Otitis

Vaginosis disease. Bacterial vaginosis in women: causes and treatment

Many women have to face the diagnosis of bacquaginosis at least once in their lives. What is this? This is the name given to a specific type of vaginal inflammation caused by an overabundance of bacteria. Microorganisms themselves are not dangerous; they always live in the vagina and perform useful functions. However, exceeding their normal amount leads to a disruption of the natural balance of microflora, and subsequently to bacterial vaginosis.

Most often, this pathology is detected, although the imbalance can be diagnosed in everyone. The causes of the disorder are still unknown to science; Only certain ones can be identified - for example, unprotected sexual intercourse or frequent douching. Taking certain medications can also trigger bakvaginosis.

Symptoms

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

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

In some cases, bacterial vaginosis is asymptomatic.

When to see a doctor

Make an appointment at a clinic or medical center if:

Vaginal discharge looks new or unusual, has a foul odor, or is accompanied by a fever. A gynecologist will help identify the cause and diagnose the disease based on signs and symptoms.
You have treated vaginal infections before, but this time the discharge has a different color and consistency.
You have had sex with multiple partners or have recently changed partners. Sometimes the symptoms of sexually transmitted diseases are similar to those of bacterial vaginosis.
You tried to treat a yeast infection yourself with over-the-counter medications, but you ended up with bacterial vaginosis, the symptoms of which don't go away.

Reasons

The inflammatory process in the vagina begins as a result of excessive growth of several types of bacteria that live in the female body. In a normal microflora state, beneficial lactobacilli outnumber “harmful” microorganisms (anaerobes). But if there are more anaerobes, the natural balance is disrupted and leads to a disease called “baquaginosis”. Is this an accident or a pattern generated by poor personal hygiene? Unfortunately, medicine is not yet able to give a definite answer to this question.

Risk factors

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

Frequent change of sexual partners or relationship with a new sexual partner. Doctors do not fully understand the connection between sexual activity and bacterial vaginosis, but the disease is more often diagnosed in women who have entered into a relationship with a new man. Representatives of non-traditional sexual orientation are at even greater risk.
Douching. The practice of cleaning the vagina with water or cleanser (douching) disrupts the natural balance of the vagina. This can lead to the growth of anaerobic bacteria, which, in turn, threatens the development of pathology. Since the vagina is capable of self-cleaning, douching is not necessary.
Lactobacilli deficiency as an individual characteristic of the body. Sometimes completely healthy women who do not change sexual partners and do not douche are diagnosed with bakvaginosis. What kind of scourge is this and why does it develop, seemingly out of nowhere? In fact, there are times when a woman's vagina is naturally unable to produce enough lactobacilli. The lack of “good” microorganisms over time leads to the appearance of unpleasant symptoms.

Complications

Usually this inflammatory process does not entail complications. In rare cases, the following are noted:

Premature birth. Bakvaginosis during pregnancy can lead to premature delivery and the birth of a child with low weight and height.
Sexually transmitted infectious diseases. If a woman does not take any measures to alleviate her condition, her body becomes more vulnerable to HIV, herpes simplex virus, chlamydia and gonorrhea. If the patient has HIV, there is an increased risk of transmitting the virus to a partner.
Risk of infection after surgery. Untreated disease increases the risk of postoperative infection after procedures such as hysterectomy or dilation and curettage of the uterus.
Inflammatory diseases of the pelvic organs. Bakvaginosis, the causes of which remain a mystery, in some cases causes inflammatory processes in the pelvis (usually the uterus and fallopian tubes are affected), which can, in turn, lead to infertility.

Diagnostics

To make an accurate diagnosis, the doctor:

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

Treatment

Use only those medications prescribed by your gynecologist. To treat the inflammatory process in the vagina, the following is usually used:

Metronidazole. This medication is convenient because it comes in tablets - you can simply drink the tablets with water. It is also available in the form of a topical gel, a small amount of which is placed in the vagina. To avoid side effects from taking the pills (which may include upset stomach, abdominal pain, or nausea), avoid drinking alcohol during therapy. It is also advisable to refrain from drinking alcohol for 24 hours after completing the course of treatment.
Clindamycin. This product comes in the form of a vaginal cream. It should be borne in mind that this drug has a destructive effect on latex condoms - both during treatment and for at least three days after the end of therapy.
Tinidazole. This drug comes in tablet form and has properties similar to those of metronidazole, the most common medication used to treat bakvaginosis. What does it mean? Follow the instructions for use and remember that you should also not drink alcohol during the course of tinidazole.

If the infected woman's sexual partner is a man, he usually does not require treatment. The situation is different for representatives of non-traditional sexual orientation; they are recommended to undergo diagnostic examinations and, if inflammation is detected, to begin a course of therapy. Timely treatment is of particular importance for pregnant women, since bacterial vaginosis can lead to premature birth.

