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Bacterial vaginosis: causes, symptoms, treatment and diagnosis

Among the many infections of the female genital organs, the most common is bacterial vaginosis (BV, vaginal dysbiosis, gardnerellosis).

According to statistics from research and educational medical institutions, this pathology is detected in almost a quarter of healthy women and over 60% of patients with clinical symptoms of vaginitis (colpitis).

According to its characteristics, it refers to non-inflammatory connective tissue diseases (non-inflammatory syndrome). The disease is caused by the qualitative and quantitative imbalance of the vaginal environment - a significant increase in opportunistic bacteria and a decrease in the concentration of the lactic acid flora, which increases the chances of increased spread of pathological microorganisms.

What it is? - In case of bacterial vaginosis of the vagina, the composition of the vaginal discharge includes a mixed microflora - peptococci, peptostreptokokki, bacteroids, mobilyunkusy, mycoplasma, gardnerella and a small amount of epithelium. So this pathology, according to scientists, is a pathological condition with a special distribution of the bacterial ecosystem and is not, as such, a tissue infection.

In medical practice, vaginal dysbacteriosis is classified according to stages - the severity of clinical manifestations:

  1. Compensated BV - characterized by the almost complete absence of microflora. Histological examination does not find changes in epithelial cells. The structure of the epithelium of the organs of the reproductive system is not broken.
  2. Subcompensated type of BV - there is an increased number of pathogens of various diseases and a decrease in the level of lactobacilli.
  3. Uncompensated type of vaginal dysbiosis is characterized by the absence of lactic flora and an increase in the concentration of pathogenic and conditionally pathogenic microorganisms. There is a modification of the epithelium.

The clinical picture of the disease may be acute, torpid, erased, or asymptomatic. The form of manifestation of the pathology greatly simplifies the task of the physician in determining how to treat bacterial vaginosis, given the type of the disease.


Etiology and genesis: causes and origin

Bacterial vaginosis

The leading role in the microenvironment of the vagina is played by lactobacilli (the main flora of the vagina is 98%), possessing:

  • the peculiarity of the production of hydrogen peroxide (peroxide);
  • the creation of a protective acidic factor - lactate;
  • stimulation of the body's immunity;
  • competitiveness for a place on the epithelial cells of the vagina, displacing and preventing other flora from developing.

It is this ability that ensures the balance of vaginal microorganisms. Various adverse factors (internal or external) cause a disturbance of the normal microcenosis of the vagina, leading to a change in the vaginal microsystem, which is the main cause of the development of dysbacteriosis.

To the internal "provocateurs" include:

  • hormonal changes caused by menopause, stress after medical abortions or after childbirth, with complications of pregnancy, etc .;
  • violations of local immunological processes;
  • non-specific infections - hypo or atrophy of the upper layer of the vagina, functional failure of the cell receptors of its epithelium;
  • changes in the biocenosis of the digestive tract.

In more than half of patients with symptoms of BV, intestinal dysbacteriosis is detected, which speaks in favor of a single dysbiotic process with a predominant lesion of the genital or digestive system. Of concomitant infections, hiding against the background of vaginous manifestations, bacteria of chlamydia , mycouraaplasm, papillomaviruses are often detected.

External provocative factors are due to a variety of reasons, including:

  • antibiotics chemotherapy, hormones, antiviral and antifungal therapy;
  • radiotherapy;
  • lack of hygiene measures;
  • frequent vaginal cleansing procedures;
  • ruptures during childbirth, contributing to the anatomical change of the vagina;
  • congenital vaginal abnormalities and gynecological surgery;
  • polyps and cystic formations of the hymen (virgin fold);
  • spermicides (contraceptives) or vaginal swabs

Although the route of sexual infection is not statistically proven, the question of such transmission of bacterial vaginosis remains controversial.

