Bacterial vaginosis of the intestine. Symptoms, treatment and causes of bacterial vaginosis. Bacterial vaginosis - why is it dangerous?

Bacterial vaginosis(vaginal dysbiosis) is a clinical syndrome caused by the replacement of lactobacilli in the vaginal flora by opportunistic anaerobic microorganisms. Currently, bacterial vaginosis is considered not as a sexually transmitted infection, but as a vaginal dysbiosis.

At the same time, bacterial vaginosis creates the prerequisites for the occurrence of infectious processes in the vagina, so it is considered together with inflammatory diseases of the genital organs. This is a fairly common infectious disease of the vagina, found in 21-33% of patients of reproductive age. About half of them also have intestinal dysbiosis.

Vaginosis can be found not only in sexually mature women, but also in adolescents who are not sexually active. The reasons may be poor hygiene and chronic diseases.

Symptoms of bacterial vaginosis

Bacterial vaginosis is much more common than thrush, but only a few women know about the existence of this disease.

Having noticed vaginal discharge and itching, many women immediately attribute it to thrush, which they have heard a lot about from friends, on television and on the Internet, and begin treatment with antifungal drugs, which are completely ineffective for bacterial vaginosis.

The main symptoms of bacterial vaginosis are:

These symptoms can be a sign not only of bacterial vaginosis, but also of other diseases (for example, gonorrhea, trichomoniasis, candidiasis), therefore, an accurate diagnosis cannot be made only by the presence of symptoms. To clarify the cause of the disease, you need to contact and get tested.

Treatment of bacterial vaginosis

Treatment of bacterial vaginosis is carried out in two stages.

At the first stage, the number of anaerobes is reduced, local and general immunity and endocrine status are corrected; on the second - restoration of normal microbial biocenosis in the vagina by colonizing the vagina with lactic acid bacteria.

First stage

The first stage includes the following treatment measures:

Already in the middle of the first stage of treatment, women feel better, the amount of leucorrhoea decreases, itching and burning disappear.

Additionally, at this stage of treatment, antihistamines (tavegil, suprastin, pipolfen) and, if the patient is bothered by pain, non-steroidal anti-inflammatory drugs (brufen, flugalin, voltaren) are prescribed to suppress the production of prostaglandins, which cause pain reactions.

A prerequisite for treatment is the exclusion of sexual, including orogenital, contact, since sperm and saliva have an alkaline reaction, which negatively affects the results of treatment.

Second phase

The second stage of treatment - restoration of the vaginal biocenosis - is carried out using biological products from lactic acid bacteria:

• lactobacterin;
• bifidumbacterin;
• acylact;
• zhlemik.

Carrying out complex therapy allows you to get a good result in 93-95% of patients.

Relapse or exacerbation

Relapse or exacerbation more often occurs against the background of genital (acute infections, exacerbation of chronic inflammatory processes) or extragenital diseases, as well as concomitant diseases (intestinal dysbiosis), leading to a decrease in general and local immunity and often occurring against the background of endocrine pathology.

Often an exacerbation occurs during menstruation, when the pH in the vagina increases significantly and the growth of microorganisms associated with bacterial vaginosis increases.

To avoid repeated relapses, there is a need to stimulate the immunological defense mechanisms of the vaginal environment; This is especially true in terms of preparing for pregnancy. For this purpose, the vaccine Solcotrichovac, obtained from weakened lactobacilli (lactic acid bacilli) of patients who have recovered from trichomoniasis, is currently used.

Such lactobacilli stimulate the production of antibodies in a woman’s body. The production of antibodies against the background of vaccination with Solcotrichovax helps to destroy atypical forms of lactobacilli, trichomonas and nonspecific pathogenic bacteria, promotes the growth of lactobacilli, restoration of normal microflora and normalization of the physiological pH value of the vaginal mucosa.

Vaccination with Solcotrichovac reduces the risk of recurrent infection and reinfection caused by Trichomonas and other pathogenic bacteria in 80% of patients with recurrent vaginal infections.

