Vaginosis is transmitted. Bacterial vaginosis. Symptoms, diagnosis, treatment of bacterial vaginosis. Factors not related to disease

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

Almost ninety percent of the microflora consists of lactobacilli bacilli, which prevent the colonization of pathogenic microorganisms and monitor the amount of opportunistic microflora. In addition, bacilli produce substances that have antibacterial activity.

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

• hormonal system. If the hormonal background changes, then the number of receptors that are located on the surface of cells also changes accordingly, and it is to these receptors that harmful bacteria attach. Also, it is the hormonal system that controls the process of renewal of the vaginal mucosa;
• immunity. This protective system controls the number of opportunistic microflora, and immunoglobulins prevent harmful bacteria from attaching to cells and penetrating deeper;
• lactobacilli. These beneficial microorganisms create an acidic environment in which pathogenic bacteria simply cannot actively reproduce.

What is bacterial vaginosis

This is a disease of the female genital organs with specific vaginal discharge that has an unpleasant odor. In simple terms, this is vaginal dysbiosis. Unlike, with bacterial vaginosis there are no inflammatory signs.

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

This disease is based on a change in the quantitative composition of the vaginal microflora. The number of beneficial bacteria decreases, while opportunistic microflora begins to actively multiply.

In each specific case, the clinical picture of the disease may differ, ranging from an asymptomatic course to a pronounced clinical picture with severe discomfort, itching and discharge.

Causes of vaginosis

As for the specific pathogen, it simply does not exist. Entire polymicrobial complexes lead to the appearance of the disease, among which are Mycoplasma and Gardnerella.

There can be many causes of vaginal dysbiosis. Let's consider the most basic provoking factors:

• changes in hormonal levels, for example, after an abortion, during menopause or pregnancy;
• weakening of general or local immunity;
• endocrine disorder;
• poor adherence to intimate hygiene rules;
• deformities of the vagina or cervix;
• frequent use of soap when washing and abuse of douching;
• the presence of foreign bodies in the vagina;
• the use of hormonal agents, as well as immunosuppressants;
• use of oral contraceptives or long-term use of intrauterine contraceptives;
• severe stressful situations;
• inflammatory processes of the urinary and reproductive systems;
• prolonged or uncontrolled use of antibiotics.

Symptoms of bacterial vaginosis

It is immediately worth noting that the disease has no characteristic symptoms. Often its only symptom is heavy vaginal discharge with an unpleasant fishy odor.

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

There are no signs of an inflammatory process such as swelling and hyperemia with vaginosis, this is a distinguishing feature from vaginitis. The disease is often accompanied by the following pathological processes: cervicitis, erosion, scarring. In approximately fifty percent of cases, patients experience vaginitis.

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

• copious grayish-white discharge of a uniform creamy consistency, which is evenly distributed over the walls of the vagina;
• discomfort during intimacy;
• pain in the perineal area;
• urinary disorders.

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

• the discharge changes its color and consistency, resembling a cheesy mass;
• leucorrhoea becomes dark green;
• pathogenic flora joins the infectious process, which leads to inflammation of the vagina, manifested in the form of swelling and redness;
• leucorrhoea can be easily removed from the walls of the vagina using a cotton swab;
• frequent and painful urination;
• itching in the vulva area.

Types of bacterial vaginosis

There are several classifications of bacterial vaginosis. Depending on the clinical manifestations, the disease is divided into the following groups:

• asymptomatic;
• monosymptomatic;
• polysymptomatic.

According to the nature of the pathological process, the disease is:

• sharp;
• chronic;
• recurrent.

Depending on the severity, bacterial vaginosis occurs in the following forms, namely:

• compensation stage. The compensated type manifests itself in the form of a slight decrease in the number of lactobacilli. At this stage, the colonization of microorganisms that have entered the body from the outside occurs;
• subcompensated stage. The reduction of lactobacilli occurs to a significant extent and the activation of opportunistic microorganisms occurs;
• stage of decompensation. Lactobacilli are completely absent. There are pronounced clinical symptoms and such a pathological process requires long-term therapeutic therapy.

Bacterial vaginosis during pregnancy

Often the disease is diagnosed during pregnancy. According to statistics, the disease occurs in every fifth woman.

In pregnant women, hormonal levels change, the immune system weakens, thus creating favorable conditions for the development of the disease. In terms of its manifestations during pregnancy, the disease is no different; the woman is also bothered by thick, foamy discharge with an unpleasant odor of stale fish.

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

• Spontaneous abortion may occur in the early stages;
• a disease that develops in the second or third trimester threatens to infect the fetus, which can lead to premature rupture of water;
• premature birth;
• complications during labor;
• purulent-septic complications in the postpartum period.

For the treatment of pregnant women, it is preferable to use local rather than systemic drugs. Drugs that include metronidazole are usually prescribed. Such drugs are used in the form of vaginal pills or gels. Doctors also prescribe the following medications to pregnant women: Trichopolum, Metrogyl, Tiberal.

The above-mentioned remedies are prescribed from the second trimester of pregnancy, since in the first trimester the formation of vital organs and systems occurs. If there is a real threat to the mother or child, then the doctor may decide to prescribe antimicrobial agents at an earlier date.

