Currently, bacterial vaginosis is considered as a condition accompanied by the appearance of pathological discharge from the vagina, in which a variety of microorganisms are found. This disease occurs in women of all ages from little girls to elderly ladies. Its frequency ranges from 15 to 64%. Bacterial vaginosis can only conditionally be classified as a sexually transmitted infection - rather, it represents a violation of the “microbial balance”, a kind of dysbiosis of the vagina.
How does the disease develop?
As you know, the skin and mucous membranes of a healthy person are by no means sterile. We all live in community with many microorganisms that make up the normal microflora of our body. Yes, y healthy women The main inhabitants of the vagina are lactobacilli (lactic acid bacteria), accounting for 95-98% of the total flora. They produce lactic acid, thereby maintaining an acidic environment in the vagina. It is a protective factor, preventing the excessive growth of other 20-30 types of bacteria. Under the influence of unfavorable factors, the number of lactobacilli decreases, the acidity of the environment changes, and the vacant place is occupied by microorganisms that normally live in the vagina in small quantities. Among these bacteria, Gardnerella vaginalis is found most often than others. This is the main, but not the only, cause of bacterial vaginosis. Hence another name for the disease - gardnerellosis. In addition to gardnerella, other microorganisms (bacteria of the genus mobiluncus, bacteroides, peptococci, peptostreptococci, mycoplasmas) are often detected in bacterial vaginosis.
The composition of the vaginal microflora can be influenced by the following factors:
- use of antibiotics and other antibacterial drugs, hormones;
- hormonal changes during puberty, after abortion, childbirth, and menstrual dysfunction;
- decreased immunity, allergies;
- climate change, various stresses;
- use of oral contraceptives, intrauterine devices;
- frequent and excessive vaginal douching, use of antibacterial agents (for example containing TRICLOSAN), antiseptic solutions;
- the use of spermicides (substances that kill sperm - they are part of contraceptive suppositories and vaginal tablets), hygienic tampons;
- dysfunction and microbial composition of the intestine.
Symptoms of the disease
The incubation period ranges from 3 to 10 days, after which symptoms of the disease appear. The main symptom is complaints of moderate (less often, heavy) grayish-white discharge with an unpleasant odor of rotten fish. The cause of the odor is the amines formed during the life of gardnerella. The smell can be constant and appear during menstruation, sexual intercourse, or when washing with alkaline soap. In this case, redness and swelling of the external genitalia and vaginal walls are usually not observed; bacterial vaginosis is almost never accompanied by itching. In some cases, the disease is complicated by inflammation of the internal genital organs, then pain in the lower abdomen, menstrual irregularities, and prolonged, heavy menstruation appear. With bacterial vaginosis, the frequency of complications after gynecological operations sharply increases, and postoperative wounds become suppurated more often.
Course of pregnancy
During pregnancy, under the influence of hormones, favorable conditions are created for the life of lactobacilli. Therefore, the incidence of bacterial vaginosis in pregnant women is lower than in other women. Bacterial vaginosis during pregnancy occurs in 10-20% of all pregnant women, half of whom have no symptoms. In pregnant women with bacterial vaginosis, a high concentration of microorganisms in the vagina can lead to the penetration of these bacteria into the upper genitalia (uterus and appendages). In such women, infection of the membranes is 2 times more likely amniotic sac and placenta, the so-called chorioamnionitis is a formidable complication of pregnancy, threatening the life of the mother and fetus. In addition, inflammation of the membranes can lead to their rupture and rupture of water long before the expected due date. In this case, the pregnancy is terminated or premature birth.
Infection in the mother can lead to infection in the baby. Children with intrauterine infection are born weakened, with low body weight, congenital pneumonia, and after birth they may develop infectious skin lesions and inflammation of the umbilical wound. Prolonged oxygen starvation, due to insufficient function of the infected placenta, can lead to neurological problems in the child.
In addition, bacterial vaginosis increases the incidence of postpartum complications in the mother, especially if the birth was performed by surgery caesarean section. In particular, the frequency of inflammation of the inner surface of the uterus (endometritis) and purulent inflammation of the mammary gland (mastitis) increases. The likelihood of endometritis with bacterial vaginosis is 10 times higher than in healthy women.
Diagnostics
Diagnosis is based on clinical examination data and laboratory research methods. There are four main signs of bacterial vaginosis; at least three of the four signs must be present for diagnosis:
1.Presence of symptoms characteristic of the disease, i.e. homogeneous, liquid, fishy-smelling discharge that adheres to the vaginal wall.
2.Intensification of the “fishy” odor when alkali solutions are added to vaginal secretions.
3. Alkaline nature of the environment in the vagina.
4. Presence of corresponding changes in the results of vaginal smear tests.
Such changes, in particular, include the detection of “key cells” in smears. These cells are the cells of the vaginal epithelium, coated as if “peppered” small sticks(gardnerellas). Such cells are found in the most common vaginal smear, which is taken from all pregnant women without exception.
In difficult cases, gardnerella DNA identification can be used for diagnosis - polymerase chain reaction (PCR).
