Bacterial vaginosis or vaginal dysbacteriosis - female doctor about thrush. Bacterial candidiasis: treatment during pregnancy

Infectious pathology of the female genital organs occupies one of the leading places in the structure of gynecological and maternal morbidity and mortality. Interest in this problem is associated not only with its frequency, but also with the possibility of transmission of infection to the fetus, perinatal losses and morbidity in children in the first days of life. Inflammatory diseases quite often proceed torpidly, without manifestations of general intoxication and severe pain syndrome. This leads to late diagnosis and treatment, which, in some cases, is not carried out at all. All these factors contribute to the formation of various complications at the level of the cervix, uterus and its appendages.

Most women experience various forms of dysplasia and ectopia of the cervix, adhesive processes are formed in the small pelvis as a result of transferred salpingo-oophoritis, which, in turn, leads to disruption of menstrual and reproductive functions. The infectious process violates the physiological course of pregnancy, which may be accompanied by its untimely interruption and complicated course (injuries during childbirth, postpartum infectious complications - endometritis, mastitis). Infections of the lower genital tract of women play a significant role in this problem. Infectious vulvovaginitis can be the result of the multiplication of pathogenic or opportunistic microorganisms that become pathogenic as a result of an imbalance in the ecosystem that has developed as a result of any diseases or their treatment. Microorganisms that inhabit the mucous membranes of the vagina, cervical canal, under certain conditions, can become virulent and participate in the development of inflammatory diseases of the internal genital organs. An obstacle to their activation and participation in inflammation are physiological defense mechanisms (desquamation and cytolysis of the surface cells of the vaginal epithelium, phagocytosis of macrophages and polymorphonuclear leukocytes, nonspecific humoral factors, immune defense mechanisms: T-lymphocytes, immunoglobulins, complement system). For the upper parts of the reproductive system, protective mechanisms at the level of the cervical canal and endometrium are of particular importance.

Etiology and pathogenesis of vulvovaginitis. Infections of the lower genital tract of women (most often vaginitis, vulvovaginitis) play a significant role in the overall problem of inflammatory gynecological diseases. The etiology of vaginitis is diverse: these are Trichomonas (up to 10% of the number of vulvovaginitis of various etiologies),Candida spp . (up to 25%), anaerobic microorganisms (up to 30%), mixed infections (15-20%). The last decade in the structure of infections of the lower genital tract is dominated by bacterial vaginosis and candidiasis of the genitals. The main complication of these infections is recurrences that disrupt the well-being of the woman in general and family life in particular. The causes of recurrence of infectious inflammatory diseases are varied: incomplete sanitation of the vagina, low compliance with treatment, vaginal dysbiosis that persists or develops during therapy.

Risk factors for genital candidiasis and bacterial vaginosis are essentially the same. These include: the use of antibacterial drugs, mainly broad-spectrum antibiotics; gynecological diseases (inflammatory diseases of the cervix and appendages account for up to 60% of the total gynecological morbidity, uterine fibroids, internal and external endometriosis, polycystic ovary syndrome, etc. - up to 44%); endocrinological pathology (mainly diabetes mellitus I and II types, diseases of the thyroid gland, occurring with its hypofunction in every third patient).

Inadequate contraception is of some importance (chemical spermicides, combined hormonal contraceptives with a high content of estrogens, violation of the rules for the use of intrauterine contraception - a long stay of an intrauterine contraceptive in the uterine cavity, the preservation of an infectedCandida spp . contraceptive in the uterine cavity in the presence of infection in the lower genital tract), immunodeficiency conditions, especially at the level of the vaginal epithelium. Both genital candidiasis and bacterial vaginosis are excluded from the list of sexually transmitted diseases. However, it should be noted that the number of sexual partners, their frequent change are of some importance and this is due to the fact that the situations listed lead to a violation of such a thing as vaginal normocenosis. Here it is appropriate to mention what the microecosystem of the vagina is. The concept of the microecosystem of the vagina is characterized by the following provisions: the dominance of lactobacilli, the presence of cells of the vaginal epithelium, the content of glycogen in the surface layers of epithelial cells, the absence of a leukocyte inflammatory reaction on the vaginal mucosa.

Despite the commonality of risk factors and pathogenetic prerequisites, candidiasis and bacterial vaginosis are completely different diseases. Candidiasis is an infectious process that occurs with the participation of fungiCandida spp .; bacterial vaginosis is a polyetiological dysbiotic process that occurs in most cases without signs of inflammation on the mucous membranes of the lower genital tract.

genital candidiasis. Candidiasis of the genitals (CG) is characterized by a recurrent course, a tendency to an increase in the etiological role of fungi that do not belong to the species C.albicans,a combination of candida infection with STI pathogens. Episodes of acute candidiasis, according to the scientific literature, occur in 75% of women of reproductive age. Chronic recurrent genital candidiasis (a special form of genital candidiasis, in which there are at least four episodes of exacerbation within one year), with a tendency to increase, is detected in 10-15% of women. Although the complaints of patients (itching, burning, cheesy discharge, dysuric phenomena, dyspareunia) and clinical manifestations of CG (swelling, hyperemia of the mucous membranes of the ecto- and endocervix, urethra, erosion and fissures, dermatitis of the perigenital area and intergluteal folds) are well known to doctors, treatment can be prescribed only after laboratory confirmation of the diagnosis.