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

Relapse

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

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

Prevention

It is better not to treat, but to prevent bakvaginosis. Reviews of special intimate hygiene products will help you make your choice - buy mild, unperfumed liquid soap and tampons or pads without fragrances.

It is not recommended to resort to douching, since the vagina does not need special cleaning - just taking a bath or a regular shower is enough. Frequent douching disrupts the balance of microflora in the vagina and increases the risk of developing infectious diseases. In addition, deliberately “cleaning” the vagina will not help in any way to calm down the inflammatory process that has already begun.

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

Bacterial vaginosis is vaginal dysbiosis, i.e. a condition in which the ratio of microorganisms normally living in the vagina is disrupted. Those that should be more numerous (lactic bacteria) become smaller, and vice versa, those that should normally be few in number multiply.

Bacterial vaginosis occurs against the background of immunity disorders, inflammatory diseases of the reproductive system, menstrual irregularities, prolonged use of an intrauterine device, unsystematic use of antibiotics and hormonal drugs.

Accompanied by copious 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. It is worth noting that this infectious disease is not sexually transmitted as such, but can be transmitted by a man from a partner to another partner.

Causes of bacterial vaginosis

Factors leading to the development of bacterial vaginosis include, first of all, long-term, sometimes uncontrolled use of antibiotics, which leads to dysbiosis not only of the vagina, but also of the gastrointestinal tract. According to a number of authors, almost every second patient with bacterial vaginosis has disorders of the intestinal microecology.

Doctors also identify several factors that presumably provoke the development of the disease:

Hormonal factors: female sex hormones affect the state of the vaginal microflora. Bacterial vaginosis is rare in teenage girls and women during menopause, when the level of sex hormones in the blood is reduced.
Taking cytostatics, antimycotic drugs and radiation therapy(weakening of immunity).
Presence of an intrauterine device– the risk of infection doubles.
Excessive desire for cleanliness(douching, frequent washing with soap and vaginal douches).
Reduced immunity– treatment of bacterial vaginosis may be required after serious illnesses, since they lead to a weakening of the body’s protective functions and promote the proliferation of harmful bacteria.
Deformation of the vagina, cervix and pelvic muscles bottom after childbirth, surgery or radiation.
represents a disturbance in the composition of the intestinal microflora and is a factor contributing to the development of bacterial vaginosis.
Pregnancy (increased progesterone synthesis causes a relative deficiency of estrogen, decreased immunity to prevent fetal rejection).

As a rule, with bacterial vaginosis, the following bacteria are found in the vagina: gardnerella vaginalis, bacteroides, fusobacteria, klebsiella, etc. Due to the presence of gardnerella in the vaginal discharge, bacterial vaginosis is often called gardnerellosis.

During pregnancy

Vaginal dysbiosis is dangerous due to its consequences and complications for both the woman and the unborn baby:

In the early stages, the disease can cause spontaneous abortion.
In the 2nd – 3rd trimesters, infection of the fetus and/or membranes may occur, which will lead to their premature rupture and prenatal rupture of water.
Premature birth, complications of the birth process and the occurrence of purulent-septic diseases after childbirth - this is an incomplete list of the dangers that gardnerellosis poses.

Treatment of bacterial vaginosis during pregnancy is prescribed only by the attending physician and is carried out under his supervision.

Symptoms of bacterial vaginosis

In women with bacterial vaginosis, the main symptom is heavy discharge with an unpleasant fishy odor, creamy consistency, and white or gray in color. Possible itching, burning, and discomfort during sexual intercourse.

In the case of bacterial vaginosis, acute or torpid, asymptomatic, monosymptomatic (only with discharge) or polysymptomatic course of the disease is distinguished. In some women, symptoms of bacterial vaginosis persist for a long time, while in others they periodically arise under the influence of unfavorable factors.

When collecting 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 the patients were repeatedly treated for nonspecific vaginitis, using antibacterial suppositories and taking various oral antibacterial agents.

Diagnostics

Before determining how to treat bacterial vaginosis, it is worth undergoing an examination and determining the causes of its occurrence. Diagnosis is based on the presence of three of the following four symptoms:

specific nature of the discharge;
acidity >4.5 (normal 3.8-4.5);
positive amino test;
presence of “key” cells. The so-called “clue cells” are mature epithelial cells (surface
layer of the vaginal epithelium), along the entire surface of which microbes are densely and in large numbers attached.

Depending on the severity of the course and severity of symptoms of bacterial vaginosis, the regimen and duration of treatment are determined.

