Bacterial vaginosis lactobacillus spp. Diagnosis and treatment of bacterial vaginosis. When does a smear indicate bacterial vaginosis?

What natural remedies and methods can be used effectively and safely treat bacterial vaginosis Houses.

It will probably seem strange to some (and to be honest, it’s hard for me to believe), but I only learned about the term Bacterial Vaginosis when I was pregnant. And not even because I had it. But because its appearance had to be prevented.

I have a rather difficult pregnancy, my cervix could not stand it and stitches were put on it (I already). And the sutures are a foreign body, and doctors were afraid that BV might occur and further complicate the course of pregnancy. But everything went well and I did not develop Bacterial Vaginosis.

When I started reading what it is and how often the fair half of humanity suffers from it, as well as the medications that doctors prescribe for treatment (antibiotics), I decided that I needed to write a post about how BV can and should be treated with natural remedies. Effective and safe, without harm to your microflora and without side effects.

What is Bacterial Vaginosis?

Bacterial Vaginosis is a common gynecological disease. Usually among young and middle-aged women. And in terms of frequency, according to statistics, 1 out of 5 has definitely suffered from it or will suffer from it.

Particularly susceptible to BV:

leading an active sex life
pregnant women
women with reduced immunity

Also, women suffering from BV have a higher risk of:

venereal diseases
other pathological conditions of the vagina
complications during pregnancy and childbirth

Cause of Bacterial Vaginosis

BV occurs due to disruption of the normal vaginal microflora. Yes, sometimes it’s hard to believe, but our vagina is its own whole ecosystem. With its bacteria and yeast.

The growth of any microorganisms or an imbalance of bacteria leads to Bacterial Vaginosis. The main culprit in this case is Gardnerella vaginalis, which has the ability to change the pH of the vagina. But it is important to understand that BV does not always develop because of it. Less common, but these can be other microorganisms.

Symptoms

So, the symptoms (or there may not be any - more on that below) of Bacterial Vaginosis begin to appear when the pH environment of the vagina changes. The usual internal pH is slightly acidic 3.8-4.2. Anything above 4.5 is BV, that is, too alkaline.

Many simply do not have any symptoms. But if there is one, then usually it is:

white or grayish discharge
the amount of discharge with an unpleasant odor increases
sometimes pain when urinating, during or after intercourse
red and inflamed, sensitive skin around the vagina

Causes of Bacterial Vaginosis

As with any condition, BV can have a variety of causes.

The most common:

dysbacteriosis/disturbed intestinal microflora
excess sugar in the diet
synthetic chemicals and odors
reception
stress

On my own behalf, I can add that Bacterial Vaginosis is a systematic disease of a woman’s entire ecosystem. Doctors often prescribe antibiotics, but this does nothing to help with the real problem and cause! This only removes the symptoms. BV needs to be treated comprehensively.

How to treat Bacterial Vaginosis

Avoid using soap and intimate hygiene products

Yes, I realize this sounds like very strange advice. But! Regular soap, aka unnatural soap, has an alkaline pH, which, as we already know, is not suitable for our vagina.

For the same reason, you should avoid all kinds of foams, sprays and other products that are advertised for feminine hygiene. The best hygiene for this delicate area is minimal with natural soap like . And no more than 1 time a day. We don't want to disturb the microflora. And that’s exactly what soap does.

Apple vinegar

Apple cider vinegar helps remove toxins and fight bacteria. And restore normal vaginal acidity.

It is very effective to sit in a basin - 1/2 cup of apple cider vinegar in a medium bowl of warm water. We sit for about 20 minutes. And also use it internally. But for this you only need (cloudy) - 1 teaspoon per glass of water, 2 times a day 30 minutes before meals.

Soda

Another effective remedy is simple soda.

Draw a bath, add 1/2 cup of soda to it and lie in it for 15-20 minutes.

Tea tree oil

Tea tree essential oil has a strong antifungal and antiseptic effect. Helps get rid of unnecessary bad bacteria.

The most effective method of use in this case is to dip a tampon in any liquid oil (ideally coconut as it has antibacterial activity) and then apply 3 drops of tea tree essential oil to the tampon. Insert overnight and repeat for a week.

