Bacterial vaginosis: symptoms, diagnosis, treatment methods

Bacterial vaginosis - pathology of the vaginal ecosystem, provoked by the active growth of anaerobic bacteria (mycoplasmas, peptococci, gardnerell). The inflammatory process is absent. Vaginosis is characterized by prolonged and abundant discharge, in which pathogenic microorganisms (trichomonads, gonococci) are not detected. Massive proliferation (growth) of mixed flora is associated with the loss of normal lactobacilli prevailing in the vaginal microflora, performing the function of a protective barrier against the penetration of pathogens from the outside. This creates a fertile ground for the development and progression of chronic pelvic inflammatory diseases.

Bacterial vaginosis: causes

Primary pathogens of the disease are anaerobic bacteria (Mycoplasma hominis, Mobiluncus spp, Gardnerella vaginalis). With bacterial vaginosis, their concentration rises by several orders of magnitude, against which the population of lactobacilli decreases, the amount of lactic acid and acidity of the vaginal contents decreases. Bacterial vaginosis is a multifactorial syndrome in which the leading role is assigned to disturbances of the vaginal microflora that occurs as a result of the influence of endogenous and exogenous factors of the disease:

• endocrine disorders, unsystematic antibacterial therapy;
• changes in the state of immunity;
• Concomitant / transferred diseases of female genital organs of inflammatory origin;
• regular exposure to ionizing radiation;
• use of contraceptives (spermicide, intrauterine, oral);
• frequent douching;
• diagnostic / surgical interventions;
• dysbacteriosis of the intestine, drug allergic reactions.

How is bacterial vaginosis transmitted

Bacterial vaginosis is usually attributed to sexually transmitted diseases. Two facts confirm this fact. The first is a high percentage of relapses among cured women whose sexual partners have not been treated. The second - recorded cases of disease of healthy women after coitus with men, the analyzes of which show the presence of anaerobic bacteria.

Bacterial vaginosis in men

In men, the disease is diagnosed much less often than in women. Most often anaerobic bacteria are isolated in association with different types of bacteroides. The inflammatory process affects the anterior urethra, the clinical picture of male bacterial vaginosis is lubricated, without severe symptoms, and sometimes scant serous-mucous discharge is noted. Theoretically, the development of complications (pyelonephritis, epididymitis, cystitis, gardnerelleous prostatitis) is possible, but in practice they are extremely rare (1-2%). Men suffering from asymptomatic / asymptomatic forms of the disease serve as sources of infection for women.

Symptoms of bacterial vaginosis in women

Clinical manifestations of bacterial vaginosis have no characteristic features, the only obvious symptom is the presence of abundant vaginal discharge, which has an unpleasant smell of stale fish. At the initial stage they are grayish or white, with a progressive selection process they acquire a yellow-green hue and become more dense. Manifestations of inflammation (hyperemia, puffiness) are absent, during the gynecological examination reveal pathologies of the cervix uteri - cervicitis , erosion, cicatricial formation. 50% of patients are concerned about itching in the area of ​​external genitalia, pain in the perineum, urination disorders, profuse menstruation.

Degrees of bacterial vaginosis

1. Compensated. Characterized by the complete absence of lactobacillary microflora in "normal" epithelial cells in the material under investigation. The condition does not refer to pathological ones, however it indicates the possibility of anaerobic bacteria populating an empty niche with the subsequent formation of vaginosis.
2. Subcompensated. It is characterized by a significant decrease in lactobacilli, the appearance of key cells against a background of mild leukocytosis.
3. Decompensated. Clinically expressed bacterial vaginosis: there are manifestations of the disease and the bacterial flora represented by anaerobes, there are no lactobacilli.

Diagnostic measures

Priority value in the diagnosis of bacterial vaginosis is given to the screening methods of the study - aminotest with a solution of potassium hydroxide (10%) and pH-metry. When lysing the glycogen of the vaginal epithelium during lactobacillus metabolism, lactic acid is formed. If the mechanism is violated, lactobacillus death occurs and the pH deviates into the alkaline reaction vector, which leads to a sharp increase in anaerobes. A positive amine test is the appearance of the smell of "rotten" fish during the mixing of a solution of potassium hydroxide and a separable vagina.