How to treat bacterial vaginosis

Women diagnosed with bacterial vaginosis, depending on the degree and nature of the pathological process, may be prescribed local or systemic antibacterial therapy. In this situation, etiotropic agents that have an antianaerobic effect are used.

The main treatment for bacterial vaginosis is the use of antibiotics (Metronidazole or Clindamycin), which suppress the development of pathogenic bacteria in the vagina and create conditions for the restoration of normal flora.

In rare cases, during treatment for bacterial vaginosis, fungal flora begins to develop in the vagina. To prevent vaginal candidiasis, especially if the patient has a history of episodes of thrush, antimycotic drugs can be prescribed. 1 - 2 weeks after the end of treatment, the examination and laboratory tests are repeated to assess the effectiveness.

After eliminating pathogenic bacteria, it is necessary to restore the normal microflora of the vagina. Restoration of the vaginal microflora is carried out using a group of medications called probiotics.

These include the following medications:

Lactobacterin, Bifidumbacterin are recommended to be inserted into the vagina one suppository before bedtime for 10 days.
Linex is available in capsules, which are recommended to be taken after meals, two capsules 3 times a day.

Separately, it is necessary to say about the treatment of sexual partners of women with bacterial vaginosis. In almost all cases, it is impractical, since the disease is not sexually transmitted. The exceptions are men with infectious diseases of the genitourinary system, and those who have active complaints.

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

Almost ninety percent of the microflora consists of lactobacilli bacilli, which prevent the colonization of pathogenic microorganisms and monitor the amount of opportunistic microflora. In addition, bacilli produce substances that have antibacterial activity.

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

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

What is bacterial vaginosis

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

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

This disease is based on a change in the quantitative composition of the vaginal microflora. The number of beneficial bacteria decreases, while opportunistic microflora begins to actively multiply.

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

Causes of vaginosis

As for the specific pathogen, it simply does not exist. Entire polymicrobial complexes lead to the appearance of the disease, among which are Mycoplasma and Gardnerella.

There can be many causes of vaginal dysbiosis. Let's consider the most basic provoking factors:

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

Symptoms of bacterial vaginosis

It is immediately worth noting that the disease has no characteristic symptoms. Often its only symptom is heavy vaginal discharge with an unpleasant fishy odor.

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

There are no signs of an inflammatory process such as swelling and hyperemia with vaginosis, this is a distinguishing feature from vaginitis. The disease is often accompanied by the following pathological processes: cervicitis, erosion, scarring. In approximately fifty percent of cases, patients experience vaginitis.

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

copious grayish-white discharge of a uniform creamy consistency, which is evenly distributed over the walls of the vagina; discomfort during intimacy; pain in the perineal area; urinary disorders.

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

the discharge changes its color and consistency, resembling a cheesy mass; leucorrhoea becomes dark green; pathogenic flora joins the infectious process, which leads to inflammation of the vagina, manifested in the form of swelling and redness; leucorrhoea can be easily removed from the walls of the vagina using a cotton swab; frequent and painful urination; itching in the vulva area.

Types of bacterial vaginosis

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

asymptomatic; monosymptomatic; polysymptomatic.

According to the nature of the pathological process, the disease is:

sharp; chronic; recurrent.

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

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

Bacterial vaginosis during pregnancy

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

In pregnant women, hormonal levels change, the immune system weakens, thus creating favorable conditions for the development of the disease. In terms of its manifestations during pregnancy, the disease is no different; the woman is also bothered by thick, foamy discharge with an unpleasant odor of stale fish.

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

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

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

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

Women are also prescribed medications containing lactobacilli to restore microflora. They can be used both internally and as douches. Treatment is carried out under the strict supervision of a doctor.

Forecast

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

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

Diagnostics

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

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

Bacterial vaginosis in men

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

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

In most cases, the causative agent of the disease easily penetrates the male body and is just as quickly eliminated after two or three. Sometimes chronic carriage may occur, in which there are no clinical manifestations. The only danger is that a man may not know about the carrier state, but still transmit gardnerella to his partner.

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

How is bacterial vaginosis transmitted?

Bacterial vaginosis is not a sexually transmitted disease!

In general, pathogens of the disease, in particular Gardnerella, can be transmitted sexually, but this will not cause the development of dysbacteriosis, because these microorganisms are part of the natural microflora in small quantities. If the immune system is normal, then the body’s defense mechanisms simply will not allow the opportunistic organism to attach to the surface of the cell, much less penetrate deeper.

Then what role does unprotected sexual intercourse play in the occurrence of the disease? The point here is not at all about infection, but about the fact that frequent changes of sexual partners upset the natural balance of microflora.

When should you see a doctor?