Don't squirt

In general, douching our intimate area is not a useful thing. For those who may have doubted it, the vagina has the ability to clean itself. And douching simply disrupts the normal bacterial balance.

During menstruation, do not use pads or tampons with any scent. Better yet, switch to organic, natural options. You can buy these on iHerb, or for example, I bought Naty pads (I needed them after giving birth). Ideally, it is better to give up tampons altogether and switch to a silicone mouth guard, for example.

Probiotics

Yes, you can’t go anywhere without them. Since the main cause of BV also lies in the intestines, it will be necessary to increase beneficial bacteria there too. Especially suitable for the vaginal environment are Lactobacillus reuteri and rhamonosus. Here is a good probiotic containing these strains.

Garlic

Or as I like to call it - (and also very cheap and safe!). I even found a study stating that taking garlic tablets can be successfully used to treat BV. During pregnancy I took this garlic.

Blood Sugar Balance

It may be a secret to some, but the sugar we consume completely destroys our microflora. And the intestines and vagina. The fact is that pathogenic organisms (as well as cancer cells) simply adore it, bloom on it and smell. Therefore, it is necessary to reduce your sugar intake as much as possible!

What is bacterial vaginosis

Vaginal abnormal discharge is the most common symptom, occurring in approximately 1/3 of gynecological patients. It is known that among women with complaints of heavy discharge from the genital tract the most common diseases are bacterial vaginosis, trichomonas vulvovaginitis, vaginal candidiasis, cervicitis caused by chlamydial infection, herpes simplex virus, gonorrheal infection, as well as increased cervical secretion. The observed increase in vaginal infections, in particular bacterial vaginosis, which occupies a leading place in the structure of obstetric and gynecological morbidity, is largely due to economic, environmental reasons, immunological disorders, changes in hormonal homeostasis, massive and irrational use of various medications, especially antibiotics.

It is important to note that at present, bacterial vaginosis is not included in the ICD-X revision, apparently due to the fact that the role and place of bacterial vaginosis in the structure of infectious diseases of the lower genitalia has not been definitively established. In the ICD-X it can be found under the code N89.5 “Unspecified leucorrhoea, as infectious” or under the code N76 - “Other types of inflammation of the vagina and vulva.” Nevertheless, much attention is still paid to this problem not only due to the widespread prevalence of bacterial vaginosis, but also the occurrence of severe pathology of the female genital organs and complications of pregnancy and childbirth. Studies by a number of authors have shown that bacterial vaginosis can lead to the development of chorioamnionitis, postpartum endometritis, premature birth and the birth of children with low body weight, inflammatory processes of the genital organs, purulent-septic complications in the mother and child in the postpartum period, etc., which influences the frequency of obstetric and neonatal pathologies.

According to various authors, incidence of bacterial vaginosis varies from 30 to 60-80% in the structure of inflammatory diseases of the genital organs. Thus, according to Kira E.F., bacterial vaginosis occurs in 19.2% of women of reproductive age in the general population and in 86.6% of women with pathological leucorrhoea. Bleker O.P. et al. identified bacterial vaginosis in 38.1% of women, Von U.B.Houme diagnosed bacterial vaginosis in 62% of women. According to the Scientific Center of Agipology of the Russian Academy of Medical Sciences, bacterial vaginosis is detected in 24% of practically healthy non-pregnant women and in 61% of patients with complaints of heavy discharge from the genital tract. Among pregnant women, bacterial vaginosis occurs in 10-46% of cases. Thus, data from a literature review indicate a significant prevalence of bacterial vaginosis, mainly in women of reproductive age.

Currently, bacterial vaginosis is considered as state of vaginal dysbiosis, in which the elimination of lactobacilli and colonization of the vagina by strict anaerobes and gardnerella occurs. In some cases, against the background of the absolute predominance of microorganisms associated with bacterial vaginosis, lactobacilli may be present in low titer and, as a rule, these are anaerobic lactobacilli, unable to produce hydrogen peroxide. At the same time, the level of anaerobic microorganisms can increase 1000 times. Studies have shown that the proportion of lactobacilli is reduced to 30% of the total number of microorganisms.

