Bacterial vaginosis is the causative agent. Bacterial vaginosis, causes, symptoms, treatment. When to See a Doctor

Vaginosis- This is a condition in which there is a violation of the microflora of the vagina. The average age of patients with vaginosis is 20-45 years. The incidence of the disease in this group is 80%. Based on these data, we can conclude that eight out of ten women suffer from vaginosis at least once in their lives.

The disease does not pose a danger to a woman's life, but can adversely affect her reproductive function. Often, even after pregnancy, patients with vaginosis have miscarriages. If she bears a child, then the disease threatens with intrauterine infection of the fetus, complications after delivery. Therefore, you need to know the main causes and symptoms of the disease, as well as be able to cope with it.

Man and microbial flora exist in indivisible tandem. There are microbes that, in the process of evolution, have adapted to live in the human body and even benefit it. This process is called biocenosis. Such flora is represented by a stable bacterial composition. Some bacteria inhabit exclusively the dermis, others live in the mouth, and others in the gastrointestinal tract. Such bacteria benefit the human body by destroying the harmful flora, producing vitamins and stimulating the work of its immunity.

Lactobacilli live in the vagina. They look like small thick sticks. The bacteria break down glycogen, which is found in the epithelium that lines the vagina. During this process, lactic acid is released. Due to which the acidic environment is maintained in the vagina. Pathogenic microorganisms die in it, which is the norm. In the biocenosis of the vagina, lactobacilli account for 95-98% of all beneficial microflora.

Sometimes it happens that lactobacilli are destroyed. Then other microbes take their place. The acidic environment of the vagina changes, which creates favorable conditions for pathogenic microorganisms to enter it. They can be sexually transmitted, or they can reproduce on their own. In the latter case, they speak of nonspecific vaginosis. Lactobacilli are replaced by flora, which inhabits the perineum, urethra, perianal folds. Microbes begin to multiply rapidly, but such flora is not able to perform the functions of lactobacilli.

A change in the biocenosis of the vagina leads to the fact that not only metabolic, but also immune processes fail in it. The production of immunoglobulin A decreases. It is this substance that prevents pathogens from attaching and penetrating deep into the epithelial wall of the organ. The epithelium itself tries to cope with bacteria, which leads to excessive desquamation of its particles. This explains the increase in the volume of vaginal discharge in vaginosis. Lactobacilli are replaced by anaerobic bacteria. This is the name of microorganisms that are able to maintain their vital activity in an oxygen-free environment. Some of them produce amino acids and volatile fatty acids. They are broken down in the vagina to volatile amines. These amines have an unpleasant odor that resembles the smell of fish.

The vaginal environment changes from acidic to alkaline. The metabolism of fats, proteins, minerals and carbohydrates is disturbed, the epithelium produces more mucus. This is the first sign of developing vaginosis. At the same time, the walls of the vagina themselves are not inflamed. All changes are purely physiological in nature.

Bacterial vaginosis cannot be called a sexual infection, since there are no infectious representatives of the flora in the vagina. This disease is called nonspecific vaginosis. The main reason for its development is a change in the vaginal environment, which further leads to an imbalance in the microflora.

A wide variety of microbes are capable of replacing lactobacilli.

Microorganisms such as:

Peptococci.

Bacteroids.

Megaspheres.

Peptostreptococci.

Aptopobium.

Leptotrichi.

Mycoplasmas.

Gardnerella.

Bacteria with disturbed microbiocenosis of the vagina begin to multiply rapidly, in 1 ml of secretion their number can reach 10 10 . In this case, for the development of bacterial vaginosis, there must be appropriate conditions. Therefore, there are 2 groups of causes that can become an impetus for the development of the disease. They are divided into internal and external.

Internal factors include:

Hormonal imbalance in the body of a woman with excessive production of progesterone.

Atrophy of the vaginal mucosa.

Deterioration of immunity.

External factors that affect the development of the disease:

Long-term use of antibiotics.

Treatment with drugs that adversely affect the immune system. First of all, this applies to cytostatics and immunosuppressants.

Radiation therapy for cancer.

The presence of a foreign object in the vagina, such as a tampon, pessary, diaphragm to prevent unwanted pregnancy.

Use of spermicides.

Douching that is done too often.

Errors in intimate hygiene.

