Bacterial vaginosis- symptoms and treatment
What is bacterial vaginosis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Yu.A. Chursina, a gynecologist with 6 years of experience.
Definition of disease. Causes of the disease
Bacterial vaginosis is an infectious non-inflammatory disease in which there is an abundant growth of certain microorganisms in the vagina and a sharp decrease in lactic acid bacteria, which have protective properties.
This pathology is one of the most common diseases of the female genital area. According to various estimates, it is found in approximately 70% of women of reproductive age.
Let's look at the name of the disease itself. The term "bacterial" emphasizes the significant increase in the number of aerobic and especially anaerobic bacteria obtaining energy from a minimal amount of oxygen. The meaning of the word “vaginosis” indicates that there are no signs of inflammation in this disease.
Previously, it was mistakenly called “gardnerellosis”, since it was believed that the cause of the pathology was bacteria Gardnerella vaginalis. However, it was found that these microorganisms are found not only in patients with symptoms of the disease, but also in 40% of women who have no complaints. Therefore, the diagnosis of “Gardnerellosis” is incorrect and incorrect: it does not reflect either the etiology or pathogenesis of the disease, and in some cases leads to a false positive diagnosis and the prescription of unreasonable treatment.
The causes of bacterial vaginosis are very diverse. These include both banal violations of intimate hygiene and more complex situations.
Factors contributing to the onset of the disease include:
- trauma during childbirth;
- various operations on the perineum;
- surgical abortion;
- menstrual irregularities;
- irrational use of antibiotics and even local antiseptics.
If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of bacterial vaginosis
The main symptom of bacterial vaginosis is profuse, liquid, homogeneous discharge from the genital tract with an unpleasant odor. They can be gray or white.
The smell of discharge is often compared to the smell of fish. It is felt especially strongly when the vaginal environment is alkalized - after sexual intercourse and during menstruation.
Approximately 50% of women, i.e. every second, have no complaints about vaginal discharge, so the disease can be asymptomatic.
Sometimes with bacterial vaginosis, patients are bothered by discomfort, itching or burning in the vagina and rectum, urination problems and pain during or after sexual intercourse.
A burning sensation and itching are also characteristic of vaginitis - an inflammatory process in the vagina. It is distinguished from bacterial vaginosis by a feeling of vaginal dryness, as well as redness and swelling of its lining.
Pathogenesis of bacterial vaginosis
Bacterial vaginosis does not have one specific pathogen - it can be caused by various microorganisms. The most common include not only those mentioned G.vaginalis, but also fusobacteria, peptostreptococci, veillonella, vaginal atopobium, as well as bacteria Peptoniphilus, Prevotella, P. bivia And M. Mulieris. Most often, the development of the disease is provoked by a combination of 2-3 microorganisms or more.
In the presence of risk factors, these pathogens begin to actively multiply during their life activity, alkalizing the vaginal environment (normally, the pH of vaginal discharge is 3.5-4.5). Only lactobacilli that produce lactic acid can prevent the growth of pathogenic bacteria, but due to an increase in the pH of the environment, their number decreases.
According to modern concepts, the bacteria that cause bacterial vaginosis are capable of creating biofilms that attach to the vaginal epithelium. Inside these films, microorganisms become less vulnerable to influence, including drugs. It is the formation of biofilms that causes frequent recurrence and unsuccessful treatment of the disease.
Bacterial vaginosis is not a sexually transmitted disease, as it also occurs in girls who have never had intimate relationships. Although it is difficult to unequivocally state that there is no connection between the disease and its sexual transmission: numerous studies confirm that changing sexual partners, having multiple sexual partners, as well as unconventional sex significantly increase the number of relapses of bacterial vaginosis.
Classification and stages of development of bacterial vaginosis
At the moment, there is no classification or division into the stages of the disease. There is also no code in ICD-10 (International Classification of Diseases) that would correspond to the diagnosis of Bacterial Vaginosis. Other codes are used to encode this state. Most often it is classified as “N86. Other inflammatory diseases of the vagina,” which is incorrect and not always correct.
