What is vaginosis in women. Bacterial vaginosis: symptoms, treatment, drugs. Restoration of the numerical and qualitative composition of the normal microflora of the vagina

Bacterial vaginosis is a condition in which there is a violation of the quantitative and qualitative composition of the microflora of the vagina. According to various data, about 20 percent of women of reproductive age suffer from this disease. This disease may not manifest itself for a long time. In some cases, external manifestations in the form of secretions from the genital tract with a pungent odor can be so pronounced that it makes a woman seek help from a gynecologist at the very debut of the disease. Unfortunately, timely seeking medical help is not always the key to successful treatment. The reason for the failure in the treatment of this disease is the many factors that can cause vaginosis.

What is the normal microflora of the vagina?

Normally, the vast majority of vaginal bacteria are lactobacilli, which are also called Doderlein sticks. These bacteria are represented by 4 species: Lactobacillus acidofilus, Lactobacillus Casei, Lactobacillus Fermentum, Lactobacillus cellobiosus. These bacteria have a number of properties inherent only to them: they produce peroxides that form an acidic environment in the vagina (normal pH is 3.8-4.4) and prevent the reproduction of other types of microorganisms in the vaginal lumen.

How does the body control the microflora of the vagina?

The immune system
It controls the microflora due to the secretion of IgA antibodies. On the surface of the cells of the vaginal mucosa, this immunoglobulin prevents bacteria from attaching to epithelial cells, which prevents the penetration of bacteria into the cell or into the layers of the mucous epithelium. With infectious inflammation, the army of leukocytes immediately moves into the lumen of the vagina to destroy the pathogenic or conditionally pathogenic microflora that caused the inflammation.

Properties of lactobacilli
Naturally, most of the bacteria colonizing the vaginal mucosa tend to create an environment that would be most favorable for their own development and unsuitable for the reproduction and development of competitors. Due to the ability of lactobacilli to secrete hydrogen peroxide, a rather acidic environment is created, which is unsuitable for life for many pathogenic bacteria.

What is vaginosis?
Vaginosis is a violation of the composition of the microflora of the vaginal mucosa that does not cause an inflammatory reaction. The clinical symptoms of such a disorder can be different - from the complete absence of symptoms, to pronounced discharge with an unpleasant odor, with a feeling of itching and discomfort.

Causes of bacterial vaginosis

• Violation of the hormonal background. A number of gynecological and endocrinological diseases are accompanied by a violation of the cyclical change in the concentrations of female sex hormones in the blood. Violation of the hormonal background leads to changes in the renewal of the vaginal epithelium, the properties of the cells of the vaginal epithelium.
• Decreased immunity. Violation of the activity of the immune system leads to a decrease in the ability of the immune system to influence the composition of the microflora, the activity of the synthesis of secretory antibodies, the activity of immune cells decreases.
• Violation of the intestinal microflora. A change in the bacterial composition of the intestine leads to a change in the composition of the microflora of the vagina. Therefore, intestinal dysbacteriosis can serve as the main cause of vaginosis.
• Use of antibiotics- in some cases, it can lead to a change in the qualitative and quantitative composition of the vaginal mucus. The thing is that antibiotics do not have a selective effect on certain types of bacteria. For example, in the treatment of bronchitis, along with the destruction of the bacteria of the bronchial tree, the antibacterial drug also destroys the beneficial microflora of the intestines and genital tract.

Symptoms of bacterial vaginosis

• Abundant or scanty discharge from the genital tract. More often, the discharge is purulent, white in color, with an unpleasant pungent odor, the discharge is more active after sexual contact or during menstruation.
• Itching is constant, may intensify during menstruation.
• Pain during genital intercourse. This symptom can be caused by a change in the mucous epithelium of the vagina and the aggressive properties of the vaginal microflora.
• Adhesion of the labia minora - associated with the active release of pus.
• Burning sensation during urination - this symptom rarely occurs and may be associated with irritation of the mucous membrane of the external urethra.

Diagnosis of bacterial vaginosis

The symptoms of bacterial vaginosis are listed in the previous chapter of the article.

Gynecological examination
On examination, the gynecologist reveals abundant purulent discharge of their genital tract, in some cases the labia are glued together with drying pus. When viewed in the mirrors, pus can be detected on the surface of the mucosa.

Laboratory research

Microscopic examination of a smear from the vaginal mucosa- is the main method in the diagnosis of vaginosis. A smear is taken from the posterior surface of the vaginal part of the cervix during a gynecological examination in the mirrors. After staining with special reagents, the smear is examined under a microscope. Most of the known bacteria that actively colonize the uterine mucosa in vaginosis can be identified as a result of this examination. The sensitivity of this method reaches 100%.

Bacteriological research not as effective in diagnosing the cause of vaginosis. However, this method in some cases is indispensable for diagnosing concomitant infectious lesions.

Amino test effective for express diagnosis of vaginosis caused by anaerobic bacteria. As a result of the vital activity of these bacteria, organic substances such as putrescine, cadaverine, trimethylamine are released into the external environment. These substances create the smell of "spoiled fish".

DefinitionspH vaginal secretion. Revealing a pH over 4.5 is one of the signs of vaginosis. As we said above, low pH values ​​​​in an acidic environment provide beneficial bacteria (Doderlein sticks). A decrease in acidity indicates that their number is reduced.

