What is it - bacterial vaginosis is also called vaginal gardnerellosis or dysbacteriosis (dysbiosis) due to infectious non-inflammatory syndrome due to a sharp decrease or absence of lactoflora and its replacement by polymicrobial associations of anaerobes and gardnerella.
In women, there is a special ecosystem in the vagina consisting of lactobacilli. They protect the vagina: they secrete lactic acid, creating an acidic environment, stimulate local immunity and inhibit the growth of pathogens.
With bacterial vaginosis, the vaginal microflora (or microbiocyanosis) are disturbed, which leads to an increase in the role of the conditional pathogenic endogenous microflora and a sharp decrease or disappearance of lactobacilli with their replacement by other microorganisms.
With bacterial vaginosis, complications may occur during pregnancy or severe pathology of a woman's genitals. Namely: premature birth at a short time and the birth of a premature baby with low weight, the development in the genitals of inflammatory processes, postpartum endometritis and the presence of purulent-septic complications in the mother and child.
Symptoms of Bacterial Vaginosis
For a long time, bacterial vaginosis can occur without special symptoms or manifest one of the signs. Therefore, only laboratory studies of secretions help to identify the disease.
In acute form, women may complain about the presence of:
- secretions: gray-white, foamy with an unpleasant smell of spoiled fish.
- itching and burning when urinating in the external genitalia and in the vagina.
- urination disorders.
- pain during sexual contact.
- increased secretions after sex and before menstruation.
- viscous, sticky, thick yellow-green whites in case of progression of the process.
- the appearance of irritation and inflammation of the skin of the perineum, thighs, zone of the anus and buttocks.
- inflammation in the urethra (with urethritis),
- inflammation on the skin of the head and foreskin of the penis (with balanoposthitis),
- pain during urination and frequent urination.
Diagnosis of bacterial vaginosis
The presence of gardnerella in men is determined by examining the secretion of the prostate gland.
In women, one more characteristic symptom of bacterial vaginosis is determined by laboratory tests - the pH of the vaginal contents becomes higher - 4.5, that is, the acidity of the vagina becomes more alkaline.
Bacterial vaginosis can hide other viruses and infections and increase the risk of sexually transmitted diseases: chlamydia, trichomoniasis, mycoplasmosis. Actively developing, the gardnerella begins to destroy the microflora, useful for the vagina, and create conditions favorable for the development of sexual infection, more dangerous for the body.
A diagnosis is established based on:
- 1) PCR and cytological studies.
- 2) An amino test in which chemicals interact with abnormal vaginal secretions, resulting in an unpleasant fish smell.
- 3) Cultural culture to identify the pathogen through culture media.
- 4) Smear microscopy with staining to determine the presence or absence of the vaginal epithelium - key cells densely populated by anaerobic bacteria: Klebsiella, Fusobacteria, Bacteroid, Gardnerella, which is typical for dysbiosis (vaginosis).
Treatment of bacterial vaginosis
Bacterial vaginosis is treated in two stages.
During the first stage, a bacterial infection (gardnerellosis) is destroyed with antibacterial and combined drugs of general and local use.
During the second stage, they restore normal vaginal microflora with biological preparations and topical drugs: tampons, baths, etc.
It is important for a woman to receive appropriate therapy in a timely manner. With a prolonged course of the disease, inflammatory processes in the uterus and appendages can occur, which leads to endometritis, salpingitis (infectious inflammation of the fallopian - uterine - tubes), complications during pregnancy and childbirth: chorioamnionitis - inflammation of the walls of the bladder (membranes of the fetus) and infection of the amniotic fluid, preterm birth, intrauterine infection of the baby and weight loss.
As well as pneumonia, pathological uterine bleeding, postoperative infectious complications, impaired reproductive and sexual function of a woman, decreased performance and neuropsychiatric disorders.
Stage One - Antibacterial Therapy
To destroy the causative agent of the disease within 7-10 days, the treatment is carried out:
- 1) Metronidazole (Trichopolum), Tinidazole, Clindamycin, Miramistin, Polycresulene (Vagotil), Chlorhexidine, Metrogyl, Betadine, Terzhinan in tablets orally.
- 2) Candles, gels, ointments or creams with the presence of the above drugs (except Tinidazole) and injected into the vagina.
- 3) Immunocorrectors - Viferon or Kipferon.
- 4) Estrogens and antihistamines.