Women are also prescribed medications containing lactobacilli for. They can be used both internally and as douches. Treatment is carried out under the strict supervision of a doctor.

Forecast

Despite treatment, in some cases relapses may occur at any stage after the end of therapy. Most likely, this is due to the fact that antibiotics acting on pathogenic microflora interfere with the rapid creation of favorable conditions for the active reproduction of beneficial bacteria.

For this reason, complex therapy should include. Their action is aimed at restoring the natural balance of microflora, which will serve as a good prevention of relapses.

Diagnostics

The most informative diagnostic method is a microscopic examination of a gynecological smear. Under a microscope, a specialist detects key cells - a clear sign of gardnerellosis. A bacteriological study is also carried out, which will help identify the pathogen.

Based on clinical symptoms alone, a specialist may suspect the presence of vaginosis, but an accurate diagnosis is made based on laboratory test data. The gynecologist conducts an examination, during which he discovers discharge characteristic of the disease.

Bacterial vaginosis in men

Many experts consider it incorrect to use the very expression “bacterial vaginosis” in relation to men, because this is vaginal dysbacteriosis. However, the causative agents of this disorder - Gardnerella - can provoke the development of a pathological process in the male body.

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

In most cases, the causative agent of the disease easily penetrates the male body and is just as quickly eliminated after two or three days. Sometimes chronic carriage may occur, in which there are no clinical manifestations. The only danger is that a man may not know about the carrier state, but still transmit gardnerella to his partner.

Sometimes these microorganisms can penetrate the urethra during sexual intercourse and cause a sluggish inflammatory process. In this situation, green discharge appears from the penis. Which practically do not bother a man. And sometimes this can lead to development with the appearance of pain and burning when urinating; this, of course, requires therapeutic therapy.

How is bacterial vaginosis transmitted?

Bacterial vaginosis is not a sexually transmitted disease!

In general, pathogens of the disease, in particular Gardnerella, can be transmitted sexually, but this will not cause the development of dysbacteriosis, because these microorganisms are part of the natural microflora in small quantities. If the immune system is normal, then the body’s defense mechanisms simply will not allow the opportunistic organism to attach to the surface of the cell, much less penetrate deeper.

Then what role does unprotected sexual intercourse play in the occurrence of the disease? The point here is not at all about infection, but about the fact that frequent changes of sexual partners upset the natural balance of microflora.

When should you see a doctor?

Let's consider the reasons that may prompt you to contact a specialist:

• the infectious process arose for the first time. The doctor will help identify the etiological factor and tell you about the characteristic symptoms, as well as tell you how to deal with them;
• This is not the first time the disease has occurred, but the symptoms are different this time;
• you have a new sexual partner. Signs of sexually transmitted diseases are similar in their manifestations to bacterial vaginosis;
• increased temperature and unpleasant odor from the vagina;
• Despite self-treatment, recovery did not occur.

How to treat bacterial vaginosis?

Bacterial vaginosis in women is treated in two main stages:

1. Restoring the physiological properties of the vagina, strengthening the body's defenses, normalizing hormonal levels and combating pathogens.
2. Restoring the natural balance of vaginal microflora.

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

Drugs for bacterial vaginosis

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

Eubiotics

Let's consider a treatment regimen with effective eubiotics:

• Baktisubtil. One capsule is drunk one hour before meals three to four times a day;
• Hilak forte. Fifty drops three times a day;
• Linux. Take two tablets three times a day.

Suppositories for bacterial vaginosis

Vaginal suppositories act directly at the site of the pathological process. The active substance is practically not absorbed into the blood, which means it causes minimal side effects.

• Ecofemin. The drug contains live lactobacilli. Suppositories are administered two to three times a day for ten days;
• Bifidumbacterin. Contains bifidobacteria. It is enough to administer one suppository before bedtime for ten days;
• . Contains chlorhexidine. A special feature of Hexicon is that it has a detrimental effect on pathogenic microorganisms, without affecting lactic acid bacteria. Suppositories are administered one or two times over a period of 10 days.

Treatment regimen for bacterial vaginosis

First, let's look at the standard treatment regimen with systemic drugs:

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

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

• Neo-Penotran. For seven days, a suppository is inserted intravaginally twice a day;
• Terzhinan. One suppository is inserted deep into the vagina twice a day for five days;
• Clindamycin cream. The full applicator is administered before bedtime for seven days.

How to treat vaginosis at home

Let's look at several ways to treat the disease at home:

• if the disease has just begun to develop, douching can provide good help. Lactic or boric acid is suitable as a solution. The liquid for the procedure should be warm, but in no case hot. One or two douches per day is enough;
• You can use tampons intravaginally. They are soaked in ascorbic or lactic acid. Tampons are also lubricated with metronidazole ointments. The tampon is left in the vagina for twenty minutes, after which you should not wash it. It is necessary to perform ten such procedures, but the effect is already visible after the third application.

Folk remedies for bacterial vaginosis

Treatment using unconventional methods takes longer, but is the safest. But this is provided that they are used correctly. Folk remedies are not an alternative to drug treatment, but only auxiliary assistance. They can be used with the permission of a doctor.