Causes of bacterial vaginosis

Factors leading to the development of bacterial vaginosis include: First of all, it should be attributed to the long-term, sometimes uncontrolled use of antibiotics, which leads to dysbiosis not only of the vagina, but also of the gastrointestinal tract. According to a number of authors, almost every second patient with bacterial vaginosis has disorders of the intestinal microecology. Thus, we can assume the presence of a single dysbiotic process in the body with its pronounced manifestation either in the reproductive or digestive system. In addition, as our studies have shown, bacterial vaginosis often occurs against the background of menstrual irregularities, mainly of the type of oligomenorrhea or defective luteal phase, and in women who have been using IUDs for a long time (more than 5 years). The occurrence of bacterial vaginosis can also be caused by previous or concomitant inflammatory diseases of the female genital organs. According to our data, among past gynecological diseases in patients with bacterial vaginosis, vaginitis is the most common (63.9%). In addition, a high incidence of benign cervical diseases is detected.

In recent years, reports have appeared in the literature about the presence of an epidemiological connection between bacterial vaginosis and neoplastic processes of the cervix. It has been shown that nitrosamines, which are metabolic products of obligate anaerobes, serve as coenzymes of carcinogenesis and can be one of the reasons for the development of dysplastic processes and even cervical cancer.

128 women of reproductive age were examined with complaints of heavy discharge from the genital tract (average age 24.3+0.9 years). Newly diagnosed bacterial vaginosis was observed in 59.4% of women (group 1), while recurrent bacterial vaginosis for 2 or more years was detected in 40.6% of women (group 2). Analysis of the condition of the cervix showed that in the 1st group of patients with bacterial vaginosis, a normal zone of transformation (NTZ) was detected in 64.3%, while in the 2nd group - in 29.3% of women; cervical ectopia with NRT was detected in 21.4% in group 1 and in 31.7% in group 2; atypical zone of transformation (AZT) - in 7.1% and 19.5%, respectively; cervical leukoplakia - in 7.1% and 14.6%; cintraepithelial neoplasia (CIN) stages I-II was detected in the 2nd group of patients.

Based on the studies conducted, it can be assumed that long-term bacterial vaginosis with frequent relapses leads to the development of degenerative processes in the cervix, as a result of which the prerequisites are created for the development of pathological conditions in it.

Bacterial vaginosis occurs as a monoinfection without signs of an inflammatory reaction and leukocytes in the vaginal discharge. Some authors associate the absence of a leukocyte reaction with the metabolic product of bacteria of the genus Bacteroides - succinate, which is present in high concentrations in vaginal samples from women with bacterial vaginosis, and with Gardnerella hemolysin, which disrupt the functional activity of leukocytes and thereby prevent a pronounced inflammatory reaction.

Clinic and diagnosis of bacterial vaginosis

Patients with bacterial vaginosis usually complain to heavy white or gray discharge from the genital tract, often with an unpleasant odor, especially after sexual intercourse or during menstruation. The duration of these symptoms can be years. As the process progresses, the discharge acquires a yellowish-greenish color, becomes thicker, slightly viscous and sticky, has the property of foaming, and is evenly distributed over the walls of the vagina. The amount of leucorrhoea varies from moderate to very profuse. Other complaints, such as itching, dysuria, dyspareunia, are less common and may be completely absent or appear periodically. However, it should be noted that in 24-50% of cases, bacterial vaginosis can be asymptomatic, without any clinical manifestations of the disease, and the diagnosis of bacterial vaginosis can be made only on the basis of laboratory research methods.

To date diagnosis of bacterial vaginosis does not present any difficulties: the diagnosis of bacterial vaginosis can be made on the basis of 3 of the 4 diagnostic tests proposed by Amsel R. et al.:

pathological nature of vaginal discharge;
pH of vaginal discharge is more than 4.5;
positive amine test;
identification of “key” cells by microscopy of wet unstained preparations of vaginal discharge and Gram-stained smears.