Treatment of bacterial vaginosis

The second and third stages are standard for all types of vaginosis:

Use of antibiotics

Restoration of the numerical and qualitative composition of the normal microflora of the vagina

It is important to note that the use of local forms of eubiotics (in the form of vaginal suppositories) does not always bring the expected result. Therefore, the recommendations are reduced to an integrated approach - the intake of eubiotic preparations orally and the local use of drugs in this group.

The duration of treatment is determined by the attending gynecologist individually, depending on the results of the intermediate diagnosis and the dynamics of the process.

The effectiveness of the treatment can be assessed only 4-6 weeks after the end of the course of treatment. The main criterion for the normalization of microflora is a quantitative and qualitative bacteriological examination of a smear from the vaginal mucosa.

Prevention of bacterial vaginosis

• Rational use of antibiotics.
• Maintaining the intestinal microflora at a normal level (prevention of intestinal dysbacteriosis).
• Normalization of the hormonal background (treatment of hormonal gynecological diseases).
• Maintaining the protective properties of the body (immunity) at a high level
• In some cases, the use of vaginal hygiene products and contraceptives should be excluded.

How to treat vaginosis during pregnancy?

For the treatment of vaginosis during pregnancy, drugs containing metronidazole. In this case, vaginal remedies are preferable to tablets that must be taken orally. It is especially convenient to use the gel with metronidazole (it is inserted into the vagina with a special syringe). The drug is used once a day at bedtime for 7 days.

Equally effective and convenient is metronidazole in the form of vaginal pills ( Klion-D) to be inserted deep into the vagina at bedtime for 10 days.

For the treatment of vaginosis in pregnant women, drugs such as Trichopolum, Metrogil, Tiberal, Ornitazol produced in various forms.

All of these drugs are used only after 20-22 weeks of pregnancy, when they cannot harm the developing fetus.

In the earlier stages of pregnancy, treatment of vaginosis with antimicrobial drugs is prescribed only in case of a real threat to the health of the mother and fetus.

In addition to specific drugs, in the treatment of vaginosis, pregnant women must be prescribed drugs containing lactobacilli. They are used both inside and in the form of douching. They are useful not only for restoring the microflora of the vagina, but also for the female body as a whole.

Treatment of vaginosis in a pregnant woman can only be carried out as directed and under the supervision of a gynecologist.

What suppositories are effective in the treatment of vaginosis?

How to treat vaginosis at home?

• In the initial stages, douching can be dispensed with. For this, a 2-3% solution of lactic or boric acid is suitable. For the procedure, it is enough to take a large syringe. The solution should be warm, but not hot. Procedures can be carried out 1-2 times a day. Efficacy depends on how early treatment is started. If the symptoms of vaginosis are not particularly pronounced, then douching will be enough, but in any case, tests should be taken after treatment.

• Medicines can be injected into the vagina using tampons. To do this, a cotton swab is moistened with the selected agent (it can be a solution of ascorbic or lactic acid; ointment with metronidazole or tinidazole; lactobacterin) and inserted deep into the vagina. The duration of the procedure is 15-20 minutes. After that, remove the swab and do not wash. The effect appears after 3-4 procedures. To achieve the desired result, you need to do 10 procedures.

• It is especially convenient to use vaginal tablets or suppositories. It can be Klion-D, Metronidazole, Vaginorm, Ecofemin, Klevazol, etc. A tablet or suppository should be inserted deep into the vagina. The duration of treatment depends on the type of drug and is indicated in the instructions. Signs that the remedy really helps will appear in a couple of days. As a rule, the itching decreases, and the discharge disappears. But do not give up treatment; you need to complete a full course of 7-10 days.

What are the traditional methods of treating vaginosis?

Infusions of medicinal plants for oral use:

• Mix equal amounts of leuzea and marshmallow roots, as well as pine buds, sweet clover grass, wormwood, cudweed, lavender. Two tablespoons of the mixture is poured with a liter of boiling water. After 6 hours, you can take the infusion inside half a glass before meals three times a day. The treatment lasts three months.
• Also inside you can use an infusion from the following mixture: elecampane roots, birch leaves, mint, chamomile, licorice, thyme, geranium and meadowsweet in equal amounts. The method of preparation and dosage are similar to those described above.
• You can try the following mixture: lingonberry leaves, knotweed, elecampane, viburnum, lavender, plantain, tansy, leuzea and mistletoe, taken in equal parts. The solution is prepared in the same way as in the previous recipes.
• Another option is to mix equal amounts of dry herbs of bergenia, knotweed, calendula, angelica, nettle, toadflax, coltsfoot; chicory and dandelion roots. Apply as in previous recipes.

• Mix dry crushed blueberry, cuff, birch, tansy and Greek leaves taken in equal amounts. Two tablespoons of the mixture is brewed with one liter of boiling water and infused for 6-8 hours. After this, the infusion must be filtered and used for douching or vaginal tampons, wetting the tampon with infusion and inserting it deep into the vagina. The procedure is carried out daily up to 2-3 times a day. One procedure will require a glass of infusion.

