Bacterial vaginosis – infectious not inflammatory damage of a vagina at which normal flora is replaced with polymicrobic associations of conditionally pathogenic bacteria. The bacterial vaginosis arises against the background of violations of immunity, inflammatory diseases of reproductive system, violations of a menstrual cycle, long use of an intrauterine spiral, unsystematic reception of antibiotics and hormonal medicines. Is followed by plentiful allocations with an unpleasant smell. Sometimes proceeds asymptomatically. The diagnosis is established on the basis of complaints, the anamnesis and these special tests. Treatment – local and general pharmacotherapy.
Bacterial vaginosis – not inflammatory infectious process at which normal lactoflora of a vagina is replaced with associations of anaerobe bacterias. Is widespread pathology, it is diagnosed for 21-33% of the patients addressing gynecologists. Can proceed it is hidden or with obvious clinical symptomatology. At improvement of the general condition of an organism symptoms of a bacterial vaginosis disappear or smooth out, at influence of various endogenous and exogenous factors appear again that causes a long recidivous course of disease. Pathology does not belong to venereal diseases. Because of hormonal changes quite often arises in the period of a gestation and a climax. Treatment of a bacterial vaginosis is performed by experts in the sphere of gynecology.
Reasons of a bacterial vaginosis
Normal more than 95% of microflora of a vagina at women of childbearing age are made by aerobic and anaerobic lactobacilli. More than 40 types of various microorganisms enter other 5%. The ratio of anaerobe bacterias and aerobes in healthy vaginal microflora makes 10:1. Lactobacilli are a basis of a natural barrier between the external environment and a cavity of a uterus. Thanks to a kislotoobrazovaniye and release of peroxide of hydrogen they create the acidic environment interfering reproduction of pathogenic and conditionally pathogenic microbes.
Under the adverse conditions arising under the influence of one or several endogenous and exogenous factors, the quantitative and qualitative players of microflora are changed. The number of lactobacilli decreases, other microorganisms, first of all – obligate anaerobe bacterias begin to breed actively. The total of bacteria increases. The bacterial vaginosis develops. Distinctive feature of this pathology is lack of the specific activator. Not one species of microorganisms, but polymicrobic associations becomes the reason of infectious process.
The bacterial vaginosis can arise at immune violations as a result of the general weakening of an organism, sharp and chronic infectious diseases. One more factor promoting development of a bacterial vaginosis are changes of a hormonal background when changing a phase of a menstrual cycle, amenory, oligomenory, single-phase cycles, in the period of a gestation, at teenage and climacteric age. Reception of hormonal means (corticosteroids, oral contraceptives), antibacterial, antiviral and antifungal medicines is of great importance.
The probability of developing of a bacterial vaginosis increases at non-compliance with rules of hygiene, frequent syringings, the raised beam loading (radiation therapy, radiation at professional contact with radioactive materials), malformations of reproductive system, states after surgeries, polyps and cysts of a vagina, application of an intrauterine spiral, diaphragms, tampons and spermitsid. Also include states after abortions and childbirth in number of risk factors of development of a bacterial vaginosis, atrophic changes of a mucous membrane of a vagina and intestinal dysbacteriosis.
Symptoms of a bacterial vaginosis
The most characteristic and often the only symptom of a bacterial vaginosis are allocations from a genital tract, is frequent with the unpleasant smell similar to a smell of stale fish. Usually bleach liquid, whitish or slightly grayish. Can be plentiful, the constants remaining within several years, or poor, short-term, appearing from time to time. The average quantity is more white at a bacterial vaginosis – about 20 ml a day that by 10 times exceeds the volume of normal allocations. At the long course of a disease (within several years) color and a consistence of allocations quite often change. Bleach become more dense, foamy, sticky, yellowish or greenish.
Character and quantity are more white at a bacterial vaginosis vary depending on age, the general state of health, a mental and emotional condition of the woman (mental injuries and intensive stresses), sexual activity, a phase of a menstrual cycle, endocrine frustration, diseases of reproductive system and somatic diseases. In some cases patients with a bacterial vaginosis show complaints to burning, an itch, violations of an urination, pain or unpleasant feelings during intimate proximity.
