Bacterial vaginosis how to treat. How to treat bacterial vaginosis naturally. Risk Factors for Bacterial Vaginosis

Bacterial vaginosis is a violation of the natural microflora of the vagina caused by infectious diseases. In other words, a woman has vaginal dysbacteriosis. If you follow the statistics, then this disease is observed most often in young girls (18–27 years old) and in women during menopause.

Etiology

The main provoking factors in bacterial vaginosis include the following:

• long-term use of antibiotics;
• douching;
• wearing synthetic, tight underwear;
• non-compliance with personal hygiene;
• use of contraceptives of dubious quality;
• use of contraceptive suppositories.

Bacterial vaginosis develops most actively in those women who often change sexual partners. Also at risk should be attributed to women who are often in stressful situations, have hormonal imbalances and weakened immunity. In fact, there are quite a few reasons for the development of an infectious process.

Symptoms

Bacterial vaginosis has pronounced symptoms. But it is possible to start treating such a violation only after an accurate diagnosis by a gynecologist. Self-medication is unacceptable, as it can only aggravate the course of the disease.

As bacterial vaginosis progresses, the following symptoms can be observed:

• a sharp, unpleasant odor from the vagina;
• burning sensation, especially when urinating;
• itching and burning during intercourse;
• pain in the lower abdomen.

Allocations are quite plentiful (up to 30 mg per day). They have a sharp fishy smell, a grayish color and a liquid consistency. Symptoms and discharge are especially aggravated after intercourse.

It is worth noting that in some cases the disease may not show any symptoms at all, which greatly complicates the diagnosis.

At the same time, it is important to understand that the presence of such symptoms is not always a harbinger of bacterial vaginosis. Symptoms of this nature may also indicate other ailments of the genitourinary and reproductive system of a woman.

Pathogenesis

In the vagina of every woman there is a set of bacteria, which is called microflora. The main bacteria in a healthy microflora are lactobacilli.

When an extraneous infection enters the microflora, lactobacilli are replaced by anaerobic microorganisms. As a result of this, an infectious process begins to develop, that is, bacterial vaginosis or. An earlier name for this pathology is.

As official medical statistics show, today bacterial vaginosis is diagnosed in 20% of the total female population of the planet. Age group - from 18 to 50 years.

Diagnostics

For an accurate diagnosis of bacterial vaginosis, symptoms alone are not enough, even if they are pronounced. A complete diagnosis of the disease is carried out through a personal examination by a gynecologist, anamnesis, analysis of symptoms. Based on this, the doctor writes out a referral for laboratory tests. Only at the conclusion of all the above procedures, it is possible to make an accurate diagnosis and prescribe the correct treatment for vaginal dysbacteriosis.

Laboratory research methods include the following procedures:

• smear from the vagina;
• study of infectious cells.

It should be noted that the diagnosis is aimed not only at confirming the diagnosis, but also at identifying the number of infectious cells, establishing the true cause of the formation of the pathological process.

Bacterial vaginosis during pregnancy

It is essential to treat bacterial vaginosis during pregnancy. And the sooner, the better for both mother and child, because. ailment during pregnancy can lead to complications such as:

• infection of the fetus in the womb;
• premature contractions;
• premature birth;
• outpouring of amniotic fluid ahead of schedule.

pathogenesis during pregnancy

Microflora bacteria are the catalyst for the biochemical reaction between the fetus and the biological mother. As a result, the production of a substance called prostaglandin begins. Its composition is very similar to hormones, which leads to premature contractions. In addition, such a violation in the microflora can cause infection of the amniotic fluid and the fetus itself. The consequences of this can be the saddest - from severe pathology of the child to death.

Bacterial vaginosis during pregnancy requires immediate treatment and constant medical supervision. In the early stages, the treatment of vaginal dysbacteriosis is effective and if it is carried out correctly, then no complications develop.

Treatment

Before starting the treatment of bacterial vaginosis, it is necessary to accurately determine the cause of the disease. Treatment is usually carried out in two stages. First of all, therapy is carried out aimed at eliminating the pathogens that provoked the onset of the infectious process. At the second stage of treatment of bacterial vaginosis, the microflora is populated with healthy lactobacilli.

The basis of drug treatment is the use of suppositories - metronidazole and clindamycin. Such antibiotics in the form of vaginal suppositories give good results already at the first stages of use. Pain and burning almost completely disappear after the introduction of 2-3 suppositories. But this does not mean that the disease has completely receded. Under no circumstances should treatment be interrupted.

It is also worth paying attention that it is possible to use vaginal suppositories for vaginal dysbacteriosis only as directed by a doctor. The dosage and duration of taking tablets and suppositories is prescribed only by a gynecologist, taking into account the general condition of the patient and the severity of her illness.

Treatment of bacterial vaginosis can lead to the progression of other underlying diseases. Most often this is . Therefore, along with suppositories, against vaginal dysbacteriosis, drugs are prescribed for the prevention of thrush.

If, after a course of treatment, bacterial vaginosis again made itself felt, the symptoms became more pronounced, you should undergo a re-examination and repeat the course of treatment.

It is also important to review your diet during treatment. Proper nutrition in combination with drug therapy gives good results. The diet should include the following foods:

• biokefir;
• yogurt;
• sauerkraut.