Carrying out a cultural method of examination, which is widely used in the practice of obstetricians and gynecologists, for diagnosing bacterial vaginosis has no diagnostic value, and currently priority is given to microscopy of Gram-stained smears. The presence in smears of “key cells” - mature epithelial cells with microorganisms associated with bacterial vaginosis adhering to them (gardnerella, mobiluncus, gram-positive cocci) is an important diagnostic sign of bacterial vaginosis. The sensitivity and specificity of this method are close to 100%.

Bacterial vaginosis is characterized by a positive amino test. Vaginal contents often have a rotten fish odor, which is the result of the formation of diamines (putrescine, cadaverine, trimethylamine) in the decarboxylation reaction of amino acids by obligate anaerobes. The salts of these compounds convert into volatile amines at alkaline pH values. As mentioned above, gardnerella, which is isolated with high frequency in bacterial vaginosis, does not produce these compounds. Therefore, in cases of complete dominance of Gardnerella in the vaginal microcenosis, the amino test will be negative. According to our data, the sensitivity and specificity of this diagnostic test are 79 and 97%, respectively.

pH value of vaginal discharge with bacterial vaginosis exceeds standard values (> 4.5), which is caused by the elimination of lactoflora or a sharp decrease in its content. To perform pH measurements, you can use universal indicator paper with a standard scale or various modifications of pH meters. The material for the study can be either vaginal discharge or washing off the vaginal contents with a sterile saline solution with a neutral pH value. The sensitivity and specificity of the test are 89 and 85%, respectively.

It should be remembered that for correct making a diagnosis of bacterial vaginosis When taking material for research, basic rules must be observed: the material must be collected before the start of antibacterial therapy; the day before, the patient should not perform intimate toilet or have sexual intercourse; microbiological examination should be carried out as quickly as possible to avoid the death of bacteria.

Treatment of bacterial vaginosis

Currently, obstetrician-gynecologists have in their arsenal a wide range of different drugs for the treatment of bacterial vaginosis, having an antianaerobic effect. It should be noted that many clinicians today prefer vaginal route of administration of drugs in the treatment of bacterial vaginosis, which is not inferior in effectiveness to oral therapy. It is more preferable since local drugs are injected directly into the lesion, and there is less likelihood of adverse reactions. Locally acting drugs can be prescribed pregnant women and women undergoing lactation, as well as for extragenital pathology, when systemic drugs are contraindicated.

Among local drugs, Dalatsin vaginal cream (2% clindamycin phosphate) has found widespread use. A distinctive feature of this broad-spectrum antibiotic is its effect on the anaerobic component of the vaginal microflora. The drug is available in 20 g tubes with three disposable applicators included. Its effectiveness, according to various authors, ranges from 86 to 92%.

Currently, in their arsenal, practicing doctors also have the drug Dalacin vaginal suppositories, with an applicator attached to it (1 suppository contains 100 mg of clindamycin phosphate). The drug is used 1 suppository in the vagina at night for 3 consecutive days. J. Paavonen et al. conducted a randomized study to comparatively study the effectiveness of the use of dalacin (for 3 days intravaginally in the form of suppositories) and metronidazole (peros at a dose of 500 mg 2 times a day for 7 days). The effectiveness of using dalacin in the form of suppositories was 68%, metronidazole - 67%. Research by other authors (J.A. McGregor) has shown that the use of Dalacin vaginal suppositories for 3 days is not inferior in effectiveness to the use of Dalacin vaginal cream for 7 days, amounting to 95%. Thus, dalacin in the form of suppositories is highly effective and compliant (a three-day course as opposed to a 7-day course of metronidazole and dalacin vaginal cream), as well as good tolerability with a low percentage of side effects.

Another drug that is widely used in the treatment of bacterial vaginosis is flagyl (metronidazole), which is highly active against anaerobic microorganisms. The drug is prescribed 1 vaginal suppository in the vagina for 10 days.

Among the systemic drugs for etiotropic treatment of bacterial vaginosis, metronidazole and clindamycin, which have an antianaerobic spectrum of action, should be mentioned. An effective drug for the treatment of bacterial vaginosis is metronidazole. The drug for bacterial vaginosis is prescribed 500 mg 2 times a day for 7 days or 2 g once. A single 2 g oral dose of metronidazole has been shown to be as effective as 5-7 days of oral administration. It should be noted that oral use of the drug often causes side effects, such as a metallic taste in the mouth, dyspeptic disorders, and allergic reactions.

