Bacterial vaginosis - the first symptoms and treatment regimen

Bacterial vaginosis - at least once in a lifetime, 8 out of 10 women of childbearing age have experienced this disease. It is also diagnosed in 76% of patients visiting a gynecologist. However, many myths still circulate around bacterial vaginosis, also known as vaginal dysbiosis or gardnerellosis. Let's try to figure out where the truth ends and the fiction begins.

Myth # 1: bacterial vaginosis is sexually transmitted

In fact, the nature of the disease is best characterized by the term "bacterial", which is prudently rendered in the name.

The vagina of every woman is a mobile ecosystem in which more than 300 species of bacteria coexist. Normally, lactobacilli predominate among them, protecting our body from the invasion and reproduction of pathogenic microbes. Bacterial vaginosis develops when, under the influence of certain factors, beneficial lactic acid bacteria give way to opportunistic microflora, which causes disease only with reduced immunity. Previously, it was believed that the responsibility for the development of pathology was borne by a single type of bacteria - the so-called gardnerella (Gardnerella vaginalis), but now scientists believe that the disease arises from the very fact of the violation of "microbial balance."

Anything can provoke bacterial vaginosis. According to the doctor of medical sciences, professor of the Department of Obstetrics and Gynecology, Faculty of Medicine, Moscow State Medical University, Alexander Tikhomirov, these are primarily sexual intercourse (more than 4-5 per week), intrauterine contraception, cunnilingus, uncontrolled use of antibiotics, the use of tampons and synthetic underwear, hygiene or, conversely, excessively frequent douching, which leads to leaching of healthy vaginal microflora. However, like any dysbiosis, this disease is not sexually transmitted.

Myth # 2: only a doctor can detect bacterial vaginosis due to the hidden course of the disease

Sometimes bacterial vaginosis does occur almost imperceptibly, without pronounced symptoms. In such cases, its diagnosis usually occurs completely by accident, for example, during a planned gynecological examination. However, much more often the disease still manifests itself. "The main, and sometimes the only symptom of vaginal dysbiosis is abundant discharge of white or gray color with a" fishy "smell that accompanies unprotected intercourse or menstruation. With the progression of the disease, the discharge acquires a yellowish-gray hue, complaints of burning and itching of the vulva, as well as pain during sexual intercourse, " - describes the clinical picture of Alexander Leonidovich Tikhomirov.

If these symptoms are detected, even if they do not bring tangible discomfort, you should immediately consult a doctor.

Myth number 3: if bacterial vaginosis is just a form of dysbiosis, then it can hardly be dangerous

Contrary to popular belief, bacterial vaginosis is quite dangerous. With virtually no discomfort in the early stages, it nevertheless increases the risk of “flourishing” much more serious diseases: vulvovaginitis (inflammation of the vagina), endometritis (inflammation of the uterine mucosa), oophoritis (inflammation of the ovaries), salpingoophoritis (inflammation of the appendages) and other . In addition, numerous studies have established a relationship between vaginal dysbiosis and premature birth, as well as the occurrence of complications such as chorioamnionitis (inflammation of the membranes of the fetus) and postpartum sepsis.

Pathology also has a negative effect on newborns - according to the observations of obstetrician-gynecologists, underweight children are most often born in women with bacterial vaginosis.

Myth number 4: bacterial vaginosis - a disease of women from 18 to 50 years old

Despite the fact that women of childbearing age are the main risk group, the disease is regularly diagnosed in teenage girls and those over 50. In non-sexually active girls, inhibition of normal vaginal microflora usually occurs due to the use of antibiotics and wearing synthetic underwear, and postmenopausal women - due to the sharp alkalization of the vaginal environment.

Myth number 5: vaginal dysbiosis should be treated with antibiotics

We will not say again that the use of antibiotics without a doctor’s prescription should not be done in principle. We only note that antibiotics destroy absolutely all bacteria: both pathogenic and beneficial. Obviously, in this case, there can be no question of any normalization of the vaginal microflora.

Treatment of bacterial vaginosis takes place in two stages. First, antimicrobial and antiseptic drugs are prescribed that reduce the number of conditionally pathogenic organisms, and then the patient takes probiotics - medicines containing the same lactobacilli. The second stage, where microflora is restored after treatment, not only normalizes the current state, but also reduces the risk of other diseases of the genital area.

Separately, we should focus on the treatment of bacterial vaginosis in adolescent girls who do not live sexually. Bacterial and biological preparations for the correction of dysbiosis are not used in this case, and oral probiotics are preferred.