Let's consider the reasons that may prompt you to contact a specialist:

the infectious process arose for the first time. The doctor will help identify the etiological factor and tell you about the characteristic symptoms, as well as tell you how to deal with them; This is not the first time the disease has occurred, but the symptoms are different this time; you have a new sexual partner. Signs of sexually transmitted diseases are similar in their manifestations to bacterial vaginosis; increased temperature and unpleasant odor from the vagina; Despite self-treatment, recovery did not occur.

How to treat bacterial vaginosis?

Bacterial vaginosis in women is treated in two main stages:

Restoring the physiological properties of the vagina, strengthening the body's defenses, normalizing hormonal levels and combating pathogens. Restoring the natural balance of vaginal microflora.

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

Drugs for bacterial vaginosis

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

Eubiotics

Let's consider a treatment regimen with effective eubiotics:

Baktisubtil. One capsule is drunk one hour before meals three to four times a day; Hilak forte. Fifty drops three times a day; Linux. Take two tablets three times a day.

Suppositories for bacterial vaginosis

Vaginal suppositories act directly at the site of the pathological process. The active substance is practically not absorbed into the blood, which means it causes minimal side effects.

Ecofemin. The drug contains live lactobacilli. Suppositories are administered two to three times a day for ten days; Bifidumbacterin. Contains bifidobacteria. It is enough to administer one suppository before bedtime for ten days; Hexicon. Contains chlorhexidine. A special feature of Hexicon is that it has a detrimental effect on pathogenic microorganisms, without affecting lactic acid bacteria. Suppositories are administered one or two times over a period of 10 days.

Treatment regimen for bacterial vaginosis

First, let's look at the standard treatment regimen with systemic drugs:

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

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

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

How to treat vaginosis at home

Let's look at several ways to treat the disease at home:

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

Folk remedies for bacterial vaginosis

Treatment using unconventional methods takes longer, but is the safest. But this is provided that they are used correctly. Folk remedies are not an alternative to drug treatment, but only auxiliary assistance. They can be used with the permission of a doctor.

Let's look at the most effective recipes:

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

Prevention

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

proper adherence to the rules of intimate and sexual hygiene; for casual sexual contacts, use barrier methods of contraception; timely treatment of inflammatory processes of the genitourinary system; adequate sleep and coping with stressful situations; balanced diet; rational use of antibiotics; normalization of hormonal levels; prevention of the development of intestinal dysbiosis; regular visits to the gynecologist.

So, bacterial vaginosis is a disease in which there is a disturbance in the natural balance of the microflora of the vaginal mucosa. A number of reasons can lead to its appearance, among which are changes in hormonal levels and weakened immunity. One of the main signs of the disease is abundant white-gray vaginal discharge with a fishy odor.

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

Bacterial vaginosis is an infectious non-inflammatory disease caused by a violation of the vaginal microflora. Under the influence of unfavorable factors, the balance of bacteria is disrupted, and the mucous membrane is colonized by pathogenic microorganisms.

Normal vaginal microflora consists of 95% lactobacilli and 5% other microorganisms, including conditionally pathogenic ones.

In small quantities they are not dangerous, but if beneficial lactobacilli reduce their population, the number of pathogenic ones increases, and vaginal dysbiosis is formed - bacterial vaginosis.

Clinical features of bacterial vaginosis

What is the difference between bacterial vaginosis and bacterial vaginitis? With the latter, an inflammatory process forms in the vagina, while vaginosis occurs without inflammation.

Bacterial vaginosis is more common in pregnant women because... it is provoked by changes in hormonal levels. At the same time, therapy requires more gentle means and a special approach, because many drugs are prohibited during pregnancy.

Preference should be given to local remedies without systemic action, and in case of mild vaginosis, try to cope without antibacterial therapy - with drugs based on lactobacilli related to the body.

Complications that vaginosis can cause during pregnancy:

inflammation of the fruit membranes; early termination of pregnancy; postpartum endometritis.

Factors that provoke bacterial vaginosis:

frequent use of contraceptives that contain 9-nonoxynol;
change of sexual partner; long-term antibiotic therapy; intestinal dysbiosis; frequent douching; hormonal disorders; menopause period; diseases of the endocrine system; pregnancy; atrophy of the vaginal mucosa; condoms treated with 9-nonoxynol on the outside.

The disease can be asymptomatic with a mild degree of microflora disturbance. But most often it manifests itself with characteristic signs:

white or grayish-white discharge; itching of the mucous membrane of the external genitalia and vagina; pain during sexual intercourse and urination - in advanced cases.

The symptoms are very similar to thrush, but differ from it in the presence of a “fishy” smell. It is important not to confuse these diseases. In medical practice, there are often cases when patients themselves diagnose thrush and choose treatment on the advice of a pharmacist. This cannot be done, because if you treat vaginosis with drugs for thrush, it will only get worse.

