– an infectious non-inflammatory lesion of the vagina, in which the normal flora is replaced by polymicrobial associations of opportunistic bacteria. Bacterial vaginosis occurs against the background of immunity disorders, inflammatory diseases of the reproductive system, menstrual irregularities, prolonged use of an intrauterine device, unsystematic use of antibiotics and hormonal drugs. Accompanied by copious discharge with an unpleasant odor. Sometimes it is asymptomatic. The diagnosis is established on the basis of complaints, anamnesis and data from special tests. Treatment is local and general pharmacotherapy.
General information
Bacterial vaginosis is a non-inflammatory infectious process in which the normal lactoflora of the vagina is replaced by anaerobic associations. It is a widespread pathology, diagnosed in 21-33% of patients visiting gynecologists. It can occur latently or with obvious clinical symptoms. With the improvement of the general condition of the body, the symptoms of bacterial vaginosis disappear or are smoothed out; when exposed to various endogenous and exogenous factors, they reappear, which causes a long-term relapsing course of the disease. Pathology does not apply to sexually transmitted diseases. Due to hormonal changes, it often occurs during gestation and menopause. Treatment of bacterial vaginosis is carried out by specialists in the field of gynecology.
Causes of bacterial vaginosis
Normally, more than 95% of the vaginal microflora in women of childbearing age consists of aerobic and anaerobic lactobacilli. The remaining 5% includes more than 40 species of various microorganisms. The ratio of anaerobes to aerobes in healthy vaginal microflora is 10:1. Lactobacilli are the basis of the natural barrier between the external environment and the uterine cavity. Thanks to acid formation and the release of hydrogen peroxide, they create an acidic environment that prevents the proliferation of pathogenic and conditionally pathogenic microbes.
Under unfavorable conditions arising under the influence of one or more endogenous and exogenous factors, the quantitative and qualitative composition of the microflora changes. The number of lactobacilli decreases, other microorganisms begin to actively multiply, primarily obligate anaerobes. The total number of bacteria increases. Bacterial vaginosis develops. A distinctive feature of this pathology is the absence of a specific pathogen. The cause of the infectious process is not just one type of microorganism, but polymicrobial associations.
Bacterial vaginosis can occur with immune disorders as a result of general weakening of the body, acute and chronic infectious diseases. Another factor contributing to the development of bacterial vaginosis is changes in hormonal levels during changes in the phase of the menstrual cycle, amenorrhea, oligomenorrhea, single-phase cycles, during gestation, adolescence and menopause. Taking hormonal drugs (corticosteroids, oral contraceptives), antibacterial, antiviral and antifungal drugs is of great importance.
The likelihood of bacterial vaginosis increases with non-compliance with hygiene rules, frequent douching, increased radiation exposure (radiation therapy, exposure to occupational exposure to radioactive substances), malformations of the reproductive system, conditions after surgical interventions, vaginal polyps and cysts, the use of an intrauterine device, diaphragms, tampons and spermicides. Risk factors for the development of bacterial vaginosis also include conditions after abortion and childbirth, atrophic changes in the vaginal mucosa and intestinal dysbiosis.
Symptoms of bacterial vaginosis
The most characteristic and often the only symptom of bacterial vaginosis is discharge from the genital tract, often with an unpleasant odor, similar to the smell of stale fish. Usually leucorrhoea is liquid, white or slightly grayish. They can be abundant, constant, persisting for several years, or scanty, short-lived, appearing from time to time. The average amount of leucorrhoea with bacterial vaginosis is about 20 ml per day, which is 10 times the volume of normal discharge. With a long course of the disease (several years), the color and consistency of the discharge often changes. The leucorrhoea becomes thicker, foamy, sticky, yellowish or greenish.
The nature and amount of leucorrhoea with bacterial vaginosis varies depending on age, general health, the mental and emotional state of the woman (mental trauma and intense stress), sexual activity, phase of the menstrual cycle, endocrine disorders, diseases of the reproductive system and somatic diseases. In some cases, patients with bacterial vaginosis complain of burning, itching, urination problems, pain or discomfort during intimacy.