Previously, the classification proposed by E.F. was used. Kira in 1995. According to it, four types of vaginal microbiocenosis were identified - a collection of microorganisms living in the vagina:
- Normocenosis - predominance of lactobacilli. is a sign of normal vaginal microflora.
- Intermediate type - moderate or reduced number of lactobacilli, the presence of gram-positive cocci and gram-negative rods. Often observed in healthy women, it can rarely be accompanied by complaints of discharge from the genital tract.
- Dysbiosis is the almost complete absence of lactobacilli, abundant polymorphic gram-negative and gram-positive rod and coccal microflora. This condition has been associated with bacterial vaginosis.
- Vaginitis - an increase in the number of leukocytes in smears. This condition has been associated with nonspecific vaginitis.
Today, such a classification is not used due to the significant expansion of knowledge about vaginal microbiocenosis and the emergence of modern laboratory diagnostic methods.
Complications of bacterial vaginosis
Unpleasant discharge from the genital tract significantly reduces a woman’s quality of life and her self-esteem, causes disorder of sexual behavior and can even lead to.
In general, bacterial vaginosis can cause a number of quite serious complications. Scientists have proven the impact of the disease on the course of pregnancy: it doubles the risk of premature birth, especially if it is detected at the beginning of the second trimester. Complications can also arise after the birth of a child: postpartum endometritis, wound infection after Caesarean section. Some researchers suggest that toxins from vaginosis pathogens can affect the fetus by penetrating the placenta, which may later become one of the causes of the child.
Relatively recently, a connection between bacterial vaginosis and: in patients with this non-inflammatory vaginal disease, the risk of infection with the human papillomavirus is higher than in healthy women. This also suggests an increased risk of cervical neoplasia.
In addition, the possible relationship between bacterial vaginosis and an increased risk of infection and other sexually transmitted diseases is currently being actively debated (,). In particular, one study noted that an HIV-infected woman with bacterial vaginosis was more likely to transmit HIV to a sexual partner than an HIV-infected woman without vaginosis.
Diagnosis of bacterial vaginosis
Diagnosis of bacterial vaginosis usually does not present significant difficulties. However, when making a diagnosis, you can often encounter errors: both overdiagnosis (when a patient is attributed a disease that she actually does not have) and underdiagnosis.
Most often, the disease can be correctly identified when a woman first consults a doctor. In such cases, the diagnosis is made on the basis of characteristic complaints, examination data and pH-metry of vaginal discharge. Sometimes a fairly extensive clinical and laboratory examination may be required.
In the diagnosis of bacterial vaginosis, R. Amsel criteria are used. These include:
- the presence of homogeneous whitish-gray discharge from the genital tract (during examination, one can note its uniform distribution along the walls of the vagina);
- increased pH in the vagina - more than 4.5;
- positive test with 10% potassium hydroxide solution - determination of volatile amines;
- detection of “key cells” in native smears and/or Gram smears, i.e. vaginal epithelial cells with gram-variable microorganisms tightly attached to their surface. Leukocytes in these smears are not detected or are contained within normal limits, which indicates the absence of inflammation, and lactobacilli are reduced to the point of complete absence.
The diagnosis of Bacterial Vaginosis is established when at least three signs are present.
There is also a semi-quantitative assessment of Gram-stained smears of vaginal fluid on a scale from 0 to 10. Nowadays this method is practically not used.
For laboratory diagnosis of bacterial vaginosis, the PCR Real Time method is used as part of a comprehensive analysis of the vaginal microflora. There are a number of test systems, the most common of which are Femoflor 16+KVM and Femoflor screen. These test systems allow you to get a fairly complete picture of the characteristics of the microbiocenosis of a woman’s vagina and prescribe reasonable treatment.
Clinical diagnostic methods include various rapid tests: Fem-exam, BVBlue, Pip-activity TestCard. However, all of these diagnostics are not widely used in clinical practice. This is mainly due to their lack of sensitivity.
In addition, it must be remembered that any woman who is sexually active and consults a doctor with complaints about discharge from the genital tract must be examined for the causative agents of trichomoniasis and gonorrhea, due to the widespread occurrence of these infections and the high incidence of complications.