It is especially important to identify the causative agent of dysbiosis in order to choose the right treatment. Methods for diagnosing bacterial vaginosis:

Gynecological examination on a chair to identify discharge and the general condition of the mucous membrane. A smear for the degree of purity to identify the causative agent of vaginosis and the degree of its colonization. A test for vaginal acidity, confirming the diagnosis if the acidity has increased to 4.5.

Treatment of bacterial vaginosis

If possible, it is necessary to exclude factors that provoke vaginosis: cure intestinal dysbiosis, use a condom when changing sexual partners frequently, switch to contraceptive methods without 9-nonoxynol.

Drugs for the treatment of bacterial vaginosis are aimed at suppressing pathogenic microflora (streptococci, Candida fungi, staphylococci, gardnarella) and restoring the natural one.

At the first stage, antimicrobial and antibacterial drugs are used: Metronidazole, Clindamycin, Ornidazole, Trichopolum. They are used systemically (in the form of tablets or injections) or locally, in the form of vaginal suppositories, gels and tablets.

For the treatment of vaginosis the following is used:

Metronidazole. 500 mg twice daily with or after meals. Duration of use - 7 days. Treatment with Metronidazole is contraindicated during the first trimester of pregnancy, with a reduced number of leukocytes and hypersensitivity to the components of the drug.

A small amount of the drug passes into breast milk, so its use during breastfeeding is undesirable. Metronidazole is not compatible with alcohol intake and drugs containing ethanol.

Clindamycin. Available in the form of capsules containing 150 mg of active substance. Take them one tablet 4 times a day for 5-7 days. Conditions and diseases for which Clindamycin is contraindicated:

pregnancy; myasthenia gravis; breast-feeding; bronchial asthma; age up to 8 years (for capsules); glucose-galactose malabsorption, lactose deficiency and galactose intolerance.

Ornidazole. Available in the form of capsules, tablets and solution for intravenous transfusion.

To treat vaginosis, tablets or capsules with a dosage of 500 mg are used. Unlike Metronidazole, Ornidazole is compatible with medications containing ethanol (some cough syrups, tinctures of medicinal herbs, Valocordin, Galstena, etc.) Contraindications for use are:

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Vaginal tablets and suppositories for the treatment of vaginosis

Local drugs are prescribed as an addition to tablet forms of the drug, or as monotherapy for uncomplicated vaginosis. Vaginal tablets, gels and suppositories for bacterial vaginosis act due to the antimicrobial protozoan action, suppressing microflora harmful to the vaginal mucosa. The following drugs are prescribed:

Metranidozole suppositories, tablets and gel. Used at a dosage of 500 mg twice a day. Usually the course of treatment is 5 days, but can be increased as prescribed by the doctor. During treatment, you must maintain sexual rest. Flagyl candles. Apply 2 times a day, 1 suppository for 7 days. Pregnancy, central nervous system diseases and blood diseases are considered contraindications for use. Vaginal tablets Ornisid. Use 1 suppository (1 g) per day, or 1 suppository (500 mg) twice a day. Contraindications for use include leukopenia, coordination problems, central nervous system diseases, pregnancy and breastfeeding. Neo-Penotran candles. Effective when vaginosis is combined with candidiasis or trichomonas vulvovaginitis. Used 2 times a day, morning and evening, 1 suppository for 7 days, for recurrent vaginitis - 14 days.
Terzhinan candles. Supplemented with anti-inflammatory components, they help cope with local inflammatory and allergic reactions. They are used once a day for a course of 6-10 days. Contraindications include age under 18 years, the first trimester of pregnancy and individual allergic reactions. If prescribed by a doctor, Terzhinan can be used in the second and third trimester of pregnancy. Vaginal cream Dalatsin. Approved for use in the 2nd and 3rd trimester of pregnancy, because in studies, its use did not cause congenital anomalies of the fetus. The only contraindication for use is individual intolerance to the components. Apply the cream once a day, preferably at night, for 3-7 days.

All vaginal suppositories are inserted deep into the vagina after toileting the external genitalia. If you have a hymen, it is better to use drugs in the form of gels.

Preparations that restore microflora

When treating vaginosis with antibacterial drugs, not only pathogenic microflora is inhibited, but also those beneficial to the body. Preparations based on lactobacilli will help restore beneficial microflora. They are safe for the body and have virtually no side effects. Most often, local drugs (suppositories, gels and tablets) are prescribed for dysbiosis:

Lactobacterin; Bifidumbacterin; Gynoflor; Lactacid; Vaginorm S; Lactonorm; Floragin gel; Lactozhinal.