- nausea and vomiting accompanied by pain in the lower abdomen,
- anorexia - the drug is used with a strong desire to lose weight,
- constipation or diarrhea, allergic reactions,
- dry or metallic taste in the mouth,
- glossitis, stomatitis, pancreatitis, candidiasis,
- irritation and irritability, peripheral neuropathy,
- cramps, weakness, hallucinations, insomnia,
- polyuria, cystitis, urinary incontinence and staining it in a brownish-red color.
Persons under the age of 18 are not prescribed the drug in combination with Amoxicillin. For pregnant women, the doctor selects a course of treatment with approved drugs at a given gestational age (fetal age).
Bacterial vaginosis is a non-inflammatory infectious process in which the normal vaginal lactoflora is replaced by anaerobic associations. It is a widespread pathology, diagnosed in 21-33% of patients visiting gynecologists. It can proceed secretly or with obvious clinical symptoms. With an improvement in 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 recurrent 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 are aerobic and anaerobic lactobacilli. The remaining 5% includes more than 40 species of various microorganisms. The ratio of anaerobes to aerobes in a healthy vaginal microflora is 10: 1. Lactobacilli are the basis of the natural barrier between the external environment and the uterine cavity. Due to acid formation and the release of hydrogen peroxide, they create an acidic environment that prevents the propagation of pathogenic and conditionally pathogenic microbes.
Under adverse conditions arising under the influence of one or more endogenous and exogenous factors, the quantitative and qualitative composition of microflora changes. The number of lactobacilli decreases, other microorganisms begin to multiply actively, primarily obligate anaerobes. The total number of bacteria is increasing. Bacterial vaginosis develops. A distinctive feature of this pathology is the absence of a specific pathogen. The cause of the infectious process is not one type of microorganism, but polymicrobial associations.
Bacterial vaginosis can occur with immune disorders as a result of a general weakening of the body, acute and chronic infectious diseases. Another factor contributing to the development of bacterial vaginosis is changes in the hormonal background during a change in the phase of the menstrual cycle, amenorrhea, oligomenorrhea, single-phase cycles, during gestation, in adolescence and menopause. Of great importance is the use of hormonal drugs (corticosteroids, oral contraceptives), antibacterial, antiviral and antifungal drugs.
The likelihood of bacterial vaginosis increases when hygiene rules are not followed, frequent douching, increased radiation exposure (radiation therapy, exposure to professional exposure to radioactive substances), reproductive system malformations, conditions after surgery, polyps and cysts of the vagina, use of the intrauterine device, diaphragms, tampons and spermicides. Among the risk factors for the development of bacterial vaginosis also include conditions after abortion and childbirth, atrophic changes in the vaginal mucosa and intestinal dysbiosis.
Treatment and prevention of bacterial vaginosis
The treatment regimen is determined individually, taking into account the severity of symptoms, the 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, a patient with bacterial vaginosis is recommended to exclude alcoholic beverages, limit the intake of spicy and spicy food.
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 funds for bacterial vaginosis is 7-10 days. If necessary, immunocorrectors and antihistamines are used simultaneously. For the prevention of candidiasis (especially true - in the presence of a fungal infection in the anamnesis) use antifungal drugs. To adjust the pH, local products with a high content of lactic acid are administered.
1-2 weeks after the completion of the first stage of treatment, a second examination and laboratory tests are performed to evaluate the effectiveness of bacterial vaginosis therapy. After 2-3 days, the second stage begins, the main task of which is to restore normal lactoflora. Apply probiotics and eubiotics. 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. With the persistent course of bacterial vaginosis, additional examinations are prescribed to identify pathogenic factors that contribute to the development of relapse of the disease.
Among the measures to prevent and timely detect bacterial vaginosis are compliance with the rules of intimate hygiene, the careful use of hygiene products, the exclusion of frequent douching and the rational selection of methods of protection, taking into account the intensity of sexual life, health status and hormonal background of the patient. Avoid uncontrolled intake of antibacterial and antifungal drugs, consult a doctor in a timely manner when symptoms of inflammatory diseases appear, regularly visit a gynecologist for routine examinations, and treat intestinal dysbiosis.
The mechanism of development of vaginosis
Man and the microbial flora exist in an indivisible tandem. There are microbes that, in the process of evolution, have adapted to live in the human body and even benefit him. This process is called biocenosis. Such flora is represented by a stable bacterial composition. Some bacteria populate exclusively the dermis, others live in the mouth, and others in the gastrointestinal tract. Such bacteria bring benefits to the human body by destroying harmful flora, producing vitamins and stimulating the functioning of his immunity.