Pregnancy management and treatment
The goal of treatment for bacterial vaginosis is to restore the normal composition of the vaginal microflora and eliminate the symptoms of the disease, and not to completely destroy gardnerella. In non-pregnant women, treatment is carried out only if symptoms of the disease are present. Since the presence of bacterial vaginosis during pregnancy is associated with a high risk of complications, pregnant women need treatment even if they are asymptomatic, especially if there is a threat of premature birth. To treat bacterial vaginosis in pregnant women, METRONIDAZOLE (TRICHOPOL, KLION, METROGYL) or ORNIDAZOLE (TIBERAL) is most often used. Numerous studies have not revealed the teratogenic effects (the ability to cause developmental defects) of these drugs on the fetus, however, due to possible negative effects, they are not used in the first trimester of pregnancy. Treatment is usually started after 20 weeks of pregnancy. In parallel with taking tablets orally, METRONIDAZOLE preparations are prescribed topically, in the form of vaginal tablets. Preparations based on CLINDAMICIN (DALACIN) can also be used during pregnancy after 20 weeks orally, but vaginal CLINDAMICIN creams are usually not prescribed, as there is evidence of an increase in the number of premature births when using these forms. Antibacterial therapy, if necessary, is supplemented by the use of immunocorrectors (KIPFERON, VIFERON), antiallergic drugs, taking into account contraindications due to pregnancy.
Treatment of sexual partners is not required, as this does not affect the success of treatment and the frequency of relapses of the disease in pregnant women. Antibacterial drugs only kill gardnerella, but do not create conditions for restoring the normal content of lactic acid bacteria. Therefore, vaginal candidiasis (thrush) often occurs after treatment. In addition, even after treatment at any stage of pregnancy, the symptoms of bacterial vaginosis may recur, so three to four weeks after treatment it is necessary to undergo a control study of the composition of the vaginal microflora. If the tests do not reveal gardnerella or candida, then drugs are prescribed that restore the normal microflora of the vagina (ACYLACT, LACTOBACTERIN, BIFIDIN).
During treatment, it is necessary to more often eat fermented milk products enriched with live cultures of bacteria, as well as products containing coarse dietary fiber.
Prevention
Prevention of bacterial vaginosis involves eliminating factors that affect the composition of the vaginal microflora. Before pregnancy, it is advisable to undergo screening for gardnerellosis and sexually transmitted infections. If diseases are detected, it is necessary to undergo a full course of treatment, including antibacterial drugs and agents that restore normal microflora. In case of frequent relapses of bacterial vaginosis of pregnancy, the SOLKO TRICHOVAC vaccine can be used. After applying this vaccine, conditions are created for the growth of lactobacilli, which prevents relapses of bacterial vaginosis. The first symptoms of improvement begin to be felt three weeks after using the vaccine.
During pregnancy, women, unfortunately, often have to deal with various problems.
One of the most unpleasant surprises for an expectant mother can be bacterial vaginosis, which is most often discovered directly when visiting a gynecologist.
This problem occurs quite often: it is detected in approximately 20% of pregnant women.
However, few people know about the causes, symptoms and possible consequences this infectious disease.
What is bacterial vaginosis
In the vagina of any woman there is a microflora, that is, a set of microorganisms that use the human body as a habitat. The majority of this flora consists of lactic acid bacteria, especially Doderlein bacilli (about 95%) among them.
Normally, these microbes do not cause any problems to a woman and even bring benefits, as they regulate acidity in the vagina, creating ideal conditions for the functioning of the reproductive system, immune protection, conception and pregnancy.
Some negative factors inhibit the usual microflora.
If infection with pathogenic microorganisms also occurs, they begin to multiply uncontrollably in the woman’s genital tract.
This is how bacterial vaginosis occurs - an infectious disease that manifests itself in changes in the bacterial flora in vaginal discharge.
At the same time, there are no leukocytes on vaginal smears, that is, inflammation does not develop.
Causes of bacterial vaginosis
The factors that cause the suppression of normal microflora and the development of pathogenic microbes are very diverse:
1 Hormonal changes during puberty, the onset of menstruation, during menopause, early stages pregnancy, as well as while taking hormonal medications.
2 Death of normal microflora under the influence of antibiotics, especially after antibacterial therapy during surgical operations (on various organs, not only reproductive ones).
3 Significant changes in the vaginal microflora occur as a result of inflammatory processes in the genital organs. They are especially noticeable if the inflammation is left untreated for a long time.
4 A general decrease in the body's immune defense due to various infectious and non-infectious diseases, poor nutrition, lack of hygiene, bad habits.
5 Use of contraceptives different types, both oral hormonal drugs and intrauterine or spermicidal devices.
They disrupt the normal environment in the woman’s genital tract.
6 The likelihood of contracting bacterial vaginosis increases significantly if a woman or her husband has relationships with several sexual partners at the same time.
Interesting! Discharge during pregnancy
The microflora existing in the genital tract is very vulnerable, so the effect of negative factors almost always affects its condition. Although a woman may not notice violations if they do not manifest tangible symptoms.
Is pregnancy possible with bacterial vaginosis?
Pregnancy can occur in the presence of bacterial vaginosis. In most cases, this happens if the woman does not undergo examination and does not eliminate the problem when planning a pregnancy, and the disease itself develops asymptomatically.
If vaginosis progresses during pregnancy, it can significantly complicate the process of bearing a child.