Clinical and microbiological signs, on the basis of which the diagnosis of bacterial vaginosis is made:

• abundant homogeneous vaginal discharge with an unpleasant odor;
• positive amine test;
• increase in the pH of the vaginal secretion is higher than 4.5;
• The presence of a large association of vaginal epitheliocytes; "Key cells" (anaerobes);
• complete absence / significant decrease in lactobacilli;
• rare presence / absence of polynucleated leukocytes;
• presence of a large amount of Fusobacterium spp, Bacteroides spp, Gardnerella vaginalis.

Bacterial vaginosis, treatment

Successful therapy of BV depends on timely and correct diagnosis, adequate and pathogenetically justified treatment, the purpose of which is to regenerate the normal vaginal microflora, to stop the reproduction of microorganisms that are not peculiar to microcenosis. To date, the treatment of BV remains a complex task, which is caused by low efficacy of drugs and frequent recurrence of the disease.

Complex two-stage pathogenetic and etiotropic therapy

1. Elimination of pathogens of bacterial vaginosis

   Drugs of choice - medication against anaerobic elements of the vaginal microflora. Their clinical effectiveness reaches 87-95%. In parallel, systemic prophylaxis of vaginal candidiasis is performed. The best results in the treatment of BV were Metronidazole (Trichopol, Metrogil), which is part of a group of antibiotics containing an imidazole ring. It penetrates into the microbial cell, binds to DNA, blocks the nucleic acid compound. Metronidazol shiroko is used in various treatment regimens, but often provokes side reactions - dyspeptic abnormalities, allergies, metallic taste in the mouth. The preferred route of administration is vaginal.

   For local treatment, doctors often use Clindamycin. The drug has a strong antibacterial activity, neutralizing protein synthesis in the microbial cell. It is possible to introduce the oral and oral application of Clindamycin. Side effect: growth of yeast-like fungi, allergic reactions.

2. Restoration of vaginal biocenosis

   It is carried out due to the local application of eubiotics - Bifidumbacterin, Acilacta, Lactobacterin. These drugs stimulate the growth of natural vaginal lactoflora, contribute to reducing the number of recurrences of bacterial vaginosis by increasing the protective qualities of the vagina.

Criteria for the effectiveness of treatment:

• dynamics of clinical symptoms of the disease;
• disappearance of subjective sensations;
• stabilization of laboratory indicators.

The quality of therapy is estimated 10-14 days after the completion of the course. It is recommended to use barrier methods of contraception throughout the treatment period.

Preparations for the treatment of bacterial vaginosis:

• Lactagel (gel). Normalizes the pH of the vagina, restores the natural microflora, creating good conditions for the growth of healthy microflora. Helps to remove abundant secretions, unpleasant odor, discomfort;
• Femilex (vaginal suppositories). According to the mechanism of action, Femilex is similar to Lactagel. In 5-10% of cases, it can provoke intense itching in the vagina. Contraindications: thrush, pregnancy, lactation;

• Vaginorm-G (vaginal tablets). Reduces the pH of the vagina, inhibits the growth of harmful bacteria, regenerates normal vaginal flora. It is well tolerated, in exceptional cases it can provoke itching / burning in the vagina, increase the intensity of mucous secretions. Contraindicated with a history of thrush;
• Acylact (vaginal suppositories). Contains live lactobacilli, which displace anaerobic bacteria, helping to restore natural immunity. It is forbidden to use for thrush;
• Clindamycin (vaginal cream). Antibacterial agent for topical use. Quickly destroys harmful bacteria, normalizes normal vaginal flora. Side effects: headache, dizziness, thrush, abdominal pain, digestive disorders;
• Bifidumbacterin (vaginal suppositories). Regenerates the equilibrium of the microflora of the vagina, destroys anaerobic organisms;
• Trichopolum (vaginal tablets). It improves the general condition, reduces the amount of secretions, eliminates an unpleasant odor, restores the normal flora of the vagina. Contraindications: pregnancy, liver failure. Side effect: frequent urination, nausea, dry mouth, candidiasis (thrush).

How does bacterial vaginosis treat folk remedies?

