Bacterial vaginosis – symptoms and treatment.
What is bacterial vaginosis? The causes, diagnosis and treatment methods are discussed in the article.
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Definition of the disease. Causes of the disease
Bacterial vaginosis is an infectious non-inflammatory disease in which abundant growth of certain microorganisms and a sharp decrease in lactic acid bacteria with protective properties occur in the vagina.
This pathology is one of the most common diseases of the female genital area. According to various estimates, it is found in approximately 70% of women of reproductive age.
Let’s analyze the name of the disease. The term “bacterial” emphasizes a significant increase in the number of aerobic and especially anaerobic bacteria that receive energy with a minimum amount of oxygen. The meaning of the word “vaginosis” indicates that there are no signs of inflammation in this disease.
Previously, it was mistakenly called “gardnerellosis”, as it was believed that the bacteria Gardnerella vaginalis were the cause of the pathology. However, it was found that these microorganisms are found not only in patients with symptoms of the disease, but also in 40% of women who have no complaints. Therefore, the diagnosis of “Gardnerellosis” is incorrect and incorrect: it does not reflect either the etiology or pathogenesis of the disease, and in some cases leads to false positive diagnosis and the appointment of unreasonable treatment.
The causes of bacterial vaginosis are very diverse. These include banal violations of intimate hygiene, as well as more complex situations.
Factors contributing to the onset of the disease include:
_ birth injuries;
_ various operations on the perineum;
_ surgical abortion;
_ menstrual irregularities;
_ irrational use of antibiotics and even local antiseptics.
Symptoms of Bacterial Vaginosis
The main symptom of bacterial vaginosis is abundant, fluid, uniform discharge from the genital tract with an unpleasant odor. They can be gray or white.
The smell of secretions is often compared to the smell of fish. It is especially strongly felt during alkalization of the vaginal environment – after intercourse and during menstruation.
Approximately 50% of women, i.e., every second, have no complaints of vaginal discharge, so the disease can be asymptomatic.
Sometimes with bacterial vaginosis, patients are disturbed by discomfort, itching or burning in the vagina and in the rectum, urinary disorders and pain during or after intercourse.
A burning sensation and itching are also characteristic of vaginitis, an inflammatory process in the vagina. It differs from bacterial vaginosis by a sense of dryness of the vagina, as well as redness and swelling of its membrane.
The pathogenesis of bacterial vaginosis
Bacterial vaginosis does not have one specific pathogen – it can be caused by various microorganisms. The most common include not only the mentioned G.vaginalis, but also fusobacteria, peptostreptococci, veylonella, vaginal atopobium, as well as bacteria Peptoniphilus, Prevotella, P. bivia and M. Mulieris. Most often, the development of the disease provokes a combination of 2-3 microorganisms or more.
In the presence of risk factors, these pathogens begin to multiply actively in the course of their life activity, alkalizing the vaginal environment (normal pH of vaginal discharge is 3.5-4.5). Only lactobacilli, which secrete lactic acid, can prevent the growth of pathogenic bacteria, but their quantity decreases due to an increase in pH.
According to modern concepts, the bacteria that cause bacterial vaginosis are capable of creating biofilms that attach to the vaginal epithelium. Inside these films, microorganisms become less vulnerable to exposure, including drugs. It is the formation of biofilms that is the cause of frequent relapse and unsuccessful treatment of the disease.
Bacterial vaginosis does not apply to sexually transmitted diseases, as it also occurs in girls who have never entered into an intimate relationship. Although it is difficult to unequivocally state that there is no connection between the disease and its sexual transmission: numerous studies confirm that the change in the sexual partner, the presence of numerous sexual partners, as well as non-traditional sex significantly increase the number of relapses of bacterial vaginosis.
Classification and stages of development of bacterial vaginosis
At the moment, there is no classification and separation at the stage of the disease. The code in the AND -10 (International Classification of Diseases), which would correspond to the diagnosis of Bacterial Vaginosis, is also missing. Other codes are used to encode this state. Most often it is referred to as “N 86. Other inflammatory diseases of the vagina”, which is incorrect and not always correct.
Previously used the classification proposed by E.F. Kira in 1995. According to her, four types of vaginal microbiocenosis were identified – a set of microorganisms that live in the vagina:
Normocytosis is the predominance of lactobacilli. is a sign of normal vaginal microflora.
The intermediate type is a moderate or reduced number of lactobacilli, the presence of gram-positive cocci and gram-negative rods. Often observed in healthy women, rarely can be accompanied by complaints of discharge from the genital tract.
Dysbiosis is the almost complete absence of lactobacilli, abundant polymorphic gram-negative and gram-positive rod and coccal microflora. This condition has been associated with bacterial vaginosis.
Vaginitis – an increase in the number of white blood cells in smears. This condition has been associated with nonspecific vaginitis.
Today, such a classification is not used due to a significant expansion of knowledge about the vaginal microbiocenosis and the emergence of modern laboratory diagnostic methods.
Complications of Bacterial Vaginosis
Unpleasant discharge from the genital tract significantly reduces the woman’s quality of life and her self-esteem, are the cause of sexual behavior disorders and can even lead to trichomoniasis). In particular, one study noted that an HIV-infected woman with bacterial vaginosis was more likely to transmit HIV to a sexual partner than an HIV-infected woman without vaginosis.
Diagnosis of bacterial vaginosis
Diagnosis of bacterial vaginosis usually does not present significant difficulties. Nevertheless, when making a diagnosis, errors can often be found: both overdiagnosis (when a patient is attributed a disease that she actually does not have), and hypo diagnosis.