Diagnosis of acute candidiasis of the genitals is not difficult - it is microscopy of pathological material (scrapings from the mucous membranes of the affected areas) and the detection of yeast budding cells and / or pseudomycelium and mycelium in native or Gram-stained preparationsCandida spp . (Fig. 1.). In all cases, sexually transmitted infections must be excluded. Vaginal pH measurements of >4.5 may be used to support trichomoniasis and bacterial vaginosis (Fig. 1). Cytological preparation of the vaginal epithelium.

If with the cytological method of researchCandida spp . not detected (the sensitivity of the method is 65-70%), in the presence of characteristic clinical manifestations, a cultural study should be performed (inoculation of the material on specialized media) in order to detect coloniesCandida spp.In the case of acute candidiasis, these diagnostic measures are quite enough to make an etiological diagnosis. In chronic recurrent genital candidiasis (CRCG), species identification of the pathogen is necessary (in this form of the disease, the frequency of detection of fungicandida,not belonging to the species C.albicans, is up to 20-25%) and determination of the sensitivity of the isolated culture of fungi to antimycotic drugs.

For the treatment of acute candidiasis of the genitals, systemic (fluconazole, itraconazole, ketoconazole) or intravaginal drugs (clotrimazole, miconazole, econazole, oxiconazole, butoconazole, bifonazole, isoconazole, etc.) from the group of azoles, polyene preparations for topical use (nystatin, pimafucin) in in the form of vaginal tablets, suppositories, ointments and creams.

The scheme of treatment of acute candidiasis of the genitals

• fluconazole - 150 mg once;
• itraconazole - 200 mg x 2 for one day or 200 mg per day - 3 days;
• ketoconazole - 400 mg per day - 5 days;
• intravaginal azole preparations - up to 7 days;
• intravaginal polyene preparations - 7-14 days.

The treatment of chronic recurrent genital candidiasis has certain features and is aimed at eliminating or reducing the severity of risk factors (treatment of background pathology), stopping the recurrence of the disease, and conducting long-term treatment in the maintenance antimycotic therapy regimen.

Treatment of CRCH (relapse relief)

• fluconazole - 150 mg, then 150 mg again after 72 hours;
• itraconazole - 200 mg x 2 for one day or 200 mg per day - 3 days;
• ketoconazole -400 mg x 2 per day - 5 days;
• intravaginal azole preparations - 14 days.

In the presence of azole-resistant strains of fungiCandida spp.

• 600 mg of boric acid (intravaginally daily) - 14 days;
• nystatin 100,000 IU (intravaginally daily) - 14 days;
• natamycin (pimafucin) 100 mg (intravaginally daily) - 6-12 days.

After stopping the recurrence, treatment in the maintenance therapy regimen is necessary. There are various schemes of maintenance therapy, they have undergone certain changes over the past two years, we offer the most optimal option for this treatment, the duration of which is 6 months. Treatment regimens for CRCH in maintenance antimycotic therapy (6 months)

• fluconazole 150 mg - once a week;
• itraconazole 100 mg - every other day;
• daily use of intravaginal antimycotic agents.

The principles of treatment of acute and chronic recurrent genital candidiasis, as well as the regimen of maintenance antimycotic therapy, are set out in accordance with the recommendations of the International Center for Control of the Diagnosis and Treatment of STIs.

In all cases, the maintenance therapy regimen must be combined with pathogenetic treatment of chronic recurrent genital candidiasis, aimed at correcting the underlying genital and extragenital pathology in patients (maximum compensation for diabetes mellitus, thyroid dysfunction, elimination of absolute or relative hyperestrogenism due to gynecological diseases).

An important point is an individual approach in choosing adequate methods of contraception, given the transferred, genital infection and the presence of chronic inflammatory and hormone-dependent diseases of the genital organs.

Bacterial vaginosis . Bacterial vaginosis (BV) is an infectious non-inflammatory syndrome characterized by a sharp decrease or absence of lactobiota and its replacement by polymicrobial associations of strict anaerobes and gardnerella. The reason for this condition may be an imbalance in the microbiota, due to a decrease in the concentration of lactobacilli, an increase in the number of anaerobic microorganisms (Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, Mobiluncus spp . etc.) There are no specific pathogens of BV, anaerobic and facultative anaerobic associations of bacteria act as an etiological factor:Bacteroides species, Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, Prevotella etc .