Let's look at the most effective recipes:

• sitz baths. The duration of this procedure is fifteen minutes. They quickly relieve itching. To carry them out, you will need two glasses of herbal infusion, which are mixed with ten liters of warm water. Infusions can be prepared from the following medicinal plants: oak bark, chamomile, wormwood, St. John's wort, calendula, dandelion, etc.;
• infusions for oral administration. Take the following ingredients in equal proportions: elecampane root, birch leaves, mint, chamomile, licorice, thyme. One tablespoon of crushed raw materials is poured with half a liter of boiling water. The product must infuse for six hours. After it is strained, the infusion is ready for use. Treatment lasts for three months. Drink half a glass half an hour before meals;
• cotton swabs are soaked in the infusion and inserted into the vagina. To prepare the medicine you will need: marshmallow root, St. John's wort, meadowsweet, dandelion leaves, blueberries and calendula. The components are taken in equal proportions, poured with boiling water and the product should infuse for several hours.

Prevention

It is important for every woman, especially those who have already been treated for gardnerellosis, to follow simple but effective preventive measures:

• proper adherence to the rules of intimate and sexual hygiene;
• for casual sexual contacts, use barrier methods of contraception;
• timely treatment of inflammatory processes of the genitourinary system;
• adequate sleep and coping with stressful situations;
• balanced diet;
• rational use of antibiotics;
• normalization of hormonal levels;
• prevention of the development of intestinal dysbiosis;
• regular visits to the gynecologist.

So, bacterial vaginosis is a disease in which there is a disturbance in the natural balance of the microflora of the vaginal mucosa. A number of reasons can lead to its appearance, among which are changes in hormonal levels and weakened immunity. One of the main signs of the disease is abundant white-gray vaginal discharge with a fishy odor.

Bacterial vaginosis should be treated by a doctor. It all starts with a diagnostic examination and an accurate diagnosis. Strict adherence to the treatment regimen, preventive measures, as well as the elimination of provoking factors will help get rid of the disease once and for all!

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 is 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: https://hvzvezda.ru/zdorove/kak-lechit-bakterialnyi-vaginoz.html

Today we will talk about:

Vaginosis is a pathological condition of the vaginal mucosa of non-inflammatory origin, caused by the replacement of normal microflora with anaerobic microorganisms. There is no specific pathogen for vaginosis. Among the causes that provoke it, there are many different microorganisms, but their presence does not provoke local inflammatory changes in the vagina. It is on this feature of the course of the disease that the differential diagnosis of vaginosis is based.

The causes of vaginosis have not been sufficiently studied, and the question of whether it belongs to diseases continues to be discussed. The only condition for the development of vaginosis is considered to be a change in the indicators of normal vaginal microbiocenosis and, as a consequence, a violation of the mechanism of protection of the mucous membranes from unwanted microorganisms.

To understand the essence of pathological processes in vaginosis, it is necessary to have a clear understanding of how the vaginal epithelium functions and through what mechanisms it protects the reproductive system from potential infection.

The vagina connects the uterus (and indirectly the appendages) with the external environment and is therefore in a constant state of counteracting its negative influence in order to protect the internal genitalia from inflammation.

The vaginal wall is formed by three layers: connective tissue, muscle and epithelial. The vaginal epithelium is formed by layers of flat-shaped cells, its uppermost layer (the one that lines the inside of the uterine cavity) is in a state of constant renewal. Every month, in accordance with cyclical changes in other genital organs, the surface layer of the vaginal epithelium is sloughed off (desquamated) and replaced by new cells. Thus, the mucous membrane is “cleansed” of the potential cause of inflammation and protects the upstream organs from infection.

The key to successful barrier function of the mucous membranes is the constancy of the vaginal microenvironment. In a healthy vagina, it is represented by a dominant amount (98%) of lactobacilli and a small population of opportunistic microorganisms. The quantitative superiority of lactoflora provides reliable protection of mucous membranes from infection. If there are fewer lactobacilli, opportunistic microbes take their place.

To ensure a numerical advantage, lactobacilli create conditions that are unsuitable for the growth of “harmful” microorganisms. They attach to the membranes of desquamated cells of the surface epithelium and “extract” glycogen from them, and then synthesize lactic acid from the latter. As a result, a constant level of acidity is maintained in the vagina (3.8 – 3.5). In an acidic environment, opportunistic flora is not able to compete with lactobacilli, and therefore remains small and safe.

Vaginosis is formed if, against the background of a quantitative decrease in lactobacilli and changes in acidity (pH), populations of opportunistic microorganisms begin to multiply in the vagina, i.e. in essence, it is a local dysbiotic disorder.

Thus, vaginosis is formed due to “its own” microflora, which is constantly present in the vagina of any healthy woman. It is impossible for them to be “infected” or betrayed to a partner during intimacy.

Acute vaginosis is rarely diagnosed. Since vaginosis does not provoke pronounced inflammation, the disease often does not have active subjective complaints. The pathological process in the vaginal mucous membranes can proceed gradually, either exacerbating or fading again.

Chronic vaginosis depletes local immunity and can cause inflammation when, against the background of a significant decrease (or complete disappearance) of lactoflora in the vagina, unwanted microorganisms begin to multiply excessively.