Any of these reasons leads to the fact that the microbiocenosis of the vagina is disturbed. In the future, this can provoke vaginosis.

During pregnancy, vaginosis develops mainly due to hormonal imbalance. In order for a woman to be able to bear a child, the level of progesterone in her body rises. This hormone helps to reduce the level of glycogen in epithelial cells. Lactobacilli will have nothing to eat, they begin to die, which provokes a change in the acidic environment of the vagina to alkaline. Another effect of progesterone is that it creates a favorable environment for the reproduction of pathogenic microflora.

Vaginosis is not a sexual infection, but its symptoms often resemble STDs. In addition, vaginosis often occurs after a change of sexual partner. About a day after intimacy, a woman has the first signs of discomfort. This happens on the condition that intimacy occurred without the use of a condom.

When the cause of vaginosis is taking antibacterial drugs, or another factor, then sexual life does not have any effect on its development.

Symptoms of acute vaginosis can be identified as follows:

Increased volume of secretions from the genital tract. They become grayish in color, have a uniform consistency. They start to smell bad. The discharge becomes more after intimacy, after menstruation, after using irritating intimate hygiene products.

Pain that occurs during intimacy.

Itching and burning in the vulva. Sometimes this symptom is absent altogether.

Some patients complain of pain during bladder emptying.

Also, pain can occur in the pubic area.

If vaginosis haunts women for 60 days or more, and the treatment does not bring the desired relief, then they talk about the chronic form of the disease. In this case, a woman is most often diagnosed with a hormonal imbalance. A complication of sluggish vaginosis is atrophy of the mucous membranes of the vagina.

To confirm the diagnosis, you need to visit a gynecologist. The doctor will take an anamnesis, find out the main complaints of the woman. The next stage of diagnosis is an examination on the gynecological chair. In the course of its conduct, the doctor collects mucus.

Facts that allow you to make a preliminary diagnosis of "vaginosis":

The age of the patient. Vaginosis most often develops in women 20-45 years old.

Recent change of sexual partner or surgery.

Recent use of antibiotics.

The presence of symptoms characteristic of vaginosis.

During a gynecological examination, the doctor evaluates the external and internal genital organs. If the disease develops due to the reproduction of opportunistic flora, then the color of the vagina does not change, its walls remain of a uniform tone, there are no signs of inflammation.

Allocations are distributed unevenly along the inner wall of the vagina. If the disease is in the acute phase, then the color of the discharge is grayish, an unpleasant odor emanates from them.

Chronic vaginosis is characterized by yellow or green discharge. They are thick, viscous and can form into curd lumps or clots. Sometimes the discharge foams.

During the examination, the doctor evaluates the acidity of the vagina. He does this with the help of an indicator strip. If a woman has vaginosis, then the indicator exceeds 6.

To confirm the diagnosis, the doctor performs a rapid test. A smear from the vagina is applied to the glass and mixed with caustic potassium at a concentration of 10%. At the same time, a sharp fishy smell begins to emanate from the collected mucus. In this case, the test is considered positive.

Another swab from the vagina is sent to the laboratory. Epitheliocytes will be found in it. These are cells of the vaginal mucosa that contain gram-variable microbes. The cells themselves do not have a clear outline, they become granular. The level of lactobacilli in the smear is significantly reduced. At the same time, streptococci, bacilli and other pathogenic flora in significant quantities will be found in it.

Bacterial sowing of a smear with suspected vaginosis is rarely performed, only when it is necessary to find out exactly which representatives of the pathogenic flora inhabit the vagina.

If there is a suspicion of sexual infections, a PCR test is performed.

Differential diagnosis of vaginosis is carried out with such diseases as: trichomonas colpitis, candidiasis,.

The effect of vaginosis on the process of conception and pregnancy

With bacterial vaginosis, a woman can become pregnant, since the disease does not cause any pathological changes in the genital tract. Male sperm itself is alkaline. Once in the vagina with vaginosis, nothing happens to the spermatozoa.

After pregnancy, opportunistic microflora can enter the uterine cavity and lead to infection of the fetus. In this case, the child will lag behind in development, will not gain the desired body weight.

Sometimes vaginosis causes miscarriage, early rupture of amniotic fluid, the birth of a premature baby.

There is also an increased risk of blood poisoning during childbirth. The danger is especially high for those women who have undergone a caesarean section.

