Bacvaginosis in women: causes, symptoms, treatment. All about bacterial vaginosis and its treatment Women present with bacterial vaginosis disease

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

The development of gardnerellosis affects women of reproductive age. Therefore, the cause of the development of the disease is often associated with sexual transmission. The physiological environment of the vagina is acidic. It is with such a microflora that pathogenic pathogens, having penetrated the genital canals, cannot have a negative impact on health.

The natural environment of the vagina is represented by lactobacilli - short thick rods that dissolve glycogen. Cells are not visible visually - their number can only be determined using a microscope. To maintain a stable pH level, the concentration of lactobacilli must be at least 98%. Bacterial vaginosis is one of the polymicrobial diseases.

The spontaneous reduction in vaginal acidity and lactobacilli is not caused by a single pathogen, but by a combination of them. The definition of "bacterial vaginosis" is explained by the peculiarities of the development of the disease. The pathogenic process proceeds with the participation of a large number of aerobic and anaerobic microflora. A feature of the pathology is the absence of leukocytes (cells that are elevated only during inflammation).

How does it develop

The replacement of the physiological environment of the vagina with pathogenic microorganisms occurs under the influence of a wide range of adverse factors. They are associated with previous interventions on the organs of the reproductive system, lifestyle, and nutritional habits.

From the moment the microflora of the vagina changes (after gardnerella gets into it) and until the first signs appear, it can take from several days to 2-3 months and even six months. In extremely rare cases, the incubation period took more than 1 year. In this matter, the determining factor is the state of the woman's immunity. The weaker the protective properties of the body, the more pronounced the symptoms of the pathology and the earlier it manifests itself.

Risk factors

With a high degree of probability, bacterial vaginosis develops in women for whom the following are relevant:

1. Frequent stress, psycho-emotional state problems
2. Recent surgical interventions or instrumental diagnostic procedures on the organs of the urogenital tract
3. Cystic neoplasms in the organs of the genitourinary system (regardless of the number, size, location, cause of development)
4. The use of drugs containing nonoxynol-9 (for example, Patentex oval, Nonoxynol)
5. Condition after recent childbirth (especially burdened)
6. Wearing underwear made from synthetic fabrics
7. The formation of the menstrual cycle (the period of hormonal changes negatively affects the condition of the vaginal mucosa, making it vulnerable)
8. Uncontrolled or unreasonably long-term use of hormonal, anti-inflammatory, antifungal drugs. This is especially true for the use of antibiotics.
9. Transferred radiation or chemotherapy (for tumor diseases)
10. Poor nutrition, obsessive diets
11. Using low quality detergents

The risk group for the development of gardnerellosis includes women who douche excessively often, do not perform hygiene procedures, and supercool. Latex intolerance, hypersensitivity to lubricants, spermicidal creams adversely affect the condition of the vaginal mucosa.

Symptoms

The main signs of the development of bacterial vaginosis:

1. Vaginal discharge. They are characterized by a sharp fishy smell, green-yellow hue, abundance (their number is 20 times higher than the norm). The consistency is thick, sticky, foamy. Secretion increases after intercourse, douching, menstruation.
2. Severe pain during intercourse, which prompts to stop it. Discomfort has an acute, burning character, persists for a certain time after intimacy.
3. Unpleasant sensations during urination (stinging, irritation inside the urethra).
4. Insomnia, discomfort in the lower abdomen during menstruation, not related to the cycle.
5. A sharp, putrid-fishy smell from urine, a change in its shade.

During the examination, the color of the mucous membranes of the vagina characteristic signs of the inflammatory process (edema, redness) is not observed. The body temperature remains within the normal range, and there are no complaints about the typical signs of intoxication (chills, weakness). Therefore, not suspecting the presence of the disease, the woman does not go to the doctor or does it late.

The reasons

Experts identify the following causes of bacterial vaginosis:

• Change in hormonal background. It is observed during puberty, pregnancy, menopause, after an abortion.
• Intestinal dysbacteriosis (violation of its natural microflora). It develops as a result of inflammation of the large or small intestine, intoxication. Violation of the microflora contributes to the observance of an exhausting diet, starvation.
• Atrophic changes in the mucous membrane of the vagina (occur mainly during menopause).
• Constant use during menstruation only tampons. They contribute to intravaginal stagnation of blood, create a favorable condition for inflammation.
• The presence of diabetes mellitus decompensated form. Pathology contributes to regular irritation of the vaginal mucosa.

The risk of developing gardnerellosis increases if a woman is sexually promiscuous, uses an intrauterine device for an excessively long time. The source of inflammation present in the body increases the likelihood of an infectious pathology.

Degrees

In gynecology, a certain classification of bacterial vaginosis is used. According to this, according to the severity of symptomatic manifestations, the disease is divided into compensated, subcompensated and clinically pronounced type.

Compensated

It is characterized by the absence of lactobacilli in the vagina, which creates the risk of replacing the natural microflora with pathogens. Such indicators do not apply to a pathological condition. Often they are associated with overly thorough hygienic treatment of the genital tract before a visit to the gynecologist. In particular, if a woman used antiseptic preparations or highly concentrated detergents to cleanse the intimate area. Also, bacterial vaginosis of this type occurs with oncological neoplasms - due to radiation and chemotherapy.

Subcompensated

It is characterized by a decrease in the number of lactobacilli, which indicates a violation of the natural microflora of the vagina. Edema and redness of the mucous membrane of the genital tract is not observed. Therefore, changes can only be detected in the laboratory. Leukocytes - 15-20 in the field of view, which refers to a moderate degree. There is an increase in other microbial flora.

Against the background of leukocytosis, the so-called "key" cells appear. Their number is up to 5 in the field of view. The main symptoms of this degree of vaginal candidiasis are itching, soreness during intimacy. Additionally, there is an increase in vaginal discharge, the appearance of an unpleasant odor from them.

clinically pronounced

It is characterized by the complete absence of lactobacilli and the presence of anaerobes. When examining a smear under a microscope, "key" cells occupy the entire field of view of the laboratory assistant. The main manifestations of the condition are a large amount of vaginal discharge, itching inside the genital tract. Pathogenic secretion, the volume of which increases after intercourse, glues the walls of the vagina.