Wide use in the treatment of infectious diseases of the genitals found clindamycin, which is a chlorinated derivative of lincomycin and has an advantage over the latter because it has greater antibacterial activity and is more easily adsorbed from the intestine. The drug binds to ribosomes and inhibits protein synthesis. It is active against obligate anaerobes. The drug is prescribed 300 mg 2 times a day per os for 7 days. It is important to note that oral administration of the drug may be complicated by diarrhea.

Ornidazole is also used to treat bacterial vaginosis. The drug is prescribed 1 tablet (500 mg) 2 times a day after meals for 5 days.

In 6-18% of cases against the background Treatment of bacterial vaginosis with antibacterial drugs may cause vaginal candidiasis. In this regard, to prevent vaginal candidiasis, it is advisable to prescribe antifungal agents. It should be emphasized that antibacterial agents, having eliminated opportunistic microorganisms, are not able to create conditions for the rapid restoration of normal vaginal microflora. Therefore, it is necessary to prescribe biological products (acylactobacterin, bifidumbacterin, acylact, etc.), which stimulate the growth of the vagina’s own lactoflora and help reduce the number of relapses of the disease by increasing the protective properties of the vagina. It is important to emphasize that the prescription of biological products is advisable after a control microbiological study confirming the absence of fungal flora.

In conclusion, I would like to note that treatment of patients must be individualized in each specific case. In this case, mandatory examination and treatment of the partner is necessary. Therapy can be considered successful if the symptoms of the disease are completely eliminated.

Errors in the diagnosis of bacterial vaginosis and inadequate treatment often lead to serious consequences.

Also relevant is the question of the need to treat bacterial vaginosis when it is asymptomatic. Treatment of bacterial vaginosis is advisable for asymptomatic cases both outside and during pregnancy in order to prevent infectious and inflammatory diseases associated with bacterial vaginosis, as well as those complications during pregnancy that this disease can lead to.

Professor V.N. Prilepskaya, Ph.D. G.R. Bayramova

"Treatment of bacterial vaginosis, drugs, treatment regimens, diagnosis" - section

Bacterial vaginosis ( gardnerellosis, vaginal dysbiosis, vaginal dysbiosis) is a common disease in women associated with a disruption of the normal microflora of the vagina and an increase in the number of other microbes, including gardnerella.

Bacterial vaginosis does not cause irritation or itching in the vagina, but it does lead to an unusual vaginal discharge called leucorrhoea. With this disease, vaginal discharge acquires the following symptoms:

strong fishy odor, especially after sexual intercourse;
white or gray color;
become liquid and watery.

For most women, bacterial vaginosis is not a serious condition. Symptoms of bacterial vaginosis in a woman during pregnancy may be a cause for concern if the pregnancy previously had complications.

About half of women with bacterial vaginosis experience no symptoms. In such cases, the disease does not threaten your health or pregnancy.

Contact your gynecologist if you notice unusual vaginal discharge, especially during pregnancy. It is important to undergo examination to rule out other infectious diseases and prevent complications.

Typically, vaginosis is easily treated with a short course of antibiotics, but the disease often recurs. More than half of women who have recovered from vaginal dysbiosis again experience symptoms of vaginosis, usually within three months after recovery.

The causes of bacterial vaginosis are not completely clear, so there is no guaranteed effective method of preventing this disease. However, you can reduce the risk of vaginal microflora disturbances in the following ways:

Avoid using perfumed soaps, scented bubble baths, and antiseptic bath liquids;
do not use vaginal deodorants;
do not douche without a doctor’s prescription;
Do not wash your underwear with strong detergents.

If these rules are often neglected, the natural bacterial balance of the vagina can be disrupted, which increases the likelihood of developing bacterial vaginosis.