Vaginosis is treated by a gynecologist. However, if a woman has diseases of other organ systems, she may be referred for a consultation with an endocrinologist or gastroenterologist. Treatment is carried out at home, the patient is not placed in the hospital.

Therapy is aimed at destroying the pathogenic flora in the vagina and restoring normal microflora in it, that is, lactobacilli. It is important not only to eliminate the symptoms of vaginitis, but also to get rid of the cause that provoked its development. As practice shows, the passage of one-stage treatment leads to the fact that in 35-50% of cases the disease recurs. To prevent this from happening, you must strictly adhere to the timing of therapy, which should be phased.

First, the patient is prescribed antibiotics. They allow you to destroy the pathogenic flora that inhabited the vagina. For this purpose, drugs such as: Metronidazole, Clindamycin, Tinidazole can be used. All these agents are destructive to anaerobes.

Doctors point out that with an uncomplicated course of the disease, it is better to give preference to local antibiotic therapy. This will avoid many of the side effects that such drugs have on the body as a whole. Local therapy of infectious vulvovaginitis involves the use of drugs in the form of vaginal tablets, suppositories or capsules, such as Macmiror Complex (vaginal capsules / cream), which is intended for the local treatment of vulvovaginitis. The active substance nifuratel, which is part of it, has antibacterial, antifungal and antiprotozoal activity, and nystatin is added to enhance antifungal activity. In clinical studies, Macmiror Complex has proven to be highly effective against fungi, bacteria, Trichomonas and their associations with other pathogenic pathogens. Macmiror Complex creates favorable conditions for maintaining a healthy vaginal biocenosis, as it does not affect lactobacilli.

Therapy is selected by the doctor on an individual basis:

Metronidazole. The drug is used in the form of a gel with a concentration of 0.75%. It is inserted into the vagina once every 24 hours. The course of treatment should last no more than 5 days.

Clindamycin gel with a concentration of the main active ingredient of 2%. The drug is injected into the vagina 1 time in 24 hours. The course of therapy is a week.

Tablets Tinidazole 2 g. They are taken 1 time in 24 hours. The course of treatment is 3 days.

Clindamycin suppositories 100 mg. They are inserted into the vagina once every 24 hours. The course of treatment should last 3 days.

Tablets Metronidazole 2 g. The drug is taken orally once.

If vaginosis develops in a pregnant woman, then antibiotics are prescribed to her no earlier than the 2nd trimester. They are used in tablet form. Treatment should last 7 days, but no longer.

During the course of therapy, it is important to exclude any alcoholic beverages. This applies even to small doses of alcohol. Drugs that are used to treat vaginosis react with ethyl alcohol and cause severe intoxication of the body. Its symptoms are similar to those of a hangover. The woman's weakness increases, there is a tremor of the arms and legs, blood pressure rises, intense headaches occur. The patient is nauseated and vomits.

The composition of the drug Clindamycin contains fat, which can damage the integrity of the condom. You need to enter any means into the vagina before going to bed. This will allow the drug to remain inside the woman's body for a long time and not leak out.

If a woman has an individual intolerance to antibacterial agents, then antiseptics are prescribed for the first-stage therapy.

These can be tools such as:

Hexicon. It will be necessary to enter 1 candle every 12 hours. The course of treatment is 10 days.

Miramistin. Irrigate the vagina with this solution once a day. The course of treatment lasts a week.

The second stage of treatment of vaginosis is reduced to the use of drugs containing lactobacilli. They allow you to normalize the microflora of the vagina. They begin to be used 2-3 days after antibiotic therapy is completed.

For this purpose, drugs such as:

Candles Acilact. They are inserted into the vagina 1 piece 2 times a day. The course of therapy lasts 5-10 days.

Bifiliz drug. It is taken orally 5 doses 2 times a day. The course of treatment lasts 5-10 days.

Experts strongly do not recommend self-medication. If you choose the wrong dose, this can lead to resistance of pathogenic microflora. It will be more difficult to cope with such a disease, as well as with a chronic form of the disease. Therefore, at the first symptoms of vaginosis, you need to go to an appointment with a gynecologist.