Features in pregnant women

Bacterial vaginosis is one of the diseases, given the danger to the fetus, gynecologists recommend undergoing a detailed preliminary study. The main consequences of the disease for the child and the expectant mother:

1. Intrauterine fetal injury. The consequences of exposure to pathogenic flora on a child are anomalies in his development. There is an incorrect laying of organs - in particular, the heart, neural tube, musculoskeletal system, skull bones.
2. Miscarriage. The infectious process stimulates uterine spasms, which contributes to the rejection of the fetal egg. The first signs of the condition are pain in the lower abdomen, the appearance of bloody discharge from the genital tract.
3. Freezing fetus. Bacterial vaginosis is a pathological process that has an extremely negative effect on the developing fetus. The infection contributes to disruption of the blood supply to the child, causes its intoxication, which leads to intrauterine death. The first signs of the condition are dark spotting from the genital tract, an increase in body temperature to high numbers. During a gynecological examination, a discrepancy between the size of the uterus and the gestational age is established.

Often, bacterial vaginosis can cause polyhydramnios or oligohydramnios, isthmic-cervical insufficiency, placental insufficiency. Also, complications of gardnerellosis are premature onset of labor or infection of the child during its passage through the birth canal. In 2% of cases, the presence of bacterial vaginosis is associated with the development of preeclampsia during pregnancy and premature rupture of the membranes.

If the pathology occurs during pregnancy, the condition becomes more complicated due to problems with the selection of treatment. The difficulty lies in the fact that antibiotics and other anti-inflammatory drugs are contraindicated during gestation.

Possible Complications

Bacterial vaginosis can cause urethritis, cystitis, colpitis, cervicitis, and in the most severe cases, endometritis. Listed inflammation of the bladder, urethra, vagina, cervical canal, the inner layer of the uterus. Due to chronic and often latent inflammation of these organs, infertility develops, but the risk of ectopic pregnancy is also high. Violation of the vaginal environment that occurs during gestation increases the risk of serious complications.

Which doctor to contact

Bacterial vaginosis is treated by a gynecologist. But the determining factor is the root cause of the pathology. If the disease is caused by diabetes mellitus, an additional appeal to the endocrinologist will be required. With the relationship of bacterial vaginosis with genital infections, it is necessary to contact a venereologist. If gardnerellosis is a consequence of intestinal dysbacteriosis, you need to consult a gastroenterologist.

Diagnostics

Initially, the doctor conducts a survey and examination of the patient. From the anamnesis, she learns about the presence of problems with digestion, the change of sexual partner, the use of new intimate products. An obstetric history is also of no small importance - you need to inform the doctor if complications occurred during pregnancy or labor. During the examination on the gynecological chair, no signs of inflammation are detected.

The purpose of the examination is to exclude the presence of diseases with similar symptoms, and then to determine the degree of organ damage and the presence of complications. Similar signs in the course of ureaplasmosis, thrush (vaginal candidiasis), trichomoniasis. Examination of the patient makes it easy to differentiate infectious pathology. Standard set of diagnostic procedures:

1. Microscopic examination of a smear from the vagina. The most revealing type of examination. Detects all changes in the vaginal microflora.
2. Blood test for glucose, general clinical and biochemical parameters.
3. Urinalysis is general (a large number of leukocytes are detected in the sample).
4. Bacteriological examination of urine (sowing).
5. PCR diagnostics (detection of the causative agent of pathology - gardnerella).

Already on the basis of the results of the smear, it becomes clear that the microflora of the vagina is disturbed. It is established that lactic acid bacteria are almost absent, the level of leukocytes corresponds to the norm or slightly exceeds it, the pH of the secretions is more than 4.5. In 95% of cases, the listed types of examination are enough to clarify the clinical picture.

Additional types of diagnostics depend on the characteristics of the underlying cause of bacterial vaginosis. It is possible that an ultrasound of the abdominal cavity and small pelvis will be required. Diagnosis is carried out on the eve of treatment, 2 weeks after its start, and 1 month after its completion.

Treatment

Gardnerellosis is not treated in an operative way - a fairly comprehensive, but conservative approach. In addition to eliminating the infectious agent, you need to restore the pH of the vagina. In the long term recovery is of no small importance strengthening the body's immune abilities.

To stop bacterial vaginosis, the patient is prescribed:

1. Use of an anti-inflammatory drug (of the options listed below, 1 or 2 is prescribed). Metronidazole (Trichopol) 1 tab. 2 p. per day, the duration of the therapeutic course is 10 days. Clindamycin (150 mg) - 1 tab. 4 p. per day. The duration of treatment is 1-1.5 weeks. Tiberal (500 mg) - 1 tab. twice a day, up to 5 days in a row.
2. The use of vaginal suppositories with anti-inflammatory, antifungal, antibacterial action. These include Vagisept, Terzhinan, Vagiferon. Assign the introduction of 1 candle 1 p. per day, after careful intimate hygiene. The therapeutic course is 10 days.
3. Restoration of intestinal microflora. Assign Linex (2 capsules 3 rubles a day, 3 weeks in a row) or Hilak Forte (1 teaspoon per 100 ml of water 3 rubles a day, 3 weeks).
4. Vitamin therapy. Group B drugs are administered individually or in the form of complexes (these include Neurobex, Neurorubin). The therapeutic course, subject to intramuscular administration of drugs, is 10 days.
5. Diet food. Refusal to eat sweets, sour, spicy, salty, smoked foods, dishes. Alcohol and caffeine are prohibited. If bacterial vaginosis is caused by intestinal dysbacteriosis, undesirable foods include fried and fatty foods, legumes.

After stopping pathogenic microorganisms, the normalization of the vaginal microflora is shown through the use of drugs such as Laktonorm, Bifidumbacterin, Acilact. Vaginally administered Vaginorm, Laktogel or their analogues.

At the time of treatment, it is necessary to observe sexual rest. It is equally important to carry out hygiene measures in full (especially after going to the toilet and during menstruation). It should be remembered that bacterial vaginitis can infect a man during intimacy, cause complications for the sexual health of a partner. Therefore, he needs to simultaneously undergo treatment by contacting a urologist.