Pathogenic microflora produces substances that can cause rupture of the membranes, provoke miscarriage or premature birth, infect the fetus itself, and lead to stunted growth and weight gain.
After childbirth, a septic process in the uterus may begin, which is very dangerous for the health and life of a woman.
Bacterial vaginosis during pregnancy: symptoms
Vaginosis goes undetected quite often. Sometimes women do not perceive its manifestations as a symptom of any disease, so they do not pay attention to them. In most cases, this disease is accompanied by:
1 The appearance unpleasant odor from vaginal discharge. It occurs due to the decomposition of fat-like substances and amino acids under the influence of pathogenic microflora, and often resembles the smell of fish.
2
Increased amount of vaginal discharge. They are white or grayish in color and may resemble foam that covers the surface of the mucous membrane of the genital tract.
3 An increase in the amount of discharge after sexual intercourse or before the onset of menstruation.
At this time, the environment in the genital organs changes, which provokes more intense formation.
4 Feeling of discomfort in the genital tract: difficulty urinating, pain, itching. They tend to get worse during or after sexual intercourse.
When examining a patient, the doctor makes a diagnosis based on several criteria. Firstly, he takes into account the patient’s complaints (if any) and determines the nature of the discharge (their color, consistency, smell).
The second, mandatory step in making a diagnosis is taking a smear from the vagina. This is a convenient method for determining the composition of the microflora of the genital tract; it gives an idea of the dominant types of pathogenic flora (but it is impossible to determine all its components, since the diversity of microbes can be extremely high).
Bacterial vaginosis during pregnancy: treatment and prevention
Prevention of vaginosis does not include any specific measures. It provides for the maximum exclusion of negative factors that can provoke the disease.
Interesting! Lingonberries during pregnancy - benefits and harms
The most important points that directly depend on a woman are the inadmissibility of promiscuity, healthy image life and strengthening of general immunity.
If the body has a high resistance to diseases, the likelihood of developing vaginosis during pregnancy is reduced.
It is better to identify this disease before pregnancy, when the woman undergoes examination when planning it.
In this case, the treatment will be more effective, because many drugs are prohibited for use when carrying a child.
If bacterial vaginosis occurs or is detected during pregnancy, it complicates the process of eliminating the problem.
Typically, treatment of bacterial vaginosis includes two stages: suppression of existing pathogenic microflora with the help of oral and vaginal antibacterial drugs (clindamycin, metronidazole, ornidazole, etc.) and restoration of normal microflora, in which lactobacilli predominate (various probiotics, lactogel, vapigel, etc. ).
Drugs such as clindamycin and metronidazole do not appear to have a negative effect on the fetus or pregnancy. However, there are also drugs prohibited for use, for example, tinidazole.
Treatment of bacterial vaginosis during pregnancy is not recommended with vaginal antibiotics.
This strategy is due to the likelihood that antibiotics can affect the early stages of fetal development, when its organs are laid down and their formation begins.
After the first trimester, the child becomes less susceptible to the effects of negative factors.
The treatment process for this disease is likely to be lengthy. The patient should also be prepared for the fact that even after eliminating vaginosis and with normal vaginal microflora test results, the likelihood of a recurrence of the disease still remains.
Therefore, if a woman has suffered from vaginosis and successfully completed the course of treatment, she still needs to regularly visit the gynecologist in order to detect a relapse of the disease in time. In addition, you need to be more attentive to your health and strictly adhere to the recommendations of your doctor.
The vaginal microflora contains about 90% beneficial bacteria and contains opportunistic microorganisms in smaller quantities. Bacterial vaginosis during pregnancy is formed when the body's immune systems decrease. When the protective barrier is weakened, harmful bacteria begin to develop, threatening the health of not only the mother, but also the child.
Causes
After conception, a woman’s body experiences a double load, hormonal levels begin to change, and the immune system decreases functionality. At the same time, the lactic acid environment rapidly decreases, giving way to opportunistic bacteria. This process causes bacterial vaginosis, which can provoke:- taking certain medicines(antibiotics, hormonal or antifungal agents);
- diseases of the endocrine system;
- allergic reactions;
- stressful situations;
- failure to comply with hygiene rules.
Symptoms of pathology
From the moment the pathogenic microflora begins to multiply until the first symptoms appear, no more than 10 days pass. The main symptom during the period of intrauterine development of the fetus is a feeling of discomfort that occurs for certain reasons:- copious discharge - white, grayish, less often, yellow tint;
- bad smell, similar to fish;
- inflammation internal organs provokes pain in the groin area;
- itching, with prolonged absence of treatment;
- pain during urination or sexual intercourse.
Can vaginosis affect pregnancy?
Vaginosis, at the stage of bearing a child, is diagnosed in only 20% of women, most of them do not experience discomfort due to the absence of symptomatic manifestations. At the same time, a high concentration of harmful microorganisms in the vaginal microflora, multiplying, penetrates higher - to the uterus and appendages.There is a threat of infection of the membrane of the fetal bladder (charyoamnionitis), a serious complication that threatens the life of the fetus. Placental rupture leads to premature birth, miscarriage and death.
Also, the development of infection, without proper therapy, can affect the course of pregnancy by other factors:
- low baby weight;
- reduced protective barrier of the body;
- development of congenital defects;
- oxygen starvation of the fetus;
- neurological disorders.