Possible acute or torpid, asymptomatic, monosymptomatic (only with discharge) or polysymptomatic course of the disease. In some patients, manifestations of bacterial vaginosis persist for a long time, while in others they periodically arise under the influence of unfavorable factors. When collecting anamnesis, it turns out that more than 90% of patients with suspected bacterial vaginosis have previously consulted a gynecologist and other specialists with complaints of discharge and other symptoms. Three quarters of the patients were repeatedly treated for nonspecific vaginitis, using antibacterial suppositories and taking various oral antibacterial agents.
Diagnosis of bacterial vaginosis
The diagnosis of bacterial vaginosis is established on the basis of complaints, anamnesis, gynecological examination data and the results of special tests. During the survey, the doctor asks whether the woman suffers from diseases of the reproductive system, endocrine and somatic diseases, whether she takes hormonal medications and antibacterial agents, whether she uses contraception, whether there has been a history of childbirth, abortion and surgical interventions on the genitals, what is the intensity of sexual activity etc.
The main laboratory test for bacterial vaginosis is microscopy of smears taken from the posterior fornix and Gram-stained. During microscopy, the number of leukocytes is assessed, the forms and types of microorganisms that make up the vaginal microflora are studied. The presence of a large number of anaerobes with a decrease in the number of lactobacilli indicates the presence of bacterial vaginosis. A characteristic sign of the disease are key cells - mature epithelial cells, on the membrane of which various microorganisms are detected (gardnerella, cocci, mobiluncus). Normally, such cells are usually not detected. In some cases, a false diagnosis of bacterial vaginosis is possible, due to the presence of epithelial cells with adherent lactobacilli in the smear.
Some works devoted to the study of bacterial vaginosis mention serological, immunoenzyme and cultural methods for diagnosing this pathology, however, such methods are still of purely scientific interest and are not used in widespread clinical practice. Diagnostic criteria for bacterial vaginosis are the presence of specific leucorrhoea, identification of key cells by smear microscopy, a pH greater than 4.5, and the appearance of a stale fish odor when the leucorrhoea reacts with potassium hydroxide. To make a diagnosis of bacterial vaginosis, at least three out of four criteria are required.
If concomitant pathology is detected, additional examinations and consultations with various specialists may be required. Patients with bacterial vaginosis may be referred for consultation to a general practitioner, endocrinologist, urologist, venereologist, mycologist or gastroenterologist. If necessary, an ultrasound of the pelvic organs, general blood and urine tests, a biochemical blood test, a stool test for dysbacteriosis, a blood test for hormones and other studies are prescribed.
Bacterial vaginosis is differentiated from gonorrhea, trichomoniasis, vaginal candidiasis and nonspecific vaginitis. The distinctive signs of gonorrhea are liquid discharge with a yellowish or greenish tint, combined with painful urination. The presence of trichomoniasis is indicated by copious sticky or foamy gray-yellow-green discharge, possibly with a stale odor. Sometimes leucorrhoea is combined with itching and pain when urinating. Candidiasis can be suspected when flaky, cheesy white discharge appears in combination with burning and itching of the vagina. To exclude these diseases, special laboratory tests are required.
Treatment and prevention of bacterial vaginosis
The treatment regimen is determined individually, taking into account the severity of symptoms, duration and form of bacterial vaginosis, the presence of concomitant inflammatory processes, changes in the reproductive system, somatic and endocrine diseases. Treatment includes two stages: taking antibacterial agents and restoring normal microflora. For the entire period of therapy, the patient with bacterial vaginosis is recommended to exclude alcoholic beverages and limit the intake of spicy and spicy foods.