In order to avoid relapse of the disease, it is extremely important to observe the rules of personal hygiene:

• Do not wear tight, synthetic underwear. It disrupts blood circulation in the pelvic organs and is poorly ventilated, creating a warm and moist environment in the perineal region - ideal conditions for the propagation of gardnerella.
• Do not abuse the use of tampons and panty liners, especially those containing fragrances.
• Properly wash yourself - not from bottom to top, but from front to back.
• Use intimate hygiene products that help restore the natural pH level of your vaginal environment. The best option is to use a combination of special soap and gel with Ph from 3.8 to 4.4 (this information should be indicated on the package). In addition, among the components, look for lactic acid, preferably in combination with plant extracts (calendula, chamomile, sage), moisturizing the mucous membranes.

Thank you for your help in preparing the material by Alexander Tikhomirov, obstetrician-gynecologist, MD, professor, and experts of the pharmaceutical company EGIS.

Causes

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

The factors provoking the development of the disease include:

• weakening of local and general immunity,
• poor nutrition,
• long-term antibacterial and hormonal therapy,
• frequent douching,
• the use of local contraceptives (condoms, creams and suppositories) which include 9-nonoxynol,
• frequent change of sexual partners,
• wearing synthetic underwear,
• endocrine and gynecological pathologies,
• non-observance of basic rules of personal hygiene,
• bowel disease.

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

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

The general symptoms of bacterial vaginosis are as follows:

• discharge with an unpleasant odor (fish), which occurs as a result of the decay of amines produced by anaerobic bacteria.
• profuse, uniform, creamy vaginal discharge of a grayish-white color, adhering to the walls of the vagina.
• sometimes there is vulvovaginal irritation in the form of itching and burning, discomfort during intercourse.
• signs of vaginal inflammation (adherence of vaginitis) are observed in half of the patients.
• rarely - urination disorders and pain in the perineum.

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

• the color of the discharge turns dark green,
• whites change their consistency, become more viscous or resemble a curdled mass,
• The following symptoms are also characteristic of secretions in vaginal dysbiosis: over time, they become thick and sticky, and their distribution along the vaginal walls is uniform. Leucorrhoea is easily removed from the walls with a cotton swab,
• during a long-running process, a number of patients complain of minor or moderate itching / burning in the vulva (see itching in the vagina),
• pain at moments of sexual contact (see pain during intercourse),
• the volume of vaginal discharge reaches 0.02 liters per day (given that normally the amount of leucorrhoea is not higher than 2 - 4 ml),
• in a number of situations, the pathogenic flora joins the described infectious process, which contributes to the development of vaginitis,
• sometimes there are disorders of urination (frequent and painful urination in women).

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

Severity

By severity in vaginal dysbiosis, there are:

With the course, acute, torpid or erased and asymptomatic vaginal dysbiosis is distinguished.

Diagnostics

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

The diagnosis can be made in the presence of 3 of the 4 listed symptoms:

• the specific nature of the discharge,
• acidity> 4.5 (normal 3.8-4.5),
• positive aminotest
• the presence of "key" cells. The so-called “key cells” are mature epithelial cells (the surface layer of the vaginal epithelium), all over which microbes are tightly and abundantly attached.

Performing one of the 4 tests is not enough to make a diagnosis.

How to treat bacterial vaginosis?

Initially, antibiotics are prescribed for a woman to treat bacterial vaginosis: they have a detrimental effect on nonspecific bacteria and cleanse the vaginal mucosa from them.

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

The treatment regimen is selected individually:

• Tinidazole 2.0 in the form of tablets is taken orally 1 time a day for 3 days,
• Metronidazole in the form of a 0.75% gel is administered once a day into the vagina for 5 days,
• Suppositories with clindamycin 100 mg are injected into the vagina 1 time per day for 3 days,
• A cream with a 2% content of clindamycin is injected into the vagina once a day for 7 days,
• Metronidazole 2.0 tablets are taken orally once.

For the duration of antibiotic therapy and the day after its completion, it is necessary to exclude the use of alcohol even in minimal doses. The drugs disrupt the metabolism of ethyl alcohol in the body, due to which there is an accumulation of toxic metabolites and severe intoxication develops. In its course, it resembles a severe hangover: a woman experiences severe weakness, her limbs are shaking, blood pressure rises, a strong throbbing headache occurs, excruciating nausea and vomiting develop.

Clindamycin cream contains fat, so it can damage a condom or a latex birth control membrane. All local forms of drugs are administered immediately before bedtime to prevent them from draining along the walls of the vagina.