Backvaginosis - treatment during pregnancy
The main focus of therapy is to normalize the sour-milk environment of the vagina and eliminate symptoms that lead to discomfort. Depending on the type of pathogen diagnosed, drug treatment is prescribed:- Metronidazole (vaginal tablets) or ornidazole are used only after the 20th week of pregnancy, since at an earlier stage the drug causes negative consequences in the formation of the fetus.
- Kipferon or Viferon is prescribed to activate immune processes and to enhance the body's defense response.
- Hexicon suppositories contain the active substance chlorhexidine. The drug is used even on early stages pregnancy, as an antimicrobial and antiseptic agent.
- Acylact, bifidin, vapigel and others medicines This direction is used to restore the normal microflora of the vagina.
In most cases, local treatment and taking vitamin complexes are enough to cope with the pathology. The duration of therapy is determined by the doctor in each case individually, but on average, medication is prescribed for a period of 7 to 10 days.
Treatment of bakvaginosis during pregnancy with folk remedies
Auxiliary and no less effective method in the treatment of bacterial vaginosis will become folk remedies. Before using any medicinal product at home, you should consult a doctor so as not to complicate the course of the disease and not cause a negative reaction from the fetus.- douching with an infusion of chamomile and cinquefoil flowers will reduce the number of pathogenic bacteria;
- warm bath with 1 glass apple cider vinegar has an anti-inflammatory effect;
- rinsing with a decoction of bird cherry fruits will significantly reduce the symptoms of the disease;
- a gauze swab dipped in squeezed radish juice is inserted into the vagina overnight. The product has antibacterial properties, relieves itching and swelling.
A pregnant woman should give preference to clothes made from natural fabrics and avoid tight, tight clothes, so as not to create a greenhouse effect and feel as comfortable as possible.
During pregnancy, women, unfortunately, often have to deal with various problems.
One of the most unpleasant surprises for an expectant mother can be bacterial vaginosis, which is most often discovered directly when visiting a gynecologist.
This problem occurs quite often: it is detected in approximately 20% of pregnant women.
However, few people know about the causes, symptoms and possible consequences of this infectious disease.
What is bacterial vaginosis
In the vagina of any woman there is a microflora, that is, a set of microorganisms that use the human body as a habitat. The majority of this flora consists of lactic acid bacteria, especially Doderlein bacilli (about 95%) among them.
Normally, these microbes do not cause any problems to a woman and even bring benefits, as they regulate acidity in the vagina, creating ideal conditions for the functioning of the reproductive system, immune defense, conception and pregnancy.
Some negative factors inhibit the usual microflora.
If infection with pathogenic microorganisms also occurs, they begin to multiply uncontrollably in the woman’s genital tract.
This is how bacterial vaginosis occurs - an infectious disease that manifests itself in changes in the bacterial flora in vaginal discharge.
At the same time, there are no leukocytes on vaginal smears, that is, inflammation does not develop.
Causes of bacterial vaginosis
The factors that cause the suppression of normal microflora and the development of pathogenic microbes are very diverse:
1 Hormonal changes during puberty, the onset of menstruation, during menopause, in the early stages of pregnancy, and also while taking hormonal medications.
2 Death of normal microflora under the influence of antibiotics, especially after antibacterial therapy during surgical operations (on various organs, not only reproductive ones).
3 Significant changes in the vaginal microflora occur as a result of inflammatory processes in the genital organs. They are especially noticeable if the inflammation is left untreated for a long time.
4 A general decrease in the body’s immune defense due to various infectious and non-infectious diseases, poor nutrition, poor hygiene, and bad habits.
5 The use of different types of contraceptives, both oral hormonal drugs and intrauterine or spermicidal devices.
They disrupt the normal environment in the woman’s genital tract.
6 The likelihood of contracting bacterial vaginosis increases significantly if a woman or her husband has relationships with several sexual partners at the same time.
Interesting! Discharge during pregnancy
The microflora existing in the genital tract is very vulnerable, so the effect of negative factors almost always affects its condition. Although a woman may not notice violations if they do not manifest tangible symptoms.
Is pregnancy possible with bacterial vaginosis?
Pregnancy can occur in the presence of bacterial vaginosis. In most cases, this happens if the woman does not undergo examination and does not eliminate the problem when planning a pregnancy, and the disease itself develops asymptomatically.
If vaginosis progresses during pregnancy, it can significantly complicate the process of bearing a child.
Pathogenic microflora produces substances that can cause rupture of the membranes, provoke miscarriage or premature birth, infect the fetus itself, and lead to stunted growth and weight gain.
After childbirth, a septic process in the uterus may begin, which is very dangerous for the health and life of a woman.
Bacterial vaginosis during pregnancy: symptoms
Vaginosis goes undetected quite often. Sometimes women do not perceive its manifestations as a symptom of any disease, so they do not pay attention to them. In most cases, this disease is accompanied by:
1 The appearance of an unpleasant odor from vaginal discharge. It occurs due to the decomposition of fat-like substances and amino acids under the influence of pathogenic microflora, and often resembles the smell of fish.
2
Increased amount of vaginal discharge. They are white or grayish in color and may resemble foam that covers the surface of the mucous membrane of the genital tract.