Treatment of bacterial vaginosis
In no case should you self-medicate - it must be prescribed by a doctor, otherwise it may negatively affect the woman’s health.
Treatment of bacterial vaginosis is carried out in the presence of clinical and laboratory signs. Pregnant women deserve special attention. Discussions about the advisability of their treatment have already been closed: it is necessarily indicated for all pregnant patients, including those with a low risk of preterm birth (cases where there has been no preterm birth in the past). Treatment of pregnant women with asymptomatic bacterial vaginosis and a high risk of premature birth (if children have been born prematurely before) can significantly reduce the risk of early termination of pregnancy.
To eliminate bacterial vaginosis, antiseptics and various combination drugs are used. Currently, the effectiveness of a two-stage treatment regimen has been proven: the first stage involves the use of antiseptics, and the second involves restoring the vaginal microflora.
There are quite a lot of both foreign and Russian recommendations and treatment regimens for this disease. In accordance with the Eurasian clinical guidelines for the rational use of antimicrobial agents in outpatient practice, the following drugs should be used to eliminate bacterial vaginosis:
First line therapy:
- cream "Clindamycin" 2%;
- gel "Metronidazole" 0.75%;
- "Metronidazole" 0.5 g (for oral administration);
- "Ornidazole" 0.5 g (for oral administration).
Second line therapy:
- suppositories "Clindamycin" 0.1 g;
- "Clindamycin" 0.3 g (for oral administration);
- "Metronidazole" 2.0 g (for oral administration).
The duration and frequency of taking these medications is determined by the doctor individually. In addition, there are a significant number of combination drugs.
To restore vaginal microflora, vaginal capsules with live lactobacilli, ascorbic acid for vaginal use and gel with lactic acid can be used.
A promising method of treating bacterial vaginosis at the moment is the treatment of the vagina with ultrasound-cavitated antiseptic solutions. This method is being actively studied and great hopes are placed on it in the treatment of not only bacterial vaginosis, but also various inflammatory diseases of the skin and mucous membranes.
Forecast. Prevention
The prognosis for timely treatment is favorable in most cases. Sometimes relapses of the disease are possible. When they occur, a comprehensive approach to the patient is required, a complete clinical and laboratory examination and exclusion of concomitant diseases that may increase the risk of recurrence of bacterial vaginosis. You also need to consult on nutrition and lifestyle issues.
To prevent the occurrence of bacterial vaginosis, it is first necessary to exclude risk factors such as:
- violation of the integrity and anatomy of a woman’s external genitalia (can occur due to injuries during childbirth, various surgical interventions);
- alkalization of the vaginal environment (possible with the use of certain lubricants, shower gels, douching);
- surgical abortions, some gynecological operations, accompanied by the removal of the mucus plug from the cervical canal;
- menstrual irregularities, hypoestrogenic state in the period before menopause;
- irrational use of antimicrobial agents and antiseptics.
A significant contribution to the development and relapse of the disease is made by frequent changes of sexual partners, severe concomitant diseases, alcohol abuse, and smoking. All this should be avoided.
An important role in prevention is played by a healthy lifestyle, adequate physical activity and adherence to proper nutrition - a vegetarian diet and increased consumption of “fast” carbohydrates increase the risk of relapse.
To prevent bacterial vaginosis, you need to follow the recommendations for intimate hygiene:
- Wash yourself at least twice a day. To wash the genitals, use only warm water or special compositions for intimate hygiene that contain substances that do not disturb the acidity of the vaginal environment.
- You should wash only with cleanly washed hands, do not use washcloths. When washing, the water stream should be directed from front to back.
- After washing, you need to blot the moisture with a towel for intimate hygiene. It should be soft, clean and strictly individual. They cannot be used on hands, face or other parts of the body.
- During menstruation, it is not recommended to take a bath or swim in a pool or pond. It is preferable to shower in the morning and evening. It is better to avoid sexual intercourse, especially in the first days of menstruation.
- During menstruation, sanitary pads must be changed at least four to five times a day, tampons - every two hours.