Vaccination is carried out three times, 0.5 ml each, with an interval between injections of 2 weeks, the fourth injection is made a year after the first administration of the vaccine. The vaccine is well tolerated and gives a lasting positive effect with no relapses in 75% of patients in the future.

Solcotrichovac is not recommended for use during pregnancy and lactation, since there is currently no data on clinical trials of the drug in this group of patients. When using solcotrichovac in preparation for pregnancy, it is rational to make the last injection 2-3 months before the expected conception.

Causative agents of bacterial vaginosis

There are no specific pathogens for bacterial vaginosis. It is caused by polymicrobial complexes, among which are Gardnerella and mycoplasma (opportunistic microorganisms).

With bacterial vaginosis, microorganisms of the genus Lactobacillus (existing in the normal microflora of the vagina) are replaced by associations of various bacteria, including Gardnerella vaginalis, anaerobes (Bacteroides, Prevotella, Porphyromonas, Peptostreptococcus, Mobiluncus) and Mycoplasma hominis.

Previously, the disease was believed to be caused by Gardnerella based on the identification of the organism in women with bacterial vaginosis. However, it has been found that more than 50% of women without signs of the disease are colonized with gardnerella.

In addition to gardnerella, anaerobic bacteria are found in large numbers in the vaginal secretions of women with bacterial vaginosis:

• bacteroides;
• peptococci;
• peptostreptococci.

Mobiluncus spp. are also associated with bacterial vaginosis. and Mycoplasma honunis, but the exact role of these bacteria in the etiology of the disease is unknown. During metabolism, gardnerella produces amino acids, from which, under the influence of anaerobes, volatile amines (putrescine, cadaverine, triethylamine) are formed. These amines cause an unpleasant odor reminiscent of rotten fish.

Causes of bacterial vaginosis

The reasons for the development of bacterial vaginosis have not been fully elucidated.

Doctors can identify only a few factors that most often provoke the replacement of normal microorganisms with pathogenic ones.

These include:

The household route of transmission of bacterial vaginosis has not been proven. But the disease can be “obtained” by frequently changing sexual partners and having sexual relations without barrier methods of contraception.

Complications of bacterial vaginosis

A large body of evidence has accumulated indicating that bacterial vaginosis is a risk factor for adverse pregnancy outcomes.

In addition, the following complications are associated with bacterial vaginosis:

The presence of large quantities of various bacteria in the vagina of women with bacterial vaginosis increases the likelihood of these microorganisms entering the male urethra during sexual intercourse, with subsequent infection of the urethra and the development of nonspecific urethritis.

The disease may also play a role in the occurrence of chronic prostatitis of unknown origin in men. It is usually called abacterial chronic prostatitis, emphasizing the absence of any infection that could cause a chronic inflammatory process.

Recently, using the polymerase chain reaction (PCR) method, a connection between such prostatitis and bacteria involved in the development of bacterial vaginosis was identified.

With further study of this problem, however, difficulties will likely arise associated with the characteristics of chronic prostatitis in this patient, the history of his sexual life and the often intermittent nature of bacterial vaginosis.

Bacterial vaginosis and pregnancy

Bacterial vaginosis occurs in 15-20% of pregnant women and is a serious risk factor for the development of infectious complications. A pronounced relationship between the disease and premature termination of pregnancy and untimely rupture of membranes has been noted. The risk of developing these complications in patients with bacterial vaginosis increases by 2.6 times compared to healthy pregnant women.

It has been established that many bacteria detected in bacterial vaginosis (Fusobacterium, G. vaginalis, Peptostreptococcus, Micoplasma hominis, etc.) can lead to increased synthesis of prostaglandins, the development of premature labor and untimely rupture of the membranes.

Moreover, an increase in vaginal pH above 4.5, characteristic of the disease, can itself lead to premature rupture of the membranes. In approximately 10% of women who give birth prematurely, gardnerella and other microorganisms are released from the amniotic fluid, whereas normally the amniotic fluid is sterile.

It is noted that women who give birth at less than 37 weeks of pregnancy have a high probability of having bacterial vaginosis. Chorioamnionitis, detected in 1% of pregnant women, is a serious complication that threatens the life of the mother and fetus. The development of chorioamnionitis associated with bacterial vaginosis in the mother can subsequently lead to premature termination of pregnancy or premature rupture of amniotic fluid.