Perhaps the only symptom of vaginosis is pathological discharge. Their color and consistency depend on what microflora displaces lactobacilli, how long vaginosis exists, and what background processes occur in the surrounding tissues.

Diagnosis of vaginosis is based on visual examination of the mucous membranes and laboratory examination of vaginal discharge. By studying the microbial composition of vaginal leucorrhoea, the severity of the disease is determined: the fewer lactobacilli in the material, the more severe the vaginosis.

Therapy for vaginosis does not have a clearly defined plan. Each treatment regimen for vaginosis is the result of an individual study of the clinical situation. As a rule, treatment is aimed at eliminating unwanted microbial flora and restoring the lactobacilli population. Oral tablets for vaginosis are prescribed according to indications. Preference is given to a topical drug (ointments, creams, suppositories).

Vaginosis often recurs. Prevention of vaginosis and its relapses lies in the exclusion of provoking factors and a reasonable attitude towards sexual life.

The reason for the formation of vaginosis is its own opportunistic microflora present in the vagina of a healthy woman. Perhaps this is the uniqueness of vaginosis: the body independently provokes the disease without attracting external resources.

The microbial composition of the vaginal environment is individual for each individual woman, so it is impossible to name the only culprit in the development of vaginosis. It is provoked by polymicrobial complexes, which consist predominantly of anaerobic microorganisms (mainly coccal in nature). More often, with vaginosis, corynebacteria, mycoplasmas, epidermal staphylococcus, lactic acid streptococci and other microbes prevail in the vaginal contents. It should be noted that the previously existing idea of ​​the dominant role of Gardnerella in the pathogenesis of vaginosis has now been refuted by numerous studies. It turned out that Gardnerella colonizes the vagina in more than 50% of healthy women, without causing pathological dysbiotic changes in the habitat. Obviously, this microorganism acts as a pathological agent only if it is associated with other microflora.

Factors that provoke dysbiotic disorders in the vagina are:

Incorrect hygiene measures. Some patients use douching too often, during which the “beneficial” microflora is simply mechanically washed off from the surface of the mucous membranes. Also, aggressive cosmetics (soaps, gels) that are not suitable in composition for intimate care have a negative effect on the vaginal epithelium.

Lack of proper intimate hygiene can also provoke vaginosis, since many unwanted microbes and their waste products accumulate on the mucous membranes.

Irrational antibiotic therapy. Free access to the purchase of antibiotics (including very “strong”) has very negative consequences: without the participation of a qualified medical examination, patients are treated independently, not always choosing and taking medications correctly.

Antibiotic therapy prescribed by specialists always involves measures to prevent dysbiotic disorders and rarely leads to the formation of vaginosis.

Hormonal dysfunction. All processes occurring in the vaginal mucosa are closely related to cyclic hormonal fluctuations. The state of the vaginal microflora is influenced by the level of estrogen; they support the renewal processes of the surface mucous layer, providing lactobacilli with a sufficient amount of glycogen. Under conditions of hypoestrogenism (especially long-term), the mucous layer becomes thinner, the population of lactobacilli decreases, and opportunistic microorganisms begin to actively vegetate.

Vaginosis in pregnant women, menopausal women, or those who have recently had an abortion is often explained by changes in normal hormonal levels.

Taking hormonal medications or contraceptives can also contribute to the appearance of vaginosis.

• Unprotected intimate relationships with different partners. In addition to the increased likelihood of getting a sexually transmitted infection, promiscuity leads to serious changes in the composition of the vaginal microflora and depletes local immunity. Moreover, the number of sexual partners increases the risk of vaginosis much more than the number of unprotected sexual intercourse.
• Intestinal dysbiosis. Symmetric dysbiosis of the intestinal and vaginal mucosa is often diagnosed, especially against the background of endocrine diseases or antibiotic therapy. Every second patient with vaginosis has diagnosed intestinal dysbiosis.
• Immunological reactivity disorders. Vaginosis can be caused by systemic allergic diseases or short-term local allergic reactions, for example, to hygiene products (vaginal tampons, soap, etc.), intimate lubricants, latex or talc contained in condoms.
• Intrauterine contraception (spiral). It provokes the appearance of vaginosis quite often (52%). Obviously, the spiral is perceived by the mucous membranes as a foreign body, and they respond to its presence with a local allergic reaction. In addition, any (even the “good”) intrauterine contraception serves as a source of local non-infectious inflammation. In order for the intrauterine contraceptive to fulfill its intended purpose without accompanying negative manifestations, it is necessary to follow simple medical recommendations and not leave it in the uterine cavity longer than prescribed.

Whatever the causes of vaginosis, short-term changes in the normal composition of the vaginal microflora in most healthy patients are eliminated through self-regulation mechanisms. The disease develops only if the body is unable to eliminate local dysbiosis on its own.

Symptoms and signs of vaginosis

The leading, and sometimes the only, symptom of vaginosis is pathological discharge (leucorrhoea). Their number and appearance depend on several factors, one of which is the duration of the disease.

Acute vaginosis is accompanied by copious white liquid leucorrhoea; sometimes the vaginal discharge has a grayish tint and an unpleasant odor. More often, an acute process occurs after hypothermia, severe emotional shock, allergic reactions, as a result of antibiotic therapy.