- It is advisable to use daily sanitary pads not regularly.
- Do not use vaginal douching for regular hygiene. They are only possible if they are prescribed by a doctor.
- Give preference to underwear made from natural fabrics with a wide gusset. It should be changed daily, in some cases twice a day. Underwear should be washed separately from other clothes, towels and bed linen.
Bacterial vaginosis is one of the most common vaginal diseases and a common cause of unpleasant odor, vaginal discharge and itching in the intimate area.
Symptoms of bacterial vaginosis
Bacterial vaginosis often causes the following symptoms:
- Unpleasant “fishy” odor from the vagina. The smell may be constant or appear during or after sex.
- , sometimes resembling mucus. Discharge can be heavy or moderate.
- Irritation, itching, discomfort, redness of the skin in intimate areas.
- Pain and cutting during urination.
- Dryness and...
You are more likely to have bacterial vaginosis if:
- Have you recently taken antibiotics?
- You recently changed your sexual partner
- You have had two or more sexual partners in the past few weeks
- You have
- Have you recently used a jacuzzi or taken a bath?
- Have you recently douched?
- You don't comply
All of the above factors are not the direct cause of inflammation, but they disrupt the vaginal microflora and predispose to the development of bacterial vaginosis.
When does a smear indicate bacterial vaginosis?
Most women find out that they have bacterial vaginosis precisely by the result. If a woman has bacterial vaginosis, the following changes are detected in the smear:
- many key cells
- many cocco-bacillary forms (bacteria that look like rods and cocci)
- abundant coccal flora
- leukocytes are elevated or within normal limits
- presence of mobiluncus
- The pH of the discharge is above 4.5
Bacterial vaginosis is often combined with other infections, so the smear may contain changes characteristic of other diseases, for example, candidiasis (),.
Gardnerella and bacterial vaginosis
Sometimes bacterial vaginosis is mistakenly called gardnerellosis, since most often it is the bacterium Gardnerella vaginalis that causes inflammation in this disease.
However, gardnerella is often found in the vagina in healthy women who do not have inflammation. That is why, if you have been diagnosed with gardnerella, but there are no signs of inflammation (there are no symptoms of inflammation and the smear result is normal), then there is no question of any bacterial vaginosis, and you are fine.
Why is bacterial vaginosis dangerous?
The bacteria that cause inflammation in bacterial vaginosis are very sensitive to standard antibiotic treatment, and the disease is easily treatable. But if bacterial vaginosis is not treated, it can cause complications:
- - inflammation of the uterus.
- Salpingitis is inflammation of the fallopian tubes.
- Adnexitis is inflammation of the uterine appendages (fallopian tubes and ovaries).
- Infertility.
Bacterial vaginosis during pregnancy can lead to premature birth.
How to treat bacterial vaginosis?
If bacterial vaginosis appears for the first time:
- Metronidazole 500 mg (Trichosept): one tablet 2 times a day for a week, or
- Vaginal gel Metronidazole 0.75% (Rozex): insert one applicator into the vagina before bed for 5 days, or
- Clindamycin vaginal cream 2% (Clindacin): insert one applicator into the vagina before bed for 7 days.
If bacterial vaginosis does not go away with the prescribed treatment, the gynecologist will prescribe an alternative treatment:
- Tinidazole: 2g per day for 2 days, or 1g per day for 5 days, or
- Clindamycin 300 mg: one tablet 2 times a day for a week.
Probiotics in the treatment of bacterial vaginosis
Probiotics are preparations that contain the same beneficial bacteria, which make up the normal microflora of the vagina and help protect against infections.
The following probiotics are used for bacterial vaginosis:
- Gynoflor: vaginal tablets
- Vagilak: tablets for oral administration
The regimen for taking probiotics for bacterial vaginosis is as follows:
- 7 days of daily use
- 7 days break
- 7 days of re-appointment
This regimen of taking probiotics will avoid the return of infection several months after the end of antibacterial treatment. According to the manufacturers, taking these drugs is not prohibited during pregnancy and breastfeeding.