• Mix in equal proportions oak bark, geranium herbs, wormwood, chamomile and violets. The infusion is prepared in the same way as in the previous recipe. It is used in the form of douching or tampons.
• A mixture of the roots of mountaineer serpentine, Veronica grass, plantain, yarrow, thyme, calendula flowers and bird cherry leaves. The components are mixed in equal amounts. The infusion is prepared in the manner described above. Used for douching.
• Marshmallow roots, St. John's wort, marigold flowers, meadowsweet grass, dandelion leaves and blueberries are mixed in equal amounts. The infusion is prepared by the method described above. It is used in the form of douching or tampons.

Bacterial vaginosis- symptoms and treatment

What is bacterial vaginosis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article by Dr. Yu.A. Chursina, a gynecologist with an experience of 6 years.

Definition of illness. Causes of the disease

Bacterial vaginosis- This is an infectious non-inflammatory disease in which an abundant growth of certain microorganisms occurs in the vagina and a sharp decrease in lactic acid bacteria with protective properties.

This pathology is one of the most common diseases of the female genital area. According to various estimates, it is found in approximately 70% of women of reproductive age.

Let's take a look at the name of the disease. The term "bacterial" emphasizes a significant increase in the number of aerobic and especially anaerobic bacteria that obtain energy from a minimum amount of oxygen. The meaning of the word "vaginosis" indicates that there are no signs of inflammation in this disease.

Previously, it was mistakenly called "gardnerellosis", since it was believed that bacteria were the cause of the pathology. Gardnerella vaginalis. However, it was found that these microorganisms are found not only in patients with symptoms of the disease, but also in 40% of women who do not have complaints. Therefore, the diagnosis of Gardnerellosis is incorrect and incorrect: it does not reflect either the etiology or pathogenesis of the disease, and in some cases leads to a false positive diagnosis and the appointment of unreasonable treatment.

The causes of bacterial vaginosis are very diverse. These include both banal violations of intimate hygiene, and more complex situations.

Factors contributing to the onset of the disease include:

• trauma during childbirth;
• various operations on the perineum;
• surgical abortion;
• menstrual irregularities;
• irrational use of antibiotics and even local antiseptics.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of bacterial vaginosis

The main symptom of bacterial vaginosis is a copious liquid homogeneous discharge from the genital tract with an unpleasant odor. They can be gray or white.

The smell of secretions is often compared to the smell of fish. It is especially strongly felt when the vaginal environment is alkalized - after intercourse and during menstruation.

Approximately 50% of women, that is, every second woman, have no complaints about vaginal discharge, so the disease may be asymptomatic.

Sometimes with bacterial vaginosis, patients are concerned about discomfort, itching or burning in the vagina and in the rectal area, urination disorders and pain during or after intercourse.

A burning sensation and itching are also characteristic of vaginitis, an inflammatory process in the vagina. It is distinguished from bacterial vaginosis by a feeling of vaginal dryness, as well as redness and swelling of its membrane.

The pathogenesis of bacterial vaginosis

Bacterial vaginosis does not have one specific pathogen - it can be caused by various microorganisms. The most frequent include not only the mentioned G.vaginalis, but also fusobacteria, peptostreptococci, veillonella, vaginal atopobium, as well as bacteria Peptoniphilus, Prevotella, P. bivia and M. mulieris. Most often, the development of the disease provokes a combination of 2-3 microorganisms or more.

In the presence of risk factors, these pathogens begin to actively multiply in the course of their life, alkalizing the vaginal environment (normally, the pH of vaginal discharge is 3.5-4.5). Only lactobacilli that secrete lactic acid can prevent the growth of pathogenic bacteria, but due to an increase in the pH of the medium, their number decreases.

According to modern ideas, the bacteria that cause bacterial vaginosis are able to create biofilms that attach to the vaginal epithelium. Inside these films, microorganisms become less vulnerable to exposure, including drugs. It is the formation of biofilms that is the cause of frequent recurrence and unsuccessful treatment of the disease.

Bacterial vaginosis is not a sexually transmitted disease, as it also occurs in girls who have never had sex. Although it is difficult to unequivocally state that the disease is not related to its sexual transmission: numerous studies confirm that the change of sexual partner, the presence of numerous sexual partners, as well as non-traditional sex significantly increase the number of relapses of bacterial vaginosis.

Classification and stages of development of bacterial vaginosis

At the moment, there is no classification and division into stages of the disease. There is also no code in the ICD-10 (International Classification of Diseases) that would correspond to the diagnosis of "Bacterial vaginosis". Other codes are used to encode this state. Most often it is referred to as "N86. Other inflammatory diseases of the vagina", which is incorrect and not always correct.

Previously, the classification proposed by E.F. Kira in 1995. According to her, four types of vaginal microbiocenosis were distinguished - a combination of microorganisms that live in the vagina:

• Normocenosis - the predominance of lactobacilli. is a sign of the normal microflora of the vagina.
• Intermediate type - a moderate or reduced number of lactobacilli, the presence of gram-positive cocci and gram-negative rods. Often observed in healthy women, it can rarely be accompanied by complaints of discharge from the genital tract.
• Dysbiosis - almost complete absence of lactobacilli, abundant polymorphic gram-negative and gram-positive rod and coccal microflora. This condition has been associated with bacterial vaginosis.
• Vaginitis - an increase in the number of leukocytes in smears. This condition has been associated with nonspecific vaginitis.

Today, this classification is not used due to a significant expansion of knowledge about the microbiocenosis of the vagina and the emergence of modern methods of laboratory diagnostics.