Chronic vaginosis can persist for years. If dysbiotic disorders in the vagina last more than two years, the discharge becomes thick and sticky, and its color changes to yellow-green. The change in the nature of leucorrhoea in chronic vaginosis is associated with the degree of local dysbiosis: the longer vaginosis lasts, the less lactobacilli remain in the vagina, and the more pronounced the influence of opportunistic microflora. Long-existing vaginosis significantly depletes the local defense mechanism of the mucous membranes and can often cause the addition of secondary pathological microflora and the development of infectious inflammation.

Vaginosis discharge has one specific difference - an unpleasant odor, reminiscent of the smell of stale fish. It is “provided” by anaerobic bacteria competing with lactoflora. They synthesize substances (amines) that decompose, releasing an unpleasant, “rotten” odor. Often what brings a patient to the doctor is not the presence of leucorrhoea, but its unusual smell.

The clinical picture of vaginosis also depends on the state of hormonal function, in particular on the level of estrogen. Lower (compared to progesterone) concentrations of estrogen lead to a decrease in glycogen content in the vaginal epithelium. Since fewer lactobacilli are required to process a small amount of glycogen, their number decreases, and the free space is competitively occupied by anaerobic microflora. A prolonged absence of proper estrogenic influence provokes thinning of the vaginal mucous layer (peat). The vagina becomes “dry” and easily vulnerable, so the amount of leucorrhoea due to vaginosis decreases, and the patient develops subjective complaints of discomfort, dryness, burning and/or itching. These are typical for women with physiological (old age) or artificial (removal of the ovaries) menopause.

Diagnosis of vaginosis does not require a large number of examinations, however, the analysis of the data obtained is associated with some difficulties. Vaginosis should be distinguished from vaginitis, which, unlike the latter, is a consequence of infectious inflammation of the vaginal mucosa. Patients often treat non-existent vaginitis for years using antibiotics, which only worsen vaginal dysbiosis and lead to the development of chronic vaginosis.

The diagnosis of vaginosis is confirmed by several reliable criteria:

• Absence of inflammatory changes in the vaginal mucosa. Upon visual examination, the mucous membrane has a normal “healthy” appearance and pink color. There is an increased amount of light discharge in the vagina without external signs of the presence of pus; often (87%) an unpleasant odor is felt upon examination.
• Changes in the acidity of the vaginal environment. To measure pH quantitatively, special indicator test strips are used. The division scale applied to them for vaginosis indicates a characteristic shift in acidity to the alkaline side (more than 4.5).

Changes in the microbial composition of vaginal discharge according to the results of laboratory diagnostics. The smears do not contain an increased number of leukocytes, which is inherent in inflammatory diseases, but there is a quantitative shift in the microbial composition: against the background of a decrease (or complete absence) of lactoflora, there is an excessive increase in populations of opportunistic microorganisms.

Among other anaerobic bacteria, large numbers of Gardnerella are often found. In acceptable quantities, their population is completely harmless to mucous membranes, but under conditions of severe dysbiosis, gardnerellas become part of microbial associations and “help” maintain the pathological process. The simple detection of Gardnerella in a smear has no independent significance.

The presence of so-called “key cells” in the smear. When microscopy of vaginal discharge with vaginosis, a large number of desquamated epithelial cells with microbes adhered to their membranes are often visualized. They are called “key”.

Thus, the diagnosis of vaginosis is confirmed:

• specific vaginal discharge (usually with a “fishy” smell);
• vaginal pH increased above 4.5;
• positive "amine test";
• key cells in the smear.

In 40% of patients with signs of vaginosis, upon examination, background diseases are detected on the cervix (cervicitis, ectropion, scars), most often pseudo-erosion. They often change the clinical picture of vaginosis and require additional colposcopic examination.

Despite the scanty symptoms, the presence of vaginosis can be suspected at the stage of studying clinical symptoms. Often in conversations, patients point out long-term, unsuccessful treatment of the so-called “inflammation” of the vagina. They may also note that the next course of anti-inflammatory therapy does not eliminate, but rather worsens, negative symptoms.

In recent years, patients are often faced with the conclusion “cytological vaginosis”. Unlike the usual, cytological vaginosis is a consequence of excessive proliferation of lactobacilli. This condition is often provoked by intimate hygiene products with an acidic pH, especially if they contain lactobacilli. Sometimes this type of vaginosis can appear against the background of hyperestrogenism. Excess estrogen stimulates excessive glycogen production, which requires more lactobacilli to be utilized.

Clinically, cytological vaginosis resembles candidal vaginitis, when profuse white “curdled” discharge appears against the background of vaginal discomfort, burning or itching. Both conditions are clinically so similar that diagnostic errors often occur.

It is possible to differentiate cytological vaginosis from it according to the following criteria:

• vaginal pH less than 3.5;
• microscopically: many cells of destroyed epithelium in the form of fragments against the background of a large number of lactobacilli;
• false key cells: instead of opportunistic microbes, lactobacilli attach to the surface of epithelial cells, imitating true key cells;
• cultures and smears for the presence of candida fungi are negative;
• no signs of inflammation (leukocytes are normal) in smears.