Treatment of bacterial vaginosis during pregnancy
Bacterial vaginosis during pregnancy can cause it, so treatment is necessary. It is recommended to take medications prescribed to pregnant women from the second trimester of pregnancy (not earlier than 13 weeks):
- Metronidazole 500 mg: one tablet 2 times a day for 7 days
- Metronidazole 250 mg: one tablet 3 times a day for 7 days
- Clindamycin 300 mg: one tablet 2 times a day for a week
Local treatment (vaginal ointments or creams) helps eliminate the symptoms of bacterial vaginosis, but does not reduce the risk of complications of the disease during pregnancy (premature birth).
Attention: These treatment regimens are indicative and may be changed by your doctor. Before using medications, be sure to consult your gynecologist!
Does my husband (sexual partner) need treatment?
It is known that in 80% of men whose sexual partners suffer from bacterial vaginosis, the main causative agent of this disease is found in the urethra Gardnerella vaginalis and other bacteria. This means that the bacteria "move" from the vagina into the man's urethra during unprotected sex.
And, nevertheless, men should be treated No need. Numerous studies have shown that treatment of sexual partners does not affect the recovery of women and does not reduce the chances of relapse.
Treatment for your partner necessary if this is not the first time you have developed bacterial vaginosis, or if you have been diagnosed with sexually transmitted diseases.
Bacterial vaginosis (or gardnerellosis) is a common disease of women, especially young women of reproductive age. The disease develops against the background of an imbalance of bacteria in the vagina.
The vagina of a healthy woman is a balanced environment where more than 1000 types of microorganisms coexist, each of which has its own role; they form normal vaginal microflora. A special role in it is played by lactobacilli, or lactobacilli (Lactobacillus spp.), as well as bifidobacteria and propionic acid bacteria.
Lactobacilli (normally almost 90%) - lactic acid bacteria, perform a primary task - they produce hydrogen peroxide, creating an acidic environment in the vagina (pH 3.8 - 4.5). It is this environment that restrains and balances the aggressive activity of other (anaerobic) representatives living in the vagina.
The “trigger mechanism” of bacterial vaginosis is always a decrease in the number of beneficial lactobacilli in the vaginal environment (or their complete disappearance), which reduces the concentration of lactic acid in the vagina. Opportunistic (not dangerous under normal conditions) anaerobic microorganisms are activated, primarily Gardnerella vaginalis, which occupy the vacated niche. Their number increases 5-6 times. Gardnerellas inhabit the vagina in the form of colonies, and the volatile compounds they produce - amines - have a characteristic odor (rotten fish).
Symptoms of bacterial vaginosis in women
Bacterial vaginosis has 2 variants of the course: with characteristic symptoms of the disease and without symptoms. Women pay attention to copious, sometimes foaming, vaginal discharge that smells like rotten fish. The smell may intensify before and after menstruation, during sexual intercourse.
During the course of the disease, the viscosity and color of the discharge may change. So, at the beginning of Garnerellosis, the symptoms are reduced to the appearance of leucorrhoea with a thin-mucous consistency; with a prolonged course, they become thick and viscous. The color of the discharge may turn yellowish-green. As a rule, the process drags on for 2-3 years.
Often the only sign of gardnerellosis in women is the appearance of gray-whitish discharge (leucorrhoea) from the genital tract. The smell of leucorrhoea, similar to the smell of rotten fish, also attracts attention. But quite often, bacterial vaginosis does not appear at all. In approximately 45% of cases, bacterial vaginosis occurs in women asymptomatically, and this complicates the diagnostic process.
Other symptoms may be added to the discharge: pain and discomfort in the genital area that occurs during sexual intercourse - dyspareunia, itching and burning in the external genital area.
With such symptoms, it is easy to suspect bacterial vaginosis. However, in approximately half of patients the disease is asymptomatic: positive laboratory signs of bacterial vaginosis and the absence of clinical symptoms. In this case, the idea of possible bacterial vaginosis is suggested by frequent and severe inflammatory diseases and regularly occurring relapses after treatment.
Why are the symptoms of gardnerellosis in men often erased?
