What causes bacterial vaginosis. Bacterial vaginosis: treatment - schemes. Etiology and genesis: causes and origin

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

The development of vaginal dysbacteriosis

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

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

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

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

Main etiological factors

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

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

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

Clinical manifestations of dysbacteriosis

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

Vaginal dysbacteriosis is most often manifested by the following symptoms:

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

Allocations have the following features:

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

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

Examination and treatment tactics

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

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

Key cells in the smear are shown in photo 3.

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

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

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

- an infectious non-inflammatory lesion of the vagina, in which the normal flora is replaced by polymicrobial associations of conditionally pathogenic bacteria. Bacterial vaginosis occurs against the background of immune disorders, inflammatory diseases of the reproductive system, menstrual irregularities, prolonged use of the intrauterine device, unsystematic use of antibiotics and hormonal drugs. Accompanied by profuse discharge with an unpleasant odor. Sometimes it is asymptomatic. The diagnosis is established on the basis of complaints, anamnesis and data from special tests. Treatment is local and general pharmacotherapy.

General information

Bacterial vaginosis is a non-inflammatory infectious process in which the normal lactoflora of the vagina is replaced by associations of anaerobes. It is a widespread pathology, diagnosed in 21-33% of patients who visit gynecologists. May be latent or with overt clinical symptoms. With the improvement of the general condition of the body, the symptoms of bacterial vaginosis disappear or smooth out, when exposed to various endogenous and exogenous factors, they reappear, which causes a long relapsing course of the disease. Pathology does not apply to sexually transmitted diseases. Due to hormonal changes, it often occurs during gestation and menopause. Treatment of bacterial vaginosis is carried out by specialists in the field of gynecology.

Causes of bacterial vaginosis

Normally, more than 95% of the vaginal microflora in women of childbearing age are aerobic and anaerobic lactobacilli. The remaining 5% includes more than 40 species of various microorganisms. The ratio of anaerobes and aerobes in a healthy vaginal microflora is 10:1. Lactobacilli are the basis of the natural barrier between the external environment and the uterine cavity. Due to the formation of acids and the release of hydrogen peroxide, they create an acidic environment that prevents the reproduction of pathogenic and conditionally pathogenic microbes.

Under adverse conditions arising under the influence of one or more endogenous and exogenous factors, the quantitative and qualitative composition of the microflora changes. The number of lactobacilli decreases, other microorganisms begin to actively multiply, primarily obligate anaerobes. The total number of bacteria increases. Bacterial vaginosis develops. A distinctive feature of this pathology is the absence of a specific pathogen. The cause of the infectious process is not one type of microorganisms, but polymicrobial associations.

Bacterial vaginosis can occur with immune disorders as a result of a general weakening of the body, acute and chronic infectious diseases. Another factor contributing to the development of bacterial vaginosis is hormonal changes during the phase of the menstrual cycle, amenorrhea, oligomenorrhea, single-phase cycles, during gestation, in adolescence and menopause. Of great importance is the use of hormonal drugs (corticosteroids, oral contraceptives), antibacterial, antiviral and antifungal drugs.

The likelihood of bacterial vaginosis increases with non-compliance with the rules of hygiene, frequent douching, increased radiation exposure (radiation therapy, exposure during professional contact with radioactive substances), malformations of the reproductive system, conditions after surgical interventions, polyps and cysts of the vagina, the use of an intrauterine device, diaphragms, tampons and spermicides. Risk factors for developing bacterial vaginosis also include post-abortion and childbirth conditions, atrophic changes in the vaginal mucosa, and intestinal dysbacteriosis.

Symptoms of bacterial vaginosis

The most characteristic and often the only symptom of bacterial vaginosis is discharge from the genital tract, often with an unpleasant odor similar to the smell of stale fish. Usually leucorrhea is liquid, white or slightly grayish. They can be abundant, constant, lasting for several years, or sparse, short-lived, appearing from time to time. The average amount of leucorrhea in bacterial vaginosis is about 20 ml per day, which is 10 times the volume of normal secretions. With a long course of the disease (for several years), the color and consistency of the discharge often change. Leucorrhea becomes thicker, frothy, sticky, yellowish or greenish.