At the first stage, metronidazole or clindamycin is prescribed orally or intravaginally, in the form of vaginal tablets, suppositories or creams. The duration of taking these medications for bacterial vaginosis is 7-10 days. If necessary, immunocorrectors and antihistamines are used simultaneously. To prevent candidiasis (especially important if there is a history of fungal infection), antifungal drugs are used. To correct the pH, topical agents with a high content of lactic acid are administered.
1-2 weeks after completion of the first stage of treatment, a repeat examination and laboratory tests are performed to assess the effectiveness of treatment for bacterial vaginosis. After another 2-3 days, the second stage begins, the main task of which is to restore normal lactoflora. Probiotics and eubiotics are used. In 90% of cases, the result of treatment is the normalization of the vaginal microflora. Tests are repeated after 10 days and 1-1.5 months. after completion of the second stage of therapy. If bacterial vaginosis persists, additional examinations are prescribed to identify pathogenic factors that contribute to the development of relapses of the disease.
Measures to prevent and timely detect bacterial vaginosis include adherence to the rules of intimate hygiene, thoughtful use of hygiene products, avoidance of frequent douching and rational selection of methods of contraception, taking into account the intensity of sexual activity, health status and hormonal levels of the patient. You should avoid uncontrolled use of antibacterial and antifungal drugs, promptly consult a doctor if symptoms of inflammatory diseases appear, regularly visit a gynecologist for preventive examinations, and treat intestinal dysbiosis.
The main function of the female body is childbearing, so nature has thought out a lot to protect the most important organs. Not only infections from the outside world, but also microbes that are usually found in the vagina in small quantities can enter the uterus through the vagina. When the microflora is disturbed, the number of lactobacilli decreases, and conditions are created for the development of opportunistic microorganisms. This phenomenon is known medically as bacterial vaginosis. Often this disease is also called gardnarellosis, dysbiosis or vaginal dysbacteriosis. According to ICD-10, this pathology is coded N89.8
Normally, the vagina contains enough lactobacilli to create an acidic environment. Lactic acid prevents pathogens from multiplying and forms natural immunity. In what cases, why and how to treat vaginal dysbiosis, this article will help you understand.
Signs of the presence of pathogenic flora
Often women do not suspect that they have any diseases in the genitourinary area, especially if they, like bacterial vaginosis, do not manifest themselves in the form of symptoms. The disease can be detected in the acute phase, but if no action is taken, the symptoms may fade away on their own, which does not indicate a cure. What signs should alert a woman and refer her to a gynecologist?
- Frequent urination with cutting pains, as with cystitis.
- Inflammation in the external genital area, accompanied by itching, burning and other uncomfortable sensations that intensify after sexual intercourse.
- Copious discharge with the smell of spoiled (rotten) fish. Color and consistency depend on the predominant bacteria.
In women who have given birth and older women, symptoms are usually more severe. In virgins and adolescents, even during the period of exacerbation of the disease, it may remain unnoticed.
Signs of bacterial vaginosis can be confused with the manifestation of thrush, which is also accompanied by a burning sensation and discharge, or with nonspecific bacterial vaginitis due to similar painful symptoms. However, these are different diseases, and they require different treatments. Self-diagnosis and self-medication at home cannot be done. Bacterial vaginitis, also known as colpitis, occurs against the background of decreased immunity and can cause infertility. Only a doctor can determine how to treat bacterial vaginitis after a thorough examination and tests.
Causes of bacterial vaginosis
Many women are embarrassed to go to a medical facility with such an intimate problem. But it has long been established that bacterial vaginosis is not at all a consequence of sexual promiscuity.
The risk of encountering genital dysbiosis exists in any woman, regardless of age and lifestyle, including a little girl.
The causes can be any factors that inhibit normal microflora:
- The entry of harmful bacteria into the vagina from the outside, for example, from the anus. These can be E. coli, Klebsiella, Proteus and other components of the intestinal flora.
- Weak immunity. With a cold, bakvaginosis becomes noticeably worse.
- Anything that weakens the body’s defenses: stress, pregnancy, hypothermia, climate change.