The “strong half” receives the bacterium Gardnerella vaginalis, the causative agent of gardnerellosis, from an infected woman during sexual intercourse. But, unlike women, gardnerellosis in men is more often observed in the carrier format. This is explained by the characteristics of the urogenital tract, into the lower sections of which gardnerella enters and remains. During this period, without knowing it (since there are no symptoms), the man is dangerous for his partners, since he infects them through sexual contact.
If, against the background of Gardnerella vaginalis, inflammation develops in a man’s genitourinary system, the symptoms become brighter: urethritis (painful urination, pain and burning in the urethra), and then inflammation of the glans penis (swelling, pain, discharge with an unpleasant odor). Symptoms of gardnerellosis in a man in the form of nonspecific inflammation help the doctor quickly make a diagnosis and prescribe treatment.
– gynecological infectious non-inflammatory disease. The disease usually occurs as a result of sexual intercourse. According to statistics, vaginosis affects 20% of women of reproductive age. The disease is characterized by changes vaginal environment and flora, production decreases lactic acid and the pH of the vaginal environment decreases. Thus, the resulting neutral environment does not interfere with the development of various microbes, including trichomonas .
The vaginal microflora can be represented as mobile ecosystem. In normal condition, the vagina contains lactobacilli , which play a protective function. Lactobacilli processing glycogen (in women of reproductive age, vaginal epithelial cells contain large quantities of glycogen) into lactic acid, thereby reducing the acidity of the vagina. In addition, lactobacilli are capable of forming. Hydrogen peroxide and the acidic environment of the vagina suppress the proliferation of opportunistic bacteria ( streptococci , staphylococci , anaerobic bacteria , coli , Mobiluncus spp. , Gardnerella vaginalis .). Which are found in small quantities in the vaginal microflora of the vast majority of women.
If the proportion of lactobacilli in the body decreases, then instead of them they occupy opportunistic bacteria(Gardnerella vaginalis primarily). The latter contribute to the release of volatile amines, which have an odor comparable to the smell of rotten fish.
Bacterial vaginosis is not sexually transmitted because it is not venereal disease. The bacteria that cause bacterial vaginosis (primarily Gardnerella vaginalis) can be transmitted through sexual contact. But their transmission from woman to woman cannot be the main cause of the disease. Since in small quantities these microbes are part of the vaginal microflora of the vast majority of women.
Unprotected sex, however, may play a role in the development of bacterial vaginosis. The whole point here is not about infectious infection, but about the fact that sperm of sexual partner or several sexual partners cause changes in the vaginal microflora.
The main cause of the disease is not simply the presence of bacteria that cause bacterial vaginosis (they are present in almost every woman in small quantities), but a change in the proportions of opportunistic microbes (which cause bacterial vaginosis) and lactobacilli. The proportion of lactobacilli in bacterial vaginosis decreases, and the proportion of pathogens increases. Therefore, bacterial vaginosis in medicine is called vaginal dysbiosis.
The occurrence of bacterial vaginosis can be caused by both internal influences of the body and external influences, the so-called exogenous And endogenous factors . These may be changes in hormonal levels, decreased immune defense, disturbances in intestinal function, in particular microbiocenosis . The disease can also be caused by reasons such as the use of immunosuppressants, as well as previous inflammatory diseases of the genitourinary system.
The bacteria that cause bacterial vaginosis are not dangerous for men. Men who have been diagnosed with Gardnerella vaginalis, as well as sexual partners of women with bacterial vaginosis, do not need treatment.
Symptoms of bacterial vaginosis
Bacterial vaginosis has no specific symptoms. The disease is characterized by some clinical manifestations, these are abundant creamy discharge from the vagina. They are uniform, grayish-white in color, and often stick to the walls of the vagina. Due to the breakdown of amines produced by bacteria, vaginal discharge often has an unpleasant, so-called “fishy” odor. The discharge causes symptoms of bacterial vaginosis such as burning and itching in the vagina. Often this becomes the cause of inflammatory diseases of the female genital organs, sometimes unpleasant and painful sensations during sexual intercourse.