The presence of chorioamnionitis in patients is histologically confirmed by the identification of relevant pathogenic microorganisms in the placental tissue, which can also be the cause of premature birth.

When studying amniotic fluid in patients, G. vaginalis, Fusobacterium nucleatum, Prevotella melaninogenica, ureaplasma, Candida albicans, E. coli are also most often detected.

There is also a connection between the presence of the disease and the development of postpartum endometritis, including after cesarean section. The microbial flora detected in the endometrium of patients with endometritis is often similar to that of bacterial vaginosis. This is especially true for anaerobic microorganisms.

In the normal course of the postpartum period, on the 3rd day the number of anaerobes decreases in logarithmic progression. However, this does not happen in patients, since the contamination of the vagina with anaerobic bacteria is many times higher than normal levels long before childbirth.

It has been established that the risk of developing postpartum endometritis in pregnant women with BV and bacterial vaginosis is times higher than in healthy women. Mixed microflora can lead to the development of other inflammatory complications, such as breast abscess, inflammation of the umbilical wound, etc.

Thus, patients with bacterial vaginosis are at increased risk of developing:

• inflammatory diseases of the pelvic organs;
• premature termination of pregnancy;
• untimely discharge of amniotic fluid;
• the occurrence of chorioamnionitis;
• postpartum and postoperative endometritis.

A high concentration of virulent microorganisms in the vagina of patients is a risk factor for the penetration of bacteria into higher parts of the genitourinary system.

Classification of bacterial vaginosis

There are several types of bacterial vaginosis, which vary in severity:

In addition, according to the course of bacterial vaginosis, there are:

• spicy;
• torpid;
• erased (asymptomatic).

Diagnosis of bacterial vaginosis

The diagnosis of bacterial vaginosis is reliable if a woman has at least three of the following four signs:

In order to detect gardnerella and anaerobic microorganisms in a smear of vaginal discharge, staining with different paints using special methods is used to diagnose bacterial vaginosis. Tissue cultures are rarely used for this purpose.

In recent years, patients with bacterial vaginosis are increasingly receiving a sensitive and highly specific oligonucleotide test. To perform this test, sets of special reagents are produced.

Bacterial vaginosis in men

Bacterial vaginosis, by definition, is vaginal dysbiosis in women. Therefore, it is wrong to make such a diagnosis for men. Carriage of transient microflora is the most common option for them.

According to various authors, 50-70% of male sexual partners of women with bacterial vaginosis have colonization of the urethra with G. vaginalis and other pathogens of the disease. At the same time, absolutely nothing bothers the man, and carriage is detected only during examination with high-precision laboratory methods.

These men are carriers of transient microflora and with frequent casual sexual contacts, they are, as it were, the main reservoir and distributors of transient microorganisms among women.

The male urethra, in contrast to a healthy female vagina, has an alkaline environment, which is a favorable factor for the habitat and reproduction of transient vaginal microflora. However, not all the strong half are susceptible to infection.

Men who have previously had sexually transmitted diseases, suffer from chronic prostatitis and abuse the use of local antiseptics to prevent sexually transmitted infections are at greatest risk. Often, with bacterial inflammation of the glans and inner layer of the foreskin of the penis, representatives of the woman’s vaginal flora are found.

Prognosis for bacterial vaginosis

Very often the disease becomes chronic and can constantly recur. Gynecologists attribute this to the fact that antibiotics only kill pathogenic microflora, but do not ensure the full restoration of the beneficial microflora that is necessary.

Therefore, it is very important, after completing the course of therapy, to use medications containing bifidiobacteria for another 10 days:

• Bificol;
• Bifidumbacterin;
• Acylact;
• Lactobacterin.

Bacterial vaginosis is not a serious disease if it is treated promptly and correctly. It is very important to adhere to the rules of hygiene, and for preventive purposes, be constantly monitored by a gynecologist, especially after a long course of treatment with antibiotics.

