Bacterial vaginosis is an imbalance of the vaginal microflora. The disease occurs frequently among women of fertile age. The vaginal microflora is a fairly mobile biological system in which the ratio of microorganisms is constantly changing, depending on environmental conditions, as well as on the general condition of the body.
So, normally, in a woman of childbearing age, lactobacilli predominate on the vaginal mucosa. These microorganisms are able to break down glycogen, which is found in the epithelial cells of the vagina, resulting in the formation of lactic acid and hydrogen peroxide.
Lactic acid changes the acid-base balance to the acidic side. An acidic environment together with hydrogen peroxide has a detrimental effect on the growth of harmful flora. As for lactobacilli, these conditions are ideal for their life. Uniting in entire columns, they form a protective layer (glycocalyx) and line the vaginal mucosa, thereby protecting it.
When exposed to unfavorable factors, some of the lactobacilli die, the vaginal environment changes to the alkaline side, which stimulates the growth of various opportunistic microbes, mainly gardnerella ( Gardnerella vaginalis).
Gardnerella begins to multiply rapidly, which provokes the growth of other pathogenic flora (staphylococci, neisseria, enterococci, ureaplasma, candida fungi and many others), as a result the number of lactobacilli sharply decreases.
Bacterial vaginosis itself does not cause inflammation, although it reduces local immunity, which increases susceptibility to infections, and the rapid proliferation of pathogenic and opportunistic microorganisms can cause inflammatory processes, disrupting a woman’s reproductive function.
The disease is not sexually transmitted and is not transmitted through sexual contact. In principle, men cannot have bacterial vaginosis, since the word “vaginosis” means vaginal localization of the process.
Bacterial vaginosis often occurs during pregnancy. This is due to hormonal changes, namely, under the influence of estrogens, the level of glycogen on the vaginal mucosa increases, which means the number of lactobacilli increases, and the pH of the environment becomes even lower. Everything seems to be fine, but it turns out that such an environment is favorable for the proliferation of some transient microorganisms (ureaplasma parvum, mycoplasma hominis). This is the insidiousness of bacterial vaginosis during pregnancy. These seemingly harmless opportunistic microorganisms can cause inflammation and then disruption of the integrity of the amniotic sac, which can lead to premature birth.
The main cause of bacterial vaginosis is considered to be a violation of the ratio of beneficial and harmful microorganisms, namely the quantitative decrease or absence of lactobacilli under the influence of unfavorable factors of the external or internal environment.
Hormonal changes, disorders of the immune system, intestinal dysbiosis, uncontrolled use of antibiotics, systemic diseases and metabolic disorders, infectious diseases - all this stimulates the body “from the inside” and causes dysbiotic phenomena in the vagina.
Irrational douching, replacement of a sexual partner, use of contraceptives containing the spermicide 9-nonoxynol; Neglect of barrier protection and personal hygiene rules negatively affect the vaginal flora “outside”.
Symptoms of bacterial vaginosis
Often the disease occurs without any symptoms, due to the absence of signs of inflammation. In most cases, women note an increase in the amount of vaginal discharge as a sign. The discharge has a grayish-yellow color, a viscous consistency and a specific odor, reminiscent of the smell of spoiled fish. This odor is due to volatile amines released by gardnerella.
Bacterial vaginosis can last for years. In this case, we are already talking about a chronic process. Over time, the number of lactobacilli becomes less and less and the opportunistic flora ascends higher and higher, affecting the cervix, uterus, and appendages.
Chronic bacterial vaginosis can be accompanied by itching, burning of the genitals, discomfort when emptying the bladder and during sexual intercourse.
Almost every woman experiences bacterial vaginosis at least once in her life, but with normal functioning of the immune system, the body itself regulates the ratio of microflora and the disease goes away on its own, without any medical intervention.
Diagnosis of the disease
Diagnosis of bacterial vaginosis, like any other disease, begins with a survey and examination. The doctor will be interested in the gynecological history, the presence of concomitant pathologies, and the nature of the woman’s complaints. During a gynecological examination, there are no signs of inflammation of the vaginal mucosa, and evenly distributed, abundant, viscous, foamy discharge with a fishy odor is detected on its walls.
With bacterial vaginosis, the pH of the vaginal environment increases, and normally this indicator fluctuates in the range of 3.8-4.5. Therefore, exceeding the pH value of 4.5 speaks in favor of the disease.
A positive amine test also speaks in favor of gardnerellosis. For the study, take a small amount of vaginal discharge and add a few drops of a 10% potassium hydroxide solution to it on a glass slide; if an increase in the specific fishy odor is observed, the test is considered positive.
Bacterial vaginosis can be suspected by microscopic examination of a general vaginal smear. A quantitative decrease in lactobacilli, the presence of “key” cells, a large amount of coccal flora - all this indicates the presence of vaginal dysbiosis.
PCR diagnosis of gardnarella (an accurate method in which even single microorganisms are detected) does not make any sense for this disease. The fact is that gardnarella is an opportunistic microorganism and is always present in small quantities in the vaginal microflora. It is important to identify not its presence, but its quantity.
Bacterial vaginosis must be differentiated from sexually transmitted diseases (chlamydia, trichomoniasis, gonorrhea), as well as thrush.
“How to treat bacterial vaginosis” is a question many representatives of the fair sex ask. The answer is simple - treatment is carried out in two stages:
- Antimicrobial and antibacterial therapy;
- Restoring vaginal microflora, increasing local immunity.
Gardnarella can be treated with antimicrobial drugs (Metronidazole, Trichopolum, Tinidazole). Metronidazole tablets are prescribed for 7 days, take 0.5 g 2 times a day in the morning and evening. The drug has side effects such as nausea, vomiting, and abdominal pain, which makes it poorly tolerated by women. In this case, Clindamycin tablets are prescribed 0.3 twice a day, but this drug also has a drawback: it inhibits the growth of lactobacilli.
If taking systemic antimicrobial drugs is contraindicated or undesirable for some reason, then use local agents that have antimicrobial properties:
- 0.75% Metronidazole. The packaging of the drug contains special applicators with which the gel is inserted into the vagina in the morning and evening for five days;
- 2% vaginal cream Clindamycin. The cream is also applied using the included applicator once a night. The course of treatment is five days.