Forecast

If you eliminate not only gardnerellosis, but also the cause of its development, the prospect of restoring health is favorable. When the pathology takes a protracted course, the reproductive function of a woman is threatened. In general, the disease lends itself well to elimination, but on condition that the treatment is made by a doctor, and the patient follows all his recommendations.

Prevention

To avoid the development of bacterial vaginosis, the following recommendations will help:

• The use of vitamins (especially during the off-season)
• Cold protection
• Maintaining a decent sex life
• Restriction from stress
• Exclusion of the use of abortion as the optimal method of birth control
• Prevention of constipation - refusal to eat dry food, fractional nutrition
• Selection of an alternative method of contraception (for latex intolerance)
• Timely correction of the state of intestinal microflora
• Full implementation of hygiene measures
• Normalization of blood glucose levels, regular visits to the endocrinologist (with a hereditary predisposition to diabetes)
• A healthy approach to the use of intimate products
• Refusal of the experimental attitude to the selection of hygiene products

Excessive use of tampons during menstruation causes irritation of the vaginal mucosa. Therefore, it is recommended to periodically apply gaskets. It is equally important to timely eliminate diseases of the organs of the urogenital tract, preventing the transition of pathologies into a chronic form. You should also adequately approach the issue of douching, taking medications.

Bacterial vaginosis is a gynecological pathology of polymorphic origin, which is eliminated without surgery. Even with a conservative approach, treatment should be comprehensive - in addition to medication, include diet, hygiene, and sexual rest. Pathology causes complications only in case of prolonged neglect of one's health. In particular, when a woman does not visit a gynecologist for a long time and does not know about the presence of the disease. If the pathology is caused by endocrine or gastrointestinal disorders, you will need to visit doctors of these profiles.

Video: How to cure bacterial vaginosis

Almost ninety percent of the microflora are lactobacillus bacilli, which prevent the colonization of pathogenic microorganisms and monitor the amount of opportunistic microflora. In addition, bacilli produce the production of substances with antibacterial activity.

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

• hormonal system. If the hormonal background changes, then the number of receptors that are on the surface of the cells changes accordingly, and it is to these receptors that harmful bacteria attach. Also, it is the hormonal system that controls the process of updating 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 multiply.

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 dysbacteriosis. Unlike vaginitis, there are no inflammatory signs in bacterial vaginosis.

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

The basis of this disease is a change in the quantitative composition of the microflora of the vagina. The number of beneficial bacteria decreases, while the conditionally pathogenic microflora begins to multiply actively.

In each 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 mycoplasmas and gardnerella can be noted.

The causes of vaginal dysbacteriosis can be very many. Consider the most important provoking factors:

• hormonal changes, for example, after an abortion, during menopause or pregnancy;
• weakening of general or local immunity;
• endocrine disruption;
• poor observance of the rules of intimate hygiene;
• deformation of the vagina or cervix;
• frequent use of soap when washing and the 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 dysbacteriosis;
• prolonged or uncontrolled use of antibiotics.

Immediately it should be noted that the disease has no characteristic signs. Often, its only symptom is profuse vaginal discharge with an unpleasant fishy odor.

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

There are no such signs of the inflammatory process as edema and hyperemia with vaginosis, this is a hallmark of vaginitis. Often the disease is accompanied by such pathological processes: cervicitis, erosion, scarring. Approximately in fifty percent of cases, patients experience the addition of vaginitis.

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

• abundant grayish-white discharge of a homogeneous creamy consistency, which is evenly distributed along the walls of the vagina;
• discomfort with intimacy;
• pain in the perineum;
• urination disorders.

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

• discharges change their color and consistency, resembling a curdled mass;
• whites become dark green;
• pathogenic flora joins the infectious process, which leads to inflammation of the vagina, manifested as swelling and redness;
• whites are easily removed from the walls of the vagina with a cotton swab;
• frequent and painful urination;
• itching around the vulva.

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.

By 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 takes place;
• subcompensated stage. The reduction of lactobacilli occurs in a significant form and the activation of conditionally pathogenic microorganisms occurs;
• stage of decompensation. Lactobacilli are completely absent. There is a pronounced clinical symptomatology 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, the hormonal background changes, the immune system weakens, thus creating favorable conditions for the development of the disease. In its manifestations during pregnancy, the disease is no different, and a woman is also worried about thick foamy discharge with an unpleasant smell of stale fish.

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

• in the early stages, spontaneous abortion may occur;
• a disease that develops in the second or third trimester threatens to infect the fetus, which can lead to premature outflow 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. Means that include metronidazole are usually prescribed. Such drugs are used in the form of vaginal pills or gels. Doctors also prescribe to pregnant women such remedies: Trichopolum, Metrogil, Tiberal.

The above funds are prescribed from the second trimester of pregnancy, so in the first there is a laying of vital organs and systems. 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 drugs containing lactobacilli to restore microflora. They can be used both inside and in the form of douching. 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. This is most likely due to the fact that antibiotics that affect pathogenic microflora interfere with the rapid creation of favorable conditions for the active reproduction of beneficial bacteria.

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

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.

Already on the basis of clinical symptoms alone, a specialist may suspect the presence of vaginosis, but an accurate diagnosis is made on the basis of laboratory data. The gynecologist conducts an examination, during which he detects a 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. Nevertheless, the causative agents of this disorder - gardnerella - can provoke the development of the pathological process in the male body.

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

In most cases, the causative agent of the disease easily penetrates the male body and is just as quickly excreted after two or three days. Sometimes there may be a chronic carriage, in which there are no clinical manifestations. The danger lies only in the fact that a man may not know about the carriage, but at the same time pass gardnerella to his partner.

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

How is bacterial vaginosis transmitted?

Bacterial vaginosis is not a sexually transmitted disease!

In general, pathogens, in particular gardnerella, can be sexually transmitted, but this will not cause the development of dysbacteriosis, because these microorganisms are part of the natural microflora in small quantities. If immunity is normal, then the body's defense mechanisms simply will not allow the opportunistic organism to attach to the surface of the cell, and even more so to penetrate deeper.