Video: gynecologist Yulia Fakhradinova Balatskaya about bacterial vaginosis:

Prevention of vaginosis

The disease is not sexually transmitted, however, changing the sexual partner can lead to the development of vaginosis. The same applies to unprotected intimacy. Therefore, in order to prevent the development of the disease, you need to use condoms.

If unprotected intercourse occurs, then it is necessary to rinse the vagina with Miramistin.

It is important to treat chronic diseases in a timely manner. If the use of antibiotics is required, then they are taken according to the scheme indicated by the doctor.

Any hormonal changes need to be corrected under the supervision of a specialist.

There are contraindications. Before use, consult your doctor.

Education: Diploma "Obstetrics and Gynecology" received at the Russian State Medical University of the Federal Agency for Health and Social Development (2010). In 2013, she completed her postgraduate studies at the NMU. N. I. Pirogov.

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

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

Symptoms

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

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

In some cases, bacterial vaginosis is asymptomatic.

When to See a Doctor

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

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

The reasons

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

Risk factors

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

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

Complications

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

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

Diagnostics

To make an accurate diagnosis, the doctor:

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

Treatment

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

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

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

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

relapse

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

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

Prevention

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

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

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

Today we will talk about:

Vaginosis- This is a pathological condition of the vaginal mucosa of non-inflammatory origin, caused by the replacement of normal microflora with anaerobic microorganisms. There is no specific causative agent for vaginosis. Among the causes that provoke it, there are many different microorganisms, but their presence does not provoke local inflammatory changes in the vagina. It is on this feature of the course of the disease that the differential diagnosis of vaginosis is based.

The causes of vaginosis are not well understood, and the question of whether it belongs to diseases continues to be discussed. The only condition for the development of vaginosis is a change in the parameters of normal vaginal microbiocenosis and, as a result, a violation of the mechanism for protecting mucous membranes from unwanted microorganisms.

To understand the essence of the pathological processes in vaginosis, it is necessary to have a clear idea of ​​​​how the vaginal epithelium functions, and by what mechanisms it protects the reproductive system from potential infection.

The vagina connects the uterus (and indirectly, the appendages) with the external environment and therefore is in a state of constant resistance to its negative influence in order to protect the internal genitalia from inflammation.

The vaginal wall is formed by three layers: connective tissue, muscle and epithelial. The vaginal epithelium is formed by layers of squamous cells, its uppermost layer (the one that lines the inside of the uterine cavity) is in a state of constant renewal. Every month, according to cyclical changes in other genital organs, the surface layer of the vaginal epithelium is shed (sloughed off) and replaced by new cells. Thus, the mucosa is "cleared" of the potential cause of inflammation and protects the upstream organs from infection.

The key to successful mucosal barrier function is the constancy of the vaginal microenvironment. In a healthy vagina, it is represented by a dominant amount (98%) of lactobacilli and a small population of opportunistic microorganisms. The quantitative superiority of lactoflora provides reliable protection of mucous membranes from infection. If there are fewer lactobacilli, opportunistic microbes take their place.

In order to provide themselves with a numerical advantage, lactobacteria create conditions unsuitable for the vegetation of "harmful" microorganisms. They attach to the membranes of desquamated cells of the surface epithelium and “extract” glycogen from them, and then synthesize lactic acid from the latter. As a result, a constant level of acidity is maintained in the vagina (3.8 - 3.5). In an acidic environment, opportunistic flora is not able to compete with lactobacteria, therefore it remains small and safe.

Vaginosis is formed in the event that, against the background of a quantitative decrease in lactobacilli and a change in acidity (pH), populations of opportunistic microorganisms begin to multiply in the vagina, i.e. in fact, it is a local dysbiotic disorder.

Thus, vaginosis is formed due to "its own" microflora, which is constantly present in the vagina of any healthy woman. It is impossible for them to "get infected" or betray a partner during intimacy.

Acute vaginosis is rarely diagnosed. Since vaginosis does not provoke pronounced inflammation, the disease often does not have active subjective complaints. The pathological process in the mucous membranes of the vagina is able to proceed erased, then aggravating, then fading again.

Chronic vaginosis depletes local immunity and can cause inflammation when, against the background of a significant decrease (or complete disappearance) of lactoflora, unwanted microorganism begin to multiply excessively in the vagina.

Perhaps the only symptom of vaginosis is abnormal discharge. Their color and consistency depend on which microflora displaces lactobacilli, how long vaginosis exists, and what background processes occur in the surrounding tissues.

