatment with cytostatics, antifungal drugs and antibiotics;
• conducting a promiscuous sexual life;
• poor nutrition;
• the use of intrauterine devices and spermicidal agents;
• the presence of chronic inflammatory diseases.

Bacterial vaginosis can be suffered for many years if the above risk factors are present. The natural microflora of the vagina largely depends on the state of the intestinal microflora. In the presence of chronic enterocolitis or dysbacteriosis, the risk of developing vaginosis is high. The risk group includes young girls who have an active sex life, often changing partners.

Clinical manifestations of dysbacteriosis

Symptoms of vaginal dysbacteriosis are different. Bacterial vaginosis can be easily distinguished from colpitis. With dysbiosis, there is no inflammation (redness, swelling of the vaginal mucosa). Very often there is a combination of vaginosis with erosions, inflammation of the cervix and scars.

Vaginal dysbacteriosis is most often manifested by the following symptoms:

• pathological discharge with a fishy smell;
• urination disorder;
• itching;
• discomfort during sexual intercourse;
• pain in the perineum.

Allocations have the following features:

• smell bad;
• up to 20 ml or more per day;
• gray-white;
• liquid;
• constant or appear periodically;
• can be frothy, sticky and thick (in the chronic course of dysbacteriosis).

A specific manifestation of vaginosis is the presence of a fishy smell coming from the discharge. Photo 2. Some women have symptoms all the time, while others have them periodically. Gynecological examination does not reveal signs of inflammation. Elderly patients may have red spots on the mucosa. Dysbacteriosis can cause complications during pregnancy.

Examination and treatment tactics

Treatment of bacterial vaginosis is carried out after microscopy of smears, instrumental examination (colposcopy, ultrasound, hysteroscopy), determination of vaginal acidity, general blood and urine tests.

An increase in pH to 4.5 and above, the presence of a large number of epitheliocytes and key cells (epithelium with bacteria), cream-colored discharge and the absence of signs of inflammation are all diagnostic criteria for vaginosis.

Key cells in the smear are shown in photo 3.

The treatment regimen for vaginosis involves the elimination of negative factors and the restoration of microflora. At the initial stage, antibiotics are used, the hormonal background is normalized and the intestinal microflora is restored. How to treat bacterial vaginosis, only an experienced doctor knows. The drugs of choice are Metronidazole and Clindamycin.

During this period, women should fully eat, give up alcohol and eliminate stress. Antihistamines are often prescribed. If the optimal treatment regimen is selected, bacterial vaginosis will pass. How to treat dysbacteriosis? Doctors often prescribe local remedies based on lactic acid. The second stage of treatment for bacterial vaginosis begins after 1-2 weeks.

Eubiotics are prescribed (Apilak, Atsilakt, Laktozhinal, Bifikol). After treatment (at stages 1 and 2), a laboratory test is carried out. Treatment of bacterial vaginosis with a predominance of anaerobes includes taking Flagyl, Metrogil or Trichopolum. To prevent the development of recurrent vaginosis after treatment, it is necessary to exclude exposure to risk factors. Prevention includes proper nutrition, elimination of stress, avoidance of alcohol, restriction of antibiotics and hormonal drugs, maintenance of normal hormonal status.

What natural means and methods can effectively and safely treat bacterial vaginosis Houses.

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

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

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

What is Bacterial Vaginosis?

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

Particularly susceptible to BV:

• having an active sex life
• pregnant
• immunocompromised women

Women with BV also have a higher risk of:

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

Cause of Bacterial Vaginosis

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

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

Symptoms

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

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

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

Causes of Bacterial Vaginosis

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

The most common:

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

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

How to Treat Bacterial Vaginosis

Avoid and use soaps and intimate hygiene products

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

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

Apple vinegar

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

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

Soda

Another effective remedy is simple soda.

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

Tea tree oil

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

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

Do not douche

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

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

Probiotics

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

Garlic

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

Blood sugar balance

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

The main function of the female body is childbearing, so nature has thought of a lot to protect the most important organs. Through the vagina, not only infections from the outside world can penetrate into the uterus, but also microbes that are usually found in the vagina in small quantities. If the microflora is disturbed, the number of lactobacilli decreases, and conditions are created for the development of conditionally pathogenic microorganisms. This phenomenon is known in medicine as bacterial vaginosis. Often this disease is also called gardnarellosis, dysbiosis or vaginal dysbacteriosis. According to ICD-10, this pathology is assigned the code N89.8

Normally, the vagina contains enough lactobacilli to create an acidic environment. Lactic acid does not allow pathogens to multiply and forms natural immunity. In what cases, why and how to treat vaginal dysbacteriosis, this article will help to understand.