The nature and amount of whites with bacterial vaginosis vary depending on age, general health, mental and emotional state of the woman (mental trauma and intense stress), sexual activity, phase of the menstrual cycle, endocrine disorders, diseases of the reproductive system and somatic diseases. In some cases, patients with bacterial vaginosis complain of burning, itching, urination disorders, pain or discomfort during intimacy.

Perhaps acute or torpid, asymptomatic, monosymptomatic (only with secretions) or polysymptomatic course of the disease. In some patients, the manifestations of bacterial vaginosis persist for a long time, in others they periodically occur under the influence of adverse factors. When collecting an anamnesis, it turns out that more than 90% of patients with suspected bacterial vaginosis have previously consulted a gynecologist and other specialists with complaints of discharge and other symptoms. Three-quarters of patients have been repeatedly treated for non-specific vaginitis using antibacterial suppositories and taking various oral antibacterial agents.

Diagnosis of bacterial vaginosis

The diagnosis of "bacterial vaginosis" is established on the basis of complaints, anamnesis, gynecological examination data and the results of special tests. During the survey, the doctor clarifies whether the woman suffers from diseases of the reproductive system, endocrine and somatic diseases, whether she takes hormonal drugs and antibacterial agents, whether she uses contraceptives, whether there were childbirth, abortions and surgical interventions on the genitals in the anamnesis, what is the intensity of sexual life etc.

The main laboratory study in bacterial vaginosis is the microscopy of smears taken from the posterior fornix and stained by Gram. During microscopy, the number of leukocytes is estimated, the forms and types of microorganisms that make up the vaginal microflora are studied. The presence of a large number of anaerobes with a decrease in the number of lactobacilli indicates the presence of bacterial vaginosis. A characteristic sign of the disease are key cells - mature epithelial cells, on the membrane of which various microorganisms (gardnerella, cocci, mobiluncus) are detected. Normally, such cells, as a rule, are not detected. In some cases, a false diagnosis of bacterial vaginosis is possible, due to the presence of epithelial cells with adherent lactobacilli in the smear.

Some studies of bacterial vaginosis mention serological, enzyme-linked immunosorbent and culture methods for diagnosing this pathology, however, such methods are still of purely scientific interest and are not used in wide clinical practice. Diagnostic criteria for bacterial vaginosis are the presence of specific leucorrhoea, identification of key cells by smear microscopy, a pH of more than 4.5, and the appearance of a stale fish odor when the leucorrhea reacts with potassium hydroxide. The diagnosis of bacterial vaginosis requires the presence of at least three of the four criteria.

If comorbidities are identified, additional examinations and consultations of various specialists may be required. Patients with bacterial vaginosis may be referred for a consultation with a general practitioner, endocrinologist, urologist, venereologist, mycologist, or gastroenterologist. If necessary, ultrasound of the pelvic organs, general blood and urine tests, a biochemical blood test, a stool test for dysbacteriosis, a blood test for hormones and other studies are prescribed.

Bacterial vaginosis is differentiated from gonorrhea, trichomoniasis, vaginal candidiasis, and nonspecific vaginitis. The hallmarks of gonorrhea are a liquid discharge with a yellowish or greenish tinge, combined with painful urination. The presence of trichomoniasis is evidenced by abundant sticky or frothy gray-yellow-green discharge, possibly with a stale odor. Sometimes whites are combined with itching and pain when urinating. Candidiasis can be suspected when flaky, cheesy white discharge appears, combined with burning and itching of the vagina. To exclude these diseases, special laboratory tests are required.

Treatment and prevention of bacterial vaginosis

The treatment regimen is determined individually, taking into account the severity of symptoms, the duration and form of bacterial vaginosis, the presence of concomitant inflammatory processes, changes in the reproductive system, somatic and endocrine diseases. Treatment includes two stages: taking antibacterial agents and restoring normal microflora. For the entire period of therapy, a patient with bacterial vaginosis is recommended to exclude alcoholic beverages, limit the intake of spicy and spicy foods.