Local treatment is usually less effective than systemic therapy, but is easily tolerated and does not cause harm to the digestive system.
If there is itching, antihistamines (Suprastin, Diazolin) help well.
Sometimes, against the background of antimicrobial treatment, thrush develops. In this case, antimycotic drugs are prescribed; Zalanin and Pimafucin suppositories have proven themselves to be effective.
After successful antimicrobial treatment, it is necessary to populate the vaginal mucosa with beneficial bifidobacteria and lactobacilli. For this purpose, vaginal suppositories (Acylact, Bifidumbacterin, Vagilak) and eubiotics in bottles (Lactobacterin, Simbiter), which are powdered, are used; before insertion into the vagina, according to the instructions, they must be diluted in boiled water.
Prevention
Because bacterial vaginosis develops against the background of dysbiotic phenomena, preventive measures should be aimed at maintaining the homeostasis of the vaginal ecoculture and eliminating predisposing factors, namely:
- It is important to keep the genitals clean, especially on menstrual days, when local immunity is significantly reduced. Tampons and pads these days must be changed every two to three hours, sexual intercourse should be avoided, and baths should not be taken. When choosing underwear, you should give preference to natural fabrics. Do not get carried away with douching - frequent irrational douching washes away beneficial bacteria.
- Respect for sexual culture. The use of barrier protection during sexual intercourse with unverified partners significantly reduces the likelihood of contracting sexually transmitted infections.
- Rational use of antibiotics. Uncontrolled antibiotic therapy destroys both harmful and beneficial microorganisms.
- Sanitation of sexually transmitted infections. Sexually transmitted diseases can occur in a mild, asymptomatic form, disrupting the normal functioning of the reproductive system.
- Regular visits to the gynecologist (once every six months). Based on a general smear, bacterial vaginosis can be suspected, which means starting therapy in time and preventing chronicity of the process.
Bacterial vaginosis is a violation of the microecology of the vagina. This is the most common condition in women of childbearing age.
Predisposing factors leading to the development of bacterial vaginosis include the following:
- use of antibacterial drugs;
- long-term use of intrauterine contraceptives;
- use of tablet contraceptives;
- previous inflammatory diseases of the urogenital tract;
- hormonal imbalance accompanied by menstrual irregularities;
- change in the state of local immunity;
- exposure to low doses of ionizing radiation;
- stress effects on the body.
In 60% of women suffering from bacterial vaginosis, disturbances in the microecology of the colon are detected (intestinal dysbiosis).
Manifestations of bacterial vaginosis
The main symptom is complaints of discharge with an unpleasant odor, which is noted by only 50% of women. Discharge is often moderate, less often abundant, and in some cases it may be completely absent. Discharge from bacterial vaginosis is grayish-white in color, homogeneous, without lumps, and has a specific “fishy smell”, which can be constant, absent, or appear during menstruation and sexual intercourse.
The duration of these symptoms can be calculated in years. During a long-term process, the discharge acquires a yellowish-green color, becomes thicker, often resembles a cheesy mass, has the property of foaming, is slightly viscous and sticky, and is evenly distributed over the walls of the vagina.
Other complaints, mainly itching and urinary disorders, are rare: they may be completely absent or appear periodically. Often women with bacterial vaginosis complain of heavy menstrual bleeding, pain in the lower abdomen, and adnexitis.
At the same time, in some cases, some patients do not show any manifestations of the disease.
Irritation of the vulva and vagina is rare, which distinguishes bacterial vaginosis from candidiasis and trichomoniasis, which are usually accompanied by severe itching.
Diagnostics
A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After the examination, discharge is taken from the posterior inferior vaginal vault.
The diagnosis can be made if 3 of the 4 listed signs are present:
- specific nature of the discharge;
- acidity >4.5 (normal 3.8-4.5);
- positive amino test;
- presence of "key" cells. The so-called “key cells” are mature epithelial cells (the superficial layer of the vaginal epithelium), along the entire surface of which microbes are densely and in large numbers attached.
Completing one of the 4 tests is not sufficient to make a diagnosis.
Treatment of bacterial vaginosis
For bacterial vaginosis, local therapeutic measures are considered optimal. A good therapeutic effect is shown for drugs from the group of nitroimidazoles (metronidazole, trichopolum, metrogil, etc.), which are prescribed intravaginally in the form of tablets, tampons or suppositories.
There are various schemes for complex treatment of bacterial vaginosis, which consist in the use of nitroimidazoles prescribed in tablets and topical agents (1% hydrogen peroxide, antiseptic solution "tomicide", benzalkonium chloride compounds, etc.), which are used for vaginal irrigation.
When prescribing nitroimidazoles in tablet form, it is necessary to take into account the possibility of side effects such as gastrointestinal dysfunction, dizziness and headache.
In severe cases of bacterial vaginosis, the fundamental principle of treatment is the use of broad-spectrum antibiotics for the purpose of general sanitation of the vaginal mucosa (clindamycin, oleandomycin, cephalosporins).
When prescribing broad-spectrum antibacterial drugs, a large number of side effects may occur, including dysbiosis of other cavities (intestines, etc.).
The effectiveness of treatment for bacterial vaginosis is assessed by the disappearance of subjective manifestations, the dynamics of clinical symptoms of the disease, and the normalization of laboratory parameters. The first control clinical and laboratory examination should be carried out a week after completion of therapy, and a second one after 4-6 weeks.
During treatment and follow-up, the use of barrier methods of contraception (condoms) should be recommended.
Currently, one of the effective drugs for the treatment of bacterial vaginosis is dalacin vaginal cream, used once a day for 3 days. The course of treatment is 3 days. One full applicator corresponds to a single dose of the drug.
Among the most common complications when using the above drugs, vaginal candidiasis should be noted. To prevent it, it is necessary to prescribe antifungal drugs - nystatin 2000 mg per day orally, simultaneously with the start of treatment. The most effective drug for non-pregnant women is fluconazole. At the same time, for the treatment of vaginal candidiasis during pregnancy, drugs such as clotrimazole, pimafucin, gino-pevaril, dafnedzhin, etc. are widely used.