Then what role do unprotected sex play in the onset of the disease? Here the point is not at all in infection, but in the fact that the frequent change of sexual partner violates the natural balance of microflora.

When should you see a doctor?

Consider the reasons that may serve as a reason for contacting a specialist:

• infectious process arose for the first time. The doctor will help identify the etiological factor and talk about the characteristic symptoms, as well as tell you how to deal with them;
• the disease did not occur for the first time, 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;
• fever and unpleasant odor from the vagina;
• despite self-treatment, recovery never came.

What is the treatment for bacterial vaginosis?

Bacterial vaginosis in women is treated in two main steps:

1. Restoration of the physiological properties of the vagina, strengthening the body's defenses, normalization of hormonal levels and the fight against pathogens.
2. Restoration of the natural balance of the microflora of the vagina.

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

Medicines for bacterial vaginosis

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

Eubiotics

Consider a treatment regimen with effective eubiotics:

• Baktisubtil. One capsule is drunk one hour before meals three to four times a day;
• Khilak forte. Fifty drops three times a day;
• Linex. It is taken two tablets three times a day.

Candles from bacterial vaginosis

Vaginal suppositories act directly in the focus of the pathological process. The active substance is practically not absorbed into the blood, which means it causes a minimum of side effects.

• Ecofemin. The composition of the drug includes live lactobacilli. Suppositories are administered for ten days two to three times a day;
• Bifidumbacterin. Contains bifidobacteria. It is enough to introduce one candle at bedtime for ten days;
• Hexicon. Contains chlorhexidine. A feature of Hexicon is that it has a detrimental effect on pathogenic microorganisms, while not affecting lactic acid bacteria. One or two suppositories are introduced for 10 days.

Treatment regimen for bacterial vaginosis

To begin with, consider the standard treatment regimen with systemic drugs:

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

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

• Neo-penotran. For seven days, a suppository is injected 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 at bedtime for seven days.

How to treat vaginosis at home

Consider several ways to treat the disease at home:

• if the disease has just begun to develop, douching can be of 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 are enough;
• You can use tampons intravaginally. They are wetted in ascorbic or lactic acid. Tampons are also lubricated with metronidazole ointments. The tampon is left in the vagina for twenty minutes, after which it should not be washed away. It is necessary to do ten such procedures, but the effect is already visible after the third application.

Folk remedies for bacterial vaginosis

Treatment with the help of non-traditional methods is longer, but the safest. But this is provided that they are correctly used. Folk remedies are not an alternative to medical treatment, but only auxiliary help. You can use them with the permission of the doctor.

Consider the most effective recipes:

• sitz baths. The duration of this procedure is fifteen minutes. They quickly remove the itch. For their implementation, 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 remedy must be infused for six hours. After it has been filtered, the infusion is ready for use. Treatment lasts for three months. Half a glass is drunk half an hour before a meal;
• 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 remedy should be infused 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 observance of the rules of intimate and sexual hygiene;
• in case of casual sexual intercourse, the use of barrier methods of contraception;
• timely treatment of inflammatory processes of the genitourinary system;
• full sleep and the fight against stressful situations;
• balanced diet;
• rational use of antibiotics;
• normalization of hormonal levels;
• prevention of the development of intestinal dysbacteriosis;
• regular visits to the gynecologist.

So, bacterial vaginosis is a disease in which there is a violation in the natural balance of the microflora of the vaginal mucosa. A number of reasons can lead to its appearance, among which we can distinguish a change in the hormonal background and weakening of the immune system. One of the main signs of the disease is copious discharge from the vagina of a white-gray color with a fishy smell.

Bacterial vaginosis should be treated by a doctor. It all starts with a diagnostic examination and an accurate diagnosis. Accurate 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 a disease of the female sphere of an infectious nature, in which the normal microflora is replaced by opportunistic bacteria. Vaginosis corresponds to vaginal dysbacteriosis of the 3rd degree. This disease does not have an inflammatory reaction and thus differs from vaginitis.

With bacterial vaginosis, the normal microflora of the vagina is disturbed

Prevalence

Bacterial vaginosis is one of the most common diseases in women. About 85% of women have had symptoms of vaginosis during their lifetime. Symptoms of this disease can be in virgins. However, it is noted that the more active and disorderly sexual life, the more often a woman suffers from vaginosis.

Causes of the disease

The cause of the disease is a change in the composition of the microflora of the vagina of women, in which a significant part of lactobacilli is replaced or completely replaced by other bacteria.

Biocenosis is normal

In healthy women, many microorganisms live on the vaginal mucosa, the proportion of lactic acid bacteria of which is more than 95%. Lactobacilli live in symbiosis with the woman's body, that is, they benefit each other. They secrete lactic acid, making the vaginal secretion sour and providing a protective barrier against unwanted microbes. The normal pH of a woman's vagina is in the range of 3.8–4.5.

The composition of the flora of the remaining 5% for each woman is unique, it includes conditionally pathogenic anaerobic cocci and bacilli that are resistant to an acidic environment.

Bacterial vaginosis occurs when pathogenic bacteria enter

Provoking factors

The stability of the microecosystem can change under the influence of a cause that causes a shift in the pH of the vagina to the alkaline side and its seeding with alien flora. This is facilitated by:

• non-compliance with feminine hygiene (rare change of underwear, long wearing of tampons during menstruation);
• improper hygiene (frequent douching, use of cosmetic alkaline soap instead of special products with low pH);
• super-intense sex life without condoms (sperm pH has an alkaline characteristic);
• frequent change of sexual partners;
• damage to the vaginal mucosa and neoplasms;
• menstrual irregularities;
• hormonal changes due to pregnancy, menopause, abortion or puberty;

Frequent douching can be a trigger for the development of bacterial vaginosis

• prolonged wearing of an intrauterine device;
• frequent use of condoms with aseptic lubrication;
• contraceptive creams and suppositories, which include antimicrobials;
• antibiotic treatment;
• taking hormonal drugs, including contraceptives;
• the presence of endocrine diseases (especially diabetes mellitus);
• women's alcoholism;
• decreased immunity and allergies;
• previous sexually transmitted diseases.