The microbiota of the vagina is normally represented by opportunistic anaerobic and aerobic microorganisms, the ratio of anaerobes/aerobes is 2:1-5:1. According to various researchers,Gardnerella vaginalisfound in 5-60% of healthy women of reproductive age,Mobiluncus- no more than 5%,Mycoplasma hominis- in 15-35% of women. At the same time, the dominance of lactobacilli is obvious, which make up 95-98% of the total number of microorganisms that inhabit the mucous membranes of the vagina of healthy women. In BV, the bacteriobiota of the vagina is different: contamination Gardnerella vaginalisfound in 100% of casesMobiluncus spp. - in 50-70%, Mycoplasma hominis- in 60-75% of cases. Thus, the ratio of anaerobes/aerobes is changed - 100:1-1000:1. In this case, there may be a small amount or complete absence of lactobacilli.

Diagnosis of BV is based on an assessment of the nature of vaginal discharge (creamy, creamy, homogeneous), pH-metry of the vaginal discharge (> 4.5), on a positive test for volatile amines (the appearance of a specific smell of volatile amines when vaginal discharge interacts with 10% - KOH solution, the specificity of the test is 94%), the detection of "key" cells by microscopy (the specificity of the test is close to 100%) - the well-known Amsel diagnostic criteria (Fig. 2.). If three of these four criteria are met, the diagnosis of BV should be considered confirmed.

The principles of etiotropic treatment of bacterial vaginosis have been developed in detail. As a rule, imidazole preparations, lincosamides are used orally and intravaginally. The success of treatment can be ensured by an adequate combination of etiotropic and pathogenetic treatment, aimed, as in candidiasis, at eliminating risk factors, choosing adequate methods of contraception, and restoring the vaginal normobiota.

Treatment regimen for bacterial vaginosis:

• metronidazole - 500 mg x 2 times a day for 7 days;
• ornidazole - 500 mg x 2 times a day for 5 days.

It is possible to use alternative schemes:

• metronidazole - 2.0 g orally once;
• clindamycin per os - 0.3 g x 2 times a day for 7 days;
• clindamycin - cream 2% 5.0 g (single dose) intravaginally 1 time per day for 3 days;
• metronidazole - gel 0.75 % 5.0 g (single dose) intravaginally 2 times a day for 5 days.

It is known that in a number of clinical observations, a combination of genital candidiasis and bacterial vaginosis is noted. The purpose of our study is to evaluate the efficacy and safety of Neo-Penotran in the combination of genital candidiasis and bacterial vaginosis in women.

MATERIALS, METHODS AND RESULTS OF THE STUDY

Based on the results of a retrospective analysis of 450 cases of CG in patients who applied to the Research Institute of Medical Mycology for the period from September 2003 to June 2004 inclusive, a significant frequency of combined forms of genital infection was determined: Candida-Trichomonas - 18%, Candida-Chlamydial - 10.6% , candida-chlamydia-trichomonas - 14.9%.

The combination of CG and BV was detected in 62 patients (13.8%) aged 17 to 53 years (median 36±1.2 years) with disease duration from 9 months to 5 years. The recurrence rate ranged from 4 to 9 per year. An in-depth clinical examination revealed risk factors and background pathology in 91.9% of patients: chronic salpingo-oophoritis - in 19.4% of cases, uterine myoma and endometriosis - in 27.4% of cases, menstrual disorders by the type of opsomenorrhea and hypermenstrual syndrome - in 6.5% of patients, hypothyroidism - in 3.2% of patients. In 8.1% of cases, patients used an intrauterine contraceptive for a long time, 12.9% of patients irrationally used chemical methods of contraception and STI prevention (pharmatex, chemical spermicides, etc.).

In 45.2% of cases, the cause of chronic vulvovaginitis was repeated courses of antibiotic therapy conducted earlier. In 4.8% of patients, the occurrence of a dysbiotic process in combination with genital candidiasis was the use of combined oral contraceptives containing more than 30 μg of ethinyl estradiol. Clinical manifestations of infection in most patients are non-specific and were mainly represented by vaginal discharges of various nature and intensity (milky, thick creamy, liquid homogeneous, cheesy, mucous, muco-purulent, etc.), accompanied by moderate itching and burning in the area external genitalia. These complaints did not have a clear connection with the phases of the menstrual cycle. The diagnosis of CG and BV was established on the basis of the pH-metry of the vaginal contents (in 100% of patients, the pH exceeded 4.5), a positive "amine" test (in 87.1% of cases), the results of microscopic and cultural studies of pathological material from the affected areas mucous membranes of the vagina, cervical canal, urethra (detection of budding yeast cells and / or pseudomycelium, "key cells", colony growthCandida spp . more than 10 3 CFU / ml, significant growth of opportunistic bacteriaGardnerella vaginalis, Bacteroides species, Prevotella spp., Mobiluncus sp . and etc.). The normal content of lactobacilli on the vaginal mucosa was noted only in 11.3% of patients, a decrease in the number of lactobacilli less than 10 4 CFU / ml - in 67.8%, and their complete absence - in 20.9% of patients. It is characteristic that a feature of the mycotic process in this contingent of patients was a pronounced dominance of the speciescandida albicans(96.6%). In two cases, S.tropicalis and S. kefir.

