Bacterial vaginosis in women causes. Bacterial vaginosis. Symptoms, diagnosis, treatment of bacterial vaginosis. At home

Bacterial vaginosis is a disease associated with a change in the balance of the microflora of the vagina. Most often, women aged 25 to 40 suffer from this problem. According to statistics, every eighth girl had to face such a problem. Vaginal dysbacteriosis does not threaten the life of the patient, but can lead to disturbances in the functioning of the reproductive system of the body. Therefore, treatment of bacterial vaginosis should be started when the first symptoms appear.

Features of the disease

The vagina of a healthy woman contains a wide variety of bacteria. They form an acidic environment, which is unfavorable for the vital activity of pathogenic microflora. Thanks to this, the reproductive system is protected from the development of inflammation.

Under the influence of negative external or internal factors, the number of lactic acid bacteria in the vagina is sharply reduced, which leads to a decrease in the acidity of the environment. Thanks to this, pathogens of various diseases, including bacterial vaginosis, are able to actively multiply.

Sometimes the disease proceeds in a latent form. More often it is accompanied by a vivid clinical picture. The severity of symptoms will depend on the ratio of beneficial and pathogenic microorganisms in the vagina. The sooner adequate treatment is started, the more likely it is to quickly restore health.

The disease does not belong to the group of venereal diseases. However, some pathogens of bacterial vaginosis are sexually transmitted. They do not become the main cause of the disease, but act as an aggravating factor.

Key causes of the development of the disease

The causes of bacterial vaginosis lie in the imbalance of vaginal microorganisms. It is impossible to isolate a specific pathogen that would provoke the development of the disease. More often, the appearance of pathology is affected by active reproduction in the vagina of the following microorganisms:

• Mycoplasmas.
• Megaspheres.
• Peptococcus.
• Gardnerella.
• Leptotrichi.
• Bacteroids.
• Atopobium.

Their entry into the human body does not cause bacterial vaginosis. Only in the presence of provoking factors does their active reproduction occur, which leads to the appearance of a problem.

Factors not associated with diseases

External factors that are not related to the state of health of a woman can give impetus to the development of the disease. Among them are:

• Excessive hygiene of the genital organs, frequent douching with the use of bactericidal agents. This leads to the death of most of the lactic acid bacteria and, as a consequence, the development of dysbacteriosis.
• Use as an intrauterine device as a contraceptive. If the technology of its installation is violated, the risk of spreading the inflammatory process to all organs of the reproductive system increases several times.
• Wrong nutrition. The use of a large amount of fatty foods, harmful foods and alcoholic beverages provokes severe dysbacteriosis.
• Wearing tight synthetic underwear. Non-natural tissues contribute to the creation of a greenhouse effect in the genitals. As a result, an environment favorable for the active reproduction of microbes is formed.
• Failure to comply with the rules of personal hygiene. If the washing of the genitals is carried out too rarely, pathogenic microorganisms get the opportunity to multiply freely. It is important for women to toilet the vagina after each bowel movement to prevent infection from the intestines.

It is necessary to begin treatment of the disease with the elimination of provoking factors. It is important to accustom yourself to proper hygiene and a healthy lifestyle.

Diseases causing vaginosis

The causes of vaginosis often lie in the progression of concomitant diseases. They provide a comfortable environment for the development of pathogenic microorganisms. These include:

• Deviations of the hormonal background. Female hormones have a significant impact on the microflora of the vagina. Related to this is the fact that dysbacteriosis often affects girls in adolescence and women who have passed into the menopausal phase. Often, women who are carrying a baby also encounter such a problem.
• A sharp decrease in immunity. With such a problem, the body loses the ability to resist the vital activity of pathogenic microflora, against which a strong inflammatory process develops.
• Damage to the vagina or cervix. This often happens in emergency situations or during difficult births.
• Intestinal dysbacteriosis. Changes in the microflora in the digestive system lead to the penetration of pathogens into the vagina, which gives impetus to the development of the disease.
• Diseases for the treatment of which long-term antibiotic therapy is used. The use of such provokes the death of beneficial bacteria, which stimulates the reproduction of dangerous microflora.

Read also related

Treatment of nonspecific colpitis in women

The presence of such pathologies complicates therapy. Long-term complex treatment is required. It should be carried out under the strict supervision of a specialist.

Symptoms

The characteristic symptoms of bacterial vaginosis help to recognize the development of the disease. Among them are the following:

• The appearance of severe itching in the genital area.
• Increased urge to go to the toilet. When urinating, there is an unbearable burning sensation.
• Unnatural discharge from the genitals. The secret is painted white or has a grayish tint. After sex, their volume increases significantly. The discharge is characterized by a sharp repulsive odor, reminiscent of the aroma of a slave.
• During sexual intercourse, a woman experiences discomfort. Because of this, libido gradually decreases.
• With advanced form of vaginal vaginosis, the discharge becomes sticky. They turn into a yellowish color, and their consistency becomes denser and thicker.

In the presence of aggravating factors, the symptoms of vaginosis appear a day after intercourse with a carrier of pathogenic microflora. If the disease occurs against the background of other pathologies or external factors, then its manifestations will in no way depend on sexual contacts. In 50% of cases, the disease does not reveal itself at all. Regular examinations by a gynecologist help to identify its presence.