Signs of the presence of pathogenic flora

Often women do not even suspect that they have any diseases in the urogenital area, especially if they, like bacterial vaginosis, do not manifest themselves in the form of symptoms. You can detect the disease in the acute phase, but if you do not take action, the symptoms may fade away on their own, which does not mean a cure. What signs should alert a woman and refer her to a gynecologist?

• Frequent urination, with cutting pains, as in cystitis.
• Inflammation in the area of ​​​​the external genital organs, accompanied by itching, burning and other uncomfortable sensations that increase after intercourse.
• Abundant discharge with the smell of spoiled (rotten) fish. Color and consistency depend on the prevailing bacteria.

Women who have given birth and older women tend to have more severe symptoms. In virgins and adolescents, even during an exacerbation of the disease, it can go unnoticed.

Signs of bacterial vaginosis can be confused with thrush, which is also accompanied by burning and discharge, or with non-specific bacterial vaginitis due to similar painful symptoms. However, these are different diseases, and they require different treatment. Self-diagnosis and self-treatment at home can not be done. Bacterial vaginitis, also known as colpitis, occurs against the background of a decrease in immunity and can cause infertility. How to treat bacterial vaginitis, only a doctor can determine after a thorough examination and testing.

Causes of bacterial vaginosis

Many women are embarrassed to go to a medical institution with such an intimate problem. But it has long been established that bacterial vaginosis is not at all a consequence of sexual promiscuity.

The risk of encountering genital dysbacteriosis exists in any woman, regardless of age and lifestyle, including a little girl.

The causes of occurrence can be any factors that inhibit the normal microflora:

• Entering the vagina of harmful bacteria from the outside, for example, from the anus. It can be E. coli, Klebsiella, Proteus and other components of the intestinal flora.
• Weak immunity. With a cold, bacvaginosis is noticeably aggravated.
• Everything that weakens the body's defenses: stress, pregnancy, hypothermia, climate change.
• Everything that changes the hormonal background: pregnancy, menopause, abortion, taking hormonal drugs.
• Douching. Aimed at getting rid of pathogens, it washes out the native microflora.
• Failure to comply with the rules of hygiene, especially during menstruation.
• Wearing synthetic or tight underwear that interferes with the flow of oxygen.
• Intrauterine devices and contraceptives containing nonoxynol (candles, condoms).
• Sanitary pads and tampons that irritate the mucous membranes.
• New sexual partner. He may not have sexual diseases, but his flora is able to inhibit the female microflora. To a permanent partner, as a rule, immunity has already been formed. Bacterial vaginosis is not an STI, so it is impossible for a man to get it from a man. The disease is not transmitted sexually.
• Venereal diseases, even if a course of treatment has been carried out (decreased immunity after taking antibiotics).

Also, bacvaginosis often occurs against the background of diseases of the cervix (including endometriosis, endocervicitis, leukoplakia) or genital infections. Ignoring discomfort in the hope that it will “pass by itself”, you can not detect a dangerous disease in time.

Causes of bacterial vaginosis:

• gardnarella (Gardnerella vaginalis);
• mobilencus (Mobiluncus spp.);
• bacteroids (Bacteroides spp.):
• peptococci.

In most cases, with bacvaginosis, a mixed infection is detected with a predominance of anaerobic flora against the background of a significant decrease in the level of vaginal lactobacilli. The greatest value in gynecology has an increase in the concentration of Gardnerella vaginalis. Often the disease occurs against the background of candidal colpitis, nonspecific vaginitis and other urogenital pathology.