Most often, the disease can be correctly determined already at the first visit of a woman to a doctor. In such cases, the diagnosis is made on the basis of characteristic complaints, examination data and ph-metric vaginal discharge. Sometimes a fairly extensive clinical and laboratory examination may be needed.
In the diagnosis of bacterial vaginosis, the criteria of R. Amsel are used. These include:
_ the presence of homogeneous whitish-gray discharge from the genital tract (upon examination, their uniform distribution along the walls of the vagina can be noted);
_increase in Ph in the vagina – more than 4.5;
_positive test with 10% potassium hydroxide solution – determination of volatile amines;
_detection of “key cells” in native smears and / or in Gram smears, that is, vaginal epithelial cells with graded microorganisms tightly attached to their surface. White blood cells in these smears are not found or are kept within normal limits, which indicates the absence of inflammation, and lactobacilli are reduced to a complete absence.
The diagnosis of Bacterial Vaginosis is established if there are at least three signs.
There is also a semi-quantitative assessment of smears of vaginal fluid stained by Gram, on a scale from 0 to 10. Now this method is practically not used.
For laboratory diagnosis of bacterial vaginosis, the PCR Real Time method is used as part of a comprehensive analysis of the vaginal microflora. There are a number of test systems, the most common of which are Femoflor 16 + KVM and Femoflor screen. These test systems allow you to get a fairly complete picture of the features of a woman’s vaginal microbiocenosis and prescribe reasonable treatment.
Clinical diagnostic methods include various rapid tests: Fem-exam, BVBlue, Pip-activity TestCard. However, all of these diagnostics are not widely used in clinical practice. This is mainly due to their lack of sensitivity.
In addition, it must be remembered that any woman who lives sexually and consults a doctor with complaints of discharge from the genital tract must be screened for the causative agents of trichomoniasis, gonorrhea, chlamydia due to the wide spread of these infections and a high frequency of complications.
Treatment of bacterial vaginosis
In no case should you self-medicate – it should be prescribed by a doctor, otherwise it can negatively affect the health of a woman.
Treatment of bacterial vaginosis is carried out in the presence of clinical and laboratory signs. Pregnant women deserve special attention. Discussions about the appropriateness of their treatment have already been closed: it is necessarily shown to all pregnant patients, including those with a low risk of premature birth (cases when there were no premature births in the past). Treatment of pregnant women with asymptomatic bacterial vaginosis and a high risk of premature birth (if the children were born earlier than this) can significantly reduce the risk of premature termination of pregnancy.
To eliminate bacterial vaginosis, antiseptic agents and various combination drugs are used. Currently, the effectiveness of a two-stage treatment regimen has been proven: the first stage is the use of antiseptic agents, and the second is to restore the vaginal microflora.
There are many recommendations and treatment regimens for this disease. In accordance with the Eurasian clinical guidelines for the rational use of antimicrobial agents in outpatient practice, when eliminating bacterial vaginosis, the following drugs should be used: Tinidazole.
The duration and frequency of taking these funds is determined individually by the doctor. In addition, there are a significant number of combination drugs.
To restore vaginal microflora, vaginal capsules with live lactobacilli, ascorbic acid for vaginal use and a gel with lactic acid can be used.
A promising method for the treatment of bacterial vaginosis at the moment is the treatment of the vagina with cavitated ultrasound solutions of antiseptics. This method is being actively studied and great hopes are placed on it in the treatment of not only bacterial vaginosis, but also various inflammatory diseases of the skin and mucous membranes.
The prognosis for timely treatment in most cases is favorable. Relapses are sometimes possible. When they occur, an integrated approach to the patient is required, a complete clinical and laboratory examination and the exclusion of concomitant diseases that may increase the risk of re-emergence of bacterial vaginosis. You should also consult on nutrition and lifestyle issues.
As a prevention of the occurrence of bacterial vaginosis, first of all, it is necessary to exclude such risk factors as:
_ violation of the integrity and anatomy of the external genitalia of a woman (may occur with injuries during childbirth, various surgical interventions);
_ alkalization of the vaginal environment (possible with certain lubricants, shower gels, douching);
_ surgical abortions, some gynecological operations, accompanied by removal of the mucous plug from the cervical canal;
_ menstrual irregularities, hypoestrogenic state in the period before menopause;
_ irrational use of antimicrobial agents and antiseptics.
Frequent changes in sexual partners, serious concomitant diseases, alcohol abuse, and smoking make a significant contribution to the development and relapse of the disease. All of this should be avoided.
An important role in prevention is played by a healthy lifestyle, adequate physical activity and a commitment to proper nutrition – a vegetarian diet and an increased consumption of “fast” carbohydrates increase the risk of relapse.
To prevent bacterial vaginosis, you need to follow the recommendations for intimate hygiene:
Wash at least twice a day. To wash the genitals, use only warm water or special intimate hygiene preparations that contain substances that do not violate the acidity of the vaginal environment.
It should be washed only with cleanly washed hands, do not use washcloths. During washing, the water jet should be directed from front to back.
After washing, dampen the moisture with a towel for intimate hygiene. It should be soft, clean and strictly individual. You can not use them for hands, face and other parts of the body.
During menstruation, it is not recommended to take a bath, swim in the pool or ponds. It is preferable to take a shower in the morning and in the evening. It is better to avoid sexual intercourse, especially in the early days of menstruation.
Sanitary pads during menstruation should be changed at least four to five times a day, tampons – every two hours.
It is advisable to use daily sanitary pads not regularly.
Do not use vaginal douching for regular hygiene. They are possible only if they are prescribed by a doctor.
Give preference to underwear made of natural fabrics with a wide gusset. It should be changed daily, in some cases – twice a day. Underwear should be washed separately from other clothes, towels and bedding.