Vaginosis during pregnancy

In half of the cases, the disease does not cause pathological subjective sensations, and an increased amount of vaginal discharge is accepted by the pregnant woman as normal.

The only reliable symptom of vaginosis in pregnant women is profuse, loose leucorrhoea with an unpleasant odor. If the discharge continues for a long time, the patient may notice a change in its consistency from liquid to thick, and in color from white to yellowish. Often in a conversation it turns out that episodes of the appearance of such leucorrhoea were observed before pregnancy.

Diagnosis of vaginosis in pregnant women is similar to that in non-pregnant women and includes the study of complaints (if any), visual examination of the vaginal mucous membranes and laboratory examination of vaginal contents. An amine test and vaginal pH measurement are also performed.

Pregnant women are examined for the presence of vaginosis three times: at the first visit, before maternity leave (27 - 30 weeks) and on the eve of childbirth. In case of a positive result, after a course of therapy, an additional examination is carried out to monitor the cure.

Vaginosis during pregnancy can provoke infectious inflammation. Against the background of reduced immunity, an infection from the vagina can rise into the cervical cavity and uterus. And although the likelihood of such a scenario is low, vaginosis in pregnant women cannot be ignored.

The treatment regimen for vaginosis in pregnant women is characterized by the predominance of local therapy. Systemic drugs are used infrequently and only in the second half of pregnancy.

Treatment of vaginosis

To cure vaginosis, it is necessary to consistently eliminate its causes: remove the unfavorable background that provokes dysbiosis in the vagina; destroy excessively multiplied opportunistic microflora and restore the normal number of lactobacilli.

To choose the right treatment strategy, it is necessary to take into account the severity of vaginosis. It is measured by the amount of lactoflora remaining in the vagina and the microbial composition of the vaginal environment.

Conventionally, there are three significant degrees of severity of vaginosis:

• The first degree of severity (compensated vaginosis) is characterized by the complete absence of microflora in the studied material, the presence of unchanged, normal vaginal epithelium. The cause of such vaginosis may be excessive intimate hygiene or antibiotic therapy. Compensated vaginosis does not always require detailed therapy; sometimes the body independently copes with a temporary disturbance in microbial balance after the cause of its appearance disappears.
• The second degree (subcompensated) of vaginosis severity is characterized by a decrease in the number of lactobacilli, a quantitative increase in the population of anaerobic bacteria and the appearance of key cells in a small number (up to five in the field of view).
• Decompensated (third) degree of severity is manifested by a pronounced clinical picture of vaginosis, the complete absence of lactobacilli against the background of a large number of microbial populations and a significant number of key cells (covering the entire field of view).

After the unwanted infection is eliminated, a niche is released in the vaginal environment, which should be occupied by lactobacilli. At the second stage of treatment, favorable conditions are created to restore normal microbial balance with the help of eu- and probiotics containing lacto- and bifidobacteria.

Two-stage treatment of vaginosis is successful in 90% of cases, but it does not guarantee the absence of relapses of the disease. Recurrent vaginosis is treated similarly to the acute process. To avoid the return of vaginosis, simple preventive measures should be followed. Prevention of vaginosis involves:

• adequate intimate hygiene;
• rational antibiotic and hormonal therapy;
• prevention (or treatment) of intestinal dysbiosis;
• culture of sexual life: restriction of sexual partners and use of barrier contraception;
• regular examinations in antenatal clinics.
• Suppositories and drugs for vaginosis

The choice of medicine depends on what microorganisms are found in the material during laboratory testing.

The local method of drug administration is preferable, so the following are most often prescribed: Chlorhexidine in solution or Hexicon vaginal suppositories; suppositories or cream Clindamycin (Metronidazole), Flagyl suppositories.

An alternative to local treatment is to take Metronidazole, Tinidazole, Ornidazole tablets according to the regimen chosen by the doctor.

One of the most common reasons for visiting a gynecologist is the clinical manifestations of bacterial vaginosis. However, cases of erased forms of the disease are not uncommon. Women do not observe pronounced symptoms and do not consult a doctor. Vaginosis that is not treated in time entails a number of unpleasant consequences. There are many factors that cause the disease, and sometimes they are harmless.

Cause of illness

Bacterial vaginosis, or dysbiosis, occurs in women aged 15 to 50 years. The disease is not considered a sexually transmitted disease, but it is transmitted through sexual contact.

The microflora of a woman’s vagina contains a set of microorganisms. Normally, lactobacilli predominate. They convert glycogen into lactic acid. As a result, the acid-base balance decreases, and the female body prevents an increase in the number of anaerobic microorganisms, gonococci, gardnerella, staphylococci, trichomonas and others.

If the volume of lactobacilli decreases, they cannot cope with the protective function, and the number of harmful microbes increases. Among them is gardnerella, the causative agent of bacterial vaginosis.

Risk factors

The following factors can provoke an increase in the number of opportunistic bacteria:

• Taking antibiotics. Medicines destroy harmful and beneficial bacteria.
• Long-term use of intrauterine contraceptives.
• Hormonal disbalance.
• Decreased immunity.
• Poor hygiene or washing out lactobacilli by douching.
• Multiple changes of sexual partners.
• Medical procedures - termination of pregnancy, curettage.
• Disturbance of intestinal microflora, which causes dysbacteriosis.
• Radiation therapy.
• Wearing synthetic underwear, pads and tampons. This prevents oxygen from entering.
• Diet limited in fermented milk products.