Previously, the treatment of combined forms of genital infection was carried out in stages (antibacterial and then antimycotic drugs), which increased its duration. To date, the "gold standard" for the treatment of vulvovaginitis of mixed etiology is the use of complex drugs with antimycotic and antibacterial actions. We evaluated the effectiveness of the new drug Neo-Penotran (manufactured by Schering AG, Germany) in the treatment of examined patients with a combination of genital candidiasis and bacterial vaginosis. Neo-Penotran is a combined preparation for intravaginal use with antifungal, antiprotozoal and antibacterial action. It contains 500 mg of metronidazole and 100 mg of miconazole nitrate. Miconazole nitrate is active against opportunisticCandida spp ., as well as some Gram-positive bacteria. Metronidazole has anti-protozoal and antibacterial action. He is active inTrihomonas vaginalis, Gardnerella vaginalis,anaerobic gram-negative bacteria:Bacteroides spp., Fusobacterium spp., Veilonella spp., Privotella spp ., anaerobic Gram-positive rods { Clostridium spp., Eubacterium spp .), anaerobic Gram-positive cocci ( Peptococcus spp., Peptostreptococcus spp .) .

Two schemes for the use of the drug are recommended - 1 suppository intravaginally twice a day for 7 days or one suppository 1 time per day at night for 14 days. We suggested that patients use the drug twice a day for a week, but 11 (17.7%) patients preferred to use the drug only at night for 14 days, choosing a more acceptable and convenient treatment regimen for them.

Against the background of the use of the drug, 6.5% of patients noted a moderate burning sensation within about 30 minutes after the administration of the suppository during the first 2-3 days of treatment. In 3.2% of cases at the end of the course (mainly on days 6-7) of treatment, a metallic taste and dry mouth, moderate nausea were noted. These side effects did not require discontinuation of the drug, and all patients were treated in full.

The effectiveness of therapy was assessed one and four weeks after its completion. The criteria for cure were the absence of complaints and clinical manifestations of the inflammatory process during an objective examination, as well as negative results of control laboratory tests. Immediately after the end of the course of treatment, all patients noted a significant improvement: the absence of itching and discharge. Clinical manifestations significantly decreased on the 2nd-3rd day of treatment and finally disappeared by the 4th-7th day of treatment. The speed of disappearance of symptoms did not depend on the scheme of drug use and was rather subjective. 1 week after the end of treatment, two patients developed moderate vaginal discharge, accompanied by slight discomfort in the external genital area, and the pH value of the vaginal contents in one of them was 5.5. Microscopic and cultural examination of the material from the vaginal mucosa in this patient revealed single "key cells", in three patients - a moderate amount of non-vegetative yeast cells and a single growth of colonies Candida albicans.Thus, the clinical and laboratory efficacy of treatment after a week was 93.5%. When analyzing the results of bacteriological studies, it was shown that the etiotropic treatment carried out not only contributed to the elimination of pathogens, but also contributed to the restoration of the normobiota in 38.7% of cases. A decrease in the number of lactobacilli or their complete absence was noted after treatment only in 37.1% and 14.5% of patients, respectively. This group of patients was locally prescribed eubiotics in standard dosages.

A repeated control comprehensive examination of patients was carried out four weeks after the end of treatment. Three patients during gynecological examination revealed moderate cheesy discharge, accompanied by discomfort, mild itching in the vulva. In these patients, microscopy of smears from the vaginal mucosa revealed moderate amounts of budding yeast cells and growth of colonies. WITH. albicans10 2 -10 3 CFU/ml. Two patients had abundant discharge with a characteristic "fishy" odor, a positive "amine" test, while the pH of the vaginal contents was 6.0 and 7.5, respectively. During microscopy and cultural examination, no fungal elements were found in these patients, "key cells" were detected, significant growthG. vaginalisand lack of lactobiota. In one patient, in the absence of complaints and the presence of moderate vaginal discharge, multiple non-vegetative yeast cells were detected, the growth of single colonies of C.albicansand a moderate amountG. vaginalis.Thus, the clinical and laboratory efficacy of treatment with Neo-Penotran, when assessed four weeks after the start of treatment, was 90.3%.

Conclusion. The article considers in comparative detail the problem of genital candidiasis and bacterial vaginosis in the structure of infectious diseases of the lower genital tract in women. Based on the analysis of modern domestic and foreign sources in the specialized literature and the results of our own clinical observations, the risk factors, the main approaches to diagnosis and etiotropic treatment are outlined, the clinical features of combined forms of candidiasis and bacterial vaginosis are presented.