Complications of bacterial vaginosis

Unpleasant discharge from the genital tract significantly reduces a woman's quality of life and her self-esteem, causes sexual behavior disorders, and can even lead to.

In general, bacterial vaginosis can cause a number of fairly serious complications. Scientists have proven the impact of the disease on the course of pregnancy: it doubles the risk of preterm birth, especially if it is detected at the beginning of the second trimester. Complications can also occur after the birth of a child: postpartum endometritis, wound infection after a cesarean section. Some researchers suggest that the toxins of vaginosis pathogens can affect the fetus, penetrating the placenta, which in the future may become one of the causes of the child.

More recently, bacterial vaginosis has also been shown to be associated with: in patients with this non-inflammatory disease of the vagina, the risk of infection with the human papillomavirus is higher than in healthy women. It also speaks to an increased risk of cervical neoplasia.

In addition, at the moment, the possible relationship of bacterial vaginosis with an increased risk of infection and other sexually transmitted diseases is being actively discussed (,). In particular, one study noted that an HIV-infected woman with bacterial vaginosis was more likely to transmit HIV to a sexual partner than an HIV-infected woman without vaginosis.

Diagnosis of bacterial vaginosis

Diagnosis of bacterial vaginosis usually does not present significant difficulties. Nevertheless, when making a diagnosis, one can often encounter errors: both overdiagnosis (when a patient is attributed a disease that she does not actually have), and underdiagnosis.

Most often, it is possible to correctly determine the disease already at the first visit of a woman to a doctor. In such cases, the diagnosis is made on the basis of characteristic complaints, examination data and pH-metry of vaginal discharge. Sometimes a fairly extensive clinical and laboratory examination may be required.

R. Amsel criteria are used in the diagnosis of bacterial vaginosis. These include:

• the presence of homogeneous whitish-gray discharge from the genital tract (on examination, one can note their uniform distribution along the walls of the vagina);
• increase in Ph in the vagina - more than 4.5;
• positive test with 10% potassium hydroxide solution - determination of volatile amines;
• detection in native smears and / or in Gram smears of "key cells", i.e. cells of the vaginal epithelium with gram-variable microorganisms tightly attached to their surface. Leukocytes in these smears are not detected or are contained within the normal range, which indicates the absence of inflammation, and lactobacilli are reduced to the point of complete absence.

The diagnosis of "Bacterial vaginosis" is established in the presence of at least three signs.

There is also a semi-quantitative assessment of smears of vaginal fluid, Gram-stained, on a scale of 0 to 10. Now this method is practically not used.

For laboratory diagnosis of bacterial vaginosis, the PCR Real Time method is used as part of a comprehensive analysis of the vaginal microflora. There are a number of test systems, the most common of which are Femoflor 16+KVM and Femoflor screen. These test systems allow you to get a fairly complete picture of the characteristics of the microbiocenosis of the woman's vagina and prescribe a reasonable treatment.

Clinical diagnostic methods include various rapid tests: Fem-exam, BVBlue, Pip-activity TestCard. However, all of them are not widely used in clinical practice. This is mainly due to their lack of sensitivity.

In addition, it must be remembered that any woman who is sexually active and goes to the doctor with complaints of discharge from the genital tract must be screened for causative agents of trichomoniasis, gonorrhea, due to the wide spread of these infections and the high frequency of complications.

Treatment of bacterial vaginosis

In no case should you self-medicate - it must be prescribed by a doctor, otherwise it may adversely affect the woman's health.

Treatment of bacterial vaginosis is carried out in the presence of clinical and laboratory signs. Pregnant women deserve special attention. Discussions about the advisability of their treatment have already been closed: it is mandatory for all pregnant patients, including those with a low risk of preterm birth (cases where there were no preterm births in the past). Treatment of pregnant women with asymptomatic bacterial vaginosis and a high risk of preterm birth (if children were already born before the due date) can significantly reduce the risk of early termination of pregnancy.

To eliminate bacterial vaginosis, antiseptic agents and various combined preparations are used. At present, the effectiveness of a two-stage treatment regimen has been proven: the first stage consists in the use of antiseptic agents, and the second - in the restoration of the vaginal microflora.

There are quite a lot of both foreign and Russian recommendations and treatment regimens for this disease. In accordance with the Eurasian clinical guidelines for the rational use of antimicrobial agents in outpatient practice, the following drugs should be used when eliminating bacterial vaginosis:

First line therapies:

• cream "Clindamycin" 2%;
• gel "Metronidazole" 0.75%;
• "Metronidazole" 0.5 g (for oral administration);
• "Ornidazole" 0.5 g (for oral administration).

Second line therapies:

• candles "Clindamycin" 0.1 g;
• "Clindamycin" 0.3 g (for oral administration);
• "Metronidazole" 2.0 g (for oral administration).

The duration and frequency of taking these drugs is determined by the doctor individually. In addition, there are a significant number of combined drugs.

To restore the vaginal microflora, vaginal capsules with live lactobacilli, ascorbic acid for vaginal use, and lactic acid gel can be used.

A promising method for the treatment of bacterial vaginosis at the moment is the treatment of the vagina with ultrasound-cavitated antiseptic solutions. This method is being actively studied and great hopes are placed on it in the treatment of not only bacterial vaginosis, but also various inflammatory diseases of the skin and mucous membranes.

