Women present with bacterial vaginosis disease. How to treat bacterial vaginosis, symptoms, causes, treatment with suppositories, tablets. How to treat bacterial vaginosis

Bacterial vaginosis - 8 out of 10 women of childbearing age have encountered this disease at least once in their lives. It is also diagnosed in 76% of cases when patients visit a gynecologist. However, there are still many myths surrounding bacterial vaginosis, also known as vaginal dysbiosis or gardnerellosis. Let's try to figure out where truth ends and fiction begins.

Myth #1: Bacterial vaginosis is sexually transmitted

In fact, the nature of the disease is best characterized by the term “bacterial,” which was thoughtfully included in the name.

Every woman's vagina is a mobile ecosystem in which more than 300 species of bacteria coexist. Normally, lactobacilli predominate among them, protecting our body from the invasion and proliferation of pathogenic microbes. Bacterial vaginosis develops when, under the influence of certain factors, beneficial lactic acid bacteria give way to opportunistic microflora, which cause the disease only with reduced immunity. Previously, it was believed that a single type of bacteria, the so-called Gardnerella vaginalis, was responsible for the development of pathology, but scientists now believe that the disease arises due to the very fact of an imbalance in the “microbial balance.”

Anything can trigger bacterial vaginosis. According to Doctor of Medical Sciences, Professor of the Department of Obstetrics and Gynecology of the Medical Faculty of Moscow State Medical University Alexander Leonidovich Tikhomirov, first of all, these are frequent sexual intercourse (more than 4-5 per week), intrauterine contraception, cunnilingus, uncontrolled use of antibiotics, the use of tampons and synthetic underwear, poor hygiene or, conversely, excessively frequent douching, which leads to the washing away of healthy vaginal microflora. However, like any dysbacteriosis, this disease is not sexually transmitted.

To avoid relapse of the disease, it is extremely important to follow the rules of personal hygiene:

• Do not wear tight, synthetic underwear. It disrupts blood circulation in the pelvic organs and is poorly ventilated, creating a warm and humid environment in the perineum - ideal conditions for the proliferation of Gardnerella.
• Do not overuse tampons and panty liners, especially those containing fragrances.
• Wash yourself wisely - not from bottom to top, but from front to back.
• Use intimate hygiene products that help restore the natural pH level of the vaginal environment. The best option is to use a combination of special soap and gel with a Ph from 3.8 to 4.4 (this information should be indicated on the packaging). In addition, among the ingredients, look for lactic acid, preferably in combination with plant extracts (calendula, chamomile, sage), which moisturize the mucous membranes.

We thank Alexander Leonidovich Tikhomirov, obstetrician-gynecologist, MD, professor, and the experts of the pharmaceutical company "EGIS" for their help in preparing the material.

Bacterial vaginosis - first symptoms and treatment regimen

The nature of the disease depends on many factors, so when your health improves, the symptoms completely disappear. The disease is not sexually transmitted and does not affect men. Unprotected sexual intercourse has a certain role in the occurrence of the disease. Frequent changes of partners contribute to changes in the vaginal microflora.

What it is?

Bacterial vaginosis is a condition of the vaginal microflora in which the number of beneficial lactobacilli is significantly reduced, and the number of pathogenic ones increases. It can develop for many reasons - from the presence of a sexually transmitted infection to a banal decrease in immunity.

Causes

To date, science does not fully have information about what actually provokes the development of non-inflammatory syndrome. However, the relevance of this problem is increasing every year.

Factors that provoke the development of the disease include:

• weakening of local and general immunity;
• poor nutrition;
• long-term antibacterial and hormonal therapy;
• frequent douching;
• the use of local contraceptives (condoms, creams and suppositories) that contain 9-nonoxynol;
• frequent change of sexual partners;
• wearing synthetic underwear;
• endocrine and gynecological pathologies;
• failure to comply with basic rules of personal hygiene;
• intestinal diseases.

Currently, bacterial vaginosis is one of the most common diseases among women of active reproductive age (from 23 to 33 years). According to statistics, about 30-35% of women suffer from vaginosis, but only half of the total number of patients know about their problem due to the presence of a characteristic odor. The rest, as a rule, don’t even know about it.

Symptoms

Often the only symptom of bacterial vaginosis is the presence of copious vaginal discharge with an unpleasant smell of stale fish, which can bother you for a long time. At the beginning of the disease, the discharge is thin, white or grayish.