According to the results of our study, in the group of patients with a combination of genital candidiasis and bacterial vaginosis, women of reproductive age predominate, which does not contradict the data of other authors. Of the risk factors in this contingent of patients, the use of antibacterial drugs in history is in the first place, the role of inflammatory and hormone-dependent genital pathology, and the use of irrational contraception are also significant. Quite often the question arises about the importance and significance of the nature of the sexual life of patients. According to our data, 37.1% of women had a history of 4 to 9 sexual partners. Currently, as is known, both CG and BV are excluded from the category of sexually transmitted infections, however, it should be noted that the number of sexual partners, their frequent change are of some importance for the formation of dysbiotic processes. Thus, it is important to remember that in addition to the primary use of etiotropic therapy, it is necessary to carry out activities aimed at eliminating risk factors and correcting the background pathology. With recurrence of the pathological process, the use of maintenance therapy is indicated, in some cases it is necessary to resolve the issue of prescribing systemic treatment. In the treatment of trichomoniasis, as a rule, the appointment of Neo-Penotran is combined with oral antiprotistocidal drugs.

Etiotropic therapy with a combination of genital candidiasis and bacterial vaginosis should be aimed at eliminating all pathogens. According to multicenter studies, Neo-Penotran showed its high clinical efficacy and safety not only in the treatment of genital candidiasis and bacterial vaginosis, but also in the treatment of acute and chronic forms of trichomoniasis. Due to the systemic absorption of metronidazole, its stable blood level is maintained, comparable to that with a standard oral dose of the drug 200 mg, which probably contributes to the high efficacy of the drug. Miconazole nitrate does not have a significant systemic effect, its pharmacological effect is manifested at the level of the vaginal epithelium.

On the basis of the results obtained by us, it can be reasonably stated that Neo-Penotran is highly effective in the treatment of episodes of combined infectious pathology (genital candidiasis and bacterial vaginosis) of the lower genital tract of women. An adequate dosage of active ingredients, a combination of antifungal and antibacterial action, good tolerability and lack of toxicity, ease of use make Neo-Penotran the drug of choice for a combination of bacterial vaginosis and genital candidiasis.

LITERATURE

1.Prilepskaya V.N., Bairamova G.R. Etiopathogenesis, diagnosis and modern trends in the treatment of bacterial vaginosis.// BC - 2002. - No. 18 - S. 21-24.

2. Muravieva V.V., Ankirskaya A.S. Features of microecology of the vagina in bacterial vaginosis and vaginal candidiasis. and gynecol. - 1996. - No. 6. - S. 27-30.

3.Mirzabalaeva A.K. Candidiasis and actinomycosis of the genitals in women: Aftoref. diss ... Dr. med. nauk.- SPb., 2002.- 38 p.

4.Diagnosis and treatment Bacterial vaginosis: Methodological guide. - Association of Obstetricians and Gynecologists of St. Petersburg. - St. Petersburg, 1999. - 28 p.

5. Mirzabalaeva A.K., Dolgo-Saburova Yu.V., Savelyeva O.G., Klimko N.N. The choice of etiotropic treatment of mycotic and

6. combined forms of genital infections in women.//Aqua vitae. - 1996. - No. 3-4. - WITH . 10-13.

7.Ba rb ope F.J., Austin P ., Louv W.C. et al.A follow-up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis and bacterial vaginosis // Am. J. Obstet. Gynecol-1990.- T .163, No. 2.- P .510-514.

7.Tikhomirov A.A., Lubnin D.M. The use of Neo-Penotran vaginal suppositories for vaginal decontamination before planned pregnancy // Gynecology. - 2003. - V.5, No. 2 - S. 5-8.

8. Mirzabalaeva A.K. Candidiasis of the genitals in women of reproductive age: Textbook, - Publishing house of St. Petersburg University of Economics, 1996. - 24 p.

9. Ozyurt E., Toykulieva V.B., Danilyians L.L. et al. Efficacy of 7 Day treatment with metronidazole+miconazole (Neo-Penotran) -a triple-active pessary for the treatment of single and mixed vaginal infections//Int. J. Gynecol Obstet. - 2001. - No. 74. - P. 35-43.

10. Prilepskaya V.N. Genital candidiasis. Modern approaches to treatment // Obstetrician. and gynecol. - 1996. - No. 6 (appendix).

11. Rogers C.A., Birdall A.J. Recurrent vulvovaginal candidiasis and its causes // Sexually transmitted infections. - 2000. - No. 3. - S. 22-27.

12. Handsfield H.Principles of treatment of STD // Sexually transmitted diseases. Eds. K. Holmes, P.A. Mardh, F. Sparling et al, - McGraw-Hill, 1999. - P. 711-721.

13. Belyanin V.L., Arabian R.A. The value of specific and nonspecific immunity in the development of opportunistic mycoses // Problems of medical sciences. mycology. - 2001. - T.Z, No. 2. - S. 33-38.