If you notice an unpleasant smell in your discharge, you must take all the necessary smears. If bacterial vaginosis is not treated, it can cause the development of various diseases, it is especially dangerous during pregnancy and can affect the baby.

Prevention of bacterial vaginosis

To prevent bacterial vaginosis, a woman needs to:

• avoid promiscuity;
• carefully observe personal hygiene;
• Visit a gynecologist for examinations at least once a year.

Questions and answers on the topic "Bacterial vaginosis"

Question:Hello. My husband has already undergone treatment, because... My femoflora analysis revealed Gardnerella vaginalis and streptococcus. I'm undergoing treatment now. I was prescribed 10 days of treatment with Ciprolet, Pimafucin, Bion3 and Gynoflor e suppositories. I took this for 6 days, but it so happened that I caught a cold, had a fever, and stopped treatment for 2 days. There was itching and discharge, but no odor. There is no way to ask your gynecologist while on vacation. Is it worth restarting treatment?

Answer: Hello! Probably, the husband was undergoing treatment for another reason. Gardnerella is a symptom of bacterial vaginosis. This is not an inflammatory process of the vagina due to a violation of the vaginal microflora. Therefore, there must be indications for treating a sexual partner. However, if there are reasons for joint treatment, then it is carried out simultaneously. Continue the treatment prescribed by your gynecologist. But in parallel, interferon preparations with antioxidants C, E (viferon) and local sanitation of the vagina (tantum rose, epigen intimate) can also be used. A control examination is carried out 4 weeks after the end of treatment.

Question:Hello. Signs of bacterial vaginosis appear periodically. There are a lot of leukocytes in the smear. According to the results of the analysis of vaginal biogenocenosis, there are very few lactobacilli - from 31 to 53 percent. There are a lot of enterobacteria - 43-58 percent. Everything else is normal (analysis for 23 groups of microorganisms). The test for sexually transmitted infections is negative (IFA and PCR method). Candida and gardnerella have never been detected. I suffer from periodic (once every few months) cheesy discharge without an unpleasant odor, severe itching and burning. The doctor always prescribes pimafucin or something else antifungal, although there is never candida in the smears. The rest of the time, the discharge is pale greenish, not abundant, and does not cause any pain. How to kill these opportunistic bacteria (enterobacteria) and increase lactobacilli in the vagina? How to prevent normal levels of lactobacilli? I have erosion and a polyp in the uterine cavity. The sexual partner is permanent. As I understand it, first you need to restore the microflora in the vagina, then cauterize the erosion and remove the polyp.

Answer: Hello! With such a number of leukocytes in the smear, antibiotics are usually prescribed both to drink and in the vagina. It is also possible to add metronidazole. After treatment, take a control smear, and if it is good, then remove the polyp and treat the erosion.

Question:Hello. My husband and I are planning a pregnancy. In this regard, I turned to a gynecologist so that he could recommend tests for preparation. The only complaints were not very heavy discharge and there is a slight erosion, which they told me not to touch for now. A microscopic examination of the smear was carried out, as a result of which vaginosis was discovered (increased levels of leukocytes, coccobacilli, blastospores and g.vaginalis). The gynecologist prescribed Terzhinan and Vagilak. After treatment, menstruation began, and after it unbearable itching, burning and heavy discharge appeared. I turned to another doctor. She prescribed a femoflora study. They also diagnosed: cervical erosion, bacterial vaginosis and urogenital vaginosis. (Lactobacilli are below normal, g. vaginalis + prevotella bivia + porphyromonas spp. 10 in 6.8, candida spp 10 in 5 and ureaplasma 10 in 5.6). Ornidazole, Neo-Penotran (the itching went away), then Femilex, Bifiform, Unidox Solutab and Fluconazole were prescribed. Plus treatment for my husband. Smear in a month. I did everything as the doctor prescribed. My period passed, after which everything was perfect for 2 days. Now the discharge has started again, thick, white, cheesy. There is no itching. Is it normal to have this kind of discharge again? Or is this a process going on? Should I wait a month before a smear?