For intestinal dysbiosis, treatment with intravaginal agents is supplemented with systemic probiotics (Linex, Normobact, Bifiform, Acipol, etc.).

This helps to consolidate the results of treatment and reduce the number of relapses. But even with proper treatment, they occur in 50% of cases. With frequent relapses of the disease, the doctor may prescribe medications that increase general immunity, such as Immunal, Cycloferon, Polyoxidonium.

A relatively new, but well-proven product is the Solcotrichovac vaccine. It is administered intramuscularly, 3 times every 2 weeks.

Vaccination creates immunity against vaginal dysbiosis for a period of 2 years. Some drugs for gardnarella reduce the effectiveness of barrier methods of contraception (condoms, diaphragms, etc.). If you use them, consult your doctor about replacement.

nervousness, sleep and appetite disturbances... frequent headaches... bad breath, plaque on the teeth and tongue... changes in body weight... diarrhea, constipation and stomach pain... exacerbation of chronic diseases...

Yakutina Svetlana

Expert of the Ginekologii.ru project

Bacterial vaginosis is an imbalance of the vaginal microflora. The disease occurs frequently among women of fertile age. The vaginal microflora is a fairly mobile biological system in which the ratio of microorganisms is constantly changing, depending on environmental conditions, as well as on the general condition of the body.

So, normally, in a woman of childbearing age, lactobacilli predominate on the vaginal mucosa. These microorganisms are able to break down glycogen, which is located in the epithelial cells of the vagina, resulting in the formation of lactic acid and hydrogen peroxide.

Lactic acid changes the acid-base balance to the acidic side. An acidic environment together with hydrogen peroxide has a detrimental effect on the growth of harmful flora. As for lactobacilli, these conditions are ideal for their life. Uniting in entire columns, they form a protective layer (glycocalyx) and line the vaginal mucosa, thereby protecting it.

When exposed to unfavorable factors, some of the lactobacilli die, the vaginal environment changes to the alkaline side, which stimulates the growth of various opportunistic microbes, mainly gardnerella ( Gardnerella vaginalis).

Gardnerella begins to multiply rapidly, which provokes the growth of other pathogenic flora (staphylococci, neisseria, enterococci, ureaplasma, candida fungi and many others), as a result the number of lactobacilli sharply decreases.

Bacterial vaginosis itself does not cause inflammation, although it reduces local immunity, which increases susceptibility to infections, and the rapid proliferation of pathogenic and opportunistic microorganisms can cause inflammatory processes, disrupting a woman’s reproductive function.

The disease is not sexually transmitted and is not transmitted through sexual contact. In principle, men cannot have bacterial vaginosis, since the word “vaginosis” means vaginal localization of the process.

Bacterial vaginosis often occurs during pregnancy. This is due to hormonal changes, namely, under the influence of estrogens, the level of glycogen on the vaginal mucosa increases, which means the number of lactobacilli increases, and the pH of the environment becomes even lower. Everything seems to be fine, but it turns out that such an environment is favorable for the proliferation of some transient microorganisms (ureaplasma parvum, mycoplasma hominis). This is the insidiousness of bacterial vaginosis during pregnancy. These seemingly harmless opportunistic microorganisms can cause inflammation and then disruption of the integrity of the amniotic sac, which can lead to premature birth.

The main cause of bacterial vaginosis is considered to be a violation of the ratio of beneficial and harmful microorganisms, namely the quantitative decrease or absence of lactobacilli under the influence of unfavorable factors of the external or internal environment.

Hormonal changes, disorders of the immune system, intestinal dysbiosis, uncontrolled use of antibiotics, systemic diseases and metabolic disorders, infectious diseases - all this stimulates the body “from the inside” and causes dysbiotic phenomena in the vagina.

Irrational douching, replacement of a sexual partner, use of contraceptives containing the spermicide 9-nonoxynol; Neglect of barrier protection and personal hygiene rules negatively affect the vaginal flora “outside”.

Symptoms of bacterial vaginosis

Often the disease occurs without any symptoms, due to the absence of signs of inflammation. In most cases, women note an increase in the amount of vaginal discharge. The discharge has a grayish-yellow color, a viscous consistency and a specific odor, reminiscent of the smell of spoiled fish. This odor is due to volatile amines released by gardnerella.

Bacterial vaginosis can last for years. In this case, we are already talking about a chronic process. Over time, the number of lactobacilli becomes less and less and the opportunistic flora ascends higher and higher, affecting the cervix, uterus, and appendages.

Chronic bacterial vaginosis can be accompanied by itching, burning of the genitals, discomfort when emptying the bladder and during sexual intercourse.