Forecast. Prevention

The prognosis for timely treatment is favorable in most cases. Sometimes relapses of the disease are possible. When they occur, a comprehensive approach to the patient is required, a complete clinical and laboratory examination and the exclusion of concomitant diseases that may increase the risk of recurrence of bacterial vaginosis. You also need to consult on nutrition and lifestyle issues.

As a preventive measure for the occurrence of bacterial vaginosis, first of all, it is necessary to exclude such risk factors as:

• violation of the integrity and anatomy of the external genital organs of a woman (may occur with injuries during childbirth, various surgical interventions);
• alkalization of the vaginal environment (possible with the use of certain lubricants, shower gels, douching);
• surgical abortions, some gynecological operations, accompanied by the removal of the mucous plug from the cervical canal;
• menstrual disorders, hypoestrogenic state in the period before menopause;
• irrational use of antimicrobial agents and antiseptics.

A significant contribution to the development and recurrence of the disease is made by frequent changes of sexual partners, severe concomitant diseases, alcohol abuse, and smoking. All this should be avoided.

An important role in prevention is played by a healthy lifestyle, adequate physical activity and adherence to proper nutrition - a vegetarian diet and increased consumption of "fast" carbohydrates increase the risk of relapse.

To prevent bacterial vaginosis, you need to follow the recommendations for intimate hygiene:

• Wash at least twice a day. To wash the genitals, use only warm water or special compositions for intimate hygiene, which contain substances that do not violate the acidity of the vaginal environment.
• Washing should only be done with cleanly washed hands, do not use washcloths. When washing, the water jet should be directed from front to back.
• After washing, it is necessary to blot moisture with a towel for intimate hygiene. It should be soft, clean and strictly individual. You can not use them for hands, face and other parts of the body.
• During menstruation, it is not recommended to take a bath, swim in the pool or ponds. It is preferable to take a shower in the morning and in the evening. It is better to avoid sexual intercourse, especially in the first days of menstruation.
• Sanitary pads during menstruation must be changed at least four to five times a day, tampons - every two hours.
• Daily sanitary napkins should not be used regularly.
• Do not apply vaginal douching for regular hygiene. They are possible only if they are prescribed by a doctor.
• Give preference to underwear made of natural fabrics with a wide gusset. It should be changed daily, in some cases twice a day. Wash underwear separately from other clothes, towels and bed linen.

Today, one of the most common problems among women of reproductive age is bacterial vaginosis (abbreviated as bacterial vaginosis). Currently, this pathology is considered as a dysbiotic condition of the vaginal environment, which has characteristic clinical manifestations.

This material is devoted to the main causes of bacvaginosis, its clinical manifestations, laboratory diagnostics and drug therapy.

Introduction

The term "bacterial vaginosis" arose and began to be perceived as a separate pathology with its own pathogenesis only in the 80s of the twentieth century.

In the past, this condition was on the same level as infectious and inflammatory diseases of the external genital organs (in particular,).

This pathology also had various "names", such as hemophilic, gardnerella vaginitis, anaerobic vaginosis and many others.

The term acquired its modern name only in 1984 at the International Conference in Stockholm on the recommendation of a scientific group.

Indeed, it is difficult to attribute to inflammatory, since there are no symptoms characteristic of inflammation (hyperemia, edema, hyperthermia, leukocytosis).

Vaginosis is much closer to intestinal dysbiosis, and, as a rule, accompanies it. (according to L. G. Tumilovich, V. P. Smetnik 1997)

2. Epidemiology

The question of the prevalence of bacvaginosis is currently quite acute. This is because:

1. 1 First, in about 50% of women, this condition is asymptomatic and can be discovered incidentally during routine examination and smear taking;
2. 2 Secondly, a large number of women have obvious symptoms of vaginosis, but do not go to their doctor and stay in this condition for years.

All this complicates not only timely diagnosis, but also further treatment.

One way or another, there is evidence that in the outpatient work of an obstetrician-gynecologist, the incidence of bacvaginosis is approximately 15-19% of all cases, among pregnant women - 10-30%, among women with inflammatory diseases of the genitourinary system - about 35% of cases.

As you can see, the numbers are by no means small, so the urgency of the problem is quite high.

3. What is bacterial vaginosis?

Bacterial vaginosis is a non-inflammatory syndrome that is characterized by a significant decrease in the number or complete absence of normal lactobacilli flora, followed by its replacement with polymicrobial associations of facultative flora. Or, in a nutshell, it is "vaginal dysbacteriosis."

4. Composition of the vaginal microflora

To fully understand the pathology, you need to know. It is represented not only by lactobacilli, in addition to them, a minor, facultative flora is found, which is necessary to maintain local immunity.

This associated flora is called conditionally pathogenic.

Normally, the biocenosis of the vagina is represented by the following types of microorganisms:

In addition to species diversity, the number of microorganisms in the vaginal biotope is of great importance.

Their total number is permissible within the range of up to 10 8 - 10 12 CFU / ml, among them 10 3 - 10 ⁵ CFU / ml fall on facultative anaerobic microorganisms, 10⁵ -10⁹ CFU / ml on aerobes.