14. Kira E.F.Bacterial vaginosis. - St. Petersburg: NEVA-LUX, 2001. - 364 p.

15. Mirzabalaeva A.K., Dolgo-Saburova Yu.V., Savelyeva O.G., Klimko N.N. Causative agents of chronic recurrent vulvovaginal candidiasis and combined forms of genital infections in women // Bulletin of the Russian Association of Obstetricians and Gynecologists. - 2001. - No. 1. - S. 79-82.

16. Sergeev A.Yu., Sergeev Yu.V. Candidiasis. The nature of the infection, the mechanisms of aggression and defense, laboratory diagnostics, clinic and treatment. - M., 2001. - 472 p.

17. Mardh P.A., Rodrigues A.G., GencN., et al. Facts and myths on recurrent vulvovaginal candidosis - a review on epidemiology, clinical manifestations, diagnosis, pathogenesis and therapy//Int. J.of STD&AIDS. - 2002. - No. 13 - P. 522-539.

18. Jack D. Sobel.Mucocutaneous candidiasis in infectious diseases. - 2000.

19. Patel D.A., Gillespie B., Sobel J.D. et al.Risk factors for recurrent vulvovaginal candidiasis in women receiving maintenance antifungal therapy: results of a prospective cohort study//Am.J. obstet. Gynecol. - 2004. - Vol.190, No. 3 - P. 644-653.

20. Prilepskaya V.N. Features of infectious processes of the lower genital tract. Possibilities of therapy with drugs for local use // Use of the drug Terzhinan in gynecological practice: Based on the materials of the symposium within the framework of VII Russian National Congress "Man and Medicine". - M.: MEDpressinform, 2003. - 48 p.

21. Peter G. Pappas, John Rex, Jack D. Sobel, Scott G. Filler, et al. , Guidelines for Treatment of Candidiasis.// Clinical Infectious Diseases. - 2004, - Vol. 38. - P. 161-189.

22. Kibbler C.C., Mackenzie D.W.R., Odds EC. Principles and practice of clinical mycology. - Chichester, New York, 1996.

23.Richardson M.D., Kokki M. Guidelines for the treatment of systemic mycoses. - Current Medical Literature LTD, 1998. - 64c.

24.Practicalguide to anti-infective chemotherapy / Edited by L. S. Strachunsky, Yu. B. Belousov, S. N. Kozlov. - M.: Borges, 2002. - 384 p.

25. Sobel J.D., Zervos M., Reed B.D. et al. Fluconasol susceptibility of vaginal isolates obtained from women with complicated Cand vaginitis: clinical implications//Antimicrob Agents Chetnother. - 2003. - T.47, No. 1. - P. 34-38.

26.Fidel P.L. Jr, Barrouse M., Espinosa T. et al. An intravaginal live Candida challenge humans leads to new hypotheses for immunopathogenesis of vulvovaginal candidiasis//Infect Immun. - 2004. - T.72, No. 5. - P. 2939-2946.

27. Klebanoff M.A., Schwebke JR., Zhang J et al. Vulvovaginal symptoms in women with bacterial vaginosis// Obstet Gynecol.-2004. - T.104, No. 2 - P. 267-272.

28.WeirE.Bacterial vaginosis: more questions than answers// Clinic. Med. Am. J. - 2004. - T.171, No. 5.- P. 448.

29. Alfonsi G.A., ShlayJ.C, Parker S. What is the best approach for managing recurrent bacterial vaginosis?// J. fam. Pract. - 2004.- T .53, No. 8. -P. 650-652.

30. Abashin V.G., Ilyin A.B., Pazychev A.A. Prevention of infectious complications after gynecological operations in medical institutions of the Ministry of Defense of the Russian Federation: Guidelines.- M.: GVKG im. N.N. Burdenko, 2004. - 24 p.

The phrase "bacterial candidiasis" does not sound quite correct for a gynecologist and venereologist, but, nevertheless, about 50% of women have encountered symptoms of this disease at least once in their lives. Sometimes, instead of bacterial candidiasis , they also use the phrase "bacterial vaginosis or vaginal dysbacteriosis."

It seems to be clear that candidiasis is a lesion of the vagina, yeast fungi of the genus Candida. Where, then, did this word come from? In fact, this is due to the addition of a secondary infection due to the vital activity of bacteria. One of the most common pathogenic bacteria is Escherichia coli. Its number occupies 80% of the entire intestinal microflora.

Development factors

You should not think that only people leading an immoral lifestyle are subject to the development of this disease, no one is immune from its appearance. The penetration of pathogenic microorganisms into the vagina is possible for the following reasons:

• non-observance of elementary hygiene rules;
• wearing tight synthetic underwear;
• excessive use of absorbent pads or tampons disrupts the normal balance of a woman's microflora;
• if the rules of intimate hygiene are not observed, the opportunistic intestinal flora enters the vagina in an ascending way; viral infections can penetrate through the blood, this path is called "hematogenous";
• a descending route of infection transmission is also possible, in this case, pathogenic microbes descend from the uterus, for example, during inflammatory processes against the background of an abortion, an installed and forgotten intrauterine device, a neglected uterine tumor.
• with the contact route of transmission, infection occurs during sexual intercourse with an unhealthy partner.
• the development of bacterial vaginosis (candidiasis) can provoke the use of hormonal contraceptives, corticosteroids.