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

• Hexicon for 1 candle is administered 2 times a day for 7-10 days,
• Miramistin in the form of a solution irrigate the vagina 1 time per day for 7 days.

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

• Acylact 1 suppository 2 times a day is injected into the vagina for 5-10 days,
• Bifilis for 5 doses is taken orally 2 times a day for 5-10 days.

Antifungal suppositories from bacterial vaginosis, as a rule, are not prescribed. The need for them arises if candidiasis, a fungal infection, joins a conditionally pathogenic microflora. In this case, Clotrimazole suppositories are prescribed once a day intravaginally for 6 days.

Pregnancy treatment

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

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

Pregnancy complications that may occur due to illness include:

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

If you are pregnant and have symptoms of vaginosis, consult your gynecologist as soon as possible. Although the risk of complications is low, treatment will help further reduce it.

Prevention

The recommendations are as follows:

• the use of barrier methods of contraception, wearing only natural fabrics,
• regular examination by a gynecologist and timely treatment of diseases,
• treatment of chronic pathologies of internal organs,
• strengthening immunity in natural ways: physical activity, hardening, etc.,
• avoidance of douching and other similar procedures.

Bacterial vaginosis is a pathology that reflects a decrease in the level of protection of the body at the moment. Often proceeding with little symptom, gardnerellosis is always detected during examination by a gynecologist. Only a doctor can prescribe the most effective pills for bacterial vaginosis, suppositories, or other forms. Do not delay the treatment!

What is bacterial vaginosis?

Under normal conditions, the female organ has a lot of sour milk bacteria (Lactobacillus acidophilus, or Doderlein bacillus and lactobacillus). Thanks to such microorganisms, an acidic environment is formed. As a rule, during sexual intercourse, the number of lactic acid microorganisms decreases, and then they are replaced by pathogenic, or rather conditionally pathogenic bacteria. Such microorganisms provoke the development of the disease with a weakened immune system. This phenomenon causes a drop in the level of acidity in the vagina. It was previously believed that bacterial vaginosis occurs due to the penetration of any one type of microorganism. Consequently, the second name for bacterial vaginosis also appeared - gardnerellosis or hemophilic vaginitis. Today it has been determined that bacterial vaginosis does not occur due to a single microbe, but because of the imbalance of different types of bacteria. As a result, bacterial vaginosis does not belong to infectious diseases and is not sexually transmitted. Unlike vaginitis, bacterial vaginosis does not provoke inflammatory processes in the vagina.

Can I get bacterial vaginosis sexually?

It is immediately worth noting that this sexual disease does not apply to sexually transmitted diseases. Провокаторы бактериального вагиноза (прежде всего гарднерелла) могут передаваться при половых контактах. Тем не менее, их передача от одного носителя к другому еще не служит причиной недуга, так как данные микроорганизмы в малом количестве присутствуют в нормальной флоре влагалища у многих женщин.

However, sexual intercourse without contraceptives affects the appearance of bacterial vaginosis. This does not concern the infection itself, but the fact that when the partner changes, the vaginal flora changes.

Risk Factors for Bacterial Vaginosis

To admit that bacterial vaginosis is present, it is possible in the following case:

- Recently, the sexual partner has changed,

- Not so long ago, antibiotics were taken,

- For several weeks there was a frequent change of sexual partners,

- There is an intrauterine device,

- Contraceptive creams and suppositories were used, in whose composition there is 9-nonoxynol (for example, Nonoxynol, Patentex Oval),

- Recently douching was carried out,

- Non-observance of personal hygiene.

The above factors are not the main root cause of the pathological process, however, they negatively affect the vaginal environment and provoke the appearance of bacterial vaginosis.

Symptoms of Bacterial Vaginosis

The main symptom in bacterial vaginosis is abundant grayish discharge from the vagina. They can be up to 30 ml per day. Allocations have a fairly liquid consistency, have a characteristic fish smell, which becomes more intense after intercourse without contraception, because the alkaline pH of sperm increases the production of volatile amines. Sometimes during sexual intercourse, you may notice a burning sensation or discomfort, as well as irritation of the vulva. In some cases, bacterial vaginosis occurs without discomfort.

General information

Bacterial vaginosis - gynecological infectious non-inflammatory disease. The occurrence of the disease due to sexual contact is characteristic. According to statistics, 20% of women of reproductive age suffer from vaginosis. Characterized by a disease of change vaginal environment and flora, production decreases lactic acid and the pH of the vaginal environment decreases. Thus, the resulting neutral environment does not impede the development of various microbes, including Trichomonas.