As can be seen from the table, the main place in the vaginal biocenosis belongs to lactobacilli. This is due to their ability to maintain not only the pH of the environment, but also local defenses due to:

1. 1 Ability to reproduce quickly in the vaginal environment;
2. 2 Tight attachment to the surface of epitheliocytes;
3. 3 Breakdown of glycogen to organic acids;
4. 4 Synthesis of natural bactericidal substances (lysozyme, bacteriocins, hydrogen peroxide).

There is another, often forgotten, ability of microorganisms to form so-called biofilms by creating a special matrix when isolated communities come into contact with each other and uniting into a common structure.

Microorganisms in biofilms are practically inaccessible to antimicrobial agents and other unfavorable factors, including cells of the immune system.

This ability can both protect and harm the body. It all depends on which microorganisms were involved in the formation of biofilms.

5. Risk factors

The formation of bacterial vaginosis has a significant difference from the classical course of an infectious disease.

Here, the leading role belongs to the suppression of the body's defenses, a decrease in the number or complete disappearance of Dederlein's sticks (lactic acid bacteria, lactobacilli) and their replacement with facultative flora.

The reason for this may be the following conditions:

1. 1 Endocrine diseases, hormonal imbalance;
2. 2 Immunosuppression;
3. 3 Somatic diseases contributing to the development of the above conditions;
4. 4 Diseases of the genitals, accompanied by the ingestion of a large number of foreign microorganisms into the vagina;
5. 5 Violation of mechanical factors of protection (damage to the perineum, genital tract, intrauterine contraceptives);
6. 6 Massive, frequent and inadequate antibiotic therapy.

Another difference between bacvaginosis and an infectious disease is the absence of any one pathogen (, staphylococci, etc.).

When comfortable conditions arise, the amount of a more aggressive opportunistic environment increases, the number of lactobacilli decreases, the acidity of the vaginal environment shifts to the alkaline side.

All this leads to the intensive growth of facultative flora, the formation of pathological biofilms, the appearance of secretions with a specific unpleasant odor.

During the vital activity of opportunistic microorganisms, amines are released (putrescine, cadaverine, trimethylamine, and others). One of the tests aimed at detecting vaginal dysbiosis, the amine test, is based on this feature.

6. Clinical manifestations

As mentioned earlier, signs of inflammation in bacterial vaginosis are usually not detected.

The leading clinical symptoms of bacterial vaginosis are:

1. 1 Homogeneous, with a grayish tinge, frothy, viscous, moderate or plentiful (on average, no more than 20 ml per day). Such secretions can accompany a woman for many years, eventually changing their color to yellowish-green, becoming curdled, thicker.
2. 2 One of the leading symptoms of bacvaginosis is characteristic,. This is what most often confuses women who turn to the doctor. This "flavor" arises due to the release of volatile amines in the process of vital activity of opportunistic microbes.
3. 3 Symptoms such as burning, irritation are noted by almost 23% of patients. At the same time, there is no exact evidence that such symptoms are caused by dysbiosis, and not by any other process. The opinions of different authors on this issue are radically different.
4. 4 In rare cases, it is possible to change the nature and duration of menstruation, irregular pains of a pulling nature, mainly in the lower abdomen. Such manifestations are more often observed with long-term dysbiosis and indicate possible complications.

7. Diagnostic methods

1. 1 Complaints with which the woman first turned to the doctor. Most often - discharge from the genital tract, more abundant than normal, with a characteristic "fishy" smell.
2. 2 When viewed in the mirrors, the color of the mucosa is not changed, the usual pink color. The only alarming symptom is abundant discharge, evenly covering all the vaults of the vagina, with possible involvement of the cervix. With colposcopy, dystrophic changes in the cervical mucosa can rarely be detected.

7.1. Amine test

An elementary test that reliably proves the presence of pathological growth of facultative flora in the vagina. The principle of the test is based on the detection of amine waste products of microbes formed during the life of opportunistic microbes.

The essence of the test is to add an alkaline solution (10% potassium hydroxide solution) in a ratio of 1:1. With a positive result, the characteristic “fishy” smell is enhanced. This method is affordable, economical and reliable.

7.2. Laboratory diagnostics

The material for assessing the state of the vaginal flora is a smear from the posterior fornix and cervix. The most common, economical and affordable is the bacterioscopic method.

In recent years, there has been an active search for more specific markers of dysbiosis. For example, in 1992 it was first found in the vaginal contents, and in 1996 a representative of the facultative flora Atopobium vaginae was described.

In 2006, Australian scientists proved that this microorganism is a highly sensitive marker of bacterial vaginosis.

7.2.1. Bacterioscopy

Characteristic for bacvaginosis. One of the leading signs.

These are desquamated epithelial cells of the mucosa, along the edge of which gram-variable bacteria, rods and cocci are adhered. These bacteria give the cells a vague outline and a granular appearance, which is clearly visible under microscopy.

Figure 1 - Key cells in a vaginal smear for bacterial vaginosis

With a smear microscopy, the number of leukocytes can be assessed. With dysbiosis, their number will be within the normal range, and an increase in their level indicates an inflammatory process.

With bacterioscopy, the acidity of the vaginal environment can be assessed. In the absence of pathological growth of facultative flora, the pH of the vagina varies within 3.8-4.5. Alkalinization of the medium with a pH value of more than 4.5 confirms the dysbiotic state.