Bacterial vaginosis does not appear from going to the pool, contact with bedding or toilet seats.

Symptoms

The disease is not accompanied by an inflammatory process at the initial stage. For bacterial vaginosis, the characteristic symptoms are light-colored liquid discharge that causes itching and discomfort. If you do not contact a gynecologist at the first signs, the discharge acquires a thick consistency, becomes viscous and foamy. The amount increases before the start of the menstrual cycle or after sexual intercourse.

With the further course of the disease, urogenital infections and pyogenic microbes are added. At this stage, inflammation develops and the discharge changes. They acquire a green tint, a uniform consistency with streaks of blood. A characteristic sign of vaginosis is the smell of “rotten fish.”

Why is bacterial vaginosis dangerous?

Vaginosis not only worsens the quality of life, but also weakens the immune system. Women are at risk of contracting more serious illnesses.

Among patients there is a predisposition to inflammatory processes of the genital organs and cervical dysplasia. Vaginal dysbiosis can provoke an unfavorable pregnancy outcome and problems during recovery. Creates a favorable environment for the development of sexually transmitted diseases: HIV infection, papillomavirus infection, hepatitis. Infectious complications after gynecological procedures occur more often in women with untreated vaginosis.

When overcoming infertility, the likelihood of successful fertilization of an egg outside the mother's body decreases in patients with bacterial vaginosis.

Vaginal dysbiosis negatively affects women's reproductive health. At risk are young girls, expectant mothers or women in labor, as well as women who are infected with sexually transmitted diseases.

Diagnostics

Having discovered the characteristic symptoms of vaginosis, you need to visit a gynecologist. Already during the examination, the doctor will preliminarily evaluate the microflora of the vagina. However, an accurate diagnosis can only be made with an integrated approach. To do this, the patient’s complaints, the condition of the vagina during a gynecological examination are taken into account, and laboratory diagnostics are performed.

According to the Amsel criteria, bacterial vaginosis is diagnosed if 3 out of 4 signs are present:

1. Amine test. With dysbacteriosis, the discharge has a “rotten fish” smell. If they are mixed in equal proportions with potassium hydroxide and the stench intensifies, then the amine test is considered positive. This laboratory method accurately determines the disease in 94% of patients.
2. Homogeneous discharge that adheres to the walls of the vagina is endowed with a foul odor.
3. The pH of vaginal secretions is above 4.5. To carry out pH measurements, indicator paper with a standard scale or various modifications of pH meters are used.
4. Identification of “key” cells by examining Gram-stained smears of vaginal discharge.

Bacterioscopy of smears is performed. If epithelial cells predominate over leukocytes, less than 5 lactobacilli are detected during enlargement with immersion, the accuracy of the study is close to 100%.

A diagnosis based on one of the criteria is inaccurate. Among all methods, the most sensitive is the detection of “key” cells.

Treatment of bacterial vaginosis

The success of therapy depends on timely and correct diagnosis of the disease. The goal is to stop the proliferation of harmful microbes and restore the balance of the vaginal microflora. How to cure bacterial vaginosis without relapse is an incompletely studied topic. The proposed medications do not always help.

Complex therapy includes treatment with antibacterial drugs and eubiotics. The action of antibiotics is aimed at eliminating dangerous microorganisms that cause vaginosis.

Metronidazole quickly fights bacteria. The drug enters the pathogen cell, contacts DNA, and stops the connection of nucleic acids. Metronidazole is effective in single doses and in 7-day courses of treatment. Oral use of the medicine may cause adverse reactions: allergic manifestations, disorders in the digestive system, metallic taste in the mouth. Studies have shown that the vaginal route of treatment with metronidazole does not cause unwanted side effects. Sometimes doctors recommend combining oral and vaginal administration of tablets.

Clindamycin actively fights the disease. Used topically and orally.

After a course of antibiotics or at the same time, eubiotics are prescribed. They restore favorable vaginal microflora and stimulate the growth of their own lactobacilli. The most common are acylact, lactobacterin, bifidumbacterin. Eubiotics reduce the likelihood of relapse by increasing the protective functions of the vagina.

While taking medications, it is advised to abstain from sexual intercourse or use barrier contraception. After completing treatment, the effectiveness of therapy can be assessed after 14 days.

ethnoscience

Folk remedies will help speed up recovery.

To restore the acidic environment of the vagina, douching is used. The procedure is carried out 1-2 times a day. This requires 200 ml of the prepared composition.

There are many douching recipes, here are some of them:

• 1 tbsp. oak bark is poured with 1 glass of boiling water;
• 2 tbsp chamomile and cinquefoil are poured with a liter of boiling water;
• 1 tbsp. Bird cherry fruits are poured with 2 cups of boiling water.

To reduce itching and burning, use a tampon. It is soaked in a mixture of aloe juice and olive oil. After which it is placed in the vagina for 7 hours.

Teas and decoctions with birch leaves, lavender flowers, thyme, and geranium leaves strengthen the immune system - recovery occurs faster. Contraindicated for use in case of individual intolerance. Before use, you should consult your doctor.