The general symptoms of bacterial vaginosis are as follows:

• discharge with an unpleasant odor (fishy), which occurs as a result of the breakdown of amines produced by anaerobic bacteria.
• copious, homogeneous, creamy vaginal discharge of a grayish-white color, adhering to the walls of the vagina.
• sometimes vulvovaginal irritation appears in the form of itching and burning, discomfort during sexual intercourse.
• signs of vaginal inflammation (addition of vaginitis) are observed in half of the patients.
• rarely - urination disorders and pain in the perineum.

If the disease continues for a long time, more than 2 years, then the following symptoms occur:

• the color of the discharge becomes dark green;
• leucorrhoea changes its consistency, becomes more viscous or resembles a curdled mass;
• Also, the following signs are characteristic of discharge due to vaginal dysbacteriosis: over time they become thick and sticky, and their distribution along the vaginal walls is even. Leucorrhoea is easily removed from the walls with a cotton swab;
• with a long-term process, a number of patients complain of minor or moderate itching/burning in the vulva area (see vaginal itching);
• pain during sexual intercourse (see pain during intercourse);
• the volume of vaginal discharge reaches 0.02 liters per day (taking into account that the normal amount of leucorrhoea is no more than 2 - 4 ml);
• in a number of situations, pathogenic flora joins the described infectious process, which contributes to the development of vaginitis;
• Sometimes urinary disorders occur (frequent and painful urination in women).

A distinctive feature of the disease is the absence of visible signs of inflammation. That is, upon visual examination, a physiological pink color of the vaginal mucosa is observed. Only in some cases, single reddish dots are noted in menopausal women.

Severity

According to the severity of vaginal dysbiosis, there are:

According to the flow, acute, torpid or erased and asymptomatic vaginal dysbiosis is distinguished.

Diagnostics

A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After the examination, discharge is taken from the posterior inferior vaginal vault.

The diagnosis can be made if 3 of the 4 listed signs are present:

• specific nature of the discharge;
• acidity >4.5 (normal 3.8-4.5);
• positive amino test;
• presence of “key” cells. The so-called “key cells” are mature epithelial cells (the superficial layer of the vaginal epithelium), along the entire surface of which microbes are densely and in large numbers attached.

Completing one of the 4 tests is not sufficient to make a diagnosis.

How to treat bacterial vaginosis?

Initially, a woman is prescribed antibiotics to treat bacterial vaginosis: they have a detrimental effect on nonspecific bacteria and clear the vaginal mucosa of them.

The drugs of choice are Metronidazole, Tinidazole, Clindamycin, as they are active against anaerobes. Local use of antibiotics is preferable to avoid systemic side effects, but in some cases the gynecologist is forced to resort to tablet forms.

The treatment regimen is selected individually:

• Tinidazole 2.0 in tablet form is taken orally 1 time per day for 3 days;
• Metronidazole in the form of a 0.75% gel is administered into the vagina once a day for 5 days;
• Clindamycin suppositories 100 mg are administered into the vagina once a day for 3 days;
• A cream containing 2% Clindamycin is injected into the vagina once a day for 7 days;
• Metronidazole 2.0 tablets are taken orally once.

During antibacterial therapy and a day after its completion, it is necessary to avoid drinking alcohol, even in minimal doses. The drugs disrupt the metabolism of ethyl alcohol in the body, which causes the accumulation of toxic metabolites and severe intoxication. In its course, it resembles a severe hangover: the woman experiences severe weakness, limbs shake, blood pressure rises, a severe throbbing headache occurs, and painful nausea and vomiting develop.

Clindamycin cream contains fat, so it can damage the condom or latex contraceptive membrane. All local forms of drugs are administered immediately before bedtime to prevent them from flowing down the vaginal walls.

If antibiotics are intolerant or there are contraindications to their use, the first stage of treatment is carried out with local antiseptics:

• Hexicon 1 suppository is administered 2 times a day for 7-10 days;
• Miramistin in the form of a solution is irrigated into the vagina once a day for 7 days.

Preparations for bacterial vaginosis, used in the second stage of treatment, contain lactobacilli and create favorable conditions for restoring the vaginal microflora. They are used 2-3 days after completion of antibacterial therapy:

• Acylact 1 suppository 2 times a day is inserted into the vagina for 5-10 days;
• Bifiliz 5 doses are taken orally 2 times a day for 5-10 days.