7.2.2. Bacteriological research

This is the sowing of the discharge from the vagina, obtained with, on a nutrient medium. More complex, time-consuming and lengthy research. At the same time, the probability of detecting opportunistic bacteria is high, and it is also possible to immediately assess the sensitivity of microorganisms to antibacterial agents.

If during bacterioscopy there is a possibility of a subjective assessment of the quantitative and qualitative composition of the flora, then with bacteriology this is not possible.

When performing bakposev, it must be remembered that the material is taken under aseptic conditions (that is, with a sterile instrument in a sterile test tube with a nutrient medium). If this condition is violated, the study is considered invalid, and the result is incorrect.

Due to its laboriousness, high requirements for the conditions of the study, the culture of vaginal discharge is rarely performed.

7.2.3. PCR diagnostics

The most popular type of PCR diagnostics is. With its help, it is possible to analyze not only the species, but the quantitative composition of the vaginal flora. This, in turn, allows you to prescribe adequate etiotropic therapy.

It is possible to identify criteria confirming the diagnosis of bacterial vaginosis a:

1. 1 The presence of homogeneous grayish discharge from the genital tract with a characteristic "fishy" smell;
2. 2 Increasing the pH level of the vaginal environment (above 4.5);
3. 3 Positive amine test with 10% KOH solution;
4. 4 Presence of key cells in smear microscopy for flora.

8. Possible complications

The disease may worsen:

1. 1 Inflammatory diseases of the organs of the reproductive system (vulvovaginitis, endometritis, salpingo-oophoritis);
2. 2 Cystitis, urethritis both in a woman and in a sexual partner;
3. 3 Decreased resistance to sexual infections, including, etc.

9. Treatment regimens

Despite the fact that bacterial vaginosis is not considered an inflammatory disease, its treatment is carried out. Treatment of bacterial vaginosis is two-stage.

The first step is antibiotic therapy, it can be local (more often) or systemic (less often).

The purpose of prescribing antibiotics is to suppress the growth of sensitive opportunistic flora.

The second step in the treatment of bacterial vaginosis is the restoration of the normal composition of the vaginal biocenosis and its colonization with lactoflora.

Tables 2-4 below list the most commonly used drugs for topical and systemic treatment of bacterial vaginosis.

Table 2 shows the main treatment regimens recommended by Russian and foreign (CDC) guidelines.

Table 2 - Main and alternative schemes of antibiotic therapy for bacterial vaginosis

Other drugs for the treatment of bacterial vaginosis are also being studied, in particular, chlorhexidine-based suppositories, combined preparations (antibiotic of the nitroimidazole group + antifungal) have a good effect.

There is a certain logic in this, as we remember, bacvaginosis is a violation of the ratio between different representatives of the vaginal microflora.

The drugs listed in Table 3 have not yet taken confident positions in clinical guidelines. Experience with their use is accumulating.

Table 3 - Other drugs for the treatment of bacterial vaginosis. Click on the table to view

The second stage - the restoration of the pH of the vaginal environment and the use of lactobacilli - is widely used only in the Russian Federation. Table 4 shows the main schemes for the use of drugs based on lactobacilli. Whether there is a future behind this stage of correction of vaginal dysbiosis, time and adequate research will show.

Table 4 - Correction of vaginal dysbiosis with drugs based on lactobacilli and lactic acid

So, we examined how and with what it is necessary to treat bacterial vaginosis in women, then we will move on to the prevention of pathology.

10. Prevention

10.1. Vaccination

Currently, non-specific vaccination is possible, aimed at activating specific and non-specific immunity with the help of the SolkoTrichovac vaccine.

Vaccination involves three injections of the vaccine intramuscularly with an interval of 14 days. The first injection is performed the next day after the end of the course of antibiotic therapy. The method is experimental, but, according to the authors, quite effective.

10.2. General preventive measures

1. 1 Maintenance of normal immune status.
2. 2 Limitation of harmful effects on the body of the environment, minimization of stress.
3. 3 Control and maintenance by a woman of her gynecological health: regular visits to a gynecologist, timely treatment of diseases, maintaining a healthy sex life with a regular partner, maintaining personal hygiene, wearing natural underwear made from natural materials that does not restrict movement.
4. 4 Often, the multiplication of an opportunistic infection is caused by the patient's uncontrolled intake of systemic antibiotics to treat comorbidities. Therefore, the appointment and administration of antibacterial drugs should be carried out under the strict supervision of the attending physician.
5. 5 Restoration of hormonal balance.
6. 6 Prevention of recurrence of the disease: it is necessary to monitor the effectiveness of therapy after 1 week and 4-6 weeks after the end of the course.

What is the treatment for bacterial vaginosis? Gardnerellosis is considered an infectious disease and is not inflammatory in nature, often with distinct symptoms in women and blurry in men.

Today we will talk about what drugs to treat, whether it is necessary to carry out therapy for pregnant women, whether it is safe.

Both the weak half of humanity and the strong can face this disease. Moreover, bacterial vaginosis is not necessarily sexual in nature, although this is often how it is transmitted.

Vaginosis is a pathogenic microorganism that affects the epithelium of the vaginal mucosa and urethral canal.

Symptoms of the disease are abundant discharge, which has a characteristic fishy smell, itching and burning. This happens due to the multiplication of microbes, adversely affecting the conditionally pathogenic flora of the genital tract.