Answer: Hello! Yes, just wait for the next analysis. Now you can conduct a second course to restore the vaginal microflora. These are immunocorrectors (Viferon) and probiotics (Acipol). Since you are planning a pregnancy, you should donate blood for the extended TORCH complex and homocysteine. It is also advisable to visit an endocrinologist and discuss taking iodine and folic acid supplements. Check the condition of your teeth.

Many women at least once in their lives have to face the diagnosis of bacquaginosis. What is this? This is the name given to a specific type of vaginal inflammation caused by an overabundance of bacteria. Microorganisms themselves are not dangerous; they always live in the vagina and perform useful functions. However, exceeding their normal amount leads to a disruption of the natural balance of microflora, and subsequently to bacterial vaginosis.

Most often, this pathology is detected, although the imbalance can be diagnosed in everyone. The causes of the disorder are still unknown to science; Only certain ones can be identified - for example, unprotected sexual intercourse or frequent douching. Taking certain medications can also trigger bakvaginosis.

Symptoms

In women of all ages, the disease manifests itself equally. Contact your gynecologist if you are concerned about:

• watery grey, white or from the vagina;
• unpleasant from the vagina;
• itching in the groin;
• burning sensation during urination.

In some cases, bacterial vaginosis is asymptomatic.

When to see a doctor

Make an appointment at a clinic or medical center if:

• Vaginal discharge looks new or unusual, has a foul odor, or is accompanied by a fever. A gynecologist will help identify the cause and diagnose the disease based on signs and symptoms.
• You have treated vaginal infections before, but this time the discharge has a different color and consistency.
• You have had sex with multiple partners or have recently changed partners. Sometimes the symptoms of sexually transmitted diseases are similar to those of bacterial vaginosis.
• You tried to treat a yeast infection yourself with over-the-counter medications, but you ended up with bacterial vaginosis, the symptoms of which don't go away.

Causes

The inflammatory process in the vagina begins as a result of excessive growth of several types of bacteria that live in the female body. In a normal microflora state, beneficial lactobacilli outnumber “harmful” microorganisms (anaerobes). But if there are more anaerobes, the natural balance is disrupted and leads to a disease called “baquaginosis”. Is this an accident or a pattern generated by poor personal hygiene? Unfortunately, medicine is not yet able to give a definite answer to this question.

Risk factors

There are circumstances that increase the risk of developing pathology. These include:

• Frequent change of sexual partners or relationship with a new sexual partner. Doctors do not fully understand the connection between sexual activity and bacterial vaginosis, but the disease is more often diagnosed in women who have entered into a relationship with a new man. Representatives of non-traditional sexual orientation are at even greater risk.
• Douching. The practice of cleaning the vagina with water or cleanser (douching) disrupts the natural balance of the vagina. This can lead to the growth of anaerobic bacteria, which, in turn, threatens the development of pathology. Since the vagina is capable of self-cleaning, douching is not necessary.
• Lactobacilli deficiency as an individual characteristic of the body. Sometimes completely healthy women who do not change sexual partners and do not douche are diagnosed with bakvaginosis. What kind of scourge is this and why does it develop, seemingly out of nowhere? In fact, there are times when a woman's vagina is naturally unable to produce enough lactobacilli. The lack of “good” microorganisms over time leads to the appearance of unpleasant symptoms.

Complications

Usually this inflammatory process does not entail complications. In rare cases, the following are noted:

• Premature birth. Bakvaginosis during pregnancy can lead to premature delivery and the birth of a child with low weight and height.
• Sexually transmitted infectious diseases. If a woman does not take any measures to alleviate her condition, her body becomes more vulnerable to HIV, herpes simplex virus, chlamydia and gonorrhea. If the patient has HIV, there is an increased risk of transmitting the virus to a partner.
• Risk of infection after surgery. Untreated disease increases the risk of post-operative infection after procedures such as hysterectomy or dilation and curettage of the uterus.
• Inflammatory diseases of the pelvic organs. Bakvaginosis, the causes of which remain a mystery, in some cases causes inflammatory processes in the pelvis (usually the uterus and fallopian tubes are affected), which can, in turn, lead to infertility.