3 An increase in the amount of discharge after sexual intercourse or before the onset of menstruation.
At this time, the environment in the genital organs changes, which provokes more intense formation.
4 Feeling of discomfort in the genital tract: difficulty urinating, pain, itching. They tend to get worse during or after sexual intercourse.
When examining a patient, the doctor makes a diagnosis based on several criteria. Firstly, he takes into account the patient’s complaints (if any) and determines the nature of the discharge (their color, consistency, smell).
The second, mandatory step in making a diagnosis is taking a smear from the vagina. This is a convenient method for determining the composition of the microflora of the genital tract; it gives an idea of the dominant types of pathogenic flora (but it is impossible to determine all its components, since the diversity of microbes can be extremely high).
Bacterial vaginosis during pregnancy: treatment and prevention
Prevention of vaginosis does not include any specific measures. It provides for the maximum exclusion of negative factors that can provoke the disease.
Interesting! Lingonberries during pregnancy - benefits and harms
The most important points that directly depend on a woman are the inadmissibility of promiscuity, maintaining a healthy lifestyle and strengthening the general immune system.
If the body has a high resistance to diseases, the likelihood of developing vaginosis during pregnancy is reduced.
It is better to identify this disease before pregnancy, when the woman undergoes examination when planning it.
In this case, the treatment will be more effective, because many drugs are prohibited for use when carrying a child.
If bacterial vaginosis occurs or is detected during pregnancy, it complicates the process of eliminating the problem.
Typically, treatment of bacterial vaginosis includes two stages: suppression of existing pathogenic microflora with the help of oral and vaginal antibacterial drugs (clindamycin, metronidazole, ornidazole, etc.) and restoration of normal microflora, in which lactobacilli predominate (various probiotics, lactogel, vapigel, etc. ).
Drugs such as clindamycin and metronidazole do not appear to have a negative effect on the fetus or pregnancy. However, there are also drugs prohibited for use, for example, tinidazole.
Treatment of bacterial vaginosis during pregnancy is not recommended with vaginal antibiotics.
This strategy is due to the likelihood that antibiotics can affect the early stages of fetal development, when its organs are laid down and their formation begins.
After the first trimester, the child becomes less susceptible to the effects of negative factors.
The treatment process for this disease is likely to be lengthy. The patient should also be prepared for the fact that even after eliminating vaginosis and with normal vaginal microflora test results, the likelihood of a recurrence of the disease still remains.
Therefore, if a woman has suffered from vaginosis and successfully completed the course of treatment, she still needs to regularly visit the gynecologist in order to detect a relapse of the disease in time. In addition, you need to be more attentive to your health and strictly adhere to the recommendations of your doctor.
- Bacterial vaginosis or bacvaginosis, vaginal dysbiosis, vaginal dysbiosis is a polymicrobial infectious non-inflammatory syndrome of the lower genitalia, which occurs against the background of a violation of the healthy balance of vaginal microflora and a decrease in the acidity of the vaginal environment.
The prevalence of bakvaginosis is very high. The disease was noted in 55.8% of women of childbearing age who consulted a gynecologist; in 60-70% of patients with inflammatory diseases of the genitals and 35% of pregnant women. The combination of intestinal dysbiosis with bacterial vaginosis is observed in 71% of cases.
Bacterial vaginosis. ICD-10 code:
N89 Other non-inflammatory diseases of the vagina.
Clarification:
There is no diagnosis of bacterial vaginosis in ICD-10. IN different years this syndrome was renamed several times: until 1955, the disease was called nonspecific vaginitis; since 1980 - gardnerellosis.
It was later found that the opportunistic bacterium Gardnerella vaginalis, considered the causative agent of bakvaginosis, is found in the vaginal discharge of 47-75% of healthy women without any clinical symptoms and is not the only “culprit” of the disease. Therefore, in 1981, gardnerellosis was renamed anaerobic vaginosis, and in 1984 the modern name appeared: bacterial vaginosis.
To identify the prevailing infectious agent, an additional ICD-10 code is used:
Q96 Other specified bacterial agents as the cause of diseases classified in other chapters.
Healthy vaginal microflora
The determining factor of normal vaginal microflora is the Doderlein flora. 90-98% of it is represented by lactobacilli (Doderlein bacilli), bifidobacteria and, to a small extent, strict anaerobes (in particular peptostreptococci).
The share of other (more than 40 species) microorganisms inhabiting a woman’s vaginal space normally accounts for only 3-5%.
/the most clinically significant microbial communities are indicated/
Characteristics of bacterial vaginosis:- A sharp decrease or disappearance of peroxide and acid-forming lactobacilli (lactobacillus). As a result, the pH of the vaginal environment increases.
- Massive reproduction of strict (obligate) anaerobes: Peptostreptococcus spp., Mobiluncus spp., Bacteroides spp., Prevotella spp., etc.
These microorganisms belong to the normal vaginal microflora. But their excessive growth, against the background of lactobacilli deficiency, leads to a decrease in the acid content in the vaginal contents and creates a favorable environment for the rapid development of opportunistic and pathogenic infections.
- Colonization of the vagina by Gardnerella.