Another effective treatment for bacterial vaginosis is the antiseptic drug povidone-iodine (Betadine).
Forecast
With all of the above treatment methods, relapses may occur, occurring at various times after treatment. Apparently, this is due to the fact that antibiotic therapy, while eliminating pathogens, often does not create conditions for the rapid restoration of beneficial bacteria.
In this regard, in the complex of therapy within 10 days after the main course of treatment, it is necessary to include such biological products as acylact, bificol, bifidum- and lactobacterin, due to their specific action aimed at restoring the normal ratio of lactobacilli in the vagina, and thereby preventing the frequency of relapses of this diseases.
An imbalance in the vaginal microflora can cause the development of bacterial vaginosis, an infectious disease that causes women significant discomfort. We tell you what kind of disease this is, how it manifests itself, and how doctors advise to treat it.
WHAT IS BACTERIAL VAGINOSIS
Bacterial vaginosis(vaginal dysbiosis, gardnerellosis, nonspecific vaginitis) is the most common cause of vaginal infections in women of childbearing age. Although the disease often develops after sexual intercourse with a new partner, bacterial vaginosis is not.
“This is one of the types of bacterial vaginitis, when the balance between normal and opportunistic microflora is disrupted under the influence of a number of factors,” says obstetrician-gynecologist Elena Berezovskaya. – The occurrence of bacterial vaginosis depends on the woman’s age, her sexual activity, hormonal balance, immunological status, genital hygiene, and the presence of skin diseases.
STIs, the use of antibiotics, hormones, endocrine disorders, surgical termination of pregnancy, surgeries, penetrative diagnostic and therapeutic procedures, intrauterine contraception and even environmental problems can also lead to an imbalance in the vaginal flora. Under the influence of these factors, there is a sharp decrease in the number of lactobacilli, which, in turn, leads to a decrease in lactic acid content and a shift in pH to the alkaline side. At the same time, conditions are created for the accelerated reproduction of opportunistic microflora and gardnerella.
Since it is Gardnerella vaginalis that in most cases causes vaginal dysbiosis, many doctors call bacterial vaginosis gardnerellosis.
CAUSES OF BACTERIAL VAGINOSIS
Obstetrician-gynecologist Vyacheslav Ivannikov told us about the causes of bacterial vaginosis:
The vaginal microflora is a mobile ecosystem. Normally, it is based on lactobacilli, which play a protective function. Lactobacilli convert glycogen into lactic acid, reducing vaginal acidity. In addition, lactobacilli produce hydrogen peroxide.
Acid and hydrogen peroxide suppress the growth of opportunistic microbes (staphylococci, streptococci, E. coli, anaerobic bacteria, gardnerella, etc.), which are detected in small quantities in the vagina of the vast majority of women. If the proportion of lactobacilli decreases, their place in the ecosystem is taken by opportunistic microbes (primarily Gardnerella).
Any woman can develop bacterial vaginosis.
Thus, the cause of the disease is not simply the presence of pathogens of bacterial vaginosis (almost every woman has them in small quantities), but a change in the ratio of the proportion of lactobacilli and opportunistic microbes that cause bacterial vaginosis. With bacterial vaginosis, the proportion of lactobacilli decreases, and the proportion of bacterial vaginosis pathogens increases. This is why bacterial vaginosis is called vaginal dysbiosis.
Bacterial vaginosis can develop in any woman, although some factors disrupt the natural microflora and increase the risk of developing the disease:
- douching with water or medicinal solutions to cleanse the vagina;
- having a new sexual partner;
- having multiple sexual partners;
- using scented soap;
- smoking;
- use of intrauterine devices (IUDs) made of plastic and copper;
- use of vaginal deodorants;
- washing underwear using some detergents.
You can NOT get bacterial vaginosis from a swimming pool, toilets, bedding or other items.
SYMPTOMS OF BACTERIAL VAGINOSIS
About 50% of women with bacterial vaginosis have no symptoms. Moreover, sometimes bacterial vaginosis can appear and disappear for no apparent reason. Statistically, even if antibiotic treatment is effective in 90% of cases, 25% of women may develop bacterial vaginosis again within the next four weeks.
The main symptom of bacterial vaginosis is vaginal discharge: thin and watery, gray or white, odorless or with a strong unpleasant “fishy” odor.
Burning during urination can also indicate vaginal dysbiosis, but are much less common.
Typically, bacterial vaginosis is diagnosed during: the gynecologist, in addition to the patient’s complaints, will pay attention to the presence of white or gray discharge and an unpleasant odor. If the patient is sexually active, there is a chance that she may have an STI, and the doctor may order some additional tests.
HOW TO TREAT BACTERIAL VAGINOSIS
“The treatment of bacterial vaginosis is quite simple - it is the use of antimicrobial drugs containing metronidazole,” says Elena Berezovskaya. – In some cases, treatment must be cyclical. After antimicrobial treatment, it is advisable to restore normal vaginal microflora with lactobacilli preparations. It is important to remember that eliminating or reducing the influence of factors that provoke the growth of opportunistic flora is the key to successful treatment. Since vaginal dysbiosis is often associated with intestinal dysbiosis, correction of the intestinal bacterial flora helps reduce the number of relapses of the disease.
Treatment of male partners does not reduce the number of relapses of vaginal dysbiosis in women.
It is noteworthy that men generally do not require treatment for bacterial vaginosis: studies have shown that simultaneous treatment of partners does not reduce the number of relapses of vaginal dysbiosis in women. Treatment of bacterial vaginosis is especially important for women, since the disease increases the risk of premature birth. Women who have previously had preterm labor or low birth weight babies should see a gynecologist even if they do not have any symptoms.
ANTIBIOTICS AND PROBIOTICS FOR THE TREATMENT OF BACTERIAL VAGINOSIS
Bacterial vaginosis can be treated with antibiotics. When used correctly, they are 85% to 90% effective.