- Anything that changes hormonal levels: pregnancy, menopause, abortion, taking hormonal drugs.
- Douching. Aimed at getting rid of pathogenic organisms, it also washes away the native microflora.
- Failure to comply with hygiene rules, especially during menstruation.
- Wearing synthetic or tight underwear, which interferes with the flow of oxygen.
- Intrauterine devices and contraceptives containing nonoxynol (suppositories, condoms).
- Sanitary pads and tampons that irritate the mucous membranes.
- New sexual partner. He may not have sexual diseases, but his flora can suppress the female microflora. As a rule, immunity to a permanent partner has already been formed. Bacterial vaginosis is not an STI, so it cannot be contracted from a man. The disease is not transmitted sexually.
- Sexually transmitted diseases, even if a course of treatment has been carried out (decreased immunity after taking antibiotics).
Also, bakvaginosis often occurs against the background of cervical diseases (including endometriosis, endocervicitis, leukoplakia) or sexually transmitted infections. By ignoring discomfort in the hope that it will “go away on its own,” you may not detect a dangerous disease in time.
Causative agents of bacterial vaginosis:
- gardnarella (Gardnerella vaginalis);
- mobiluncus (Mobiluncus spp.);
- bacteroides (Bacteroides spp.):
- peptococci.
In most cases, bakvaginosis reveals a mixed infection with a predominance of anaerobic flora against the background of a significant decrease in the level of vaginal lactobacilli. The greatest importance in gynecology is the increase in the concentration of Gardnerella vaginalis. Often the disease occurs against the background of candidal colpitis, nonspecific vaginitis and other urogenital pathologies.
Complications of bacterial vaginosis
In addition to the fact that vaginal dysbiosis itself overshadows existence, it can cause other problems. It is especially dangerous during pregnancy. But there are two situations:
- Pregnancy has led to a surge in the activity of pathogenic bacteria, because this is a powerful hormonal shock for the body. In this case, there is practically no danger. In some cases, treatment is prescribed, in others it is dispensed with, especially if there are no clinical manifestations of infection. In most cases, symptoms of bacterial vaginosis disappear after childbirth.
- The onset of the disease was noted before pregnancy. The vaginal microflora was once suppressed, and if no effective treatment was carried out, during pregnancy in conditions of reduced immunity, the pathological process can lead to inflammation and infection of the fetus. The result can be premature birth, disturbances in fetal development, hypoxia and other negative consequences for the mother and child.
In combination with other infections, bakvaginosis can become an obstacle to conceiving a child.
Diagnosis of bacterial vaginosis
Any warning signs should prompt you to visit a doctor. Do not consider itching and foul-smelling discharge to be normal. After such complaints or taking a smear with a characteristic odor, a specialist must refer to:
- PCR diagnostics. This method determines the presence of pathogenic microorganisms, but is not decisive, since many of them, mainly gardnerella, are present in almost all women in small quantities.
- Amniotest, which allows chemical reactions to enhance the smell of secretions.
- Bacteriological culture. This method determines the pathogen and its quantity, as well as sensitivity to antibiotics.
- Survey stroke. Allows you to diagnose inflammation and identify “key cells” - a sign of gardnarellosis.
- Smear for oncocytology. Conducted annually for all women. A cytogram allows you to identify cervical pathology at an early stage.
When planning a pregnancy, it is important to get tested for hidden infections, even if nothing worries you. The attending physician must determine whether the disease is caused by a pathogenic (venereal) or opportunistic microorganism; in the first case, it is necessary to treat oneself and the partner, and in the second, treatment of the partner is not required (bakvaginosis is not contagious).
Treatment
The treatment regimen depends on the main causative agent of the disease. They are usually divided into three groups:
The principle of treatment is to normalize the vaginal microflora. If the cause of the disorder is only opportunistic bacteria, difficulties should not arise. The doctor prescribes drugs to which these microorganisms are sensitive; they are based on metronidazole, ternidazole, ornidazole. Girls are usually prescribed tablets, and women are prescribed vaginal suppositories and ointments. As a result of using these products, a positive effect is noted after just a week of use.