Almost every woman experiences bacterial vaginosis at least once in her life, but with normal functioning of the immune system, the body itself regulates the ratio of microflora and the disease goes away on its own, without any medical intervention.

Diagnosis of the disease

Diagnosis of bacterial vaginosis, like any other disease, begins with a survey and examination. The doctor will be interested in the gynecological history, the presence of concomitant pathologies, and the nature of the woman’s complaints. During a gynecological examination, there are no signs of inflammation of the vaginal mucosa, and evenly distributed, abundant, viscous, foamy discharge with a fishy odor is detected on its walls.

With bacterial vaginosis, the pH of the vaginal environment increases, and normally this indicator fluctuates in the range of 3.8-4.5. Therefore, exceeding the pH value of 4.5 speaks in favor of the disease.

A positive amine test also speaks in favor of gardnerellosis. For the study, take a small amount of vaginal discharge and add a few drops of a 10% potassium hydroxide solution to it on a glass slide; if an increase in the specific fishy odor is observed, the test is considered positive.

Bacterial vaginosis can be suspected by microscopic examination of a general vaginal smear. A quantitative decrease in lactobacilli, the presence of “key” cells, a large amount of coccal flora - all this indicates the presence of vaginal dysbiosis.

PCR diagnosis of gardnarella (an accurate method in which even single microorganisms are detected) does not make any sense for this disease. The fact is that gardnarella is an opportunistic microorganism and is always present in small quantities in the vaginal microflora. It is important to identify not its presence, but its quantity.

Bacterial vaginosis must be differentiated from sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea), as well as thrush.

“How to treat bacterial vaginosis” is a question many representatives of the fair sex ask. The answer is simple - treatment is carried out in two stages:

Antimicrobial and antibacterial therapy;
Restoring vaginal microflora, increasing local immunity.

Gardnarella can be treated with antimicrobial drugs (Metronidazole, Trichopolum, Tinidazole). Metronidazole tablets are prescribed for 7 days, take 0.5 g 2 times a day in the morning and evening. The drug has side effects such as nausea, vomiting, and abdominal pain, which makes it poorly tolerated by women. In this case, Clindamycin tablets are prescribed 0.3 twice a day, but this drug also has a drawback: it inhibits the growth of lactobacilli.

If taking systemic antimicrobial drugs is contraindicated or undesirable for some reason, then use local agents that have antimicrobial properties:

0.75% Metronidazole. The packaging of the drug contains special applicators with which the gel is inserted into the vagina in the morning and evening for five days;
2% vaginal cream Clindamycin. The cream is also applied using the included applicator once a night. The course of treatment is five days.

Local treatment is usually less effective than systemic therapy, but is easily tolerated and does not cause harm to the digestive system.

If there is itching, antihistamines (Suprastin, Diazolin) help well.

Sometimes, against the background of antimicrobial treatment, thrush develops. In this case, antimycotic drugs are prescribed; Zalanin and Pimafucin suppositories have proven themselves to be effective.

After successful antimicrobial treatment, it is necessary to populate the vaginal mucosa with beneficial bifidobacteria and lactobacilli. For this purpose, vaginal suppositories (Acylact, Bifidumbacterin, Vagilak) and eubiotics in bottles (Lactobacterin, Simbiter), which are powdered, are used; before insertion into the vagina, according to the instructions, they must be diluted in boiled water.

Prevention

Because bacterial vaginosis develops against the background of dysbiotic phenomena, preventive measures should be aimed at maintaining the homeostasis of the vaginal ecoculture and eliminating predisposing factors, namely:

It is important to keep the genitals clean, especially on menstrual days, when local immunity is significantly reduced. Tampons and pads these days must be changed every two to three hours, sexual intercourse should be avoided, and baths should not be taken. When choosing underwear, you should give preference to natural fabrics. Do not get carried away with douching - frequent irrational douching washes away beneficial bacteria.
Respect for sexual culture. The use of barrier protection during sexual intercourse with unverified partners significantly reduces the likelihood of contracting sexually transmitted infections.
Rational use of antibiotics. Uncontrolled antibiotic therapy destroys both harmful and beneficial microorganisms.
Sanitation of sexually transmitted infections. Sexually transmitted diseases can occur in a mild, asymptomatic form, disrupting the normal functioning of the reproductive system.
Regular visits to the gynecologist (once every six months). Based on a general smear, bacterial vaginosis can be suspected, which means starting therapy in time and preventing chronicity of the process.

Bacterial vaginosis is one of the most common vaginal diseases and a common cause of unpleasant odor, vaginal discharge and itching in the intimate area.