Many people think that PP cannot be infected, but this is not true. In an acute form, this is possible. Males have little to no symptoms initially, but are carriers.

The risk group is everyone who leads an active sex life. It is mandatory to get rid of the infection in order to exclude complications.

Therapy

The treatment regimen for bacterial vaginosis takes place in several stages.

1. Regeneration of the normal flora of the genital tract, restoration of immune forces, stabilization of hormonal balance, destruction of pathogens.
2. Reception of lactobacilli to establish a normal acid-base environment of the vagina and urethral canal. Assigned to both sexual partners.

Gardnerellosis

His treatment should be mandatory. This disease is fraught with complications that can lead to inflammation of the prostate gland, damage to the urethral canal and the genitourinary system.

Depending on the severity of the course of the disease, treatment is prescribed for a course of 3-10 days. urologist. If there is no result from therapy with one drug, it changes to another, but you should not do it yourself.

• Refuse intimate relationships during therapy.
• Drinking alcohol.
• Visiting public baths and saunas.
• Excessive physical activity.
• Prevent stressful situations and nervousness.

To prevent the occurrence of the disease in the future, you need to follow some tips:

1. Use condoms.
2. Do not neglect hygiene.
3. Drink vitamin complexes that strengthen the immune system.
4. Seek medical attention in a timely manner if there is an unpleasant smell in intimate areas.

How to treat

Based on the symptoms, antibiotic therapy is prescribed to eliminate acute signs of the disease.
The scheme of bacvaginosis often includes the main drug "Metronidazole". Produced in various forms. Which is very convenient.

• Tablets: 0.5 g * 2 rubles / day.
• Candles: twice.
• Gel: 1 time.

The course varies from 5-10 days, is prescribed by a doctor, do not self-medicate. Analogues of the drug are "Metrogil".

It is available as a solution for intravenous use and tablets. Flagyl is also prescribed, it is available in capsules, suppositories and a solution for intravenous administration. Along with the usual regimen, suppositories and creams for vaginal use are often used.


To restore the microflora of the vagina, it is necessary during treatment and after taking drugs to increase lactobacilli - Dederlein's sticks:

1. "Lactoginal" Lactoginal.
2. "Bioselak".
3. "Lacidophilus".
4. "Vaginorm".
5. "Bifoval".
6. "Bactisubtil".

The duration of treatment and the amount of the daily norm is prescribed by the doctor. You may not guess with the dose, and the therapy will not bring results. In the treatment of gardnerellosis, it is necessary to strengthen the immune system, therefore, vitamin complexes are prescribed among them:

• "Viferon".
• "Ruferon".
• "Genferon".
• "Interal".
• "Altevir".

The doctor prescribes antifungal drugs for candidiasis, specific pathologies of the genital area. These include gonorrhea, chlamydial infection, gonorrhea. Therapy will be with the use of etiotropic drugs.

Pregnancy

If the disease is detected in the first term, treatment is not carried out, it starts from the second trimester.

Bactaginosis tablets:

• "Metronidazole" Metronidazole: 2 rubles / day * 3-5 days.
• "Clindamycin" Clindamycin: 2 p./d - 3-5.

Candles and gels are successfully used in the treatment of vaginosis in pregnant women. They are safer and non-toxic to the fetus. The course of therapy and the amount of medication is prescribed by the gynecologist who leads the pregnancy.

Candles and ointments:

1. "Betadine" or "Povidone-iodine";
2. "Hexion";
3. "Chlorhexidine";
4. "Terzhinan";
5. "Polygynax".

It is contraindicated to take drugs without the supervision of a gynecologist. The instruction is indicated for a general idea of ​​​​the treatment of the disease.

Preparations

These remedies for bacterial vaginosis are used after the main one and should be prescribed by a specialist.

• "Baktisubtil" Bactisubti: 1 tab. * 4 p. / Day before meals.
• Linnex or Probifor.
• Bifidumbacterin Forte.
• "Immunal".

Suppositories to combat vaginal discharge:

• "Ecofemin" vaginal capsules.
• "Hexicon".

At home

Use healing herbs in the initial stages of the disease in combination with basic antibacterial drugs, as an alternative to expensive suppositories and ointments for vaginal administration.

Some believe that with bacterial vaginosis, if you douche with lactic acid products, you can get rid of unpleasant symptoms on your own and improve the vaginal flora.

But this is not so, in no case can not be done. In addition to important lactobacilli, you can pick up harmful ones. Throughout the course of treatment, use one of the recipes below.

You can do douching or tampons based on tinctures and decoctions. For procedures such as baths and douching, you need to devote at least 10 minutes of your time. It is advisable to put tampons at night.

Folk remedies

Recipe #1

1. Chamomile pharmacy: 1.0 tablespoons
2. Goose foot: 1.0 tablespoons

Mix everything, cook in a water bath with 1.0 liters of boiling water, cool, strain, refrigerate, use warm.

Recipe #2

1. Oak bark: 1.0 tbsp.
2. Pour boiling water (1 glass), let it brew, strain, apply warm, consume within a day.

Recipe #3

1. Common bird cherry: 1.0 tablespoons

Pour (2 cups.), Cook in a water bath for up to 8 minutes, let it brew and cool.