Antifungal suppositories for bacterial vaginosis are usually not prescribed. The need for them arises if candidiasis, a fungal infection, joins the opportunistic microflora. In this case, Clotrimazole suppositories are prescribed intravaginally once a day for 6 days.

Treatment during pregnancy

How to treat bacterial vaginosis in case of pregnancy? In the first trimester of gestation, systemic therapy for the disease is not performed (metronidazole and other drugs are toxic to the embryo). Local administration of etiotropic drugs in the early stages is used with caution.

Taking metronidazole or clindamycin begins in the second trimester and is carried out in short courses. Metronidazole 0.5 g. (2 tablets) twice a day for 3–5 days, and clindamycin is prescribed in a dosage of 0.3 g. 2 times a day for 5 days.

Pregnancy complications that may occur due to the disease include:

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

Prevention

• using barrier methods of contraception, wearing underwear only made from natural fabrics;
• regular examination by a gynecologist and timely treatment of diseases;
• treatment of chronic pathologies of internal organs;
• strengthening the immune system in natural ways: physical activity, hardening, etc.;
• avoiding douching and other similar procedures.

Bacterial vaginosis is a pathology that reflects a decrease in the body’s level of defense at the moment. Often occurring asymptomatically, gardnerellosis is always detected during examination by a gynecologist. Only a doctor can prescribe the most effective tablets for bacterial vaginosis, suppositories or other forms. Don't delay treatment!

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Pathogens

What is bacterial vaginosis?

How does the disease develop?

Factors predisposing to the development of bacterial vaginosis include:
Long-term treatment with antibacterial drugs, including antibiotics
Past inflammatory diseases of the genital organs
Oral and intrauterine contraception
Frequent change of sexual partners
Hormonal disorders
Decreased immunity
Chronic intestinal diseases and other diseases that can cause dysbiosis
Poor nutrition – lack of fermented milk products in the diet
Excessive use of panty liners and tampons
Frequent wearing of tight-fitting, tight-fitting synthetic underwear and trousers.

If the balance of the vaginal microflora is disturbed, the pH of the vaginal contents changes from 4.5 to 7.0 - 7.5. As a result of the activity of pathogenic microorganisms, complex chemical compounds (volatile amines) are formed in the vagina, which contributes to the release of the unpleasant odor of “rotten fish”. These pathological mechanisms disrupt the normal functioning of natural biological barriers in the vagina and favor the development of various inflammatory diseases of the genital organs and postoperative infectious complications.

Clinical manifestations

• The main complaint is numerous homogeneous creamy grayish-white foamy vaginal discharge, slightly viscous. Discharge sticks to the walls of the vagina and is evenly distributed along its walls. The discharge is accompanied by an unpleasant smell of “rotten fish”


• Itching and burning in the vaginal area


• Dyspareunia – discomfort and pain during sexual intercourse


• Urinary dysfunction

How to diagnose bacterial vaginosis?

• The bacterioscopic method can also detect a small number of leukocytes in the field of view, a reduced number or complete absence of Dederlein rods


• Culture of vaginal microflora


• Antibioticogram - determination of pathogen sensitivity to antibiotics


• Polymerase chain reaction - to determine the genetic material of Gardnerella vaginalis

Complications of the disease

How to treat bacterial vaginosis?

The first direction is to destroy pathogenic and pathogenic microorganisms and restore the balance of normal vaginal microflora. For this, vaginal suppositories and gels are used, which contain antibiotics and antiseptics - Metronidazole, Ornidazole, Clindamycin. They use drugs such as Macmiror and Terzhinan in the form of vaginal suppositories or tablets.

The second direction involves the use of eubiotics - drugs containing lactobacilli (Lactobacterin, Bifidum-bacterin, Acylact). Use internally or locally - in the vagina. Yoghurts and biokefirs are recommended.
Vitamin therapy and biogenic stimulation - to increase the overall resistance of the body.
Immunotherapy and immunoprophylaxis - the Solko Trikhovak vaccine containing special strains of lactobacilli. As a result of the introduction of the vaccine, antibodies are formed that successfully destroy the causative agents of the disease, normalize the vaginal microflora and create immunity that prevents the development of relapses of bacterial vaginosis.