At the first stage, metronidazole or clindamycin is prescribed orally or intravaginally, in the form of vaginal tablets, suppositories or creams. The duration of taking these drugs for bacterial vaginosis is 7-10 days. If necessary, immunocorrectors and antihistamines are used simultaneously. For the prevention of candidiasis (especially important - in the presence of a history of fungal infection), antifungal drugs are used. To correct the pH, topical agents with a high content of lactic acid are introduced.

1-2 weeks after the completion of the first stage of treatment, a re-examination and laboratory tests are carried out to evaluate the effectiveness of bacterial vaginosis therapy. After another 2-3 days, the second stage begins, the main task of which is to restore normal lactoflora. Probiotics and eubiotics are used. In 90% of cases, the result of treatment is the normalization of the vaginal microflora. The tests are repeated after 10 days and 1-1.5 months. after completion of the second stage of therapy. With a persistent course of bacterial vaginosis, additional examinations are prescribed to identify pathogenic factors that contribute to the development of relapses of the disease.

Among the measures for the prevention and timely detection of bacterial vaginosis include compliance with the rules of intimate hygiene, the thoughtful use of hygiene products, the exclusion of frequent douching and the rational selection of methods of protection, taking into account the intensity of sexual activity, the state of health and the hormonal background of the patient. Uncontrolled intake of antibacterial and antifungal drugs should be avoided, consult a doctor in a timely manner if symptoms of inflammatory diseases appear, regularly visit a gynecologist for preventive examinations, and treat intestinal dysbacteriosis.

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

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

Signs of the presence of pathogenic flora

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

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

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

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

Causes of bacterial vaginosis

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

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

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

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

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

Causes of bacterial vaginosis:

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

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

Complications of bacterial vaginosis

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

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

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

Diagnosis of bacterial vaginosis

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

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

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

Treatment

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

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

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

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

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

Other means to restore the normal microflora of the vagina:

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

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

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

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

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

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

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

Folk remedies

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

Prevention of bacvaginosis

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

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

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

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

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

• Bacterial vaginosis or bacvaginosis, vaginal dysbacteriosis, vaginal dysbiosis is a polymicrobial infectious non-inflammatory syndrome of the lower genitalia, which occurs against the background of a violation of the healthy balance of the vaginal microflora and a decrease in the acidity of the vaginal environment.

The prevalence of bacvaginosis is very high. The disease was noted in 55.8% of women of childbearing age who applied to a gynecologist; in 60-70% of patients with inflammatory diseases of the genitals and 35% of pregnant women. The combination of intestinal dysbacteriosis with bacterial vaginosis is observed in 71% of cases.

Bacterial vaginosis. ICD-10 code:

N89 Other non-inflammatory diseases of the vagina
Clarification:
There is no diagnosis of bacterial vaginosis in the ICD-10. Over the years, this syndrome was repeatedly renamed: until 1955, the disease was called nonspecific vaginitis; since 1980 - gardnerellosis.

Later it was found that the conditionally pathogenic bacterium gardnerella (Gardnerella vaginalis), which was considered the causative agent of bacvaginosis, is found in the vaginal discharge in 47-75% of healthy women without any clinical symptoms and is not the only "culprit" of the disease. Therefore, in 1981, gardnerellosis was renamed anaerobic vaginosis, and in 1984 the modern name appeared: bacterial vaginosis.

To identify the prevailing infectious agent, an additional ICD-10 code is used:
B96 Other bacterial agents listed as the cause of diseases classified elsewhere.

Healthy vaginal flora

The determining factor in the normal microflora of the vagina is the Doderlein flora. At 90-98% it is represented by lactobacilli (Doderlein sticks), bifidobacteria and, to a small extent, strict anaerobes (in particular, peptostreptococci).