Predisposing factors include the state of pregnancy, menopause. The presence of severe pathology on the part of the immune systems, for example, with AIDS, in almost 99% of cases will lead to the development of bacterial thrush.

Bacterial vaginosis (candidiasis), in the absence of sexually transmitted infections, naturally, will not be considered a sexually transmitted disease, but a frequent change of sexual partners can trigger the development of this disease.

In addition, the causes of comorbidity include uncontrolled intake of antibacterial drugs, of particular importance is the local use of antibiotics, i.e. direct frequent entry of an antibacterial drug into the woman's vagina (with a condom treated with an antibacterial agent, in the form of irrigations, creams, ointments).

Illiterate antibiotics can cause dysbacteriosis, which will lead to a reduction in the population of bifidus and lactobacilli. At this stage, there is one step before the development of bacterial thrush. The fact is that the wall of the vagina borders on the wall of the rectum, and it is not difficult for pathogenic bacteria to move from the rectum to the vagina. In some cases, thrush can be almost asymptomatic, they are described mainly in asocial women.

Symptoms of bacterial candidiasis

The disease has nonspecific symptoms and can easily be confused with the classic form of thrush.

1. Redness and itching in the genital area.
2. An unpleasant specific smell of rotten fish.
3. Quite abundant vaginal discharge, depending on the flora, options are possible. With the predominance of fungal flora, the presence of cheesy secretions, white in color, is noted. If there is a bacterial flora, the discharge is yellowish-white, frothy.
4. General weakness. Due to the fact that all these fungi and bacteria described above carry out their “dark” work, the body accumulates the remains of their metabolic products, which are quite toxic. Against this background, a state of general weakness, apathy develops.

It is worth noting that when having sex or urinating, a woman may feel discomfort, and in some cases, pain. This can lead to a decrease in the quality of life of the patient and a complete rejection of sexual activity.

Bacterial vaginosis during pregnancy

Bacterial vaginosis during pregnancy poses a threat to the life of the mother and fetus. When passing through the birth canal, a newborn can become infected with thrush. Infection with a "bouquet" of amniotic fluid pathogens will lead to a delay in intrauterine development of the fetus, low birth weight, and congenital pathology of immunity.

Possible intrauterine malformations in the fetus. In early pregnancy, infection of the amniotic fluid can lead to miscarriage or miscarriage. However, a woman who does not miss an appearance in a antenatal clinic is not particularly threatened by these troubles.

Diagnosis and treatment of bacterial candidiasis

When examining a smear, you can find representatives of sexually transmitted diseases. These include chlamydia, trichomonas, ureaplasma, mycoplasma, gardnerella. These protozoa can be identified, in addition to the existing fungi of the genus Candida, both individually and in various combinations, or even as a whole “bouquet”. Bacterial vaginosis is treated by a gynecologist.

If necessary and in the presence of STDs, the therapy prescribed by the gynecologist is under the control of a dermatovenereologist.

When sowing the vaginal discharge, in most cases, E. coli is sown in large quantities (high titer), but there may be other types of opportunistic bacteria. Normally, the growth of pathogenic flora is restrained by the activity of beneficial bacteria that inhabit the intestines of a healthy person.

Ureaplasma, mycoplasma, chlamydia, gardnerella, if there are no concomitant microorganisms and predisposing factors, the inflammatory process in the vagina itself does not cause, but when there are several pathogens at the same time that enhance the action of each other, and with a background seeding with fungi of the genus Candida, a massive inflammatory the process in the vagina can no longer be avoided.

In the arsenal of doctors there are enough antifungal, antibacterial drugs, depending on the duration of pregnancy, individual treatment is selected, and the risk of adverse consequences for the unborn child is minimized.

Summing up, it should be noted that the described pathology of the woman's vagina really exists. Bacterial infection against the background of thrush is always secondary. There are many ways to avoid the occurrence of such a disease, such as - bacterial candidiasis . At the first manifestations of ill health in the female genital area, an examination by a gynecologist is necessary. During pregnancy, untreated bacterial vaginosis or candidiasis can be fatal.

Bacterial candidiasis is a disease that includes the symptoms of two diseases: gardnerellosis and thrush (candidiasis). These two diseases are closely intertwined. Given the impact of pathogenic yeast fungi of the genus Candida, the microflora of the woman's vagina suffers.

Considering that with a decrease in immunity and a violation of the microflora, bacterial diseases often occur, one of which is bacterial vaginitis. In turn, bacterial vaginitis provokes the activation of fungi, which leads to the appearance of thrush (candidiasis).