Before the start of the course of therapy, it is recommended to consult a doctor to avoid complications and side effects. With a competent approach, the use of folk recipes helps to remove unpleasant symptoms and restore a healthy vaginal microflora.

1. Solutions for syringing:

   • take flowers of chamomile medicinal and goose fuzz (one tablespoon), pour a liter of boiling water, insist 30-40 minutes, apply in a warm form;
   • take in equal proportions the root of angelica, badana, chicory, dandelion, calendula herb, leaves of mother and stepmother, thyme. Grind, mix, measure two tablespoons of the collection, brew with a liter of boiling water, insist 10-12 hours, apply in a warm form;
   • A tablespoon of the crushed bark of an oak to brew with 250 milliliters of pure water, to take in a water bath of 10-15 minutes, to insist 3-4 hours. Before syringing infusion, cool and strain;
   • take a tablespoon of cherry fruit, boil on moderate fire for 20-25 minutes, cool, drain. Use for rinsing the vagina.

2. Soothing baths:

   • soak 250 grams of oak bark in cool water, leave for 2-3 hours, mix the mixture boil, add to the previously prepared bath. Therapeutic procedure eliminates inflammation, promotes wound healing;
   • combine walnut leaves, oat straw, juniper berries, chamomile, oak bark. Boil for 30-40 minutes on low heat, add the broth to the prepared bath. The drug has antimicrobial, antiviral, antifungal action.

Bacterial vaginosis in pregnancy

Violation of the vaginal microflora during pregnancy is a prognostic factor of risk of intrauterine infection of the fetus and inflammatory complications in the mother. There is a direct relationship between the severity of bacterial vaginosis and the complicated course of pregnancy. Bacterial vaginosis can lead to spontaneous miscarriage, premature birth, untimely outpouring of amniotic fluid, endometritis, chorioamnionitis (infection of membranes). Pregnancy against the background of microbial pathology is often complicated by abnormalities of fetal development - a delay in intrauterine development, failure of the cardiovascular system, hypoxia.

Therapy of bacterial vaginosis in pregnant women

The main direction of treatment - the use of systemic or local drugs that have antianaerobic effect:

• Clindamycin. Assign one of the dosage forms of the drug: cream Invavaginally once a day for 6 days, vaginal tablets 100 mg intravaginally once a day for 3 days;
• Hexicon. It is used in the form of candles, restores a healthy microflora of the vagina, prevents the progression of infectious and inflammatory processes in the postpartum period;
• Metronidazole. Do not appoint in the first trimester of pregnancy due to a possible negative effect on the fetus, the course of treatment Metronidazole is carried out after the twentieth week. When pregnant, it is advisable to use a medicine in the form of candles. The vaginal route of therapy with BV is not worse than oral treatment, and in some cases even surpasses it. With topical application, the active substance enters directly into the cluster of pathogens of the disease - this eliminates the systemic effect on healthy tissues, reduces the likelihood of adverse reactions;
• Limafucine. It is characterized by a powerful local action, is active against anaerobic microflora, does not adversely affect the fetus.

Can I get pregnant with bacterial vaginosis? You can, the presence of the disease pregnancy does not exclude. But it's not worth risking your own health and the health of the baby's future. With the BV problem, 10-35% of women are still at the planning stage of pregnancy. Unfortunately, the blurred symptomatology leads to the fact that the pathology is discovered quite by accident. Bacterial vaginosis should be eliminated before pregnancy - this will help to avoid serious complications during childbearing and childbirth.

Prevention of recurrence and the occurrence of bacterial vaginosis:

• rational nutrition, maintaining the normal functioning of the intestine;
• the correct intake of antibacterial drugs;
• proper hygienic care for external genital organs;
• use of barrier contraception during sexual contact with an untested partner.

Bacterial vaginosis is a common pathology of the vaginal ecosystem, requiring comprehensive and adequate therapy. Lack of timely treatment contributes to the chronization process, the emergence of diseases of the reproductive system, the development of complications during pregnancy and childbirth. Gynecologists recommend if any doubtful signs (unusual discharge, itching / burning, pain in the lower abdomen) appear, undergo a complete examination and, if necessary, a course of treatment that takes 12-14 days.