The vaginal microflora can be represented as rolling ecosystem. In a normal state, the microflora of the vagina contains lactobacillithat play a protective function. Lactobacillus Recycling glycogen (in women of reproductive age, vaginal epithelial cells contain large amounts of glycogen) into lactic acid, thereby lowering the acidity of the vagina. In addition, lactobacilli are able to form hydrogen peroxide. Hydrogen peroxide and the acidic environment of the vagina suppress the reproduction of opportunistic bacteria (streptococcus, staphylococcus, anaerobic bacteria, E. coli, Mobiluncus spp, Gardnerella vaginalis.). Which in small quantities are detected in the microflora of the vagina of the vast majority of women.

If the body decreases the proportion of lactobacilli, then instead of them in the ecosystem opportunistic bacteria (Gardnerella vaginalis in the first place). The latter contribute to the release of volatile amines, which are comparable in smell to the smell of rotten fish.

Bacterial vaginosis is not sexually transmitted because it is not sexually transmitted disease. Bacterial pathogens of bacterial vaginosis (primarily Gardnerella vaginalis) can be transmitted through sexual contact. But their transmission from woman to woman cannot serve as the main cause of the disease. Since in small quantities these microbes are part of the vaginal microflora of the vast majority of women.

Unprotected sex, however, can play a role in the appearance of bacterial vaginosis. The whole point is not in infectious infection, but in the fact that sexual partner seed or several sexual partners cause a change in the microflora of the vagina.

The main cause of the disease is not just the presence of bacterial pathogens of bacterial vaginosis (they are present in almost every woman in small quantities), but a change in the proportions of opportunistic microbes (which cause bacterial vaginosis) and lactobacilli. The proportion of lactobacilli with bacterial vaginosis decreases, and the proportion of pathogens increases. Therefore, bacterial vaginosis in medicine is called vaginal dysbiosis.

Bacterial vaginosis can be caused by both internal influences of the body and external influences, the so-called exogenous and endogenous factors. This can be changes in the hormonal background, a decrease in immune defense, disruption in the intestines, in particular microbiocenosis. Causes of the disease can also be caused by the use of antibiotics, hormonal drugs, immunosuppressants, as well as previous inflammatory diseases of the genitourinary system.

Bacterial pathogens of bacterial vaginosis are not dangerous for men. Men who have detected the causative agent of Gardnerella vaginalis, as well as the sexual partners of women with bacterial vaginosis, do not need treatment.

When a smear indicates bacterial vaginosis

Diagnosis of bacterial vaginosis is carried out due to characteristic vaginal discharge, changes in the vaginal smear, and a decrease in acidity. Many patients will learn about the diagnosis by a smear test on Wednesday. If the patient has bacterial vaginosis, then the following changes are present in the smear:

- Many key cells (cells of the vaginal epithelium that cover a large number of coccobacilli),

- A large number of cocco-bacillary forms (bacteria in the form of cocci and rods),

- Lactic acid bacteria are practically absent,

- White blood cells are at a normal level or slightly elevated,

- Presence of Mobiluncus (Mobiluncus),

- The pH of the discharge exceeds 4.5.

Treatment of bacterial vaginosis

The disease requires conservative treatment. Antibiotics are prescribed, such as metronidazole, clindamycin, tinidazole. They are made in preparations for oral and vaginal use. it Flagil, metrogel, cleocin, tindamax. Vaginal preparations are more effective, they are often included in the treatment of bacterial vaginosis. They cause fewer side effects, but the risk remains thrush.

The best way to treat bacterial vaginosis is metronidazole (eg, trichopolum) take within 7 days, 2 times a day, 500 mg orally. Sometimes the drug is difficult to tolerate (may cause nausea). Totally incompatible with alcohol. But systemic treatment can reduce the likelihood of complications caused by bacterial vaginosis.

Reserve drugs:

Clindamycin (dalacin, menopause) for 7 days, 2 times a day, 300 mg orally. Clindamycin not only inhibits bacterial growth Gardnerella vaginalis, but also lactobacilli (Lactobacillus spp.) Clindamycin is prescribed in case of intolerance to patients with metronidazole.

Clindamycin Cream, with a concentration of 2% (dalacin) is administered using the attached applicator into the vagina for 5 days 1 time per day (at night). Of course, topical treatment is tolerated much better, but less effective systemic treatment reduces the risk of complications of bacterial vaginosis.