Despite the presence of provoking factors, the immunity of women is of greater importance. That is, in healthy women with good immunity, age-related hormonal changes, pregnancy and frequent sexual intercourse will not cause vaginosis. The weaker the immune system, and this is usually associated with the presence of concomitant pathology, the greater the risk of developing the disease. And the more difficult it is to treat.

Taking antibiotics provokes violations of the normal microflora of the vagina

Bacteria that cause vaginosis

What is conditional pathogenicity? Unlike pathogenic bacteria (syphilis, gonorrhea), these microorganisms do not harm a person, provided they are small in number. However, with the growth of colonies above the maximum permissible norm, they begin to show their pathogenicity - they harm the body of women.

Most often, with vaginosis, they are found in excess of the norm:

• gardnerella;
• clostridia;
• klebsiella;
• coli;
• streptococci;
• staphylococci;
• corynebacteria;

Mycoplasma - the bacterium that causes bacterial vaginosis

• mycoplasmas;
• fusobacteria and others.

Vaginosis is caused not by one type of bacilli, but by the colonization of various species of anaerobes, many of which are not identified in the laboratory. In fact, the biocenosis of each woman with vaginosis is unique.

Symptoms

Due to the absence of a local and general inflammatory reaction, the symptoms of dysbacteriosis are poor. Clinical signs of vaginosis:

• profuse, homogeneous and thick discharge from the vagina of a white or grayish color, aggravated before menstruation and after intercourse;
• possible unpleasant odor (sometimes up to the “stink of rotting fish”);
• brief and unexpressed episodes of itching or burning (these symptoms may appear only when urinating);
• there may be pain during intercourse.

Bacterial vaginosis causes profuse vaginal discharge

More pronounced clinical signs rather indicate vaginitis - an infectious inflammatory process. Vaginosis often has a sluggish, chronic, relapsing course. In the absence of smell and discomfort, when vaginosis is manifested only by abundant "whiteness", many women perceive this as the norm, and therefore do not go to the doctor. This circumstance contributes to the chronization of the process.

Vaginosis during pregnancy

Bacterial vaginosis is rarely caused by hormonal changes alone. More often, a woman already suffered from dysbacteriosis, and pregnancy increased its degree to vaginosis. The question remains whether or not to treat bacterial vaginosis during pregnancy. The decision is made by the obstetrician-gynecologist, depending on the ratio of possible benefits and harms for the unborn baby. When deciding the issue, the duration of pregnancy and the presence of possible threats to its course are taken into account.

In the treatment of pregnant women, standard drugs are prescribed, but mostly locally. A possible complication of vaginosis is vaginitis. And then there may be an ascending infection of the uterus, placenta, membranes and amniotic fluid. And as a result, miscarriage or premature birth. But the risk of developing such an outcome is minimal. The best prevention of vaginosis in pregnant women is to plan pregnancy and treat it before it occurs.

The treatment regimen for bacterial vaginosis during pregnancy is standard

Classification

There is no separate official classification of vaginosis. Many authors use the classification of dysbacteriosis, but vaginosis corresponds to it only in stages 3-4.

Dysbacteriosis means any imbalance of the biocenosis:

• I degree - the absence of microflora. The state of the epithelium is normal. There is a possibility of colonization by alien microbes. The causes of this condition are the consequences of a long and powerful course of antibiotic treatment or chemotherapy.
• II degree - the proportion of opportunistic bacilli exceeds 5%, but less than 50%. The smear will show the detection of a negligible number of "clue cells". Normal condition of the vaginal mucosa.
• III degree - this is vaginosis. A diverse microflora dominates over lactic acid bacteria and makes up more than 50%. In addition to the violation of the balance of ratios, the total contamination increases due to conditionally pathogenic species. Smear - detection of "key cells" in large numbers. Mucous membrane without signs of inflammation.

Bacterial vaginosis is a grade 3 vaginal dysbacteriosis.

• IV degree - morphologically mixed flora completely displaces lactobacilli from the vagina. At this stage, for some time there may still be no inflammatory reaction - this corresponds to vaginosis.

Clinical symptoms: pain, pain, burning, itching, subfebrile condition. And signs of local inflammation: swelling, redness, leukocytosis. Indicate a complication of vaginitis.

Diagnostics

To establish a diagnosis, you need to contact a specialist - a gynecologist. He will appoint the necessary list of studies, correctly interpret the results, establish the cause of vaginosis, conduct a differential diagnosis with other pathological conditions, and prescribe treatment.

Survey

Diagnostic scheme for bacterial vaginosis includes:

• questioning and collecting anamnesis;

Diagnosis of bacterial vaginosis includes a gynecological examination of the vagina

• examination of the vaginal mucosa;
• gynecological palpation;
• a smear of vaginal secretion and its microscopic examination to determine the flora and "key cells";
• determination of the pH of the vagina;
• aminotest;
• sowing the vaginal secretion for microflora with the determination of sensitivity to antibiotics (according to indications);
• detailed analysis of blood and urine;
• colposcopy (according to indications);
• examination of the sexual partner (according to indications).

If necessary, colposcopy may be performed to clarify the diagnosis.

Differential Diagnosis

Differential diagnosis is carried out with similar pathological conditions:

• With dysbacteriosis of 1-2 degrees.
• With nonspecific vaginitis.
• With milkmaid. Candidiasis can have a picture of vaginosis or vaginitis, but is not caused by bacteria, but by fungi. At the same time, vaginal discharge takes on a curdled character (with dense flakes), and with vaginosis they are homogeneous. The difference is also constant itching.
• with venereal diseases.

These diseases are characterized by their own characteristics. However, often gonorrhea, trichomoniasis, chlamydia and even syphilis in women have erased symptoms. Sometimes they are discovered incidentally during examinations for other diseases.

Differential diagnosis is necessary to distinguish bacterial vaginosis from other diseases with similar symptoms.

This pathology needs specific therapy and, if left untreated, causes significant complications.

Complications

Vaginosis does not bring much concern to women, but its treatment is necessary, since the lack of a local protective reaction contributes to the development of inflammation and the penetration of foreign pathogenic microbes.

• With vaginosis, the risk of getting venereal diseases increases by 2 times.
• The possibility of developing candidiasis increases, which will only increase the alkalinity of the environment.
• The lack of protection in case of damage to the mucosa (erosion) also contributes to the degeneration of the epithelium and the development of malignant diseases.