- Increasing the total concentration of bacteria in vaginal discharge to 10 9 - 10 11 microorganisms per 1 ml (CFU/ml).
Representatives of the Doderlein flora
Lactobacilli.More than 10 different types of lactobacilli are isolated in the vaginal contents of different women. They produce lactic acid (as a result of the destruction of glycogen accumulated by the vaginal epithelium), hydrogen peroxide, lysozyme, and stimulate local immunity.
By blocking receptors of surface epithelial cells, lactobacilli prevent the adhesion of pathogenic agents. By colonizing the mucous membrane, they participate in the formation of a protective ecological film and provide colonization resistance of the vaginal biotope.
The pronounced acidic environment created by lactobacilli suppresses the proliferation of acidophobic opportunistic and transient pathogenic microorganisms.
The reduction or disappearance of vaginal lactobacilli contributes to the development of infectious diseases of the female genital tract. Bifidobacteria.The second representatives of the beneficial flora of Doderlein also belong to acid-forming microorganisms. They are playing important role in maintaining low pH values of the vaginal environment, they produce alcohols, lysozyme, bacteriocins, amino acids, vitamins, and stimulate the immune system.
Propionic acid bacteria- useful representatives of anaerobes. By actively processing glycogen, they secrete acetic and propionic acids and suppress the growth of opportunistic microflora.
The degree of contamination of vaginal discharge with certain microorganisms in women of childbearing age.
Causes of bacterial vaginosis
The mechanisms of development of vaginal dysbiosis are still not entirely clear.
An important role in the pathogenesis of the disease is played by:
- Changes in hormonal status.
- Changes in general and/or local immunity, decreased body resistance.
- Decompensated diabetes.
- Taking antibiotics, cytostatics, radiation therapy, ionizing radiation.
Risk factors for bacterial vaginosis:
— Puberty, menopause, pathology of pregnancy, postpartum, post-abortion period, menstrual irregularities (amenorrhea, oligomenorrhea).
— Hypotrophy and atrophy of the vaginal mucosa.
— Impaired sensitivity of the vaginal mucosa to sex hormones.
— Sexually transmitted infections.
— Inflammatory processes of the urogenital tract.
— Taking glucocorticosteroids, antibacterial, antiviral, and chemotherapy drugs.
- Long-term, uncontrolled use of oral and intrauterine contraceptives.
— Foreign bodies in the vagina and uterus (tampons, IUDs, etc.)
— Cysts, polyps of the genital tract.
— Surgical gynecological operations.
— Poor genital hygiene.
— Inadequate use of douching, vaginal douches, deep washing.
— Use of condoms, uterine caps, diaphragms treated with spermicide (nonoxynol-9).
— Frequent change of sexual partners.
- Chronic stress.
Development of bacterial vaginosis
Under the influence of external and/or internal factors that disrupt the healthy balance of the vaginal microecosystem, the number of the H2O2-producing pool of lactobacilli decreases, the production of lactic acid decreases, and the pH of the vaginal contents increases.
The growth of the pool of strict anaerobes increases. The waste products of these bacteria decompose into volatile amines, with a characteristic smell of “rotten fish”.
Hormonal imbalance “progesterone / estrogens” accelerates the proliferation (reproduction) of the vaginal epithelium. Activation of the receptors of these cells for bacteria stimulates the adhesion of strict anaerobes to the vaginal mucosa and the formation of “key” cells.
- “Clue” cells are desquamated vaginal epithelial cells covered with gram-negative bacilli (rod-shaped bacteria, not lactobacilli).
Abundant exfoliation of the “key” epithelium is accompanied by increased production of vaginal discharge up to 20 ml per day (the norm is 2 ml).
Symptoms of bacterial vaginosis
Indirect signs of bakvaginosis:1. Whitish-gray, creamy vaginal discharge, usually with a “fishy” odor of varying intensity. The unpleasant odor either disappears or intensifies after sexual intercourse, menstruation, douching, or washing.
It is the characteristic discharge that is the main complaint of patients with bakvaginosis. Liquid discharge may subsequently acquire a yellowish-greenish color, become sticky, thick, and foaming.
2. Patients often feel discomfort in the external genital area, painful sexual intercourse (dyspareunia).
3. Very rarely, itching and burning of the genitals or painful urination (dysuria) occurs.
Objective clinical symptoms of bakvaginosis
Amsel criteria
1. Copious, uniform whitish-gray vaginal discharge.
2. “Key” cells in vaginal smears.
3. Acidity of vaginal contents: pH>4.5.
4. Positive amino test.
The presence of 3 out of 4 possible signs confirms the diagnosis of bacterial vaginosis.
Diagnosis of bacterial vaginosis
1. Inspect the vaginal walls using a speculum.
Evidence in favor of bakvaginosis is:
- The presence of copious discharge (leucorrhoea), evenly covering the vaginal mucosa.
- Normal pink coloration of the vaginal walls no signs of inflammation.
2. Calposcopy.
Confirms the absence of inflammation of the vaginal mucosa.
3. Microscopy: bacterioscopic examination vaginal smears are the main, most accessible and reliable method for diagnosing bacterial vaginosis.
Microscopy of smears of patients with bakvaginosis reveals:
— Reduction or disappearance of lactobacilli (gram-positive rods of various sizes).