The advantage of suppositories is that they act directly on the affected areas, are compatible with other medications, and can be prescribed to pregnant women.
If you complain of excessive burning or unbearable pain in the vagina, local painkillers may be additionally recommended.
Next, local immunity and healthy microflora should be restored. The product Femilex, the main substance in which is lactic acid, is popular. Bifidobacteria, eubiotics and probiotics naturally populate the vagina, related to the vaginal flora, lactobacilli, vitamins help improve overall immunity.
Other means to restore normal vaginal microflora:
- Vagilak;
- Lactagel;
- Bifiform;
- Acyclact;
- Lactonorm;
- Lactobacterin;
- Lactozhinal;
- Bifidumbacterin.
Restoration of microflora is an obligatory stage of complex treatment of bacterial vaginosis. A deficiency of lactic acid bacteria threatens relapse of the disease and the development of complications. You can compensate for the lack of lactobacilli and recreate the acidic environment in the vagina using the above means.
To strengthen the body's defenses, immunomodulators (Viferon, etc.) are also prescribed. The dosage and duration of therapy are determined by the doctor. If you need to change the drug or replace it with a cheaper analogue, you should also consult a doctor.
In medicine, there is currently no clear opinion on the treatment of bacterial vaginosis in a latent form. Many experts believe that the presence of opportunistic flora in a smear is not a disease and does not require any treatment. Others equate ureaplasma, mycoplasma and gardnerella to the causative agents of sexually transmitted diseases. In what cases should a woman play it safe and consult with different doctors before treating bakvaginosis?
- during an exacerbation and in the presence of symptoms of the disease;
- before or during pregnancy, even if there is no discomfort.
A competent specialist should talk not only about how to treat bacterial vaginosis, but also about the mandatory conditions for recovery. During this period it is necessary:
- abstain from sexual intercourse;
- give up alcohol, especially when taking medication in tablet form;
- follow a diet (avoid spicy, fried, spicy foods);
- use intimate hygiene products;
- keep the genitals clean.
Folk remedies
Vaginal itching and other symptoms are well relieved with the help of baths and douches from various decoctions. Oak bark, chamomile, juniper berries, oat straw and walnut foliage, calendula, aloe and other medicinal plants are mixed in different proportions. But such treatment can only be done after visiting a specialist to exclude dangerous pathogens.
Prevention of bakvaginosis
By following the rules, you can practically reduce the risk of disease to zero:
- Maintain hygiene: on menstrual days, wash yourself several times a day with clean water, change pads and tampons every 3-4 hours.
- Avoid introducing intestinal bacteria into the vagina.
- Do not get carried away with douching; if an unpleasant odor appears, you should consult a doctor, and not try to remove it, thereby destroying the microflora.
- Do not overuse antibiotics and antifungals.
- Avoid unprotected sex with new partners.
- Regularly see a gynecologist and visit a doctor at the first signs of illness.
- Give preference to loose cotton underwear.
- Follow the principles of proper nutrition: more dairy and plant products, less smoked and salty foods.
In some cases, for prevention, the gynecologist may prescribe a drug containing lactic acid. This applies to a greater extent to women at risk: after long-term hormonal treatment, during menopause, etc.
The appearance of signs of bacterial vaginosis should not be alarmed, but it is also dangerous to ignore them. An unscheduled visit to a gynecologist will clarify the nature of the disease, which causes many problems, but is quite easily eliminated.
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. The symptoms of bacterial vaginosis are varied and not always pronounced. But regular examinations by a gynecologist will allow you not to miss the disease and prescribe therapy on time. Who is at risk? And what is the most effective way to treat bacterial vaginosis?