If acute vaginosis is not cured in a timely manner, then the problem becomes chronic. Against this background, there are significant changes in the hormonal background, as well as atrophy of the mucous surface of the vagina. Therapy in such a situation will be especially difficult.

Diagnostic measures

The symptoms of bacterial vaginosis are similar to those of other diseases. Only a doctor can make an accurate diagnosis after the patient has undergone an appropriate medical examination. It includes the following activities:

• History taking and visual examination. The doctor should examine the patient's medical history, her lifestyle to identify factors that provoke the appearance of the problem. The condition of the mucous surfaces of the vagina, the presence of characteristic symptoms, as well as the consistency and color of the vaginal secret are assessed.
• Examination of a smear from the genital organs. Biological material is taken, into which vaginal discharge also enters. It is studied with a microscope and the number of pathogenic microorganisms is estimated.
• pH meter. During this test, the acidity of the environment in the vagina is determined. In a healthy lady, this figure can vary from 3.8 to 4.5. With a significant excess of the normative indicators, they speak of the development of the disease.
• amine test. Vaginal discharge is mixed with sodium hydroxide. After that, the smell of the resulting mixture is evaluated. If it exudes a fishy unpleasant odor, it is concluded that there is a pathology.
• bacteriological research. A swab from the genitals is placed in a special nutrient medium and left for several days. In the presence of a disease in the test sample, bacteria begin to actively multiply, forming colonies. They become clearly visible under a microscope.

Diagnosis of bacterial vaginosis is supplemented by a study of the sensitivity of the identified pathogenic microflora to modern antibiotics. This allows you to more accurately determine the drugs that will help you quickly cope with the problem.

Medical treatment

As soon as the first symptoms of vaginosis appear, it is necessary to start treatment. The main method is taking various medications. The following groups are used:

• oral antibiotics. More often from vaginosis, Metronidazole, Clindamycin, Tinidazole tablets are prescribed. They are most active against anaerobic bacteria. The dosage and duration of taking the funds is chosen by the attending physician.
• local preparations. The use of creams and suppositories for bacterial vaginosis is preferred. Such preparative forms allow you to quickly deliver the active substance to the site of infection. They have fewer side effects compared to oral medications. Clindamycin cream, Metronidazole suppositories, Neo-penotran, Fluomizin help to cure the disease. The suppository is used mainly at bedtime. The cream is injected into the genitals using a special applicator.
• Medicines for the restoration of microflora. After defeating pathogenic bacteria, you need to make up for the deficiency of beneficial microorganisms. To do this, a couple of days after the end of antibiotics, they begin to drink probiotics. Often prescribed Linex, Bifiform, Bifiliz. To achieve a quick effect, lactobacilli in the form of suppositories are used.
• Medications to maintain immunity. Treatment of vaginosis weakens the protective properties of the body. The drug Viferon or its analogues helps to restore immunity.

The doctor will tell you the specific means of treating bacterial vaginosis based on the results of your tests. Hospitalization for such a disease is not required, since there is no threat to the patient's life. But therapy should be carried out under the constant supervision of a specialist. Repeated testing will help determine the effectiveness of the chosen scheme. If necessary, drugs should be replaced by potent analogues.

The disease is prone to relapse. Even with proper treatment, in 30% of women the problem returns after a while. A multi-stage therapy program helps to avoid this.

If a woman suffers from bacterial vaginosis, then pathogenic microorganisms are found in her constant sexual partner. When STD pathogens become them, the man will need appropriate treatment.

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?

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, with bacterial vaginosis there are no inflammatory signs.

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;
• prolonged or uncontrolled use of antibiotics.

Symptoms of bacterial vaginosis

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 for. 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, complex therapy should include. 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 development with the appearance of pain and burning during urination, this of course requires medical therapy.

How is bacterial vaginosis transmitted?

Bacterial vaginosis is not a sexually transmitted disease!

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

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

When should you see a doctor?

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

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

What is the treatment for bacterial vaginosis?

Bacterial vaginosis in women is treated in two main steps:

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

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

Medicines for bacterial vaginosis

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

Eubiotics

Consider a treatment regimen with effective eubiotics:

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

Candles from bacterial vaginosis

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

• Ecofemin. The composition of the drug includes live lactobacilli. Suppositories are administered for ten days two to three times a day;
• Bifidumbacterin. Contains bifidobacteria. It is enough to introduce one candle at bedtime for ten days;
• . 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!

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

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

What is bacterial vaginosis

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

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

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

Causes of the disease

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

Internal:

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

External:

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

Symptoms of the disease

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

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

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

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

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

Does the disease affect conception and pregnancy

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

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

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

Diagnosis of the disease

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

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

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

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

Treatment of a gynecological disease

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

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

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

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

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

Folk remedies for bacterial vaginosis

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

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

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

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

Disease prevention

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

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

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

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

Signs of the presence of pathogenic flora

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

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

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

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

Causes of bacterial vaginosis

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

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

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

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

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

Causes of bacterial vaginosis:

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

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

Complications of bacterial vaginosis

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

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

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

Diagnosis of bacterial vaginosis

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

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

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

Treatment

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

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

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

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

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

Other means to restore the normal microflora of the vagina:

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

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

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

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

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

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

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

Folk remedies

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

Prevention of bacvaginosis

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

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

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

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

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 mycoorganisms 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 accompanying 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 followed. 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.