The share of other (more than 40 species) microorganisms that inhabit the vaginal space of a woman normally accounts for only 3-5%.

/the most clinically significant microbial communities are indicated/

• A sharp decrease or disappearance of peroxide- and acid-forming lactobacilli (lactobacilli). As a result, an increase in the pH of the vaginal environment.
• Massive reproduction of strict (obligate) anaerobes: Peptostreptococcus spp., Mobiluncus spp., Bacteroides spp., Prevotella spp., etc.

These microorganisms belong to the normal vaginal microflora. But their excessive growth, against the background of a deficiency of lactobacilli, leads to a decrease in the content of acids in the vaginal contents and creates a favorable environment for the rapid development of opportunistic and pathogenic infections.

• Colonization of the vagina with gardnerella.
• An increase in the total concentration of bacteria in the vaginal discharge to 10 9 - 10 11 microorganisms in 1 ml (CFU / ml).

Representatives of the Doderlein flora

In the vaginal contents of various women, more than 10 types of unequal lactobacilli are isolated. They produce lactic acid (as a result of the destruction of glycogen accumulated by the vaginal epithelium), hydrogen peroxide, lysozyme, and stimulate local immunity.

By blocking the receptors of the cells of the surface epithelium, lactobacilli prevent the adhesion of pathogenic agents. Colonizing the mucous membrane, they participate in the formation of a protective ecological film and provide colonization resistance of the vaginal biotope.

The pronounced acidic environment created by lactobacilli suppresses the reproduction of acidophobic opportunistic and transient pathogenic microorganisms.

The second representatives of the useful flora of Doderlein also belong to acid-forming microorganisms. They play an important role in maintaining low pH values ​​of the vaginal environment, produce alcohols, lysozyme, bacteriocins, amino acids, vitamins, and stimulate the immune system.

propionic acid bacteria- useful representatives of anaerobes. Actively processing glycogen, they secrete acetic and propionic acids, inhibit the growth of opportunistic microflora.

Causes of bacterial vaginosis

The mechanisms of development of vaginal dysbiosis are still not entirely clear.

An important role in the pathogenesis of the disease is played by:

• Change in hormonal status.
• Changes in general and / or local immunity, a decrease in the body's resistance.
• Decompensated diabetes.
• Taking antibiotics, cytostatics, radiation therapy, ionizing radiation.

Risk factors for bacterial vaginosis:

- Puberty, menopause, pathology of pregnancy, postpartum, post-abortion period, menstrual disorders (amenorrhea, oligomenorrhea).
- Hypotrophy and atrophy of the vaginal mucosa.
- Violation of the sensitivity of the vaginal mucosa to sex hormones.
- Sexually transmitted infections.
- Inflammatory processes of the urogenital tract.
- Taking glucocorticosteroids, antibacterial, antiviral, chemotherapeutic drugs.
- Long-term, uncontrolled use of oral and intrauterine contraceptives.
- Foreign bodies in the vagina and uterus (tampons, IUDs, etc.)
- Cysts, polyps of the genital tract.
— Surgical gynecological operations.
- Violation of the hygiene of the genital organs.
- Inadequate use of douches, vaginal douches, deep washing.
- The use of condoms, uterine caps, diaphragms treated with spermicide (nonoxynol -9).
- Frequent change of sexual partners.
- Chronic stress.

Development of bacterial vaginosis

Under the influence of external and / or internal factors that disrupt the healthy balance of the vaginal microecosystem, the number of H 2 O 2 -producing pool of lactobacilli decreases, the production of lactic acid decreases, the pH of the vaginal contents increases.

The growth of the pool of strict anaerobes is increasing. The waste products of these bacteria decompose to volatile amines, with a characteristic smell of "rotten fish".

Hormonal imbalance "progesterone / estrogens" accelerates the proliferation (reproduction) of the vaginal epithelium. Activation of the receptors of these cells to bacteria stimulates the adhesion (adhesion) of strict anaerobes to the vaginal mucosa and the formation of "key" cells.