Bacterial vaginosis increases risk of miscarriage during pregnancy

• Bacterial vaginosis during pregnancy, complicated by ascending infection, is a common cause of threatened miscarriage or premature birth.

This disease does not apply to sexually transmitted diseases, that is, it is not transmitted through a sexual partner. Naturally, men cannot suffer from vaginosis, since they do not have such an organ. However, men also have their own microflora on the mucous membranes of the urethra, the exchange of which is inevitable during sexual intercourse with a woman. Thus, if a partner suffers from vaginosis for a long time and has bacteria to which a man’s immunity is reduced, he may gradually develop urethritis.

Treatment

The treatment regimen for vaginosis includes 2 stages:

• Stage 1 - antibiotic therapy. It pursues the goal - the suppression of unnecessary flora. The standard includes antimicrobial drugs: Metronidazole, Tinidazole, Clindamycin, Ornidazole. Antibiotics are used more often topically (vaginal suppositories, creams, gels), less often in the form of tablets inside. For douching, drugs are used: Chlorhexidine or Miramistin. Use combined candles Hexicon or Flagyl. The course of treatment lasts 7 days.

Antibacterial agents are prescribed to treat bacterial vaginosis

• Stage 2 - the use of probiotics. The goal is to create conditions for increasing the intensity of reproduction of lactobacilli and their colonization of the vagina to the required concentration. Probiotics are prescribed after antibiotics are discontinued. Apply suppositories containing lactic acid bacteria: Atsilakt, Acipol, Lactobacterin. Or combined candles: Bifiform, Lineks.

During treatment, it will be necessary to temporarily change lifestyle and some habits:

• Abstinence from sexual intimacy to prevent reinfection.
• Refusal to drink alcohol. Firstly, alcohol itself shifts the pH to the alkaline side, reduces local immunity and provokes vaginosis. Secondly, against the background of taking antiprotozoal drugs, ethanol tolerance decreases and withdrawal increases.

Treatment for bacterial vaginosis includes taking probiotics

• Restriction of spicy food (can also affect the pH level).

Prevention

Prevention of vaginosis is the maximum possible elimination of provoking factors. For this you need:

Detailed information about bacterial vaginosis is presented in the video:

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

The development of vaginal dysbacteriosis

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

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

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

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

Main etiological factors

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

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

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

Clinical manifestations of dysbacteriosis

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

Vaginal dysbacteriosis is most often manifested by the following symptoms:

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

Allocations have the following features:

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

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

Examination and treatment tactics

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

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

Key cells in the smear are shown in photo 3.

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

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

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

Causes and symptoms of bacterial vaginosis in women, as well as methods of treatment with drugs and folk remedies.

Intimate health problems in women are always an acute issue. Even bacterial vaginosis - a disease, at first glance, not a terrible one - can cause a lot of problems and troubles. It is dangerous with complications, and therefore requires mandatory treatment.

What is bacterial vaginosis

The microflora of the vagina of a healthy woman is 95-98% composed of lactobacilli, which maintain a constant acidity. Normally, it is 3.8-4.5. This level of acidity does not allow pathogenic bacteria and microbes to multiply, which make up the remaining 2-5%.

As a result of various adverse factors, the number of lactobacilli may decrease. This entails a decrease in acidity and the growth of pathogenic microorganisms. This is the nature of the development of bacterial vaginosis.

This disease is not inflammatory, it is a violation of the qualitative and quantitative composition of the vaginal microflora. It is a purely female disease, does not apply to sexual infections. It occurs in 80% of women of reproductive age.

Causes of the disease

The causes leading to the development of the disease are divided into internal and external.

Internal:

• hormonal system disorders;
• intestinal dysbacteriosis;
• endocrine diseases;
• damage to the inner lining of the vagina;
• weakening of the immune system;
• polyps and cysts in the vagina.

External:

• long-term antibiotic treatment;
• douching abuse;
• neglect of personal hygiene;
• consequences of radiation therapy;
• long-term use of an intrauterine device, a contraceptive diaphragm, a ring;
• taking oral contraceptives for a long time without interruption.

Symptoms of the disease

Bacterial vaginosis is often asymptomatic, especially in the early stages of the disease. Sometimes, with minor violations of the microflora, the body itself is able to adjust the deviations.

A distinctive symptom of the disease is vaginal discharge - leucorrhoea. Usually they are white or with a grayish tinge, liquid with an unpleasant stale smell. Their number may be different, but in any case exceeds the amount of daily allocations.

If the symptoms of the disease do not decrease in manifestations against the background of the treatment received, chronic bacterial vaginosis occurs. In this case, periods of exacerbations are replaced by remission, and the disease becomes protracted.

In chronic bacterial vaginosis, the leucorrhea becomes more dense, sticky, with a green or yellow tint. In addition, the following symptoms are noted:

• itching, burning;
• discomfort during sex;
• pain when urinating.

Does the disease affect conception and pregnancy

Bacterial vaginosis is not sexually transmitted. The diagnosis is not a ban on sexual relations, except in cases where the disease becomes acute. In such situations, having sex can bring discomfort and discomfort.

This gynecological disease is not an obstacle to conception, but it poses a danger to future pregnancy. Pathogenic microflora from the vagina can enter the uterus and damage the fetus. The so-called intrauterine infection will provoke growth retardation, pathology in the development of the fetus.

Bacterial vaginosis increases the risk of postpartum complications, especially if the birth ended with surgery. The likelihood of such consequences is extremely low, but during pregnancy, this disease requires mandatory monitoring and treatment.

Diagnosis of the disease

An experienced gynecologist, even during examination, can put bacterial vaginosis under suspicion. Abundant discharge along the walls of the vagina in the absence of an inflammatory process, an unpleasant smell of mucus indicate this disease. To clarify the diagnosis, the following tests are performed:

1. Measuring the level of acidity using an indicator strip.
2. Reaction with potassium hydroxide solution, which enhances the smell of stale fish inherent in the secretions.
3. Smear microscopy.