Complications of bacterial vaginosis

In addition to the fact that vaginal dysbacteriosis overshadows existence in itself, it can cause other problems. It is especially dangerous during pregnancy. But there are two situations:

1. Pregnancy led to a surge in the activity of pathogenic bacteria, because this is the most powerful hormonal shake-up for the body. In this case, there is practically no danger. In some cases, treatment is prescribed, in others it is dispensed with, especially if there are no clinical manifestations of infection. In most cases, after giving birth, the symptoms of bacterial vaginosis disappear.
2. The onset of the disease was noted before pregnancy. The microflora of the vagina was already once suppressed, and if no effective treatment was carried out, during pregnancy in conditions of reduced immunity, the pathological process can lead to inflammation and infection of the fetus. The result can be premature birth, impaired fetal development, hypoxia and other negative consequences for the mother and child.

In combination with other infections, bacvaginosis can become an obstacle to conceiving a child.

Diagnosis of bacterial vaginosis

Any alarming symptoms should be a reason to visit a doctor. Itching and foul-smelling discharge should not be considered the norm. After such complaints or taking a smear with a characteristic odor, the specialist must refer to:

1. PCR diagnostics. This method determines the presence of pathogenic microorganisms, but is not decisive, since many of them, mainly gardnerella, are present in almost all women in small quantities.
2. Amniotest, which allows using chemical reactions to enhance the smell of secretions.
3. Bacteriological culture. This method determines the pathogen and its quantity, as well as sensitivity to antibiotics.
4. Review smear. Allows you to diagnose inflammation and identify "key cells" - a sign of gardnarellosis.
5. A smear for oncocytology. Held for all women annually. The cytogram allows you to identify the pathology of the cervix at an early stage.

When planning a pregnancy, it is important to get tested for hidden infections, even if nothing bothers you. The attending physician must determine whether the disease is caused by a pathogenic (venereal) or opportunistic microorganism, in the first case, it is necessary to treat yourself and your partner, and in the second, partner treatment is not required (bakvaginosis is not contagious).

Treatment

The treatment regimen depends on the underlying causative agent of the disease. They are usually divided into three groups:

The principle of treatment is to normalize the microflora of the vagina. If the cause of the violation is only opportunistic bacteria, difficulties should not arise. The doctor prescribes drugs to which these microorganisms are sensitive, their basis is metronidazole, ternidazole, ornidazole. Girls, as a rule, are prescribed pills, and women are prescribed vaginal suppositories and ointments. As a result of the use of these funds, a positive effect is noted after a week of use.

The advantage of suppositories (suppositories) is that they act directly on the affected areas, are compatible with other drugs, and can be prescribed to pregnant women.

If you complain of excessive burning or unbearable pain in the vagina, local painkillers may be additionally recommended.

Next, local immunity and healthy microflora should be restored. The Femilex remedy is popular, the main substance of which is lactic acid. Bifidobacteria, eubiotics and probiotics naturally populate the vagina related to the vaginal flora lactobacilli, vitamins help to improve overall immunity.

Other means to restore the normal microflora of the vagina:

• Vagilak;
• Lactagel;
• Bifiform;
• Acyclact;
• Lactonorm;
• Lactobacterin;
• Lactoginal;
• Bifidumbacterin.

Restoration of microflora is a mandatory step in the complex treatment of bacterial vaginosis. Deficiency of lactic acid bacteria threatens the recurrence of the disease and the development of complications. You can fill the lack of lactobacilli and recreate the acidic environment in the vagina using the above means.

To strengthen the body's defenses, immunomodulators are also prescribed (Viferon and others). The dosage and duration of the course of therapy are determined by the doctor. If you need to change the drug or replace it with a cheaper analogue, you should also consult a doctor.

In medicine, at the moment there is no unequivocal opinion about the treatment of bacterial vaginosis in a latent form. Many experts believe that the presence of opportunistic flora in a smear is not a disease and does not require any treatment. Others equate ureaplasma, mycoplasma and gardnerella to the causative agents of sexually transmitted diseases. In what cases should a woman play it safe and consult with different doctors before treating bacterial vaginosis?

• during the period of exacerbation and in the presence of symptoms of the disease;
• before or during pregnancy, even if there is no discomfort.

A competent specialist should tell not only about how to treat bacterial vaginosis, but also about the mandatory conditions for recovery. During this period it is necessary:

• refrain from sexual intercourse;
• give up alcohol, especially when taking medicine in the form of tablets;
• follow a diet (refuse spicy, fried, spicy foods);
• use means for intimate hygiene;
• keep the genitals clean.