• "Key" cells are desquamated cells of the vaginal epithelium, covered with gram-negative bacilli (rod-shaped bacteria, not lactobacilli).

Abundant exfoliation of the "key" epithelium is accompanied by increased production of vaginal discharge up to 20 ml per day (at a rate of 2 ml).

Symptoms of bacterial vaginosis

1. Whitish-gray, creamy vaginal discharge, usually with a "fishy" smell of varying intensity. The unpleasant odor either disappears or intensifies after intercourse, menstruation, douching, washing.

It is the characteristic discharge that is the main complaint of patients with bacterial vaginosis. Liquid secretions can subsequently acquire a yellowish-greenish color, become sticky, thick, foamy.

2. Often patients feel discomfort in the external genital area, painful sexual contact (dyspareunia).

3. Very rarely there is itching and burning of the genital organs or painful urination (dysuria).

Objective clinical symptoms of bacterial vaginosis
Amsel criteria
1. Abundant, homogeneous whitish-gray discharge from the vagina.
2. "Key" cells in vaginal smears.
3. Acidity of vaginal content: pH>4.5.
4. Positive amino test.

The presence of 3 out of 4 possible signs confirms the diagnosis of bacterial vaginosis.

Diagnosis of bacterial vaginosis

1. Inspection of the walls of the vagina with a mirror.
In favor of bacvaginosis testify:
- The presence of abundant secretions (whites), evenly covering the vaginal mucosa.
- The usual pink color of the walls of the vagina no signs of inflammation.

2. Calposcopy.
Confirms the absence of inflammation of the vaginal mucosa.

3. Microscopy: bacterioscopic examination vaginal smears are the main, most accessible and reliable method for diagnosing bacterial vaginosis.

Microscopy of smears of patients with bacvaginosis reveals:
- Reduction or disappearance of lactobacilli (gram-positive rods of various sizes).
- Increased mixed non-lactobacillary microflora.
- "Key" cells. The edges of the "key" epithelial cells are uneven, indistinct due to the adherence of gram-variable rods and cocci, including Gardnerella vaginalis, Mobiluncus, etc., to them; it is often difficult to distinguish microorganisms from each other.
- In most cases: a small number of leukocytes.

Not characteristic of isolated bacterial vaginosis.

4. Determination of acidity (pH) of the vaginal secretion using indicators.

5. Aminotest.
When mixed on a glass slide of vaginal discharge from a patient with bacvaginosis with an equal amount of potassium hydroxide solution (solution KOH 10%), an unpleasant smell of rotten fish appears.

Additional methods for diagnosing bacterial vaginosis

They are used according to indications, in cases of frequent recurrence of the disease.

1. Cultural study.
It consists in determining the species and quantitative composition of the vaginal microflora: isolation and identification of Gardnerella v., other facultative and obligate anaerobes, lactobacilli (with a sharp decrease in their number

2. Molecular biological methods: PCR, etc.
Test systems detect specific fragments of DNA and/or RNA of microorganisms (A. vaginae, G. vaginalis, M. hominis and Ureaplasma spp., etc.), including difficult-to-cultivate bacteria.

Differential Diagnosis

The diagnosis of bacvaginosis requires the exclusion of urogenital microbial-viral sexually transmitted infections (gonococcal, trichomonas, chlamydial, and other STIs). It is also important to differentiate infections caused by opportunistic agents and fungi (genital mycoplasmas, facultative anaerobic and aerobic microorganisms, candida).

Degrees of bacterial vaginosis

/Microscopic characteristics of smears according to Mavzyutov A.R./

1 degree

It is characterized by a meager amount of any microbial, including lacto-flora in a vaginal smear.

Such a smear is not considered a pathology. Often it is due to excessive preparation of the patient for a visit to the gynecologist (deep washing with disinfectants), previous antibacterial treatment (taking broad-spectrum antibiotics) or intensive chemotherapy.

2 degree

Subcompensated bacterial vaginosis:- decrease in the number of lactobacilli;
— a commensurate increase in other microbial flora;
- the appearance in the smear of single (1-5) "key" cells.