The main drugs used to treat bacterial vaginosis:
Metronidazole (Metrogyl, Trichopolum, Flagyl) helps stop the growth of harmful bacteria. This type of medicine is prescribed in doses of five hundred milligrams in the morning and evening. The course of treatment is seven days. When using these medications, side effects such as allergic reactions, digestive disorders, vomiting, nausea and others may become apparent.

Clindamycin is an antibiotic drug that tends to inhibit both the growth and reproduction of pathogenic bacteria. You can purchase this medication both in the form of capsules and in the form of vaginal cream or vaginal suppositories. As for vaginal cream, it should be inserted into the vagina using a special applicator once a day before going to bed. The course of therapy is six days.

Prevention

• Maintaining genital hygiene


• Proper and nutritious nutrition


• Timely treatment of inflammatory diseases of the genitourinary organs


• Avoiding abuse of antibiotics


• Wearing comfortable underwear made from natural fabrics

Reviews

I “brought” bakvaginosis from the sea, not the first time, by the way, such nonsense. They prescribed treatment in two stages: first vaginal tablets, and then lactozhin capsules. Everything went away without consequences, otherwise it happened that later the thrush came out again. I’ll understand this thanks to dlactoginal, because... he restores the flora.

I have treated vaginosis several times, I know firsthand what kind of disgusting thing it is. At first they prescribed courses for ten days, but there were still relapses. The most successful treatment was the last time, only salvagin gel was prescribed, but there was no relapse after this prescription, although almost a year had passed

Vaginosis is, of course, terrible, especially when you don’t have time to be treated, and after a couple of months it appears again. Salvagin helped me get rid of it, it’s an intravaginal gel. Five tubes were enough to completely restore the flora, the immune system has strengthened quite well, apparently copes with bacteria and there are no more relapses.

I treated vaginosis with Metronidazole, it helped well, although it also requires a good probiotic, because it kills all microflora indiscriminately.

Please tell me I had a medical examination and found out that I had vaginosis. Are they allowed to work with such a diagnosis? Or only after treatment?

Hello! Please tell me! Can bacterial vaginosis contribute to the development of ovarian cysts?

Julia,
Vaginosis is NOT sexually transmitted! This is a natural disease (infection) of the vagina, or rather, vaginal dysbiosis. And yet, a man cannot suffer from vaginosis, vaginosis and the name from “vaga” - vagina, vagina. The man doesn't have it.

Pauline,
In my observations, the patients did not experience chest pain. Go to a mammologist or gynecologist about your breasts. A compaction may be present.

Hello! I am a specialist in gynecology. Write questions, I will answer. About vaginosis! My daughter (11 years old) has a whitish and transparent discharge, without gas bubbles, not foamy, no itching, no burning, urination, according to my observations, is normal. She put her finger in there and let me smell it. Stupid, of course...I didn’t smell anything! And she says either some kind of onion, or garlic, or she already stinks of iron. If anyone knows what this is, please tell me!! Even though I am a gynecologist myself, I still can’t figure it out completely. In my opinion, this is normocenosis.

Hello, I would like to know if there are chest pains and bloating in the lower abdomen with vaginosis? (Other symptoms of vaginosis are present)

It’s not true that microflora can be restored! I drank Lactofiltrum + Terzhinan vaginal suppositories. and everything will be fine! I advise...

Girls, most of you here advise you to definitely consult a doctor. They say that the doctor will definitely help to properly cure this very vaginosis. Doctors haven’t been able to cure him for three years now. Various antibiotics are prescribed, then probiotics. That's all. The same scheme with the only difference in the names of the drugs. In my case, Acylact, on the contrary, provokes thrush (although, in theory, it should prevent it), sometimes I have to give up everything halfway because terrible itching and discomfort begins. In general, the microflora is not restored to any level. This is precisely why I wander around the forums to read at least some other options for possible treatment (and healing, without relapses), because the regimens prescribed by doctors do not bring any benefit.

Vaginosis is a very nasty thing, I suffered from it myself =(((Oh, how I suffered with it... I ran around to doctors until Vaginorm-S was prescribed. It was my savior! I was already tired of the unpleasant-smelling discharge, and Vaginorm eliminated it in just 6 days! I recommend it to everyone!