Metronidazole– the most common antibiotic for the treatment of bacterial vaginosis.
He is appointed:
- in the form of tablets taken orally 2 times a day for 7 days. This is the preferred treatment method if a woman is breastfeeding or expecting a baby;
- in the form of tablets that are taken orally once. Compared with a seven-day course of treatment, a single dose of metronidazole may lead to a relapse of bacterial vaginosis;
- in the form of a vaginal gel, which is applied once a day for 5 days;
- in the form of probiotics with metronidazole.
In a Cochrane systematic review, researchers reported that probiotics together with antibiotics increase the effectiveness of treating vaginal dysbiosis. Important: metronidazole does not interact well with alcohol, so when taking this antibacterial drug, you should not drink alcohol for at least 48 hours after finishing treatment.
Clindamycin is an antibiotic that is often used to treat bacterial vaginosis if metronidazole does not work or the disease has returned.
He is appointed:
- in the form of a vaginal cream, which is applied once a day for 7 days;
- in the form of a capsule, which is taken orally 2 times a day for 7 days.
This method is rarely used nowadays due to the risk of developing pseudomembranous colitis.
Important: when treated with clindamycin, some barrier methods of contraception become less effective (latex condoms, diaphragms), so women are advised to use additional contraceptives (polyurethane condoms).
Tinidazole- another antibiotic that will help get rid of bacterial vaginosis if metronidazole is ineffective. It is taken orally 1 time. You should not drink alcohol while taking this medicine.
TREATMENT OF BACTERIAL VAGINOSIS WITH FOLK REMEDIES
On the Internet you can find a lot of advice on alternative treatment for bacterial vaginosis. Most often it is recommended to douche with infusions of chamomile, decoctions of oak bark, bird cherry, coltsfoot leaves and juniper fruits. There are also recipes for baths made from herbal decoctions.
It is categorically not recommended to treat bacterial vaginosis on your own using unverified folk recipes: firstly, a woman may miss the accompanying inflammation, in which heating is contraindicated, and secondly, scientists have proven that douching increases the risk by 2 times and can contribute to the development of candidiasis () and some sexually transmitted infections.
Improper treatment of vaginal dysbiosis can lead to dangerous consequences. If you want to cure bacterial vaginosis without antibiotics, be sure to consult a gynecologist.
Improper treatment of vaginal dysbiosis can lead to dangerous consequences:
- make a woman more susceptible to HIV infection, chlamydia, gonorrhea and HPV;
- increase the risk of developing certain pregnancy complications: premature birth, miscarriage, chorioamnionitis and postpartum endometritis, pelvic inflammation and upper genital tract infection.
Source Zvezda - socio-political newspaper of the Khvalynsky district. Khvalynsk: http://hvzvezda.ru/zdorove/kak-lechit-bakterialnyi-vaginoz.html
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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Bacterial vaginosis is one of the most common obstetric and gynecological diseases. Recently, it occupies 30–50% of all vaginal pathologies and requires enormous attention from gynecologists. The incidence of bacterial vaginosis in non-pregnant women during puberty ranges from 4 to 61%. This wide range of incidence must be due to the lack of objective criteria used to diagnose bacterial vaginitis. The likelihood of occurrence in pregnant women is 14–20%. Bacterial vaginosis most often occurs in women under the age of 35–40 years.Pathogens
Many experts are of the opinion that bacterial vaginosis is nothing more than a violation of the vaginal ecosystem, which is provoked by the increased growth of pathogenic, often anaerobic bacteria. A very rapid decrease in vaginal acidity and the quantitative concentration of lactobacilli (inhabitants of the normal vaginal microflora) is carried out not by one pathogenic microorganism, which later becomes predominant, but by a combination of several microorganisms at once. For example, they may be: Gardnerella vaginalis, Bacteroides sp., Peptococcus sp., Mycoplasma hominis, Mobiluncus and other representatives. Bacterial vaginosis is a polymicrobial disease, so it is impossible to isolate any dominant pathogen from this group of microorganisms - any of them can be contained in small quantities in the vaginal contents of healthy women. Vaginal discharge normally contains from 105 to 107 microorganisms per 1 ml.What is bacterial vaginosis?
This is a disease that occurs as a result of the replacement of lactobacilli of the normal microflora of a woman’s vagina with opportunistic anaerobic microorganisms. This is a qualitative change in the composition of the vaginal flora under the influence of various factors. Bacterial vaginosis creates favorable conditions for the occurrence of various infectious processes in the vagina.How does the disease develop?
Lactobacilli dominate in the normal vaginal microflora. When the microecology of the vagina is disrupted, the number of predominant lactobacilli sharply decreases, and the rate of growth and development of opportunistic anaerobic bacteria increases. Previously, scientists claimed that the causative agent of bacterial vaginosis is Gardnerella vaginalis. But later it turned out that there are other causes of vaginosis and that gardnerella is part of the normal microflora of the vagina. Factors predisposing to the development of bacterial vaginosis include:
Long-term treatment with antibacterial drugs, including antibiotics
Past inflammatory diseases of the genital organs
Oral and intrauterine contraception
Frequent change of sexual partners
Hormonal disorders
Decreased immunity
Chronic intestinal diseases and other diseases that can cause dysbiosis
Poor nutrition – lack of fermented milk products in the diet
Excessive use of panty liners and tampons
Frequent wearing of tight-fitting, tight-fitting synthetic underwear and trousers.
If the balance of the vaginal microflora is disturbed, the pH of the vaginal contents changes from 4.5 to 7.0 - 7.5. As a result of the activity of pathogenic microorganisms, complex chemical compounds (volatile amines) are formed in the vagina, which contributes to the release of the unpleasant odor of “rotten fish”. These pathological mechanisms disrupt the normal functioning of natural biological barriers in the vagina and favor the development of various inflammatory diseases of the genital organs and postoperative infectious complications.