Symptoms of bacterial vaginosis

Symptoms of bacterial vaginosis

The severity of the main signs and symptoms of bacterial vaginosis is due to:

  • prolonged, abundant or moderate secretions;
  • an unpleasant smell of fish tripe, aggravated during menstruation and after sexual intercourse;
  • in the initial period of the disease, the whites have the structure of a liquid consistency, white or grayish ;
  • as the process progresses, the structure and color of the whiter changes. They become thick or cheesy, the color changes to yellow or greenish;
  • in rare cases, discomfort manifests itself in the form of itching, irritation, burning pain during intercourse;
  • long, pronounced signs of the disease manifest themselves in recurrent vaginosis, often in the “company” of erosive pathologies of the uterus and its cervix.

In a quarter of diseased patients, the clinical symptoms of bacterial vaginosis may not appear at all. Despite the general signs of BV, the clinic of the disease in each patient is individual.

Bacterial vaginosis during pregnancy

The manifestation of bacterial vaginosis during pregnancy due to changes in the woman's body, occurring during this period. The balance of bacteria in the vagina is disturbed, as the bacteria produce lactic acid, which maintains the balance of the vaginal flora. Reduced immunity opens up the possibility of pathogenic microbes to vigorously grow and increase their number.

In addition, latent, asymptomatic forms of pathology, which take a long time in women, can manifest themselves during the period of pregnancy "in all its glory", and favorable factors have to do with it. Delay in the treatment of bacterial vaginosis in pregnant women threatens with dangerous complications:

  • the development of diseases of organs located in the space of the lower pelvis;
  • infect the internal organs of the reproductive system, the fetal membrane or placenta;
  • migration of infection leads to the development of inflammation in the fetal membrane, to their purulent fusion and rupture, which ultimately results in premature birth or spontaneous miscarriage;
  • the infection can affect the child, cause functional disturbances in the placenta and blood vessels, which provokes prolonged oxygen starvation in the fetus;
  • after birth, in such children, as a rule - low weight, pneumonia, pathology of the nervous system.

With timely treatment, neither the mother nor the child is in danger.

Bacterial Vaginosis Treatment

Bacterial Vaginosis Treatment

Before starting treatment of vaginosis, it is necessary to undergo a series of diagnostic procedures. Specific tests are prescribed by the attending physician, the main ones are:

  1. The study of emissions to determine the acidity.
  2. Detection of vaginosis by the amine test method.
  3. The study of vaginal smear to determine the ratio of the bacterial flora;
  4. Diffuse and dilution methods, which determine the degree of sensitivity of harmful bacteria to antibiotic drugs;
  5. In controversial situations - an analysis of the proportion of succinic and lactic acid.

The tactics of treatment of bacterial vaginosis - phased.

The first stage of treatment involves the destruction of microflora, which damages the vaginal flora. Prescribed medications are local effects that suppress the reproduction and growth of the main pathogens:

  • candles or tampons;
  • drugs containing antibiotics - "Trichopol" "Clindamycin" "Metrogil" "Metronidazole", etc .;
  • preparations restoring intestinal microflora (side effects of antibiotics).

The choice of drugs is carried out in accordance with the indicators of the sensitivity of bacterial microflora to antibiotics.

The second stage is due to the restoration of microflora and colonization of the vaginal environment by lactic acid bacteria. Probiotic preparations are prescribed that contain live strains of beneficial microflora: “Bifidumbacterin”, “Lactobacterin”, “Linex”, etc.

After a week-long course of treatment, a gynecologist is examined and a follow-up examination is taken. The final stage is a control examination after one and a half months.

Prevention measures for BV

The main measure of prevention of bacterial forms of vaginosis and its recurrence is the elimination of provoking factors.

  1. Reasonable use of antibiotic drugs.
  2. Maintain intestinal microflora at the proper level.
  3. Timely treatment of gynecological and hormonal pathologies.
  4. Maintain the normal functions of the immune system.
  5. In most cases, the use of contraceptives and the use of vaginal hygiene products are excluded.

It should be remembered that an alternative to questionable self-treatment, even at first glance, minor disorders in the body, is a qualitative examination and well-chosen treatment by a specialist.


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