— Increase in mixed non-lactobacillary microflora.
- “Key” cells. "Key" edges epithelial cells uneven, unclear due to the adhesion of gram-variable rods and cocci on them, including Gardnerella vaginalis, Mobiluncus, etc., microorganisms are often difficult to distinguish from each other.
- In most cases: low white blood cell count.
Not typical for isolated bacterial vaginosis.
4. Determination of acidity (pH) of vaginal secretions using indicators.
5. Aminotest.
When mixing vaginal discharge on a glass slide from a patient with bakvaginosis with an equal amount of potassium hydroxide solution ( solution KOH 10%) an unpleasant smell of rotten fish appears.
Additional methods for diagnosing bacterial vaginosis
Used according to indications, in cases of frequent recurrence of the disease.
1. Cultural examination.
It consists of determining the species and quantitative composition of the vaginal microflora: isolation and identification of Gardnerella v., other facultative and obligate anaerobes, lactobacilli (with a sharp decrease in their number
2. Molecular biological methods: PCR, etc.
Test systems detect specific fragments of DNA and/or RNA of microorganisms (A. vaginae, G. vaginalis, M. hominis and Ureaplasma spp., etc.), including difficult-to-cultivate bacteria.
Differential diagnosis
The diagnosis of bakvaginosis requires the exclusion of urogenital microbial viral infections that are sexually transmitted (gonococcal, trichomonas, chlamydial and other STIs). It is also important to differentiate infections caused by opportunistic agents and fungi (genital mycoplasmas, facultative anaerobic and aerobic microorganisms, candida).
Degrees of bacterial vaginosis
/Microscopic characteristics of smears according to Mavzyutov A.R./
1st degree
Compensated bakvaginosis.It is characterized by a tiny amount of any microbial organism, including lacto-flora, in the vaginal smear.
Such a smear is not considered a pathology. It is often caused by excessive preparation of the patient for a visit to the gynecologist (deep washing with disinfectants), previous antibacterial treatment (taking broad-spectrum antibiotics) or intensive chemotherapy.
2nd degree
Subcompensated bakvaginosis:- reduction in the number of lactobacilli;
— a commensurate increase in other microbial flora;
- appearance of single (1-5) “key” cells in the smear.
3rd degree
Clinically evident bacterial vaginosis:— almost complete absence of lactobacilli;
— the field of view is filled with “key” cells;
— bacterial flora is represented by various (except lactobacilli) cultures in all kinds of species combinations.
How to treat bacterial vaginosis
The first stage of treatment of the disease is carried out with antibacterial agents of the 5-nitroimidazole or clindamycin group, to which anaerobic bacteria and gardnerella are most sensitive.
- Metronidazole
Trade names: Trichopolum, Metrogyl, Flagyl, Klion - Tinidazole
Trade names: Fazizhin, Tiniba (500 mg) - Ornidazole
Trade names: Tiberal, Dazolik, Gairo, Ornisid, etc. - Clindamycin
Trade names: Dalatsin, Klindacin
Vaginal tablets and suppositories for bacterial vaginosis:
A promising method for the treatment of bakvaginosis in last years consider local combined vaginal products with antibacterial, antifungal, anti-inflammatory effects:
- Polygynax
- Terzhinan
- Vagisept
- Vagiferon
- Elzhina
Use: one suppository (tablet) in the vagina for 10 days.
The second stage of treatment is carried out after the complete eradication of anaerobic and opportunistic microflora. Restoration of vaginal normocenosis is carried out by local administration of biological products:
- Lactozhinal
- Acylact
- Floragin Gel
- Lactonorm
- Lactobacterin
- Bifidumbacterin
- and etc.
The effectiveness of bottom biological products, unfortunately, is limited by the low survival rate of “foreign” strains of lactobacilli in the vagina.
To restore normal vaginal microflora, intravaginal products are also recommended:
- Lactogel (lactic acid + glycogen)
- Multi-Gyn Actigel
- Vaginorm
They are used both for the treatment and prevention of bacterial vaginosis.
In cases of atrophic changes in the vaginal mucosa, local estrogens (estriol preparations) are used:
- Trioginal
- Orniona, vaginal cream 1%
According to indications, antiallergic drugs and vitamins A, E, C are prescribed.
Recommended methods of treating bacterial vaginosis with antibacterial agents
Scheme 1Metronidazole, tablets 500 mg. 1 tablet 2 times a day, orally (by mouth).
Course of treatment: 7-10 days.
Tinidazole 2.0 g (4 tablets of 500 mg) at a time, orally, once a day.
Course of treatment: 3 days.
Given the local nature of the infection, many specialists prefer local treatment of bacterial vaginosis. The best therapeutic effect was shown by intravaginal suppositories and gels with Metronidazole or Clindamycin.
Scheme 33.1 Vaginal suppositories with Metronidazole 500 mg (Flagyl, vaginal suppositories)
Use once a day, intravaginally, at night.
Course: 7-10 days.
3.2 Metrogyl (Metronidazole), gel 1%
Apply intravaginally 5.0 g (one full applicator) 1 time per day, at night.
Course: 5 days.
3.3 Metronidazole gel 0.75%. Apply 5.0 g intravaginally (one full applicator) 1 time per day, at night.
Course: from 5 days to 2 weeks.