Clinical manifestations
- The main complaint is numerous homogeneous creamy grayish-white foamy vaginal discharge, slightly viscous. Discharge sticks to the walls of the vagina and is evenly distributed along its walls. The discharge is accompanied by an unpleasant smell of “rotten fish”
- Itching and burning in the vaginal area
- Dyspareunia – discomfort and pain during sexual intercourse
- Urinary dysfunction
How to diagnose bacterial vaginosis?
A diagnosis of bacterial vaginosis can be made if at least 3 of the following 4 signs are present:1. Homogeneous vaginal discharge
2. The pH of the vaginal discharge is above 4.5
3. positive amine test
4. the presence of “key cells” (desquamated vaginal epithelial cells densely covered with gram-variable rods) in smears of vaginal discharge, stained with Gram and examined under a microscope. Normally, “key cells” are not found in the vagina.
- The bacterioscopic method can also detect a small number of leukocytes in the field of view, a reduced number or complete absence of Dederlein rods
- Culture of vaginal microflora
- Antibioticogram - determination of pathogen sensitivity to antibiotics
- Polymerase chain reaction - to determine the genetic material of Gardnerella vaginalis
Complications of the disease
Frequent uterine bleeding Development of inflammatory diseases of the pelvis (reproductive system and genitourinary tract)
Infertility
Premature rupture of membranes during childbirth and their inflammation
Endometritis in the postpartum period
Stopped development of the newborn
How to treat bacterial vaginosis?
Treatment of bacterial vaginosis must be carried out under the strict supervision of the attending physician. All attempts at self-medication are excluded. There are two directions in the treatment of this disease:
The first direction is to destroy pathogenic and pathogenic microorganisms and restore the balance of normal vaginal microflora. For this, vaginal suppositories and gels are used, which contain antibiotics and antiseptics - Metronidazole, Ornidazole, Clindamycin. They use drugs such as Macmiror and Terzhinan in the form of vaginal suppositories or tablets.
The second direction involves the use of eubiotics - drugs containing lactobacilli (Lactobacterin, Bifidum-bacterin, Acylact). Use internally or locally - in the vagina. Yoghurts and biokefirs are recommended.
Vitamin therapy and biogenic stimulation - to increase the overall resistance of the body.
Immunotherapy and immunoprophylaxis - the Solko Trikhovak vaccine containing special strains of lactobacilli. As a result of the introduction of the vaccine, antibodies are formed that successfully destroy the causative agents of the disease, normalize the vaginal microflora and create immunity that prevents the development of relapses of bacterial vaginosis.
The main drugs used to treat bacterial vaginosis:
Metronidazole (Metrogyl, Trichopolum, Flagyl) helps stop the growth of harmful bacteria. This type of medicine is prescribed in doses of five hundred milligrams in the morning and evening. The course of treatment is seven days. When using these medications, side effects such as allergic reactions, digestive disorders, vomiting, nausea and others may become apparent.
Clindamycin is an antibiotic drug that tends to inhibit both the growth and reproduction of pathogenic bacteria. You can purchase this medication both in the form of capsules and in the form of vaginal cream or vaginal suppositories. As for vaginal cream, it should be inserted into the vagina using a special applicator once a day before going to bed. The course of therapy is six days.
Prevention
- Maintaining genital hygiene
- Proper and nutritious nutrition
- Timely treatment of inflammatory diseases of the genitourinary organs
- Elimination of abuse in antibiotic treatment
- Wearing comfortable underwear made from natural fabrics
Reviews
I “brought” bakvaginosis from the sea, not the first time, by the way, such nonsense. They prescribed treatment in two stages: first vaginal tablets, and then lactozhin capsules. Everything went away without consequences, otherwise it happened that later the thrush came out again. I’ll understand this thanks to dlactoginal, because... he restores the flora.
I have treated vaginosis several times, I know firsthand what kind of disgusting thing it is. At first they prescribed courses for ten days, but there were still relapses. The most successful treatment was the last time, only salvagin gel was prescribed, but there was no relapse after this prescription, although almost a year had passed
Vaginosis is, of course, terrible, especially when you don’t have time to be treated, and after a couple of months it appears again. Salvagin helped me get rid of it, it’s an intravaginal gel. Five tubes were enough to completely restore the flora, the immune system has strengthened quite well, apparently copes with bacteria and there are no more relapses.
I treated vaginosis with Metronidazole, it helped well, although it also requires a good probiotic, because it kills all microflora indiscriminately.
Please tell me I had a medical examination and found out that I had vaginosis. Are they allowed to work with such a diagnosis? Or only after treatment?
Hello! Please tell me! Can bacterial vaginosis contribute to the development of ovarian cysts?
Julia,
Vaginosis is NOT sexually transmitted! This is a natural disease (infection) of the vagina, or rather, vaginal dysbiosis. And yet, a man cannot suffer from vaginosis, vaginosis and the name from “vaga” - vagina, vagina. The man doesn't have it.
Pauline,
In my observations, the patients did not experience chest pain. Go to a mammologist or gynecologist about your breasts. A compaction may be present.
Hello! I am a specialist in gynecology. Write questions, I will answer. About vaginosis! My daughter (11 years old) has a whitish and transparent discharge, without gas bubbles, not foamy, no itching, no burning, urination, according to my observations, is normal. She put her finger in there and let me smell it. Stupid, of course... I didn’t smell anything! And she says either some kind of onion, or garlic, or she already stinks of iron. If anyone knows what this is, please tell me!! Even though I am a gynecologist myself, I still can’t figure it out completely. In my opinion, this is normocenosis.
Hello, I would like to know if there are chest pains and bloating in the lower abdomen with vaginosis? (Other symptoms of vaginosis are present)
It’s not true that microflora can be restored! I drank Lactofiltrum + Terzhinan vaginal suppositories. and everything will be fine! I advise...
Girls, most of you here advise you to definitely consult a doctor. They say that the doctor will definitely help to properly cure this very vaginosis. Doctors haven’t been able to cure him for three years now. Various antibiotics are prescribed, then probiotics. That's all. The same scheme with the difference only in the names of the drugs. In my case, Acylact, on the contrary, provokes thrush (although, in theory, it should prevent it), sometimes I have to give up everything halfway because terrible itching and discomfort begins. In general, the microflora is not restored to anything. This is precisely why I wander around the forums to read at least some other options for possible treatment (and healing, without relapses), because the regimens prescribed by doctors do not bring any benefit.