There are several types of vaginitis, each of them has its own symptoms:
- Aerobic vaginitis– appears as a result of contact with the mucous membrane of aerobic microflora, during a one-time decrease in the normal lactoflora of the vagina.
- Trichomonas vaginitis– is one of the most common types of vaginitis.
- Candidal vaginitis– an inflammatory fungus, the main causative agents of which are yeast-like fungi Candida .
- Allergic vaginitis- is one of the types of genital diseases, which is caused by the use of drugs to prevent unwanted pregnancy or treat diseases of the genital organs.
- Desquamative inflammatory vaginitis- one of the types of nonspecific vaginitis.
Diagnosis of bacterial vaginosis
Diagnosis of the disease is carried out in several stages. First of all, a laboratory examination of smears is carried out for the presence of key cells. When a smear is stained with methylene blue, one can detect flat epithelial cells to which gardnerella , which is why the cells take on a peppered appearance. In addition, laboratory analysis of smears includes amine test. During examination, vaginal discharge is diluted with a 5-10% solution potassium hydroxide . The resulting smell, fishy or, more precisely, an amine smell, indicates the presence of a disease.
Diagnosis of bacterial vaginosis also includes determining the pH level of the vaginal microflora. To do this, directly during an examination on a gynecological chair, the doctor inserts pH paper into the secretion of the vaginal vault using tweezers. The presence of the disease is determined at pH 4.5.
The presence of all these signs, as well as the symptoms of bacterial vaginosis, accurately confirm the diagnosis. The disease can also be diagnosed by isolating a pure culture of bacteria, but such diagnostics is ineffective. This is due to the fact that more than 58% of healthy women have high levels of germs Gardnerella vaginalis in vaginal secretions.
Treatment of bacterial vaginosis
The disease requires conservative treatment. Antibiotics are prescribed, such as,. They are produced in preparations for oral and vaginal use. This , metrogel
, cleocin
, Tindamax
. Vaginal medications are more effective and are often included in the treatment of bacterial vaginosis. They cause fewer side effects, but the risk remains.
The best treatment for bacterial vaginosis is metronidazole (for example,) take 500 mg orally for 7 days, 2 times a day. Sometimes the drug is difficult to tolerate (may cause nausea). Completely incompatible with alcohol. But systemic treatment can reduce the likelihood of complications caused by bacterial vaginosis.
Reserve drugs:
Clindamycin ( , climycin ) for 7 days, 2 times a day, 300 mg orally. Clindamycin inhibits the growth of more than just bacteria Gardnerella vaginalis, but also lactobacilli ( Lactobacillus spp.). Clindamycin is prescribed in case of intolerance to metronidazole by patients.
Clindamycin cream , with a concentration of 2% ( dalacin ) is inserted into the vagina using the supplied applicator for 5 days, 1 time per day (at night). Of course, local treatment is much better tolerated, but less effective systemic treatment reduces the risk of complications of bacterial vaginosis.
Gel Metronidazole , 0,75% ( , flagyl ) is inserted into the vagina using the supplied applicator for 5 days, 2 times a day. As with the previous drug, local treatment is much better tolerated, but less effective systemic treatment reduces the risk of complications of bacterial vaginosis.
There is another treatment for bacterial vaginosis, its system consists of two stages. First, it is necessary to suppress reproduction pathogens . For these purposes, irrigation with solutions of boric and lactic acids is used, but there are also more modern medical preparations. Namely, the drug - an antiseptic medicine with a wide spectrum of effects - is used intravaginally once (one tablet) for 6 days.
It is worth noting that this drug can be used during pregnancy to sanitize the birth canal. It is performed according to the same scheme, the beginning of therapeutic treatment is 6-7 days before the PDR.
At the second stage, restoration is carried out vaginal biocenosis. For these purposes they are used locally eubiotics , medicinal products containing strains of lacto- and bifidobacteria.
Complications of bacterial vaginosis: unpleasant odor of discharge, discomfort, itching; development (after cesarean section, post-abortion, postpartum); risks of premature birth and late pregnancy.