Diagnosis of vaginosis is based on a visual examination of the mucous membranes and a laboratory study of the vaginal discharge. By studying the microbial composition of vaginal leucorrhoea, the severity of the disease is determined: the less lactobacilli in the material, the more severe the vaginosis.

Therapy of vaginosis does not have a clearly defined plan. Each regimen for the treatment of vaginosis is the result of an individual study of the clinical situation. As a rule, treatment is aimed at eliminating unwanted microbial flora and restoring the lactobacillus population. Inside pills for vaginosis are prescribed according to indications. Preference is given to a local preparation (ointments, creams, suppositories).

Vaginosis often recurs. Prevention of vaginosis and its recurrence consists in the exclusion of provoking factors and a reasonable attitude towards sexual life.

The reason for the formation of vaginosis is its own opportunistic microflora present in the vagina of a healthy woman. Perhaps this is the uniqueness of vaginosis: the body independently provokes the disease without the involvement of external resources.

The microbial composition of the vaginal environment for each individual woman is individual, so it is impossible to name the only culprit in the development of vaginosis. It is provoked by polymicrobial complexes, which consist mainly of anaerobic microorganisms (mainly coccal nature). More often, with vaginosis, corynebacteria, mycoplasmas, epidermal staphylococcus aureus, lactic acid streptococci and other microbes prevail in the vaginal contents. It should be noted that the previously existing idea of ​​the dominant role of gardnerella in the pathogenesis of vaginosis has now been refuted by numerous studies. It turned out that gardnerella colonize the vagina in more than 50% of healthy women, without causing pathological dysbiotic changes in the habitat. Obviously, this microorganism acts as a pathological agent only if it is associated with another microflora.

Factors provoking dysbiotic disorders in the vagina are:

Incorrect hygiene measures. Some patients use douching too often, during which the “useful” microflora is simply mechanically washed off the surface of the mucous membranes. Also, aggressive cosmetics (soaps, gels) that are not suitable for intimate care have a negative effect on the vaginal epithelium.

The lack of proper intimate hygiene can also provoke vaginosis, as many unwanted microbes and their waste products accumulate on the mucous membranes.

Irrational antibiotic therapy. Free access to the purchase of antibiotics (including very "strong" ones) has very negative consequences: without the participation of a qualified medical examination, the sick are treated on their own, not always choosing and taking medicines correctly.

Antibiotic therapy prescribed by specialists always involves measures to prevent dysbiotic disorders and rarely leads to the formation of vaginosis.

Hormonal dysfunction. All ongoing processes in the vaginal mucosa are closely related to cyclic hormonal fluctuations. The state of the vaginal microflora is affected by the level of estrogens, they support the processes of renewal of the surface mucous layer, providing lactobacilli with a sufficient amount of glycogen. Under conditions of hypoestrogenism (especially long-term), the mucous layer becomes thinner, the population of lactobacilli decreases, and conditionally pathogenic microorganisms begin to vegetate intensively.

Changes in the normal hormonal background are more likely to explain vaginosis in pregnant women, women in menopause, or in women who have had a recent abortion.

Taking hormone-containing medications or contraceptives can also contribute to the appearance of vaginosis.

• Unprotected intimate relationships with different partners. In addition to an increased likelihood of getting a venereal infection, promiscuity leads to serious changes in the composition of the vaginal microflora and depletes local immunity. Moreover, the number of sexual partners increases the risk of vaginosis much more than the number of unprotected sex.
• Intestinal dysbacteriosis. Symmetric dysbiosis of the intestinal and vaginal mucosa is often diagnosed, especially against the background of endocrine diseases or antibiotic therapy. Every second patient with vaginosis has a diagnosed intestinal dysbacteriosis.
• Violations of immunological reactivity. The cause of vaginosis can be systemic allergic diseases or short-term local allergic reactions, for example, to hygiene products (vaginal tampons, soap, etc.), intimate lubricant, latex or talc contained in condoms.
• Intrauterine contraception (spiral). It provokes the appearance of vaginosis quite often (52%). Obviously, the spiral is perceived by the mucous membranes as a foreign body, and they respond to its presence with a local allergic reaction. In addition, any (even the most “good”) intrauterine contraception serves as a source of local non-infectious inflammation. In order for the intrauterine contraceptive to fulfill its intended purpose without concomitant negative manifestations, it is necessary to follow simple medical recommendations and not leave it in the uterine cavity for longer than the prescribed period.