Vaginosis is a very nasty thing, I suffered from it myself =(((Oh, how I suffered with it... I ran around to doctors until Vaginorm-S was prescribed. It was my savior! I was already tired of the unpleasant-smelling discharge, and Vaginorm eliminated it in just 6 days! I recommend it to everyone!
Vaginosis is a terrible scourge!! I had it several times in my life, there were, so to speak, relapses, I was treated with Vagilak. Until one fine day I went to the doctor and they prescribed Vaginorm for me for a week - it doesn’t cause any inconvenience, nothing gets in the way “there”)) A week later I was terribly glad that it was all over!! Six months have already passed, and so far, pah-pah, no relapses... I recommend it in general))
Thanks to the authors for the article! It’s a shame they didn’t mention oral probiotics, which restore the vaginal microflora. Because yoghurts and kefir are, of course, good, but from the stomach they enter the intestines and affect the intestinal microflora, not the vagina. There are modern drugs (gaprimer Vagilac) that restore female microflora!
Bacterial vaginosis is pathological changes in the vagina that are not inflammatory in nature and occur against the background of dysbiotic changes with the participation of anaerobic microflora.
Bacterial vaginosis
The vaginal environment has the function of protecting the uterus and appendages from inflammatory processes that can provoke various infectious agents entering the vagina from the outside or already present there, which, rising upward, provoke inflammation. The vaginal environment has the property of constancy; pathogenic organisms cannot stay in it for a long time and multiply in its mucous layer. All this happens due to the constant level of acidity (pH) of the vaginal environment and its composition: as a rule, the female vagina has an acidity level that can range from 3.8 to 4.5, and lactobacilli predominate in its composition. If the number of lactobacilli decreases or the vaginal pH increases (more than 4.5), then favorable conditions are created in which opportunistic bacteria multiply well.
Nonspecific microflora can cause many disorders in the immune and metabolic processes of the vagina. The production of protective immunoglobulin A, which does not allow pathogenic agents to attach to the vaginal epithelium, is reduced. Epithelial cells begin to slough off rapidly, which explains the increased discharge that accompanies bacterial vaginosis. Lactobacilli are usually replaced by anaerobes - bacteria that function without oxygen. The products of their metabolism, for example, amino acids and volatile fatty acids in the vagina are broken down into volatile amines, which have a specific fishy odor.
Due to the changes described above, the pH of the vaginal environment shifts from acidic to alkaline values. These shifts lead to progressive changes in carbohydrate, protein, lipid and mineral metabolism of the epithelium. Mucus production increases significantly and this leads to heavy discharge, which is the main symptom of bacterial vaginosis. But all these changes are only functional in nature; there is no inflammatory reaction on the walls of the vagina.
Proceeding without pronounced inflammation, bacterial vaginosis can manifest itself with both bright and meager symptoms. If the process lasts for a long period and relapses occur, then chronic bacterial vaginosis already occurs.
Sometimes the disease lasts a long time and in an erased form, as if it fades away, and then returns again. Against the background of existing dysbiosis, under unfavorable conditions in the vaginal environment, an increase in the amount of pathogenic flora can occur, which leads to an inflammatory process. Like any other dysbiotic conditions, bacterial vaginosis, which does not receive special treatment, can become the basis for other, more serious diseases of the uterus and appendages.
Can you get bacterial vaginosis during sexual intercourse?
This disease is not a sexually transmitted disease. Its pathogens can be transmitted during sexual intercourse. But, nevertheless, their transmission from woman to woman will not cause the disease, because a small number of these microbes are part of the normal microflora in the vaginas of most women.
However, bacterial vaginosis can be transmitted during unprotected sexual intercourse. And here the reason is not infection at all. This is explained by the fact that if a woman changes her sexual partner or has many sexual partners, then her vaginal microflora changes.
Bacterial vaginosis: causes
The disease is not a sexually transmitted infection and it does not have a single pathogen, therefore it is also called nonspecific vaginosis. The main cause of the disease is changes in the vaginal environment, due to which a disturbance in the microbiocenosis occurs. The microflora that replaces lactobacilli comes in different types and quite often appears as associations of opportunistic bacteria. For example like this:
- bacteriodes;
- megaspheres;
- peptococci;
- peptostreptococci;
- atopobium;
- leptotrichus;
- mycoplasma;
- gardnerella.
The growth of such bacteria is usually excessive and in vaginal secretions their number can reach 1010 per 1 ml. But such good conditions for the growth of bacteria can only arise due to the influence of certain factors in the internal or external environment of the female body.
The main reasons why the disease occurs can be divided into two main groups:
Internal or endogenous:
- The vaginal mucosa is atrophied.
- Hormonal balance is disturbed when progesterone predominates.
- Presence of intestinal dysbiosis.
- Immunity impairment.
- With long-term treatment with antibiotics that can kill bacteria, including milk bacteria.
- With poor nutrition and insufficient consumption of fermented milk products, which are necessary for the formation of lactic bacteria.
- The presence of chronic intestinal diseases that cause dysbiosis and dislocation in the intestines of lactic bacteria that enter with food.
- With immunodeficiency, when the immune system cannot cope with pathology in the body.
- Consequences of previous diseases of the pelvic organs, when there was a serious inflammatory process.
- The presence of concomitant diseases of the cervix (endometriosis, leukoplakia, pseudoerosion, endocervicitis).
- Hormonal disorders and menstrual phase disorders.
- Taking oral contraceptives, as well as contraceptives with 9-nonoxynol (suppositories, condoms, creams).
External or exogenous:
- after radiation therapy of tumors;
- with long-term use of antibiotics;
- foreign objects located in the vagina (contraceptive ring or diaphragm, sanitary tampons, etc.);
- frequent douching or use of spermicides;
- lack of personal hygiene;
- underwear made of synthetic material, which fits tightly to the body, as it does not allow oxygen to penetrate to the external genitalia, and at the same time to the vaginal mucosa;
- the presence of an intrauterine device, pads and tampons, which, when worn daily, irritate and rub the mucous membrane.