Causes of bacterial vaginosis

Bacterial vaginosis occurs when the natural bacterial balance in the genital tract is disrupted. Lactobacilli (milk bacteria) live in the vagina and produce lactic acid. This creates a slightly acidic environment, preventing the growth of other bacteria. In women with bacterial vaginosis, the number of lactobacilli is temporarily reduced, causing the acidity level in the vagina to become lower, creating a favorable environment for the proliferation of “bad bacteria”.

It's still not entirely clear what causes bacterial imbalance, but the following factors may increase your susceptibility to it:

active sex life, new sexual partner or several partners;
use of an intrauterine device - a means of contraception;
smoking;
scented soaps, antiseptic bath liquids or bubble baths;
washing the vagina with water or other liquids (douching) without a doctor’s prescription;
vaginal deodorants;
washing underwear with aggressive detergents.

For unknown reasons, vaginal dysbiosis is more common in black women than in any other ethnic group.

Typically, bacterial vaginosis is not considered a sexually transmitted infection (STI), but opinions differ on this matter. There are the following arguments in favor of the fact that vaginal dysbiosis is an STI. Bacterial vaginosis:

more common in women who have multiple sexual partners;
less common in women who have sex with a condom.

There is also evidence that women with bacterial vaginosis can pass the disease to other women during sexual intercourse, but it is not clear how this happens.

There are also arguments in favor of the fact that vaginal dysbiosis is not an STI:

There is no such disease in men, and there is no evidence that the bacteria that causes bacterial vaginosis in women can be transmitted sexually to men.
treatment of a male sexual partner with antibiotics does not prevent recurrence of the disease in a woman;
The prevalence of bacterial vaginosis in different ethnic groups can vary significantly, which cannot be explained solely by sexual activity;
Sometimes vaginal dysbiosis occurs in women who are not sexually active.

Many experts believe that sexual activity plays a role in the development of bacterial vaginosis, but other factors likely play a role in its development.

Diagnosis of bacterial vaginosis

If you experience unusual vaginal discharge, contact your gynecologist as soon as possible. This is necessary primarily in order to exclude more dangerous diseases with similar symptoms, for example, trichomoniasis or gonorrhea. Both of these conditions can cause vaginal leucorrhoea.

A gynecologist can make a diagnosis based on your symptoms and after examining your vagina. However, additional tests are needed to confirm the diagnosis.

During a gynecological examination, the doctor will take a smear from the vaginal wall using a plastic stick - a sample of cells and secretions. The procedure takes only a few seconds and is painless, although it may cause discomfort for a short time.

The sample taken is examined for the presence of various microbes, which allows us to judge the state of the vaginal microflora and the presence of vaginosis. Some clinics may receive results immediately, but if the sample is sent to a laboratory, the wait for results may take up to a week.

Your doctor may also measure the pH level of your vagina. A swab will be taken from the vagina and then passed over specially treated paper. The color of the paper will change depending on the acidity level. A pH level above 4.5 may indicate the presence of vaginosis.

Treatment of bacterial vaginosis

Bacterial vaginosis can be successfully treated with antibiotics. There is currently no evidence that probiotics, which are found in some yogurts, help treat or prevent vaginal dysbiosis.

The most commonly prescribed antibiotic for treatment is metronidazole. It comes in three forms:

tablets, which should be taken twice a day for 5-7 days;
one higher strength tablet, taken only once;
a gel that is applied to the vaginal walls once a day for five days.

In most cases, metronidazole tablets are recommended and should be taken for 5-7 days, as they are considered the most effective treatment. They can be taken if you have symptoms of bacterial vaginosis during pregnancy. If you are breastfeeding, you will likely be recommended metronidazole gel, as metronidazole tablets may pass into breast milk.

In some cases, another antibiotic, such as clindamycin cream, is recommended instead of metronidazole, which should be applied to the vaginal walls once a day for seven days. The cream may be prescribed, for example, if you have had a negative reaction to metronidazole in the past.

Whatever course of antibiotics you are prescribed, it is important to complete it, even if you start to feel better. This will help reduce the risk that your symptoms will not go away or will return.

Metronidazole may cause nausea, vomiting, and a mild metallic taste in the mouth. It is better to take the drug after meals. If you start vomiting after taking the drug, consult your doctor; they may recommend another treatment method. Do not drink alcohol while taking metronidazole and for at least two days after finishing your course of antibiotics. Mixing alcohol with the drug may increase side effects.