It is also important to give the body the necessary vitamins to strengthen the immune system.

During treatment, sexual intercourse should be completely abandoned, even with a condom. If you still have sex, you should take into account the following - vaginal suppositories destroy the condom. Therefore, it is better to use birth control pills for this period.

Forecast

Violation of the microflora of the vagina is not a life-threatening disease. But if left untreated, it can lead to serious complications. Women who have had an illness are more susceptible to inflammatory processes of the genitourinary system, infections. But, if drug treatment is started in a timely manner and brought to an end, there can be no complications.

Prevention

It is almost impossible to completely eliminate a disorder of this kind. But you can minimize the risk of its formation. To do this, you need to apply in practice the following rules:

• examination by a gynecologist at least 2 times a year;
• you can not wear tight, synthetic underwear;
• you need to monitor personal hygiene;
• it is desirable to completely eliminate the frequent change of sexual partners.

For any symptoms, you should seek medical help, and not resort to the advice of friends, forums and self-medicate.

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

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

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

Symptoms of bacterial vaginosis

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

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

The main symptoms of bacterial vaginosis are:

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

Treatment of bacterial vaginosis

Treatment of bacterial vaginosis is carried out in two stages.

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

First stage

The first stage includes the following therapeutic measures:

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

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

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

Second phase

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

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

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

Relapse or exacerbation

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

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

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

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

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

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

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

Causes of bacterial vaginosis

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

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

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

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

• bacteroids;
• peptococci;
• peptostreptococci.

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

Causes of bacterial vaginosis

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

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

These include:

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

Complications of bacterial vaginosis

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

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

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

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

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

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

Bacterial vaginosis and pregnancy

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

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

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

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

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

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

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

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

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

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

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

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

Classification of bacterial vaginosis

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

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

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

Diagnosis of bacterial vaginosis

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

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

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

Bacterial vaginosis in men

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

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

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

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

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

Prognosis for bacterial vaginosis

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

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

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

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

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

Prevention of bacterial vaginosis

In order to prevent bacterial vaginosis, a woman needs:

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

Questions and answers on the topic "Bacterial vaginosis"

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

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

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

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

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

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

Bacterial vaginosis - 8 out of 10 women of childbearing age have experienced this disease at least once in their lives. It is also diagnosed in 76% of cases of patients visiting a gynecologist. However, there are still many myths surrounding bacterial vaginosis, also known as vaginal dysbiosis or bacterial vaginosis. Let's try to figure out where truth ends and fiction begins.

Myth #1: Bacterial vaginosis is sexually transmitted.

In fact, the nature of the disease is best characterized by the term "bacterial", prudently placed in the name.

The vagina of every woman is a mobile ecosystem in which more than 300 species of bacteria coexist. Normally, lactobacilli predominate among them, protecting our body from the invasion and reproduction of pathogenic microbes. Bacterial vaginosis develops when, under the influence of certain factors, beneficial lactic acid bacteria give way to opportunistic microflora, which causes the disease only with reduced immunity. Previously, it was believed that only one type of bacteria, the so-called gardnerella (Gardnerella vaginalis), is responsible for the development of pathology, but scientists now believe that the disease occurs due to the very fact of disturbing the "microbial balance".

Anything can cause bacterial vaginosis. According to Alexander Leonidovich Tikhomirov, Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology of the Faculty of Medicine of the Moscow State Medical University, first of all, these are frequent sexual intercourses (more than 4-5 per week), intrauterine contraception, cunnilingus, uncontrolled use of antibiotics, the use of tampons and synthetic underwear, hygiene violations or, conversely, excessively frequent douching, which leads to the washing out of healthy vaginal microflora. However, like any dysbacteriosis, this disease is not sexually transmitted.

To avoid recurrence of the disease, it is extremely important to observe the rules of personal hygiene:

• Do not wear tight, synthetic underwear. It disrupts blood circulation in the pelvic organs and is poorly ventilated, creating a warm and humid environment in the perineal area - ideal conditions for the reproduction of gardnerella.
• Do not abuse the wearing of tampons and panty liners, especially those containing fragrances.
• Properly wash yourself - not from the bottom up, but from front to back.
• Use intimate hygiene products that help restore the natural pH of the vaginal environment. The best option is to use a combination of special soap and gel with Ph from 3.8 to 4.4 (this information should be indicated on the package). In addition, among the components, look for lactic acid, preferably in combination with plant extracts (calendula, chamomile, sage), moisturizing mucous membranes.

We thank Alexander Leonidovich Tikhomirov, obstetrician-gynecologist, MD, professor, and experts of the pharmaceutical company "EGIS" for their help in preparing the material.

Bacterial vaginosis (gardnerellosis) is an infectious disease of the female reproductive system. It has a polymorphic origin, but the essence of the pathology is a change in the microflora of the vagina. It develops against the background of reduced protective properties of the body. The disease proceeds in a latent form, is not characterized by severe symptoms. The difference from vaginitis is the absence of signs of an inflammatory process. The predominant symptom is copious discharge from the genital tract. The pathology is treated by a gynecologist, to whom a woman should contact before the development of complications.

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. An 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

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.