It is smear microscopy that shows which bacteria and microbes predominate in the vaginal microflora, how much the number of lactobacilli has changed. This analysis allows you to establish the presence of "key" cells - elements of the exfoliated vaginal epithelium. Their presence, even in small quantities, indicates the severity of the disease and the duration of its course.

Based on laboratory tests, examination, complaints and questioning, the patient is prescribed treatment.

Treatment of a gynecological disease

In each case, the treatment regimen and dosage of drugs are individual.

Important! Self-treatment and incorrectly selected doses lead to the development of drug resistance in bacteria and the complication of further treatment.

Treatment is aimed at sanitizing the vagina from pathogenic microorganisms and increasing the number of lactobacilli. Consists of two stages.

At the first stage, antibacterial drugs are prescribed that suppress the reproduction of pathogenic microbes and bacteria. In most cases, this is . They have an advantage over tablets, as they are injected directly into the vagina and do not have side effects on the organs of the digestive system. At the second stage, probiotics with lactobacilli are prescribed to quickly restore the normal microflora of the vagina.

To relieve itching and burning, antihistamines are prescribed ( Zodak, Tsetrin). To restore the correct acidity of the vagina - lactic acid preparations ( Femilex).

Folk remedies for bacterial vaginosis

In the early stages of the disease, with mild symptoms, you can use folk remedies. These include douching and baths with decoctions of herbs. Such treatment will require perseverance and patience, since the minimum course is 2-3 weeks.

To obtain the effect of the procedure, you need to repeat 2-3 times a day. All decoctions are prepared in the same way: 2 tbsp. l. herbal collection, pour 1 liter of hot water and let it brew for 5-6 hours. For one douching procedure, 1 tbsp. (200 ml) ready-made broth. You can use the following herbs:

• oak root, geranium, chamomile, violet;
• marshmallow root, St. John's wort, calendula, dandelion and blueberry leaves,.

These recipes can be used for sitz baths. For this, 2 tbsp. the finished broth is dissolved in 10 liters of warm water. The duration of the procedure is 15-20 minutes.

Disease prevention

Bacterial vaginosis is a common disease. Compliance with simple rules will allow, if not to avoid this disease, then at least reduce the manifestation of unpleasant symptoms. For prevention, you should:

• observe personal hygiene;
• treat sexual infections in time;
• rational use of antibiotics;
• correctly use hormonal contraceptives;
• do not abuse douching;
• regularly observed in the antenatal clinic.

Bacterial vaginosis

general information

Bacterial vaginosis - an infectious non-inflammatory disease characterized by a change in the normal ecosystem and pH of the vagina in women. In particular, there is an imbalance of microorganisms that, under physiological conditions, colonize and protect the vaginal environment (the so-called saprophytic microflora).

The result is a polymicrobial infection that affects the vagina, in which various types of bacteria are involved, able to synergistically create suitable conditions for the development of others. Thus, there is a change in the microflora of the vagina with a decrease in the number lactobacilli(usually protective and responsible for maintaining the slightly acidic environment of the vagina) and the reproduction of pathogenic microorganisms.

Indication of bacterial vaginosis itching, intimate burning and increase (homogeneous grayish-white discharge, characterized by a bad smell), but in about half of the cases it is asymptomatic.

If ignored, the disease can cause gynecological complications, as well as promote sexual transmission of sexually transmitted diseases.

What is meant by bacterial vaginosis?

Bacterial vaginosis is one of the most common vaginal infections among women.

The most important aspect is that the disease is characterized by severe change in the vaginal ecosystem, i.e. various populations of microorganisms that usually inhabit this region of the body and acquire a state of mutual equilibrium ( flora or vaginal microbiota).

The most important bacteria in the vaginal ecosystem are lactobacilli(Dederlein rods), and like the organism itself, these protective microorganisms benefit from this symbiosis. The lactobacillus flora feeds essentially on the glycogen present in vaginal secretions and synthesizes lactic acid, helping to keep the vaginal environment slightly acidic, while pH around 3.8-4.5. This acidity is especially important for the body, as it inhibits the growth of other harmful pathogens that can cause infections.

Causes and risk factors

Usually, in women of reproductive age, lactobacilli (or Dederlein sticks) are the predominant components of the vaginal microflora. Colonization with these bacteria is usually protective as it keeps the vaginal pH at normal levels (between 3.8 and 4.2) and prevents overgrowth of pathogens. However, in the presence of situations that change the vaginal ecosystem, the sexual organ becomes vulnerable.

What are the causes of bacterial vaginosis?

The causes of bacterial vaginosis are still being studied and researched medically. The etiological picture is actually quite complex: the occurrence of the disease seems to depend on simultaneous interaction of various factors rather than from a single microorganism or factor.

In any case, certain circumstances create an imbalance in the vaginal flora, where microorganisms predominate, which, as a rule, should not be present or should be present only in limited quantities. All this affects the microflora of the vagina.

Thus, some microbes can find favorable conditions and multiply abnormally, becoming dangerous and causing bacterial vaginosis.

Microorganisms that play a leading role in pathogenesis include: Gardnerella vaginalis, Mobiluncus spp. and Prevotella spp..

Predisposing and/or aggravating factors

Any woman can get bacterial vaginosis, but certain activities and behaviors can greatly increase this risk.

- Unprotected intercourse and a large number of sexual partners.

Bacterial vaginosis is more common in sexually active women.

Failure to use condoms during intercourse is a possible cause of vaginosis. In particular, vaginal dysmicrobiosis may be associated with a period of greater frequency of unprotected intercourse. In fact, sperm cells raise the pH of the vagina to create a more favorable environment for sperm to live; however, this condition may encourage the growth of certain bacteria.

Frequent change of sexual partner is also considered an important risk factor for the disease.

- Other risk factors.

Other conditions that disrupt the normal balance of the bacterial flora of the vagina and predispose to the development of bacterial vaginosis:

• topical or systemic antibiotic therapy;
• use of intrauterine mechanical contraceptives, for example, spirals;
• intimate hygiene with too aggressive detergents or insufficient pH.

Factors such as psychophysical stress can also affect the immune system, thus predisposing to bacterial vaginosis.