If you are being treated for bacterial vaginosis (BV), there are a few things you should avoid doing to increase the potential effectiveness of your treatment. For example, you should not wash your vagina or use antiseptics, scented soaps, or bubble baths.

Some women cannot cure bacterial vaginosis with one course of antibiotics. If the first course of treatment does not help you, your doctor will check to see if you took the medications correctly. If so, one of the alternative treatments listed below may be recommended for you.

If you have been placed with an intrauterine device, which your doctor thinks may be causing problems with your vaginal flora, you may be advised to remove it and use another method of contraception.

Correction of vaginal acid-base balance- a relatively new method of treating vaginal dysbiosis. Typically, this involves applying a gel to the vaginal walls, which will change the acid-base balance, making the vaginal environment less favorable for the growth of harmful bacteria. Most products for correcting the acid-base balance of the vagina can be bought at the pharmacy without a prescription, but the effectiveness of such treatment has not yet been confirmed. Some studies have shown that it helps treat vaginosis, while others suggest that it is ineffective or less effective than antibiotics.

Complications of bacterial vaginosis

Most women can treat bacterial vaginosis without any complications. However, there is a small risk of complications if the disease is not treated.

There is evidence that if left untreated, bacterial vaginosis that causes symptoms during pregnancy may increase your risk of developing pregnancy-related complications, especially if you have had similar complications in the past.

Pregnancy complications that may occur due to bacterial vaginosis include:

premature birth - when a baby is born before the 37th week of pregnancy;
miscarriage - loss of a fetus during the first 23 weeks;
premature rupture of the amniotic sac - a bladder containing fluid in which the fetus develops;
chorioamnionitis - infection of the chorion and amnion membranes (the membranes that make up the fetal sac) and amniotic fluid (the fluid surrounding the fetus);
postpartum endometritis - infection and inflammation of the uterine tissue after childbirth.

If you are pregnant and experience symptoms of vaginosis, contact your gynecologist as soon as possible. Although the risk of complications is low, treatment will help reduce it further. If bacterial vaginosis does not cause any symptoms, there is no reason to believe that it will increase the risk of complications during pregnancy. Therefore, if you are pregnant and you have been diagnosed with a violation of the vaginal microflora, but it does not manifest itself clinically, you may be advised to refrain from treatment.

There is evidence that vaginosis may increase the risk of STIs such as chlamydia. This may be because changes in the number of bacteria in your vagina reduce your defenses against infection.

There is evidence to suggest that bacterial vaginosis may increase the risk of developing pelvic inflammatory disease (PID). PID involves infection and inflammation of the upper part of the female genital tract, including the uterus, fallopian tubes and ovaries.

Symptoms of PID include:

pain in the pelvic area or lower abdomen;
discomfort or pain deep in the pelvic area during sexual intercourse;
bleeding between periods and after sex.

If diagnosed early, PID can usually be successfully treated with a course of antibiotics. However, approximately one in five women who have this condition will become infertile due to severe scarring of the fallopian tubes.

If you notice any symptoms of PID, consult your gynecologist. Delaying treatment or recurrence of PID may increase the risk of infertility.

Women with vaginal dysbiosis who undergo in vitro fertilization (IVF) have a lower chance of success and a higher risk of early miscarriage. Therefore, if you are undergoing IVF, timely restoration of the normal composition of the vaginal microflora is necessary.

Which doctor should I consult for bacterial vaginosis?

Using the NaPravku service, you can treat and diagnose bacterial vaginosis.

Localization and translation prepared by site. NHS Choices provided the original content for free. It is available from www.nhs.uk. NHS Choices has not reviewed, and takes no responsibility for, the localization or translation of its original content

All site materials have been checked by doctors. However, even the most reliable article does not allow us to take into account all the features of the disease in a particular person. Therefore, the information posted on our website cannot replace a visit to the doctor, but only complements it. The articles have been prepared for informational purposes and are advisory in nature.

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 secretions is above 4.5

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

Gardnerella and bacterial vaginosis

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

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