Whatever the causes of vaginosis, a short-term change in the normal composition of the vaginal microflora in most healthy patients is eliminated through self-regulatory mechanisms. The disease develops only if the body is unable to eliminate local dysbiosis on its own.

Symptoms and signs of vaginosis

The leading, and sometimes the only, symptom of vaginosis is pathological discharge (leucorrhoea). Their number and appearance depend on several factors, one of which is the duration of the disease.

Acute vaginosis is accompanied by abundant white liquid leucorrhoea, sometimes the vaginal discharge has a grayish tint and an unpleasant odor. More often, an acute process occurs after hypothermia, severe emotional shock, allergic reactions, due to antibiotic therapy.

Chronic vaginosis can exist for years. If dysbiotic disorders in the vagina last more than two years, the discharge becomes thick and sticky, and its color changes to yellow-green. The change in the nature of leucorrhea in chronic vaginosis is associated with the degree of local dysbiosis: the longer vaginosis lasts, the less lactobacilli remain in the vagina, and the more pronounced the influence of opportunistic microflora. Long-term vaginosis significantly depletes the mechanism of local protection of the mucous membranes and can often cause the attachment of secondary pathological microflora and the development of infectious inflammation.

Allocations with vaginosis have one specific difference - an unpleasant odor, reminiscent of the smell of stale fish. It is “provided” by anaerobic bacteria competing with lactoflora. They synthesize substances (amines), which decompose with the release of an unpleasant, "rotten" odor. Often the patient is brought to the doctor not by the presence of whites, but by their unusual smell.

The clinic of vaginosis also depends on the state of hormonal function, in particular, on the level of estrogen. Lower (in comparison with progesterone) concentrations of estrogens lead to a decrease in glycogen content in the vaginal epithelium. Since less lactobacilli are required to process a small amount of glycogen, their number decreases, and anaerobic microflora occupies the vacated place on a competitive basis. Prolonged lack of proper estrogenic influence provokes thinning of the mucous layer of the vagina (orthia). The vagina becomes "dry", easily vulnerable, so the amount of whiteness against the background of vaginosis decreases, and the patient has subjective complaints of discomfort, dryness, burning and / or itching. Similar ones are typical for women with physiological (older age) or artificial (removal of the ovaries) menopause.

Diagnosis of vaginosis does not require a large number of examinations, however, the analysis of the data obtained is associated with some difficulties. Vaginosis should be distinguished from vaginitis, which, unlike the latter, is the result of an infectious inflammation of the vaginal mucosa. Often, patients treat non-existent vaginitis for years, using antibiotics, which only aggravate vaginal dysbiosis and lead to the development of chronic vaginosis.

The diagnosis of vaginosis is confirmed by several reliable criteria:

• Absence of inflammatory changes in the vaginal mucosa. On visual examination, the mucosa has the usual "healthy" appearance and pink color. In the vagina there is an increased amount of light discharge without external signs of the presence of pus, often (87%) during examination, their unpleasant odor is felt.
• Change in the acidity of the vaginal environment. To measure pH quantitatively, special indicator test strips are used. The division scale applied to them with vaginosis indicates a characteristic shift in acidity to the alkaline side (more than 4.5).

Changes in the microbial composition of the vaginal discharge according to the results of laboratory diagnostics. In smears, there is no increased number of leukocytes inherent in inflammatory diseases, but there is a quantitative shift in the microbial composition: against the background of a decrease (or complete absence) of lactoflora, an excessive increase in populations of opportunistic microorganisms is observed.

Among other anaerobic bacteria, a large number of Gardnerella are often found. In acceptable quantities, their population is completely harmless to the mucous membranes, but under conditions of pronounced dysbiosis, gardnerella enter into microbial associations and “help” maintain the pathological process. The simple detection of Gardnerell in a smear does not have independent significance.

The presence in the smear of the so-called "key cells". Microscopy of the vaginal discharge with vaginosis often visualizes a large number of desquamated epithelial cells with microbes adhering to their membranes. They are called "key".