Gel Metronidazole, 0,75% (Metrogil, flag) is introduced into the vagina using the attached applicator for 5 days 2 times a day. As with the previous drug, local treatment is much better tolerated, however, less effective systemic treatment reduces the risk of bacterial vaginosis complications.

There is another treatment for bacterial vaginosis, its system consists of two stages. First, it is necessary to suppress reproduction pathogens. For these purposes, irrigation with solutions of boric and lactic acids is used, but there are more modern medicines. Namely, the drug fluomizine - antiseptic medicine with a wide spectrum of effects - is applied intravaginally once (once per tablet) for 6 days.

It is worth noting that this drug can be used during pregnancy for the rehabilitation of the birth canal. It is carried out according to the same scheme, the beginning of therapeutic treatment - 6-7 days before the DA.

In the second stage, recovery is carried out vaginal biocenosis. For these purposes are used locally. eubiotics, medicinal substances containing strains of lactobacilli and bifidobacteria.

Complications of bacterial vaginosis: unpleasant discharge odor, discomfort, itching, development endometritis (after cesarean section, post-abortion, postpartum), the risks of premature birth and miscarriage in late pregnancy.

Differential diagnosis of bacterial vaginosis of the vagina with trichomoniasis, candidiasis and ureaplasmosis

Orally

■ Metronidazole (Trichopolum) 2 gr. inside once.

■ Metronidazole (Trichopolum) 250 mg take one tablet twice a day (morning and evening) during or after meals. The course is 10 days.
When taking Metronidazole, staining of urine in a reddish brown color may be observed due to the presence of a water-soluble pigment resulting from the metabolism of metronidazole.

■ Tinidazole 2 g per day, it is 4 tablets of 500 mg (therapy lasts 2 days) or 1 g per day - 2 tablets (treatment lasts 5 days).

■ Clindamycin 150 mg It is necessary to take 1 tablet 4 times a day. The duration of treatment is 7-10 days.

■ Ornidazole (Tiberal) 500 mg 1 tablet or capsule 2 times a day. The course of treatment, as a rule, is 5 days.

Vaginally

■ Clindamycin (Dalacin)2% 100 mg (vaginal cream). At night, one applicator (5 g of cream) should be administered. The duration of treatment is 1 week.

■ Metronidazole (Flagil, Metrogil) 500 mg (vaginal suppositories). At night, you need to enter one candle. The course of treatment is 10 days.

■ Neo-penotran forte a combination drug that consists of metronidazole and
miconazole. It has antimicrobial and antifungal effects. 1 suppository is administered deep into the vagina at night for 7-14 days.

■ Fluomizine one vaginal suppository at bedtime for 6 days.

■ Betadine (povidone iodine) 200 mg one candle per week.

■ Chlorhexedine Biglucanate (Hexicon) 1 candle 2 times a day for 1 week.

PH normalization

Biofam - a means to restore your own microflora of the intimate zone by creating the most favorable conditions due to the content of lactic acid, which maintains a pH of 3.8-4.5. Vaginal products, which contain strains of lactobacilli, are designed to replace the dead own microflora, but it is difficult to predict the survival of foreign microflora. Biofam not only creates a favorable environment for the growth and reproduction of its own microflora, but also due to glycogen - a nutrient substrate - supports their vital functions, and thyme oil reduces the likelihood of an increase in pathogenic strains and relapse.

The probiotic regimen is as follows:

- A week of admission without interruptions.
- Week of rest.
- Week of secondary admission.

This drug regimen makes it possible to avoid re-infection after a certain period of time after the end of antibiotic therapy. Probiotics are not allowed during pregnancy and lactation.

Should my husband (sexual partner) need treatment?

According to statistics, the majority of the male population, whose sexual partners were affected by the disease, found the main provocateurs of bacterial vaginosis (gardnerella and other bacilli) in the urethra. This may indicate that the bacterium with unprotected sex is able to move from the vagina to the male urethra.
However, men may not be treated. Many studies have shown that therapy with sexual partners does not affect the improvement of a woman's condition and the likelihood of secondary disease does not decrease.

Treatment for a man may be needed when bacterial vaginosis in a woman does not develop for the first time, or when sexually transmitted diseases have been diagnosed.

What is dangerous bacterial vaginosis

The bacteria that provoke the pathological process with bacterial vaginosis are very susceptible to simple treatment with medications, and the disease can be cured easily. Nevertheless, ignoring the disease may develop such complications:

- Inflammation of the uterus, ovaries and fallopian tubes (adnexitis),

- Uterine inflammation (chronic endometritis),