3 degree

Clinical bacterial vaginosis:- almost complete absence of lactobacilli;
- the field of view is filled with "key" cells;
- the bacterial flora is represented by various (except for lactobacilli) cultures in various species combinations.

How to treat bacterial vaginosis

The first stage of treatment of the disease is carried out with antibacterial agents of the 5-nitroimidazole or clindamycin group, to which anaerobic bacteria and gardnerella are most highly sensitive.

• Metronidazole
  Trade names: Trichopolum, Metrogil, Flagyl, Klion
• Tinidazole
  Trade names: Fazizhin, Tiniba (500 mg)
• Ornidazole
  Trade names: Tiberal, Dazolik, Gyro, Ornisid, etc.
• Clindamycin
  Trade names: Dalacin, Clindamin

Vaginal tablets and suppositories for bacterial vaginosis:

In recent years, local combined vaginal agents with antibacterial, antifungal, anti-inflammatory effects have been considered a promising method for treating bacvaginosis:

• Polygynax
• Terzhinan
• Vagisept
• Vagiferon
• Elzhina

Apply: one suppository (tablet) in the vagina for 10 days.

The second stage of treatment is carried out after the complete eradication of anaerobic and conditionally pathogenic microflora. Restoration of the normocenosis of the vagina is carried out by local administration of biological preparations:

• Lactoginal
• Acylact
• Floragin Gel
• Laktonorm
• Lactobacterin
• Bifidumbacterin
• and etc.

The effectiveness of bottom biopreparations, unfortunately, is limited by the low survival rate of "foreign" strains of lactobacilli in the vagina.

To restore normal vaginal microflora, intravaginal agents are also recommended:

• Lactogel (lactic acid + glycogen)
• Multi-Gyn Actigel
• Vaginorm

They are used both for the treatment and prevention of bacterial vaginosis.

In cases of atrophic changes in the vaginal mucosa, local estrogens (estriol preparations) are used:

• Trioginal
• Orniona vaginal cream 1%

According to indications, antiallergic drugs and vitamins A, E, C are prescribed.

Recommended Antibacterial Treatments for Bacterial Vaginosis

Metronidazole 500mg tablets. 1 tablet 2 times a day, orally (by mouth).
Course of treatment: 7-10 days.

Tinidazole 2.0 g (4 tablets of 500 mg) at a time, by mouth orally, once a day.
Course of treatment: 3 days.

Given the local nature of the infection, many specialists prefer topical treatment for bacterial vaginosis. The best therapeutic effect was shown by intravaginal suppositories and gels with Metronidazole or Clindamycin.

3.1 Vaginal suppositories with Metronidazole 500 mg (Flagyl, vaginal suppositories)
Apply once a day, intravaginally, at night.
Course: 7-10 days.

3.2 Metrogyl (Metronidazole), gel 1%
Apply intravaginally at 5.0 g (one full applicator) 1 time per day, at night.
Course: 5 days.

3.3 Metronidazole gel 0.75%. Apply 5.0 g intravaginally (one full applicator) 1 time per day, at night.
Course: from 5 days to 2 weeks.

Dalacin (Clindamycin, Clindamycin), cream 2%
1 full applicator (5.0 g cream = 100 mg clindamycin) deeply intravaginally 1 time per day, at night.
Course: 7 days

Alternative Treatments for Bacterial Vaginosis

Metronidazole 2.0 g (8 tablets of 250 mg or 4 tablets of 500 mg) at a time, once, inside, orally.
Treatment result:
closest is good
remote - not good enough

Scheme 2A Tiberal (Ornidazole) 500 mg, 1 tablet orally 2 times a day.
Course: 5 days.

The effectiveness of the drugs Metronidazole and Clindamycin is approximately the same. But taking Clindamycin is less likely to cause unwanted side effects.

During treatment and within 24 hours after the end of taking Metronidazole it is forbidden to take alcohol.