Thus, the diagnosis of vaginosis is confirmed by:

• specific vaginal discharge (often with a "fishy" smell);
• increased above 4.5 vaginal pH;
• positive "amine test";
• key cells in the smear.

In 40% of patients with signs of vaginosis, when viewed on the cervix, background diseases (cervicitis, ectropion, scars) are found, more often pseudo-erosion. They often change the clinic of vaginosis and require additional colposcopic examination.

Despite the meager symptoms, the presence of vaginosis can be suspected at the stage of studying the clinical symptoms. Often in a conversation, patients point to a long, unsuccessful treatment of the so-called "inflammation" of the vagina. They may also note that the next course of anti-inflammatory therapy does not eliminate, but exacerbates negative symptoms.

In recent years, patients often face the conclusion of "cytological vaginosis". Unlike the usual, cytological vaginosis is the result of excessive reproduction of lactobacilli. This condition is often provoked by intimate hygiene products with an acidic pH, especially if they contain lactobacilli. Sometimes this type of vaginosis can appear against the background of hyperestrogenism. Excess estrogen stimulates excessive production of glycogen, which requires more lactobacilli to utilize.

Clinically, cytological vaginosis resembles candidal vaginitis, when, against the background of vaginal discomfort, burning or itching, abundant white "curdled" discharge appears. Both conditions are clinically so similar that diagnostic errors often occur.

It is possible to differentiate cytological vaginosis from according to the following criteria:

• vaginal pH less than 3.5;
• microscopically: many cells of the destroyed epithelium in the form of fragments against the background of a large number of lactobacilli;
• false key cells: instead of opportunistic microbes, lactobacilli are attached to the surface of epithelial cells, imitating true key cells;
• cultures and smears for the presence of candidal fungi are negative;
• no signs of inflammation (white blood cells are normal) in smears.

Vaginosis during pregnancy

In half of the cases, the disease does not cause pathological subjective sensations, and an increased amount of vaginal discharge is accepted by the pregnant woman as the norm.

The only reliable symptom of vaginosis in pregnant women is abundant liquid leucorrhoea with an unpleasant odor. If the discharge continues for a long time, the patient may notice a change in their consistency from liquid to thick, and in color from white to yellowish. Often in a conversation it turns out that episodes of the appearance of such whites were observed even before pregnancy.

Diagnosis of vaginosis in pregnant women is similar to that in non-pregnant women and includes examination of complaints (if any), visual examination of the vaginal mucosa, and laboratory examination of vaginal contents. An amine test and a vaginal pH measurement are also performed.

Pregnant women are examined for the presence of vaginosis three times: at the first visit, before maternity leave (27-30 weeks) and on the eve of childbirth. In the case of a positive result after the course of therapy, an additional examination is carried out to monitor the cure.

Vaginosis during pregnancy can provoke an infectious inflammation. Against the background of reduced immunity, an infection from the vagina can rise into the cervical cavity and uterus. And although the likelihood of such a scenario is small, it is impossible to leave vaginosis in pregnant women unattended.

The treatment regimen for vaginosis in pregnant women is characterized by the predominant use of local therapy. Systemic drugs are used infrequently and only in the second half of pregnancy.

Treatment of vaginosis

To cure vaginosis, it is necessary to consistently eliminate its causes: remove the unfavorable background that provokes dysbiosis in the vagina; destroy the excessively multiplied opportunistic microflora and restore the normal amount of lactobacilli.

To choose the right treatment tactics, it is necessary to take into account the severity of vaginosis. It is measured by the amount of lactoflora remaining in the vagina and the microbial composition of the vaginal environment.

Conventionally, there are three significant degrees of severity of vaginosis:

• The first degree of severity (compensated vaginosis) is characterized by the complete absence of microflora in the test material, the presence of unchanged, normal, vaginal epithelium. The cause of such vaginosis may be excessive intimate hygiene or antibiotic therapy. Compensated vaginosis does not always require detailed therapy, sometimes the body independently copes with a temporary violation of the microbial balance after the disappearance of the cause of its appearance.
• The second degree (subcompensated) severity of vaginosis is characterized by a decrease in the number of lactobacilli, a quantitative increase in the population of anaerobic bacteria and the manifestation of key cells in a small amount (up to five in the field of view).
• Decompensated (third) degree of severity is manifested by a pronounced clinic of vaginosis, the complete absence of lactobacilli against the background of a large number of microbial populations and a significant number of key cells (covering the entire field of view).