Due to all of the above factors, the normal functioning of the vaginal mucosa is disrupted or a large number of lactobacilli die, thereby freeing up space, which is immediately occupied by opportunistic microflora.
Bacterial vaginosis: symptoms
Initially, bacterial vaginosis may occur for quite a long time without obvious signs, or one of the symptoms may be present. In this case, the presence of the disease can only be determined through laboratory tests of the discharge.
In the acute form there may be complaints of:
- discharge that is gray-white, foamy and has an unpleasant odor of spoiled fish;
- urinary disturbance;
- burning and itching during urination in the vagina and external genitals;
- pain during sexual intercourse;
- more abundant discharge before menstruation, as well as after sex;
- in case of further progression, the disease develops viscous, sticky and thick green-yellow leucorrhoea;
- the appearance of inflammation and irritation of the skin in the perineum, thighs, buttocks and anal area.
If the disease is not treated in time, then asymptomatic bacterial vaginosis quite often becomes chronic and manifests itself in a protracted course with periods of remissions and exacerbations. If the disease lasts a long time, then the lactobacilli in the vagina become less and less, and then they may disappear altogether. The protective function of the vagina is significantly reduced, which quite often causes the addition of secondary pathogenic microflora and the occurrence of an inflammatory process. Inflammation rising higher can cause inflammatory changes in the cervix, on the uterus itself and in the appendages. Bacterial vaginosis in this case can become a background for already quite serious gynecological diseases.
Even healthy women experience quantitative changes in the composition of the vaginal microflora. But when a woman is healthy and the changes are not very significant, then the body is able to solve this problem on its own, that is, thanks to internal self-regulation mechanisms, it eliminates the violations that have arisen. It is believed that every woman experiences bacterial vaginosis at least once in her life, but not every woman develops a pathological process that requires drug treatment.
For each woman, the amount of vaginal discharge is individual, and it can change with age and depends on whether there are gynecological diseases, on the state of the nervous system, hormonal levels, sexual activity and other factors.
A large amount of discharge from a woman who is absolutely healthy may be associated with her upcoming period. As a rule, a woman knows how much discharge is normal for her, especially for those who regularly attend antenatal clinics. If the amount of discharge increases, this does not always indicate some kind of pathological process. What is the reason here is determined after examination by a doctor and laboratory tests.
Bacterial vaginosis in men
In infected men, the disease manifests itself as follows:
- Inflammation of the urethra (urethritis);
- Inflammation of the foreskin of the skin of the head of the penis (balanoposthitis);
- Frequent urge to urinate and pain during urination.
If a woman is pregnant, various physiological changes occur in her body, thanks to which a successful gestation of the fetus is ensured and a successful birth occurs. Sometimes there are cases that such changes lead to the occurrence of bacterial vaginosis. During pregnancy, a different system of hormonal regulation appears in the female body, in which gestagens, the so-called “pregnancy hormones,” predominate. Thanks to them, the amount of cervical mucus increases and the pH of the environment fluctuates. The result is a violation of the mechanism of self-regulation of the vaginal microflora, the number of opportunistic bacteria increases, and then the development of bacterial vaginosis occurs.
But this disease is not observed in all pregnant women. On the contrary, the number of people who became ill outside of pregnancy exceeded those who became ill during pregnancy. Experts believe that this is due to an increase in the content of lactobacilli in the vagina of the expectant mother.
In the case where pregnancy is the cause of bacterial vaginosis, the disease usually does not cause the woman any particular inconvenience and is quite easy to treat, and after childbirth it completely disappears. The situation may be different if, even before pregnancy, a woman was diagnosed with bacterial vaginosis. During pregnancy, the pathological process can only worsen and ultimately lead to undesirable consequences.
In expectant mothers, bacterial vaginosis has the same symptoms as in non-pregnant mothers. The severity of the disease will depend on whether there are other underlying or concomitant diseases and on the duration of the process. Often the only complaint is the presence of discharge of varying intensity from the genital tract. In pregnant women, bacterial vaginosis may not cause any symptoms at all.
Even if the pathological process in a pregnant woman is asymptomatic, in no case should you ignore it, since against the background of reduced immunity, pathogenic flora can join in, and then an inflammatory process can develop. Then pathogenic microorganisms rise to the cervix and then enter the pregnant uterus, where the developing fetus is located. This can result in intrauterine infection of the fetus, complications of the birth process, as well as the postpartum period. Despite the fact that such complications occur very rarely, doctors still conduct a full examination to identify bacterial vaginosis in pregnant women and, if necessary, prescribe appropriate treatment.
How can the disease affect conception and pregnancy?
Since bacterial vaginosis affects women of fertile age, many of them ask the question: will this diagnosis prevent them from getting pregnant? The changed microflora in the vagina does not cause inflammatory changes in the genital tract and therefore no problems with conceiving a child arise. Normally, sperm has an alkaline environment. Spermatozoa, entering the vagina with an increased pH, find themselves in fairly comfortable conditions.
What is the danger of bacterial vaginosis in case of pregnancy? Often, when penetrating the pregnant uterus, nonspecific microflora can infect the developing fetus. This condition is called intrauterine infection of the fetus, it can lead to developmental delays and lack of body weight. There are cases when the infection becomes the impetus for spontaneous miscarriage, premature rupture of amniotic fluid, as well as the birth of a premature baby. With this disease, the risk of developing purulent complications and sepsis in women in labor increases, especially in those who have undergone a cesarean section.
Diagnosis of bacterial vaginosis
A gynecologist, after listening to the patient’s complaints, examining her in a gynecological chair and studying laboratory data, makes a diagnosis. The following evidence suggests that the disease is bacterial vaginosis:
- age – the disease most often occurs in women of sexually active, reproductive age;
- moderate or mild severity of clinical signs of the disease;
- change of sexual partner, previous surgery, treatment of any other diseases.