Read in this article
Reasons for appearance
Nature has provided various mechanisms in a woman’s body to protect against the development of pathologies, including infections. But modern fashion trends in genital hygiene, a variety of sexual contacts, etc. – all this often disrupts the normal biocenosis of the mucous membrane, contributing to the development of bacterial vaginosis.
Normal flora
In the vagina, “guarding order” are Dederlein’s sticks, which are named after the discoverer. Their number normally should exceed 1*10 8 CFU/ml when inoculating contents from the mucosa, and should reach 95 - 98% of the total number of microorganisms. These lactobacilli perform a number of functions, quietly protecting the woman’s body from the development of opportunistic and pathogenic flora, which may be present in the vagina permanently or temporarily. Their main action:
- During their life, Dederlein's rods secrete lactic acid, which creates an acidic environment in the vagina. Under such conditions, many disease-causing bacteria die immediately. And the Dederlein rods themselves multiply unhindered at an acidic pH.
- Lactobacilli also produce lysozyme, a substance that “dissolves” pathogenic microorganisms.
- The acidic environment carries out a “selection” among sperm, leaving only healthy forms for fertilization of the egg.
The role of Dederlein sticks is invaluable. But their number can vary significantly, which depends on many factors.
Stages of development of bacterial vaginosis
Under certain conditions, the number of beneficial lactobacilli decreases. At the same time, they begin to be actively replaced by pathogenic microorganisms that either entered the vagina or were always present here, but in minimal quantities.
Such bacteria create an alkaline environment, which prevents the proliferation of Dederlein bacilli and further aggravates the situation. In this case, the epithelium of the vaginal mucosa begins to actively slough off due to the impact of pathogens on it. As a result, leucorrhoea appears in quantities exceeding normal values.
Metabolic products of pathogenic microbes include various fatty acids and other substances that have a characteristic “fishy” odor.
As a result, the main composition of the vaginal microflora is not lactobacilli, but others: peptococci, bacteroides, leptotrichs, mycoplasmas, ureaplasmas and others. Among them, clear pathogens may appear that enter the vagina during unprotected sexual intercourse - Trichomonas, gonococci, as well as viruses or papillomas.
Effective treatment of bacterial vaginosis involves the elimination of all pathogenic microorganisms and the creation of conditions for the active reproduction of Dederlein rods.
Risk factors
Bacterial vaginosis is not an inflammatory pathology, but it can occur against the background of an existing sexually transmitted infection. This condition is often called gardnerellosis, since these bacteria predominate in most cases.
Bacterial vaginosis develops under the influence of the following factors:
- Disorders of the balance of sex hormones (with a predominance of progesterone), the functioning of the thyroid gland (more often with hypothyroidism). Also with increased androgens.
- With the development of systemic autoimmune diseases and long-term use of cytostatic and hormonal drugs.
- When the intestinal microflora is disrupted, the qualitative and quantitative composition of vaginal microorganisms also changes.
- Often develops against the background of atrophic changes in the mucosa.
- With long courses of antibacterial therapy for a disease.
- If the rules are not followed. For example, many people believe that douching is beneficial. But prolonged vaginal rinsing can, on the contrary, be harmful.
- Also, the use of certain spermicides (in particular, those containing nonoxynol) contributes to the disruption of the flora.
- Frequent change of sexual partners and lack of protection against infections.
It is possible to identify women who are at risk for developing bacterial vaginosis. These include:
- Those who have acute (disease-related) or chronic immunodeficiency conditions.
- Women of “easy” behavior and promiscuous sexual intercourse.
- Overweight. There is a fact of hormonal imbalance in the body.
- Those who regularly practice oral, anal and other types of sex.
- Women with thyroid pathology, diabetes mellitus or other metabolic disorders.
Symptoms of pathology
Clinical manifestations of bacterial vaginosis can appear even in girls who are not yet sexually active. In such situations, this is due to some kind of disturbance in the body. Symptoms of gardnerellosis can develop regardless of sexual intercourse. But if it is provoked by it, then the first signs appear only after 24 - 48 hours. These include:
Bacterial vaginosis during menstruation. Violation of the vaginal microflora occurs for various reasons and quite often.