After the unwanted infection is eliminated, a niche is released in the vaginal environment, which must be occupied by lactobacilli. At the second stage of treatment, favorable conditions are created for restoring normal microbial balance with the help of eu- and probiotics, which contain lacto- and bifidobacteria.

Two-stage treatment of vaginosis is successful in 90% of cases, but it does not guarantee the absence of recurrence of the disease. Relapses of vaginosis are treated similarly to the acute process. To avoid the return of vaginosis, simple preventive measures should be observed. Prevention of vaginosis involves:

• adequate intimate hygiene;
• rational antibiotic and hormone therapy;
• prevention (or treatment) of intestinal dysbiosis;
• culture of sexual life: restriction of sexual partners and use of barrier contraception;
• regular examinations in the conditions of the antenatal clinic.
• Candles and preparations for vaginosis

The choice of medicine depends on which microorganisms are found in the material during laboratory testing.

The local method of administering the drug is preferable, therefore, the following are more often prescribed: Chlorhexidine in solution or Hexicon vaginal suppositories; suppositories or cream Clindamycin (Metronidazole), Flagyl suppositories.

An alternative to local treatment is taking Metronidazole, Tinidazole, Ornidazole tablets according to the scheme chosen by the doctor.

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

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

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

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

How does it develop

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

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

Risk factors

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

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

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

Symptoms

The main signs of the development of bacterial vaginosis:

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

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

The reasons

Experts identify the following causes of bacterial vaginosis:

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

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

Degrees

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

Compensated

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

Subcompensated

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

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

clinically pronounced

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

Features in pregnant women

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

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

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

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

Possible Complications

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

Which doctor to contact

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

Diagnostics

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

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

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

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

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

Treatment

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

To stop bacterial vaginosis, the patient is prescribed:

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

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

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

Forecast

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

Prevention

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

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

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

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

Video: How to cure bacterial vaginosis

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

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

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

What is bacterial vaginosis

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

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

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

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

Causes of vaginosis

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

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

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

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

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

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

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

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

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

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

Types of bacterial vaginosis

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

• asymptomatic;
• monosymptomatic;
• polysymptomatic.

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

• sharp;
• chronic;
• recurrent.

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

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

Bacterial vaginosis during pregnancy

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

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

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

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

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

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

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

Forecast

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

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

Diagnostics

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

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

Bacterial vaginosis in men

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

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

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

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

How is bacterial vaginosis transmitted?

Bacterial vaginosis is not a sexually transmitted disease!

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

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

When should you see a doctor?

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

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

What is the treatment for bacterial vaginosis?

Bacterial vaginosis in women is treated in two main steps:

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

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

Medicines for bacterial vaginosis

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

Eubiotics

Consider a treatment regimen with effective eubiotics:

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

Candles from bacterial vaginosis

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

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

Treatment regimen for bacterial vaginosis

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

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

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

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

How to treat vaginosis at home

Consider several ways to treat the disease at home:

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

Folk remedies for bacterial vaginosis

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

Consider the most effective recipes:

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

Prevention

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

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

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

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

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

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

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

Symptoms of bacterial vaginosis

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

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

The main symptoms of bacterial vaginosis are:

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

Treatment of bacterial vaginosis

Treatment of bacterial vaginosis is carried out in two stages.

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

First stage

The first stage includes the following therapeutic measures:

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

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

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

Second phase

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

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

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

Relapse or exacerbation

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

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

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

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

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

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

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

Causes of bacterial vaginosis

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

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

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

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

• bacteroids;
• peptococci;
• peptostreptococci.

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

Causes of bacterial vaginosis

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

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

These include:

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

Complications of bacterial vaginosis

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

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

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

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

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

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

Bacterial vaginosis and pregnancy

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

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

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

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

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

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

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

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

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

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

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

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

Classification of bacterial vaginosis

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

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

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

Diagnosis of bacterial vaginosis

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

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

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

Bacterial vaginosis in men

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

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

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

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

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

Prognosis for bacterial vaginosis

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

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

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

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

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

Prevention of bacterial vaginosis

In order to prevent bacterial vaginosis, a woman needs:

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

Questions and answers on the topic "Bacterial vaginosis"

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

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

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

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

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

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