Dalatsin (Clindacin, Clindamycin), cream 2%
1 full applicator (5.0 g of cream = 100 mg of clindamycin) deep intravaginally 1 time per day, at night.
Course: 7 days
Alternative Treatments for Bacterial Vaginosis
Scheme 1AMetronidazole 2.0 g (8 tablets of 250 mg or 4 tablets of 500 mg) at a time, once, orally.
Treatment result:
the closest one is good
distant – not good enough
Regimen 2A Tiberal (Ornidazole) 500 mg, 1 tablet orally 2 times a day.
Course: 5 days.
The effectiveness of Metronidazole and Clindamycin is approximately the same. But taking Clindamycin is less likely to cause unwanted side effects.
During treatment and within 24 hours after stopping taking Metronidazole It is prohibited to drink alcohol.
Bacterial vaginosis during pregnancy - treatment features
Treatment of bakvaginosis in pregnant women requires an individual approach in choosing dosages and therapeutic regimens. Taking oral antibiotics is possible only from the 2nd trimester of pregnancy under the strict supervision of laboratory diagnostics in a specialized medical institution.
Antibacterial treatment regimens for bacterial vaginosis from the 2nd trimester of pregnancy:1. Metronidazole, tablets 500 mg.
Take 1 tablet 2 times a day orally. Course of treatment: 7 days.
2. Metronidazole, tablets 250 mg.
Take 1 tablet 3 times a day orally. Course: 7 days.
3. Clindamycin, capsules 300 mg.
Take 1 capsule orally 2 times a day. Course: 7 days.
Prognosis for bacterial vaginosis
The disease does not pose a direct threat to the patient's life. Treatment takes place at home (there are no indications for hospitalization).
The therapeutic effect is monitored 14 days after the end of treatment: examination by a gynecologist + repeat smear.
If the result is insufficient, the doctor chooses alternative drugs or methods.
Despite the “harmlessness” of the disease, it is important to carry out its timely treatment and prevention.
Possible complications of bacterial vaginosis:
- Spontaneous abortion (miscarriage).
— Pathology of pregnancy: intra-amniotic infection.
— Pathology of childbirth and postpartum period: premature rupture of amniotic fluid, premature labor, endometritis and/or sepsis after cesarean section.
- Risk of having low birth weight babies.
— The risk of developing infectious complications after gynecological operations or abortions.
— Risk of development inflammatory diseases pelvic organs: peritonitis, abscesses of the pelvic organs after the introduction of intrauterine contraceptives, after invasive manipulations.
— Risk of developing cervical dysplasia (neoplasia). Read in detail: .
— Increased susceptibility to sexually transmitted infections, including HIV, genital herpes.
Risks of recurrence of bacterial vaginosis
Frequent recurrence of bakvaginosis is observed in women with impaired immune and/or endocrine status. Such patients need advice:
- gynecologist-endocrinologist,
- endocrinologist,
- gastroenterologist.
Practice shows that preventive treatment of a sexual partner has little effect on the recurrence of episodes of bakvaginosis in the patient. Examination and treatment of a sexual partner is mandatory if there are clinical symptoms of balanoposthitis, urethritis or other urogenital diseases.
Traditional methods of treating bacterial vaginosis
Among unconventional methods For the treatment of gynecological diseases, douching with solutions of medicinal herbs remains the “favorite” means of traditional healers.
In the case of bacterial vaginosis, such procedures are undesirable and even dangerous. They provoke the leaching of beneficial vaginal lactoflora, the introduction of pathogenic and opportunistic microorganisms into the cervical canal, allergic reactions and inflammation of the mucous membranes.
Permitted procedures:
Micro-douching with an aqueous solution of boric acid 2-3%:Dissolve 1 teaspoon of boric acid pharmaceutical powder (sold in bags) in 1 cup of boiling water. Cool. Using a sterile syringe, inject 100 ml of a freshly prepared lukewarm solution into the vagina. Carry out the procedure once a day for a week.
Micro-douching and washing with an aqueous solution of potassium permanganate (potassium permanganate):Prepare a weakly concentrated (barely noticeable pinkish color) solution of potassium permanganate. Wash and douche once a day for a week.
Micro-syringing and washing with an aqueous solution of hydrogen peroxide:Dilute 1 tablespoon of hydrogen peroxide solution for external use 3% (hydrogen peroxide 3%, sold in pharmacies) in 500 ml of freshly boiled lukewarm water. Wash and douche once a day for a week.
Self-medication is dangerous to health. Contact a specialist.
Prevention of bacterial vaginosis
- Controlled intake of antibacterial and other medications.
- Adequate diagnosis and treatment of gynecological (including age-related dyshormonal) diseases.
Thanks to proper treatment of gynecological and endocrine pathologies, the glycogen content (the main nutritional component of lactobacilli) in the vaginal epithelium is normalized, and normal vaginal microflora develops.
- Genital hygiene.
- Sexual hygiene, fidelity to one partner.
- Quitting bad habits (smoking, etc.)
- Normalization of immune and neuroendocrine status.
- Physical activity: combating congestion in the pelvic area.
Save the article for yourself!
VKontakte Google+ Twitter Facebook Cool! To bookmarks