Prevention

If a woman has encountered bacterial vaginosis, it is recommended to complete the prescribed treatment, otherwise relapses are inevitable. Infections of the genitourinary system provoke the development of the disease. Therefore, they need to be treated on time, without waiting for complications.

It has been proven that people who regularly consume probiotics rarely experience dysbiosis. This happens because probiotics consist of living beneficial bacteria that restore the normal microflora of the vagina and digestive system.

Maintaining intimate hygiene, avoiding promiscuity and hypothermia are the main preventive measures, and strong immunity increases the body's resistance to an increase in the number of harmful bacteria.

If dysbiosis develops, you should not self-medicate. Only the doctor can determine how to treat vaginosis. Otherwise, complications are likely to occur.

Pregnant women are less likely to suffer from bacterial vaginosis. The disease can cause the following problems:

• early spontaneous abortion;
• early birth, before 37 weeks of pregnancy;
• early rupture of membranes;
• postpartum infection of uterine tissue.

To avoid complications, the expectant mother must visit a gynecologist who will prescribe the correct treatment. Until the 20th week of pregnancy, local therapy is prescribed. This is due to the fact that medications can negatively affect the development of the fetus.

In the second half of pregnancy, the doctor may resort to systemic therapy.

A diet containing fermented milk products increases the effectiveness of treatment. Moderate physical activity, strengthening the immune system and good mood help normalize the vaginal microflora.

Bacterial vaginosis in men

Men become infected with vaginosis from a sexual partner. A woman may not know that she has dysbiosis. After all, symptoms do not always appear, and gardnerella is present in the vaginal microflora and is safe with minimal content.

Symptoms appear no earlier than a week after sexual intercourse. A man experiences discomfort when urinating. A green discharge with a rotten odor appears on the head of the penis, and the genitals become covered in a rash. If treatment is not started, cystitis, epididymitis, and pyelonephritis cannot be ruled out.

Therapeutic methods in men include taking immunomodulators, antibiotics and bifidobacteria. For effectiveness, instillation into the urethra or a series of physiotherapy procedures are prescribed.

Bacterial vaginosis can be transmitted even through shared hygiene products. To avoid infection, you need to eliminate risk factors.

How to cure chronic bacterial vaginosis in women can be determined by a gynecologist depending on the symptoms and provoking factors. The disease is a long-term process accompanied by vaginal dysbiosis. The chronic type of pathology is characterized by a violation of the vaginal microflora, while the number of opportunistic microorganisms predominates over lactobacilli.

Causes of development of chronic gardnerellosis

The causes of chronic gardnerellosis can be different; the appearance of vaginal dysbiosis is due to the influence of a number of factors, the main of which are:

Signs of illness

Symptoms characterizing chronic gardnerellosis are as follows:

The chronic form of the disease does not cause any particular inconvenience, but as immunity declines, the symptoms may become more pronounced.

Diagnostics

If a chronic type of gardnerellosis is suspected, the gynecologist takes a smear, with which it is possible to identify opportunistic microflora. An important change in pH is the increase in pH, which creates a favorable environment for the growth of bacteria.

The presence of gardnerella in a smear does not make it possible to make an accurate diagnosis, since these representatives of opportunistic microflora are also present in healthy women. The doctor takes into account the ratio of bacteria and lactobacilli. If the former are superior to the latter, additional tests are prescribed:

As an additional diagnostic method, ultrasound is used to determine the presence of an inflammatory process in the ovaries, bladder and uterus, which is due to an advanced form of the disease.

Treatment of chronic bacterial vaginosis

The chronic form of the disease is amenable to complex treatment. For therapy, oral medications are used, as well as suppositories and ointments. Groups of medications that are prescribed for the treatment of gardnerellosis:

When treating chronic gardnerellosis, it is important to follow a diet. It is necessary to include as many vegetables, fruits and dairy products in the menu as possible. You should avoid alcohol, coffee and soda. It is necessary to exclude fats and smoked foods. It is recommended to consume more freshly squeezed juices.

During treatment, it is important to abstain from sexual intercourse. If there is a concomitant infection, therapy is required for both partners. If there is a chronic type of pathology, then it is necessary to wash yourself at least 2 times a day, and it is advisable to use a chamomile decoction, which will help get rid of unpleasant sensations in the vagina. Soap must be used without fragrances. Economic or tar will be useful. During treatment, panty liners should not be used.

Prevention

Prevention of chronic gardnerellosis comes down to following the rules, the main ones of which are:

To prevent chronic gardnerellosis, it is important to undergo an examination by a gynecologist at least once a year and take a smear for microflora. If you experience heavy discharge with an unpleasant odor, you should immediately consult a doctor.

Possible complications

If treatment is not taken in a timely manner, chronic gardnerellosis often causes complications, the main of which are:

• the occurrence of endocervicitis;
• spread of the inflammatory process to the ovaries;
• adhesions in the pelvic organs;
• addition of other types of pathogenic microflora;
• the appearance of cervical erosion.

If, in addition to gardnerella, trichomonas, chlamydia, fungi and other pathogens are present, then the risk of developing cystitis in the chronic form of the disease increases.