Bacterial vaginosis during pregnancy - treatment features

Treatment of bacvaginosis in pregnant women requires an individual approach in the choice of dosages and therapeutic regimens. Taking oral antibiotics is possible only from the 2nd trimester of pregnancy under the strict control of laboratory diagnostics in a specialized medical facility.

1. Metronidazole, tablets 500 mg.
Take 1 tablet 2 times a day orally. Course of treatment: 7 days.

2. Metronidazole, tablets 250 mg.
Take 1 tablet 3 times a day orally. Course: 7 days.

3. Clindamycin 300 mg capsules.
Take 1 capsule orally 2 times a day. Course: 7 days.

Prognosis for bacterial vaginosis

The disease does not pose a direct threat to the life of the patient. Treatment takes place at home (there are no indications for hospitalization).

The control of the therapeutic effect is carried out 14 days after the end of treatment: examination by a gynecologist + repeated smear.

If the result is insufficient, the doctor chooses alternative drugs or methods.

Despite the "harmlessness" of the disease, it is important to carry out its timely treatment and prevention.

Possible complications of bacterial vaginosis:

- Spontaneous abortion (miscarriage).
- Pathology of pregnancy: intra-amniotic infection.
- Pathology of childbirth and the postpartum period: premature rupture of amniotic fluid, premature birth, endometritis and / or sepsis after caesarean section.
- The risk of having children with low body weight.
- The risk of developing infectious complications after gynecological operations or abortions.
- The risk of developing inflammatory diseases of the pelvic organs: peritonitis, abscesses of the pelvic organs after the introduction of intrauterine contraceptives, after invasive manipulations.
- The risk of developing dysplasia (neoplasia) of the cervix. Read in detail:.
- Increased susceptibility to sexually transmitted infections, including HIV, genital herpes.

Risks of recurrence of bacterial vaginosis

Frequent recurrence of bacvaginosis is observed in women with impaired immune and/or endocrine status. Such patients need advice:
– gynecologist-endocrinologist,
— endocrinologist,
- gastroenterologist.

Practice shows that prophylactic treatment of the sexual partner has little effect on the recurrence of episodes of bacvaginosis in the patient. Examination and treatment of a sexual partner is mandatory in the presence of clinical symptoms of balanoposthitis, urethritis or other urogenital diseases.

Alternative methods of treatment of bacterial vaginosis

Among the non-traditional methods of treating gynecological diseases, douching with solutions of medicinal herbs remains the "favorite" means of traditional healers.

In the case of bacterial vaginosis, such procedures are undesirable and even dangerous. They provoke the washing out of useful vaginal lactoflora, the introduction of pathogenic and opportunistic microorganisms into the cervical canal, allergic reactions and inflammation of the mucous membranes.

Permitted procedures:

Dissolve 1 teaspoon of Boric acid pharmaceutical powder (sold in bags) in 1 cup of boiling water. Cool down. With a sterile syringe, inject 100 ml of a freshly prepared tepid solution into the vagina. The procedure is carried out 1 time per day for a week.

Prepare a weakly concentrated (barely noticeable pinkish color) solution of potassium permanganate. Wash and douche once a day for a week.

Dilute 1 tablespoon of hydrogen peroxide solution for external use 3% (hydrogen peroxide 3%, sold in a pharmacy) in 500 ml of freshly boiled tepid water. Wash and douche once a day for a week.

Prevention of bacterial vaginosis

• Controlled intake of antibacterial and other drugs.
• Adequate diagnosis and therapy of gynecological (including age-related dyshormonal) diseases.

Thanks to the correct treatment of gynecological and endocrine pathology, the content of glycogen (the main nutritional component of lactobacilli) in the vaginal epithelium normalizes, normal vaginal microflora develops.

• Hygiene of the genitals.
• Hygiene of sexual life, fidelity to one partner.
• Giving up bad habits (smoking, etc.)
• Normalization of immune and neuroendocrine status.
• Physical activity: the fight against congestion in the pelvic area.

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