Vaginosis is a terrible scourge!! I had it several times in my life, there were, so to speak, relapses, I was treated with Vagilak. Until one fine day I went to the doctor and they prescribed Vaginorm for me for a week - it doesn’t cause any inconvenience, nothing gets in the way “there”)) A week later I was terribly glad that it was all over!! Six months have already passed, and so far, pah-pah, no relapses... I recommend it in general))

Thanks to the authors for the article! It’s a shame they didn’t mention oral probiotics, which restore the vaginal microflora. Because yoghurts and kefir are, of course, good, but from the stomach they enter the intestines and affect the microflora of the intestines, not the vagina. There are modern drugs (gaprimer Vagilac) that restore female microflora!

Bacterial vaginosis (or gardnerellosis) is a common disease of women, especially young women of reproductive age. The disease develops against the background of an imbalance of bacteria in the vagina.

The vagina of a healthy woman is a balanced environment where more than 1000 types of microorganisms coexist, each of which has its own role; they form normal vaginal microflora. A special role in it is played by lactobacilli, or lactobacilli (Lactobacillus spp.), as well as bifidobacteria and propionic acid bacteria.

Lactobacilli (normally almost 90%) - lactic acid bacteria, perform a primary task - they produce hydrogen peroxide, creating an acidic environment in the vagina (pH 3.8 - 4.5). It is this environment that restrains and balances the aggressive activity of other (anaerobic) representatives living in the vagina.

The “trigger mechanism” of bacterial vaginosis is always a decrease in the number of beneficial lactobacilli in the vaginal environment (or their complete disappearance), which reduces the concentration of lactic acid in the vagina. Opportunistic (not dangerous under normal conditions) anaerobic microorganisms are activated, primarily Gardnerella vaginalis, which occupy the vacated niche. Their number increases 5-6 times. Gardnerellas inhabit the vagina in the form of colonies, and the volatile compounds they produce - amines - have a characteristic odor (rotten fish).

Symptoms of bacterial vaginosis in women

Bacterial vaginosis has 2 variants of the course: with characteristic symptoms of the disease and without symptoms. Women pay attention to copious, sometimes foaming, vaginal discharge that smells like rotten fish. The smell may intensify before and after menstruation, during sexual intercourse.

During the course of the disease, the viscosity and color of the discharge may change. So, at the beginning of Garnerellosis, the symptoms are reduced to the appearance of leucorrhoea with a thin-mucous consistency; with a prolonged course, they become thick and viscous. The color of the discharge may turn yellowish-green. As a rule, the process drags on for 2-3 years.

Often the only sign of gardnerellosis in women is the appearance of gray-whitish discharge (leucorrhoea) from the genital tract. The smell of leucorrhoea, similar to the smell of rotten fish, also attracts attention. But quite often, bacterial vaginosis does not appear at all. In approximately 45% of cases, bacterial vaginosis occurs in women asymptomatically, and this complicates the diagnostic process.

Other symptoms may be added to the discharge: pain and discomfort in the genital area that occurs during sexual intercourse - dyspareunia, itching and burning in the external genital area.

With such symptoms, it is easy to suspect bacterial vaginosis. However, in approximately half of patients the disease is asymptomatic: positive laboratory signs of bacterial vaginosis and the absence of clinical symptoms. In this case, the idea of ​​possible bacterial vaginosis is suggested by frequent and severe inflammatory diseases and regularly occurring relapses after treatment.

Why are the symptoms of gardnerellosis in men often erased?

The “strong half” receives the bacterium Gardnerella vaginalis, the causative agent of gardnerellosis, from an infected woman during sexual intercourse. But, unlike women, gardnerellosis in men is more often observed in the carrier format. This is explained by the characteristics of the urogenital tract, into the lower sections of which gardnerella enters and remains. During this period, without knowing it (since there are no symptoms), the man is dangerous for his partners, since he infects them through sexual contact.

If, against the background of Gardnerella vaginalis, inflammation develops in a man’s genitourinary system, the symptoms become brighter: urethritis (painful urination, pain and burning in the urethra), and then inflammation of the glans penis (swelling, pain, discharge with an unpleasant odor). Symptoms of gardnerellosis in a man in the form of nonspecific inflammation help the doctor quickly make a diagnosis and prescribe treatment.

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, low titer lactobacilli may be present and, as a rule, these are anaerobic lactobacilli that are 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) grades 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.:

1. pathological nature of vaginal discharge;
2. pH of vaginal discharge is more than 4.5;
3. positive amine test;
4. 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 is, according to various authors, 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