Lactobacilli live in the vagina. They look like small thick sticks. Bacteria break down glycogen, which is located in the epithelium lining the vagina. During this process, lactic acid is released. Due to what an acidic environment is maintained in the vagina. Pathogenic microorganisms die in it, which is the norm. In the vaginal biocenosis, lactobacilli account for 95-98% of all useful microflora.
Sometimes it happens that lactobacilli are destroyed. Then other microbes come in their place. The acidic environment of the vagina changes, which creates favorable conditions for the entry of pathogenic microorganisms into it. They can be transmitted sexually, and can reproduce on their own. In the latter case, they speak of nonspecific vaginosis. Lactobacillus is replaced by flora, which populates the perineum, urethra, perianal folds. Microbes begin to multiply rapidly, but such flora is not able to perform the functions of lactobacilli.
A change in the vaginal biocenosis leads to the fact that in it there is a failure of not only metabolic, but also immune processes. The production of immunoglobulin A decreases. It is this substance that prevents the pathogens from attaching and penetrating deep into the epithelial wall of the organ. The epithelium itself is trying to cope with bacteria, which leads to excessive desquamation of its particles. This explains the increase in vaginal discharge during vaginosis. Anaerobic bacteria come in place of lactobacilli. So-called microorganisms that are able to maintain their vital activity in an oxygen-free environment. Some of them produce amino acids and volatile fatty acids. They break down into the vagina to volatile amines. These amines have an unpleasant odor that resembles the smell of fish.
The vaginal environment from acidic becomes alkaline. The metabolism of fats, proteins, minerals and carbohydrates is disrupted, the epithelium produces a greater amount of mucus. This is the first sign of developing vaginosis. In this case, the walls of the vagina are not inflamed. All changes are exclusively physiological in nature.
Causes of Vaginosis
Bacterial vaginosis cannot be called a genital infection, since there are no infectious representatives of the flora in the vagina. Such a disease is called nonspecific vaginosis. The main reason for its development is a change in the vaginal environment, which subsequently leads to an imbalance of microflora.
A variety of microbes are able to replace lactobacilli.
Microorganisms such as:
What is bacterial vaginosis?
Bacterial vaginosis is a non-inflammatory process that occurs due to a violation of the normal vaginal microbiocenosis. It is customary to separate it into a separate nosological group, characterized by violations of the quantitative and qualitative composition of microflora, not associated with the presence of STDs, as well as the presence of protozoa or fungal microorganisms. With the development of a pathological condition, the number of permanent inhabitants of the vagina, lactic acid bacteria producing hydrogen peroxide is significantly reduced. At the same time, the number of gram-negative anaerobic bacteria (gardnerella, mobiluncle, peptostreptococcus, bacteroid, mycoplasma, ureaplasma, fusobacterium) significantly increases.
Useful lactic acid bacteria create an acidic environment in the vagina, stimulate local immunity and compete with other microflora for adhesion (adhesion) to epithelial cells.
With the development of bacterial vaginosis, another representative of the normal microflora of the vagina, gardnerella, normally living in small amounts in the female genital tract, begins to multiply intensively, displacing beneficial lactobacilli. In the process of its life, it releases pyruvic acid and amino acids, which are a nutrient substrate for another vaginal microflora. As a result, anaerobic opportunistic bacteria are activated, producing amines and giving the vaginal secretions an unpleasant fish smell.
Causes of bacterial vaginosis
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. 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.
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-compliance with basic rules of personal hygiene,
- bowel disease.
- Ovarian inflammation (salpingitis)
- Inflammation of the cervix (cervicitis),
- Postoperative infectious complications,
- Yeast infection
- Bacteremia (a condition that develops when bacteria enter the bloodstream). May occur after childbirth and invasive gynecological procedures,
- Genital infections
- Urinary tract infections.
Prevention of bacterial vaginosis
In order to prevent the development of the pathological process and reduce the recurrence rate of the disease, it is necessary, if possible, to eliminate the factors that provoke its occurrence. It is not recommended to take antibiotics on your own, without medical supervision, you should abandon frequent douching, decide on the advisability of using an intrauterine device, liquid soap for intimate hygiene, which can lead to disruption of the normal microflora of the vagina, and also to avoid frequent promiscuous sexual contacts.