Symptoms of bacterial vaginosis

Bacterial vaginosis often causes the following symptoms:

Unpleasant “fishy” odor from the vagina. The smell may be constant or appear during or after sex.
, sometimes resembling mucus. Discharge can be heavy or moderate.
Irritation, itching, discomfort, redness of the skin in intimate areas.
Pain and cutting during urination.
Dryness and...

You are more likely to have bacterial vaginosis if:

Have you recently taken antibiotics?
You recently changed your sexual partner
You have had two or more sexual partners in the past few weeks
Do you have
Have you recently used a jacuzzi or taken a bath?
Have you recently douched?
You don't comply

All of the above factors are not the direct cause of inflammation, but they disrupt the vaginal microflora and predispose to the development of bacterial vaginosis.

When does a smear indicate bacterial vaginosis?

Most women find out that they have bacterial vaginosis precisely by the result. If a woman has bacterial vaginosis, the following changes are detected in the smear:

many key cells
many cocco-bacillary forms (bacteria that look like rods and cocci)
abundant coccal flora
leukocytes are elevated or within normal limits
presence of mobiluncus
The pH of the secretions is above 4.5

Bacterial vaginosis is often combined with other infections, so the smear may contain changes characteristic of other diseases, for example, candidiasis (),.

Gardnerella and bacterial vaginosis

Sometimes bacterial vaginosis is mistakenly called gardnerellosis, since most often it is the bacterium Gardnerella vaginalis that causes inflammation in this disease.

However, gardnerella is often found in the vagina in healthy women who do not have inflammation. That is why, if you have been diagnosed with gardnerella, but there are no signs of inflammation (there are no symptoms of inflammation and the smear result is normal), then there is no question of any bacterial vaginosis, and everything is fine with you.

Why is bacterial vaginosis dangerous?

The bacteria that cause inflammation in bacterial vaginosis are very sensitive to standard antibiotic treatment, and the disease is easily treatable. But if bacterial vaginosis is not treated, it can cause complications:

- inflammation of the uterus.
Salpingitis is inflammation of the fallopian tubes.
Adnexitis is inflammation of the uterine appendages (fallopian tubes and ovaries).
Infertility.

Bacterial vaginosis during pregnancy can lead to premature birth.

How to treat bacterial vaginosis?

If bacterial vaginosis appears for the first time:

Metronidazole 500 mg (Trichosept): one tablet 2 times a day for a week, or
Vaginal gel Metronidazole 0.75% (Rozex): insert one applicator into the vagina before bed for 5 days, or
Clindamycin vaginal cream 2% (Clindacin): insert one applicator into the vagina before bed for 7 days.

If bacterial vaginosis does not go away with the prescribed treatment, the gynecologist will prescribe an alternative treatment:

Tinidazole: 2g per day for 2 days, or 1g per day for 5 days, or
Clindamycin 300 mg: one tablet 2 times a day for a week.

Probiotics in the treatment of bacterial vaginosis

Probiotics are preparations that contain the same beneficial bacteria, which make up the normal microflora of the vagina and help protect against infections.

The following probiotics are used for bacterial vaginosis:

Gynoflor: vaginal tablets
Vagilak: tablets for oral administration

The regimen for taking probiotics for bacterial vaginosis is as follows:

7 days of daily use
7 days break
7 days of re-appointment

This regimen of taking probiotics will avoid the return of infection several months after the end of antibacterial treatment. According to the manufacturers, taking these drugs is not prohibited during pregnancy and breastfeeding.

Treatment of bacterial vaginosis during pregnancy

Bacterial vaginosis during pregnancy can cause it, so treatment is necessary. It is recommended to take medications prescribed to pregnant women from the second trimester of pregnancy (not earlier than 13 weeks):

Metronidazole 500 mg: one tablet 2 times a day for 7 days
Metronidazole 250 mg: one tablet 3 times a day for 7 days
Clindamycin 300 mg: one tablet 2 times a day for a week

Local treatment (vaginal ointments or creams) helps eliminate the symptoms of bacterial vaginosis, but does not reduce the risk of complications of the disease during pregnancy (premature birth).

Attention: These treatment regimens are indicative and may be changed by your doctor. Before using medications, be sure to consult your gynecologist!

Does my husband (sexual partner) need treatment?

It is known that in 80% of men whose sexual partners suffer from bacterial vaginosis, the main causative agent of this disease is found in the urethra Gardnerella vaginalis and other bacteria. This means that the bacteria "move" from the vagina into the man's urethra during unprotected sex.

And, nevertheless, men should be treated No need. Numerous studies have shown that treatment of sexual partners does not affect the recovery of women and does not reduce the chances of recurrence of the disease.

Treatment for your partner necessary if this is not the first time you have developed bacterial vaginosis, or if you have been diagnosed with sexually transmitted diseases.