Diagnostics

To make an accurate diagnosis, the doctor:

• Ask questions about your medical history. The specialist will ask if you have had vaginal infections or sexually transmitted diseases before.
• During this test, the doctor examines the vagina for signs of infection and places two fingers inside while pressing on the abdomen with the other hand to check if the pelvic organs are healthy.
• Take a sample of vaginal discharge for analysis (smear). This procedure is performed to detect an excess of anaerobic bacteria in the vaginal microflora. The specialist will examine the discharge under a microscope, looking for "clue cells" - vaginal cells covered in rod-shaped microbes.
• Check the pH level in the vagina. The acidity of the vagina is checked by placing a special test strip inside. If the pH reaches 4.5 or higher, the doctor diagnoses bakvaginosis (photo).

Treatment

Use only those medications prescribed by your gynecologist. To treat the inflammatory process in the vagina, the following is usually used:

• Metronidazole. This medication is convenient because it comes in tablets - you can simply drink the tablets with water. It is also available in the form of a topical gel, a small amount of which is placed in the vagina. To avoid side effects from taking the pills (which may include upset stomach, abdominal pain, or nausea), avoid drinking alcohol during therapy. It is also advisable to refrain from drinking alcohol for 24 hours after completing the course of treatment.
• Clindamycin. This product comes in the form of a vaginal cream. It should be borne in mind that this drug has a destructive effect on latex condoms - both during treatment and for at least three days after the end of therapy.
• Tinidazole. This drug comes in tablet form and has properties similar to those of metronidazole, the most common medication used to treat bakvaginosis. What does it mean? Follow the instructions for use and remember that you should also not drink alcohol during the course of tinidazole.

If the infected woman's sexual partner is a man, he usually does not require treatment. The situation is different for representatives of non-traditional sexual orientation; they are recommended to undergo diagnostic examinations and, if inflammation is detected, to begin a course of therapy. Timely treatment is of particular importance for pregnant women, as bacterial vaginosis can lead to premature birth.

Take medications or use a cream or gel strictly for the period prescribed by your gynecologist, even if the symptoms disappear earlier. Terminating therapy prematurely may increase the risk of relapse.

Relapse

Even if you asked your doctor exactly how to treat bakvaginosis and strictly followed his recommendations, the disease can recur after a period of three months to a year. Research is currently underway into methods to prevent recurrent vaginal inflammation. Be sure to consult a doctor if symptoms of infection recur; You may be given an additional course of metronidazole.

There is a scientifically unsubstantiated but widespread belief that eating foods rich in lactobacilli helps restore the natural balance. Proponents of this point of view suggest that women suffering from recurrent bacterial vaginosis add more natural yogurt and other foods containing probiotics to their daily diet. Although this assumption may have a rational basis, scientists cannot yet give a definite answer to the question of the usefulness of menu changes.

Prevention

It is better not to treat, but to prevent bakvaginosis. Reviews of special intimate hygiene products will help you make your choice - buy mild, unperfumed liquid soap and tampons or pads without fragrances.

It is not recommended to resort to douching, since the vagina does not need special cleaning - just taking a bath or a regular shower is enough. Frequent douching disrupts the balance of microflora in the vagina and increases the risk of developing infectious diseases. In addition, deliberately “cleaning” the vagina will not help in any way to calm down the inflammatory process that has already begun.

Avoid contracting sexually transmitted infections. Use male latex condoms, limit the number of sexual partners you have, or temporarily abstain from sexual activity to minimize your risk of contracting a sexually transmitted disease.

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 their 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.

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

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

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

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

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

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

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

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

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

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

Causes of bacterial vaginosis

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

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

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

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

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

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

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

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

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

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

Diagnosis of bacterial vaginosis

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

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

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

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

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

Treatment of bacterial vaginosis

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

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

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

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

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

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

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

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

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

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

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

Complications of bacterial vaginosis

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

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

Pregnancy complications that may occur due to bacterial vaginosis include:

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

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

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

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

Symptoms of PID include:

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

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

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

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

Which doctor should I consult for bacterial vaginosis?

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

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