Good afternoon, I want to tell you about my experience. For 2 years now I have been suffering from a very unpleasant disease - bacterial vaginosis. At first there was itching and smell, discharge. Then the story changed and only the disgusting smell of something rotten began to haunt me. There was no talk about hygiene violations, because... shower twice a day always, and because of this “rotten smell” and more.
I went to the doctor several times and was treated with antibiotics. It helps a lot, but not for long. After a couple or three months it’s all over again. I had already stopped going to the gynecologist, and was treated at home myself, with the same thing that I had in my experienced piggy bank.
Once again, there was a lot of discharge, I was afraid that it might be something else, and I ran to the doctor. Everything is like in the movie “Groundhog Day”: examination, analysis, the same antibiotics, but then a new drug appeared on the list - Lactozhinal. As the doctor explained to me, this is to restore the microflora. After antibiotics, we kill almost all bacteria, good and bad. And it is difficult for new good bacteria to reproduce in such difficult conditions, so the disease returns. With Lactozhinal the situation should return to normal. I decided to try it.
It had to be used vaginally like suppositories. What’s convenient: there was no need to store them in the refrigerator and I carried them with me in my purse. I was prescribed 1 capsule morning and evening for 2 weeks. In general, six months have passed since the last course of treatment and the vaginosis has not returned. Laktozhinal worked, let's see how long the result lasts.
Daria Shirochina (obstetrician-gynecologist)
Hello! Bacterial vaginosis in its “pure form” is not so scary. Already after the first tablets you will feel an improvement. But metronidazole is prescribed in a course of 1 day, usually in the form of tablets, sometimes supplemented with suppositories. Regarding bioflora - it is needed to restore the flora, in fact, its intake is at your discretion. You can put it in the form of candles for 10 days, it is more effective to drink it for a long time. But it should be borne in mind that sometimes bacterial vaginosis is the “tip of the iceberg” and is a marker of sexually transmitted infections. I hope you have been tested for STIs and only then started treatment). Otherwise, the symptoms of vaginosis will bother you until the course of treatment for other infections is completed. All the best!
Zhanna
Thanks for the advice! Yes, I was tested for general floracoenosis and NCMT, everything was clear, the results showed only vaginosis. In the end, I finally bought Lactozhinal instead of bioflora and took it together with metronidazole, that is, I completed the course. So far so good. I'm going on vacation with peace of mind!
Antimicrobial drugs for the treatment of bacterial vaginosis are most often used in the form of vaginal tablets, gels or ointments. In severe cases, antibiotics with antianaerobic activity are prescribed orally or intravenously. Complex therapy includes immunocorrectors and drugs that restore vaginal lactoflora. After 3-4 weeks, it is necessary to undergo a follow-up examination to avoid relapse of bacterial vaginosis.
Treatment of gardnerellosis
Principles of treatment for bacterial vaginosis:
- antimicrobial therapy;
- optimization of vaginal microbiocenosis;
- immunocorrective therapy.
The doctor, based on clinical examination data and laboratory results, prescribes treatment individually.
Treatment eliminates unpleasant symptoms - itching and discharge. By restoring the vaginal lactoflora, the risk of developing inflammatory diseases of the pelvic organs is reduced.
Therapy for bacterial vaginosis in pregnant women reduces the risk of pregnancy complications.
Types of medicines
At the first stage, bacterial vaginosis is treated with local or systemic antibiotics, which is aimed at suppressing the causative agents of the disease and relieving symptoms. However, antibiotics, together with pathogenic bacteria, kill beneficial microflora. An alkaline environment is formed in the vagina, favorable for the activity of pathogenic microorganisms.
After using antibiotics, it is necessary to restore the lactoflora with the help of probiotics and eubiotics.
Nitroimidazoles are drugs with a broad spectrum of action, active against anaerobic bacteria in the treatment of bacterial vaginosis:
- Ornidazole;
- Tinidazole;
- Secnidazole.