In determining vaginal dysmicrobiosis, which sets the ideal conditions for an increase in pathogenic bacteria and genital infections, the patient's medical history and age also contribute, in particular, it has been noted that bacterial vaginosis is rarer in prepubertal women than in postmenopausal women. probably due to the lower number of relationships and sexual partners in these two age groups and the characteristic hormonal pattern that distinguishes them from the period of fertility.

Bacterial vaginosis in pregnancy

During pregnancy vitamin D deficiency, seems to play a role in the occurrence of vaginosis, and also correlates with , preeclampsia and the need to resort to caesarean section. Vitamin D is involved in the modulation of the immune system and the regulation of cell proliferation, so an adequate supply of the vitamin is essential for the health of the pregnant woman and the fetus. If the supply of a vitamin is insufficient, it is necessary to supplement it (after consulting a doctor) to reduce the risk of these gestational complications.

Symptoms and signs

Bacterial vaginosis is not always symptomatic (it can be asymptomatic in 50% of cases), but it is usually indicated by plentiful greyish-white, rather thin and foul-smelling vaginal discharge.

Some women with vaginosis compare bad smell secretions from smell fish and report it, especially after intercourse, soap use, or menstruation. This foul-smelling leucorrhea due to the production by some microbes of certain substances obtained as a result of the decomposition of amino acids, called aromatic amines (putrescine, cadaverine, tyramine).

In some cases, the presence of the disease may signal:

• itching in an intimate place;
• burning sensation when urinating;
• pain during intercourse.

Possible Complications

In most cases, bacterial vaginosis does not cause serious complications, but the characteristic increase in vaginal pH increases the risk of infection with various sexually transmitted diseases, such as and .

Bacterial vaginosis can also contribute to pelvic inflammatory disease (PID)) :

• endometritis;
• parametritis.

If not treated promptly and correctly, the condition can damage the tubes, increasing the risk of ectopic pregnancy and even infertility.

In addition, in the case of vaginosis during pregnancy and if not properly treated, there is a chance of preterm labor because the infection can spread to the amniotic membrane, causing early rupture. During pregnancy, there is a risk of developing fetal-placental infections and postpartum endometritis.

Diagnostics

Bacterial vaginosis is diagnosed when gynecological examination. The doctor examines the vagina and measures the pH level. In the case of bacterial vaginosis, the pH level is usually above 4.5.

During a gynecological examination, the vulva and vagina have a normal appearance, but there is a homogeneous milky-grayish leucorrhea adhering to the walls of the vaginal canal.

During the examination, a sample of vaginal secretions is also taken for microscopic examination to look for bacteria associated with bacterial vaginosis. When in contact with an alkaline substance such as potassium hydroxide (KOH), the sample releases a fishy odor suggestive of vaginosis.

Microscopic examination of a vaginal secretion sample reveals the classic " clue cells”, i.e. epithelial cells of the vagina, covered with numerous bacteria, which give the cells a granular appearance. Presence white blood cells(leukocytes) on microscopic glass indicates co-infection such as gonorrhea or chlamydia and requires test cultures. However, cultural studies on ( Gardnerella vaginalis) are weakly specific (this bacterium can be isolated from 50% of healthy women).

Diagnosis can also be confirmed:

• the Gram stain method (a relatively fast test used to detect the presence of bacteria);
• analysis of the ratio of lactobacilli and other bacteria (Nugent criteria).

But the Pap smear is unlikely to be useful, because it is not very sensitive to the diagnosis of bacterial vaginosis.

- Clinical criteria (Amsel criteria) for the diagnostic definition of bacterial vaginosis.

The diagnosis of the disease is established when 3 of the 4 following clinical criteria are met:

• copious discharge from the vagina of a grayish-white, homogeneous consistency (leukorrhea), evenly covering the walls of the vagina;
• vaginal pH >4.5;
• positive fishy odor test (10% KOH);
• presence on re-examination of cue cells (vaginal epithelial cells [at least 20% of epithelial cells]).

Treatment of bacterial vaginosis

Sometimes vaginosis spontaneously regresses, but if symptoms or complications are present, a specific therapeutic protocol established by a general practitioner or reference gynecologist is always indicated.

The first drug of choice for the treatment of bacterial vaginosis is metronidazole(tablets of 500 mg 2 times a day for a week).

Intravaginal therapy using 2% clindamycin cream(applied every night for a week) or 0.75% metronidazole gel(applied 2 times a day for 5 days) is also effective.

Treatment with a single dose of 2 g of metronidazole usually gives good clinical results, but is characterized by an increased rate of recurrence of infection.

Topical treatments based on creams or gels are preferred for pregnant women because they are less likely to develop systemic side effects.

These drugs have the advantage of providing a quick response, but they should be combined with foods that can stimulate the proliferation of lactobacilli: in the presence of vaginosis, it is important to restore the normal ecosystem by taking probiotics. A diet high in fiber and low in simple sugars may also be beneficial. various sweets, candies and drinks with sugar.

Finally, it should be remembered that during treatment it is always important to avoid contact or sexual intercourse in order to reduce the risk of reinfection.

Attention! The topical drug clindamycin, used to treat bacterial vaginosis, reduces the effectiveness of latex condoms and diaphragms. Therefore, women using them cannot rely on these methods of contraception during therapy.

Forecast

The prognosis is favorable. Bacterial vaginosis usually clears up after a few days but often recurs. If it recurs often, you may need to take antibiotics for a long time.

Prevention

To prevent vaginosis and an imbalance in the vaginal bacterial flora, it is important to follow a few simple tips. First of all, it is important to take care of intimate hygiene.

An intimate cleanser should be selected so as not to damage the acid-base balance (pH level) of the vagina. Also, excessive vaginal washing, vaginal cleansing, intimate hygiene sprays, and overly harsh or perfumed soaps should be avoided.

Additionally, when washing intimate places, it is recommended to perform a movement starting from the vulva to the anus, and not vice versa; thus, the spread of fecal bacteria from the anal area to the vagina is prevented. After completing intimate hygiene procedures, dry the area well and gently. Finally, another important tip - avoid wearing synthetic and too tight underwear.

Specialty: Cardiologist, Therapist, Doctor of Functional Diagnostics.