Folk remedies

Vaginal itching and other symptoms are well removed with the help of baths and douches from various decoctions. Oak bark, chamomile, juniper berry, oat straw and walnut leaves, calendula, aloe and other medicinal plants are mixed in different proportions. But you can engage in such treatment only after visiting a specialist to exclude dangerous pathogens.

Prevention of bacvaginosis

By following the rules, you can practically reduce the risk of the disease to zero:

• Monitor hygiene: on the days of menstruation, wash yourself several times a day with clean water, change pads and tampons every 3-4 hours.
• Avoid getting intestinal bacteria into the vagina.
• Do not get involved in douching, when an unpleasant odor appears, you need to consult a doctor, and not try to remove it, thereby destroying the microflora.
• Do not abuse antibiotics and antifungal agents.
• Avoid unprotected sex with new partners.
• Regularly observed by a gynecologist, at the first sign of the disease, visit a doctor.
• Prefer loose cotton underwear.
• Follow the principles of proper nutrition: more dairy and vegetable products, less smoked and salty.

In some cases, for prevention, the gynecologist may prescribe a drug containing lactic acid. This is more true for women at risk: after long-term hormonal treatment, with menopause, etc.

The appearance of signs of bacterial vaginosis should not be frightened, but it is also dangerous to ignore them. An unscheduled visit to the gynecologist will clarify the nature of the disease, which causes many problems, but is quite easily eliminated.

- gynecological infectious non-inflammatory disease. Characterized by the occurrence of the disease due to sexual intercourse. According to statistics, 20% of women of reproductive age suffer from vaginosis. The disease is characterized by changes vaginal environment and flora, production decreases lactic acid and the pH of the vaginal environment decreases. Thus, the resulting neutral environment does not prevent the development of various microbes, including Trichomonas .

The microflora of the vagina can be represented as mobile ecosystem. Normally, the vagina contains lactobacilli that play a protective role. Lactobacilli processing glycogen (in women of reproductive age, the epithelial cells of the vagina contain glycogen in large quantities) into lactic acid, thereby lowering the acidity of the vagina. In addition, lactobacilli are able to form. Hydrogen peroxide and the acidic environment of the vagina inhibit the reproduction of opportunistic bacteria ( streptococci , staphylococci , anaerobic bacteria , coli , Mobiluncus spp. , Gardnerella vaginalis .). Which in small quantities are detected in the microflora of the vagina of the vast majority of women.

If the proportion of lactobacilli in the body decreases, then instead of them in the ecosystem they occupy opportunistic bacteria(Gardnerella vaginalis in the first place). The latter contribute to the release of volatile amines, which are comparable in smell to the smell of rotten fish.

Bacterial vaginosis is not sexually transmitted because it is not venereal disease. Bacteria that cause bacterial vaginosis (primarily Gardnerella vaginalis) can be transmitted through sexual contact. But their transmission from woman to woman cannot be the main cause of the disease. Since in small quantities these microbes are part of the vaginal microflora of the vast majority of women.

Unprotected sex, however, may play a role in bacterial vaginosis. It's not about infection, it's about sexual partner's seed or several sexual partners are the cause of changes in the microflora of the vagina.

The main cause of the disease is not just the presence of bacteria that cause bacterial vaginosis (they are present in almost every woman in small quantities), but a change in the proportions of opportunistic microbes (which cause bacterial vaginosis) and lactobacilli. The proportion of lactobacilli in bacterial vaginosis decreases, and the proportion of pathogens increases. Therefore, bacterial vaginosis in medicine is called vaginal dysbacteriosis.

Both internal influences of the body and external influences, the so-called exogenous And endogenous factors . These may be changes in hormonal levels, a decrease in immune defenses, disturbances in the functioning of the intestines, in particular microbiocenosis . The disease can also be caused by such reasons as the use of immunosuppressants, as well as previous inflammatory diseases of the genitourinary system.

Bacteria that cause bacterial vaginosis are not dangerous for men. Men who have been diagnosed with the pathogen Gardnerella vaginalis, as well as sexual partners of women with bacterial vaginosis, do not need treatment.