The advantage of metronidazole is that it does not suppress lactobacilli.
Clindamycin, a representative of the lincosamide group, has a wider spectrum of antibacterial activity compared to Metronidazole. This drug also has an immunomodulatory effect.
Metronidazole or Clindamycin tablets are combined with intravaginal administration in the form of suppositories or 0.75% gel.
Hexicon vaginal suppositories have a wide spectrum of antimicrobial action. After their use, the growth of normal vaginal microflora is maintained.
Trichopolum has high antimicrobial activity and is available in dosage forms for local and systemic use.
In mild cases, they are limited to local administration of drugs.
For bacterial vaginosis, Vaginorm-C is used to restore and maintain the physiological pH of the vagina in the range of 3.8–4.5.
Effective in the treatment of gardnerellosis, Ginalgin is presented in the form of vaginal tablets, which contain metronidazole and chlorquinaldol, which affects opportunistic microflora and fungi of the genus Candida.
Neo-Penotran and Neo-Penotran Forte contain antibacterial, antiprotozoal and anticandida components.
The combined drug Neo-Penotran is safe for the treatment of bacterial vaginosis in pregnant women starting from the 2nd trimester.
Bacterial biological preparations, eubiotics and probiotics, promote the growth of lactobacilli and reduce the frequency of relapses of bacterial vaginosis.
Eubiotics are prescribed by a doctor after microbiological confirmation of the absence of pathogenic bacteria in the vagina:
Lactobacillus preparations help increase the protective properties of the vaginal environment.
To maintain normal vaginal lactoflora, it is recommended to treat intestinal dysbiosis with fermented milk drinks containing 10⁷–10⁸ CFU of bifidobacteria and lactobacilli.
Often, treatment of bacterial vaginosis with Metronidazole or Clindamycin is complicated by the occurrence of vulvovaginal candidiasis. For its prevention, Clotrimazole, Pimafucin, Ginopevaril are prescribed.
If necessary, antibacterial therapy is supplemented with immunomodulators and antiallergic drugs.
Immunomodulators
The complex therapy of bacterial vaginosis includes immunomodulatory drugs that allow you to maintain the positive effect of treatment for a long time and maintain normal vaginal biocenosis.
Genferon in the form of vaginal suppositories has antiviral, immunomodulatory, antioxidant and analgesic effects.
Polyoxidonium increases the effect of antibacterial drugs and allows you to shorten the course of taking medications.
Contraindications
Alcohol is contraindicated during treatment of bacterial vaginosis with Metronidazole and for 24 hours after stopping the drug.
Intolerance to oral Metronidazole also excludes intravaginal administration.
Oral administration of Clindamycin may cause adverse reactions - pseudomembranous colitis, allergies, diarrhea.
Ornidazole and Metrodinazole are contraindicated in the 1st trimester of pregnancy. When taken orally, side effects are possible - nausea, drowsiness, complications from the central and peripheral nervous system. Therapy of gardnerellosis during pregnancy is complicated by the possible negative effect of antibacterial drugs on the fetus. To avoid the development of side effects, preference is given to topical drugs.
During the treatment of bacterial vaginosis, it is advisable to stop using alkaline soap and replace it with special mild detergents for feminine intimate hygiene.
Wearing panty liners promotes the development of anaerobic bacteria. Douching and sex using condoms and spermicides are also contraindicated during treatment.
An imbalance in the vaginal microflora can cause the development of 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
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, menstrual dysfunction, surgical termination of pregnancy, surgeries, penetrative diagnostic and therapeutic procedures, 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
He told us about the causes of bacterial vaginosis obstetrician-gynecologist Vyacheslav Ivannikov:
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.
The acidic environment of the vagina 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 in 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 contraceptives () 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 signs of bacterial vaginosis are: thin and watery, gray or white, odorless or with a strong unpleasant “fishy” odor.
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