Classification of symptoms of the disease

With bacterial vaginosis, the number of lactobacilli decreases, and the number of anaerobes and aerobes increases from 100 to 1000 times. Mycoplasma, gardnerella, bacteroids, peptostreptococci, peptococci and other bacterial flora are also found. In this case, the pH of the vaginal environment shifts to the alkaline side. The reasons for such violations are as follows:

• Disorders of the endocrine system.
• Taking broad-spectrum antibiotics.
• Diseases of the genital area (infectious and inflammatory).
• Prolonged use of various methods of contraception.
• Frequent douching.
• Weakened immune systems of the body and, in particular, the vaginal barriers.

Vaginal candidiasis and bacterial vaginosis affect the vaginal mucosa, but these diseases must be distinguished from each other.

Clinical manifestations in vaginal candidiasis

Symptoms:

• Itching and burning in the genitals. In an acute process, these symptoms are pronounced.
• Allocations. Curdled or creamy, white. Quantity is different.
• The smell of secretions. Peculiar to kefir, unsharp.
• Pain during urination and intercourse. For an acute process - characteristic.
• Swelling and redness of the vaginal mucosa. There are always. In an acute process, they are pronounced. In chronic, to a lesser extent.

Clinical manifestations of bacterial vaginosis

Symptoms:

• Itching and burning of the genitals. Not always present.
• Allocations. Viscous, homogeneous and foamy. Color - white or yellowish green. May be curdled.
• The smell of secretions. Unpleasant fishy odor.
• Pain during urination and intercourse. No characteristic pain is noted.
• Swelling and redness of the vaginal mucosa. Mucous, without signs of inflammation. There is no redness or swelling.

You need to know that yeast is the causative agent in candidiasis. This type of disease is transmitted sexually. Vaginitis is an inflammatory disease. The source of inflammation is a bacterial infection, which is often not sexually transmitted.

Treatment of bacterial candidiasis

Candidiasis, which is accompanied by bacterial vaginitis, is of interest to patients in the method of treatment. It is necessary to know the pathogenesis of the disease. Existing underlying diseases (hypofunction of the thyroid gland, diabetes mellitus, inflammation of the cervix, disease of the genital organs) - all this must be treated, since all of the above diseases can be the cause of the disease. Gynecologists usually advise Itraconazole, Fluconazole and other antimycotic drugs that act on bacterial candidiasis. Treatment of vaginosis is represented by such drugs: Ornizadol, Clindamycin, Metronizadol.

Note that the optimal combination of bacterial vaginosis and vaginal candidiasis is the use of drugs that simultaneously affect both the fungus and the opportunistic bacterial flora. Such a remedy is Metrogyl Plus ointment. It is injected into the vagina in an amount of 5 g twice a day. The course of treatment is 5 days. This medicine contains Metronidazole, which works against bacteria, and Clotrimazole, which kills the fungus. Treatment with this drug has an effectiveness of 94%. To normalize the microflora of the vagina, bifidobacteria and lactobacilli are used. They are used both internally and locally - on tampons.

Treatment during pregnancy

First of all, I would like to say that a pregnant woman must necessarily pass all the examinations that the doctor will prescribe for her. These are examinations for venereal diseases and inflammatory processes. It is very important to protect the unborn child from infection. Bacterial candidiasis, as a rule, is treated locally during pregnancy, acting directly on pathogenic fungi and microorganisms. After high-quality treatment, the doctor recommends drugs that restore the vaginal microflora. After the course of treatment, laboratory tests are prescribed to be sure that the disease has been cured. If the case is complex (a woman has bacterial candidiasis and the symptoms are pronounced), the woman is recommended to perform a caesarean section during childbirth.

Disease prevention

Measures to prevent this disease are of great importance, so it is necessary:

• Observe hygiene standards (wash daily, change underwear).
• Remember about the prevention of sexually transmitted diseases (use condoms, use antibacterial suppositories). Especially in cases where sexual partners are random and often change.
• Keep under control the immune system and the microflora of the genital organs. These activities include the normalization of nutrition, daily routine, as well as hardening and walks in the fresh air.

Folk remedies

1st recipe. Grate two medium-sized carrots and squeeze out the juice. 10 cloves of garlic - crush. Chop a small head of cabbage, put it in a saucepan, add 2 cups of water and boil for 15 minutes. Then add carrot juice, garlic, boil for 1 minute and remove from heat. When the remedy has cooled, strain and take ½ cup before meals twice a day.

2nd recipe. Pour 2 tablespoons of dry mountain ash with 2 cups of boiling water and boil for 15 minutes over low heat. Remove from heat, add 2 tablespoons of honey and let it brew for 4 hours. After that, grate 2 onions and a grater and mix with infusion of mountain ash. Take a tablespoon 3 times a day before meals.

All the recommendations that you have read in this article are for informational purposes, and not a guide to action. Only a doctor, on the basis of laboratory tests, can establish a diagnosis and prescribe a qualified treatment.