Symptoms of bacterial vaginosis

Bacterial vaginosis has no specific symptoms. The disease is characterized by some clinical manifestations, these are abundant creamy discharge from the vagina. They are homogeneous, have a grayish-white color, often stick to the walls of the vagina. Due to the breakdown of amines produced by bacteria, vaginal discharge often has an unpleasant, so-called "fishy" odor. The discharge causes symptoms of bacterial vaginosis such as burning and itching in the vagina. Often this causes inflammatory diseases of the female genital organs, sometimes unpleasant painful sensations during intercourse.

There are several types of vaginitis, each of which has its own symptoms:

• Aerobic vaginitis- appears as a result of contact with the mucosa of aerobic microflora, during a one-time decrease in the normal lactoflora of the vagina.
• Trichomonas vaginitis- is one of the most common types of vaginitis.
• candida vaginitis- an inflammatory fungus, the main causative agents of which are yeast-like fungi Candida .
• Allergic vaginitis- is one of the types of genital, which is caused by the use of drugs to prevent unwanted pregnancy or treat diseases of the genital organs.
• Desquamative inflammatory vaginitis- one of the types of nonspecific vaginitis.

Diagnosis of bacterial vaginosis

Diagnosis of the disease is carried out in several stages. First of all, a laboratory examination of smears is carried out for the presence of key cells. When staining a smear with methylene blue, squamous epithelial cells can be detected, to which gardnerella , because of which the cells take on a kind of peppered appearance. In addition, laboratory analysis of smears includes amine test. In the study, vaginal discharge is diluted with a 5-10% solution potassium hydroxide . The resulting smell, fish, or more precisely, the amine smell indicates the presence of the disease.

Diagnosis of bacterial vaginosis also includes determining the pH level of the vaginal microflora. To do this, directly during the examination on the gynecological chair, the doctor introduces pH paper with tweezers into the secret of the vaginal fornix. The presence of the disease is determined at pH 4.5.

The presence of all these signs, as well as the symptoms of bacterial vaginosis, confirm the diagnosis. It is also possible to diagnose the disease by isolating a pure culture of bacteria, but such a diagnosis is ineffective. This is due to the fact that more than 58% of healthy women have high levels of microbes. Gardnerella vaginalis in the vaginal secretion.

Treatment of bacterial vaginosis

The disease requires conservative treatment. Antibiotics are prescribed, such as,. They are produced in preparations for oral and vaginal use. This , metrogel , cleocin , tindamax . Vaginal preparations are more effective, they are more often included in the treatment of bacterial vaginosis. They cause fewer side effects, but the risk remains.

The best treatment for bacterial vaginosis is metronidazole (for example,) take for 7 days 2 times a day, 500 mg orally. Sometimes the drug is difficult to tolerate (may cause nausea). Completely incompatible with alcohol. But systemic treatment can reduce the chance of complications from bacterial vaginosis.

Reserve drugs:

Clindamycin ( , climicin ) for 7 days 2 times a day, 300 mg orally. Clindamycin not only inhibits the growth of bacteria Gardnerella vaginalis, but also lactobacilli ( Lactobacillus spp.). Clindamycin is prescribed in case of intolerance to patients with metronidazole.

Cream Clindamycin , with a concentration of 2% ( dalacin ) is injected with the attached applicator into the vagina for 5 days 1 time per day (at night). Of course, local treatment is much better tolerated, but less effective systemic treatment reduces the risk of complications of bacterial vaginosis.

Gel Metronidazole , 0,75% ( , flagyl ) is injected into the vagina with the supplied applicator for 5 days 2 times a day. As with the previous drug, local treatment is much better tolerated, but less effective systemic treatment reduces the risk of complications of bacterial vaginosis.

There is another treatment for bacterial vaginosis, its system consists of two stages. First, it is necessary to suppress the reproduction pathogens . For these purposes, irrigation with solutions of boric and lactic acids is used, but there are also more modern medicines. Namely, the drug - an antiseptic drug with a wide spectrum of effects - is applied intravaginally once (one tablet each) for 6 days.

It should be noted that this drug can be used during pregnancy for the sanitation of the birth canal. It is carried out according to the same scheme, the beginning of therapeutic treatment - 6-7 days before the PDR.

The second stage is the restoration vaginal biocenosis. For these purposes, they are used locally. eubiotics , medicinal products containing strains of lacto- and bifidobacteria.

Complications of bacterial vaginosis: unpleasant odor of discharge, discomfort, itching; development (after caesarean section, postabortion, postpartum); risks of preterm birth and late pregnancy.