When examining the patient, the doctor assesses the condition of the external genitalia, vagina and, of course, the cervix. The mucous membrane with nonspecific changes is pink, not inflamed, and the discharge is unevenly distributed. In the presence of acute bakvaginosis, the discharge is white-gray in color and has an unpleasant odor. In the chronic form of the disease, when it has lasted for several years, the discharge becomes yellow-green, more viscous and thick, reminiscent of cottage cheese. A gynecologist, examining a woman, uses an indicator strip to measure the pH of the vagina: in the presence of bacterial vaginosis, its value is above six.
In males, the presence of gardnerella is determined by examining prostate secretions.
Sometimes bacterial vaginosis hides other infections and viruses and increases the risk of sexually transmitted diseases, such as chlamydia, mycoplasmosis, trichomoniasis. Gardnerella begins to actively develop and destroys microflora beneficial to the vagina, thereby creating favorable conditions for the development of sexually transmitted infections, which are more dangerous for the body.
The diagnosis is made based on:
1. Carrying out an amino test.
2. PCR and cytological examination.
3. Smear microscopy.
4. Cultural sowing.
Bacterial culture is done to determine the composition of the vaginal microflora: quantitative and qualitative. The diagnosis of bacterial vaginosis is confirmed on the basis of a positive result of the diagnostic methods indicated above, especially with regard to the smear. After confirming the diagnosis, a special course of treatment is prescribed.
How to treat bacterial vaginosis
Treatment of bacterial vaginosis occurs in two stages.
At the first stage, the bacterial infection (gardnerellosis) is destroyed with the help of antibacterial and various combination drugs for local and general use.
At the second stage, thanks to biological preparations and topical medications (baths, tampons, etc.), the normal vaginal microflora is restored.
It is very important when a woman receives treatment in a timely manner, since in the case of a prolonged course of the disease, inflammation can occur in the uterus and appendages, which will ultimately lead to salpingitis (infectious inflammation of the fallopian tubes), endometritis, complications during pregnancy and during childbirth. This may be chorioamnionitis - inflammation of the walls of the amniotic sac, infection of the amniotic fluid, and may also cause premature birth or intrauterine infection of the fetus and a decrease in its weight.
The consequences of the disease can be pneumonia, postoperative infectious complications, pathological uterine bleeding, neuropsychiatric disorders, disorders of the sexual and reproductive function of women and decreased performance.
The first stage of treatment for vaginosis is antibacterial therapy.
To destroy the causative agent of the disease, the following treatment is carried out within 7-10 days:
1. Oral tablets: metronidazole (Trichopol), miramistin, tinidazole, clindamycyt, polycresulene (vagotil), terzhinan, metrogil, betadine, chlorhexidine.
2. Ointments, gels, suppositories or creams that contain the above drugs (except tinidazole). They are inserted into the vagina.
3. Immunocorrectors – vaferon and kipferon.
4. Antihistamines and estrogens.
During the period of use of metronidazole or tinidazole, alcohol consumption is not allowed, otherwise abdominal pain and vomiting may occur. Metronidazole can also cause the following side effects:
- pain in the lower abdomen, nausea and vomiting;
- anorexia (the drug is often used by women who want to lose weight);
- dryness or metallic taste in the mouth;
- allergic reactions, diarrhea or constipation;
- candidiasis, stomatitis, pancreatitis, glossitis;
- insomnia, weakness, hallucinations, convulsions;
- cystitis, urinary incontinence, polyuria;
- increased excitability, irritation, peripheral neuropathy.
Metronidazole is contraindicated in patients with organic lesions of the nervous system, leukopenia, severe liver failure, during pregnancy and lactation.
Patients under 18 years of age should not be prescribed this drug together with amoxicillin. Pregnant women are given a special course of drugs that are allowed at this stage of fetal development.
The second stage is the restoration of microflora
The microflora is restored by colonizing bacteria beneficial to the vagina. Probiotics and toothiotics are used for this purpose. More often than others, Linex, Bifiform, Bifidumbacterin, Acylact are used.
In particularly severe cases, treatment is carried out according to the scheme.
While undergoing antibacterial therapy and for another day after its completion, alcohol should be excluded even in the smallest doses, because due to medications, the metabolism of ethyl alcohol in the body is disrupted, toxic metabolites accumulate and severe intoxication develops. It is similar to a very severe hangover: severe weakness, severe throbbing pain in the head, high blood pressure, painful nausea and even vomiting, and shaking limbs.
Clindamycin cream contains fat that can damage the condom or latex birth control membrane. To prevent local forms of drugs
flow down the walls of the vagina, they are inserted immediately before the woman goes to bed.
If there is intolerance to antibiotics or there are contraindications to their use, then at the first stage, treatment is carried out using local antiseptics:
Hexicon – one suppository twice a day for 7-10 days;
Miramistan (solution) – the vagina is irrigated once a day for 7 days;
At the second stage of treatment for bacterial vaginosis, drugs are used that contain lactobacilli and create favorable conditions to restore the vaginal microflora. They begin to be used 2-3 days after the end of antibacterial therapy:
Bifiliz - taken twice a day, 5 doses for 5-10 days;
Acylact - one suppository is inserted into the vagina twice a day, treatment lasts 5-10 days.
Antifungal suppositories are not usually prescribed for the treatment of bacterial vaginosis. They are necessary only when a fungal infection - candidiasis - is added to the opportunistic microflora. Then treatment with clotrimazole is prescribed intravaginally once a day for 6 days.
It is strictly not recommended to treat yourself at home, because an incorrectly chosen dose of the drug or duration of treatment can lead to the development of resistant bacteria, which will subsequently be very difficult to get rid of, which will subsequently lead to a chronic course of the disease. Only a specialist doctor can determine how to properly treat bacterial vaginosis.
Prevention of vaginosis
To avoid getting bacterial vaginosis, you must:
- regularly, at least once a year, be examined by a gynecologist;
- do not douche with hygiene products that contain antiseptics;
- during sexual intercourse, use protective equipment, do not abuse douching, and maintain genital hygiene;
- Do not take antibacterial and hormonal medications on your own without a doctor’s prescription;
- do not be treated with antibiotics for a long time;
- eat healthy food.