Perhaps sharp or torpedo, asymptomatic, monosimptomny (only with allocations) or the polisimptomny course of a disease. At one patients of display of a bacterial vaginosis remain for a long time, at others periodically arise under the influence of adverse factors. When collecting the anamnesis it becomes clear that more than 90% of patients with suspicion of a bacterial vaginosis addressed the gynecologist and other experts with complaints to allocations and other symptoms earlier. Three quarters of patients were repeatedly treated for a nonspecific vaginit, using antibacterial candles and accepting various oral antibacterial means.
During gynecologic survey of the patient with a bacterial vaginosis signs of an inflammation are not found. Vagina walls usually pink, at patients of climacteric age sometimes come to light small reddish specks. Allocations at a bacterial vaginosis are evenly distributed on vagina walls, well are removed a wadded tampon. At measurement pH more than 4,5 decides on use of an indicator strip. When mixing is more white from 10% solution of potassium hydroxide emergence or strengthening of a smell of rotten fish is noted. At a kolposkopiya hypostasis, hyperaemia, infiltration and hemorrhages are absent. Pathological changes of a vaginal part of a neck are diagnosed for 39% of patients with a bacterial vaginosis: hems, erosion, or tservitsit.
Diagnosis of a bacterial vaginosis
The diagnosis "a bacterial vaginosis" is established on the basis of complaints, the anamnesis, the yielded gynecologic survey and results of special tests. During the poll the doctor specifies whether the woman diseases of reproductive system, endocrine and somatic diseases has, whether it accepts hormonal medicines and antibacterial means, whether he uses contraceptives, whether there was in the anamnesis childbirth, abortions and surgeries on genitals, what intensity of sex life and so forth.
The main laboratory research at a bacterial vaginosis is the microscopy of the dabs taken from the back arch and painted on Gram. During microscopy estimate quantity of leukocytes, study forms and types of the microorganisms which are a part of microflora of a vagina. Existence of a large number of anaerobe bacterias at decrease in quantity of lactobacilli demonstrates existence of a bacterial vaginosis. A characteristic symptom of a disease are key cages – mature cages of an epithelium on which membrane various microorganisms come to light (a gardnerella, cocci, ). Normal such cages, as a rule, are not found. The false diagnosis of a bacterial vaginosis caused by existence in dab of cages of an epithelium with adgezirovanny lactobacilli is in some cases possible.
Serological, immunofermental and cultural methods of diagnosis of this pathology are mentioned in some works devoted to researches of a bacterial vaginosis, however, such techniques are of purely scientific interest so far and are not used in broad clinical practice. Diagnostic criteria of a bacterial vaginosis existence of specific serve more white, identification of key cages at microscopy of dab, pH more than 4,5 and emergence of a smell of stale fish at reaction is more white with potassium hydroxide. For diagnosis "the bacterial vaginosis" is required existence at least of three criteria from four.
At detection of the accompanying pathology additional inspections and consultations of various experts can be required. Patients with a bacterial vaginosis can be directed to consultation to the therapist, the endocrinologist, the urologist, the venereologist, the mycologist or the gastroenterologist. If necessary appoint ultrasonography of bodies of a small pelvis, the general blood tests and urine, biochemical blood test, the analysis a calla to dysbacteriosis, blood test on hormones and other researches.
The bacterial vaginosis is differentiated with gonorrhea, trichomoniasis, vaginal candidiasis and a nonspecific vaginit. Distinctive symptoms of gonorrhea are liquid allocations with a yellowish or greenish shade in combination with a painful urination. Existence of trichomoniasis is demonstrated by plentiful sticky or foamy gray-flavovirent allocations, it is possible with a stale smell. Sometimes bleach are combined with an itch and morbidity at an urination. Candidiasis can be suspected at emergence of flaked curdled white allocations in combination with burning and an itch of a vagina. For an exception of the listed diseases special laboratory researches are required.
Treatment and prevention of a bacterial vaginosis
The scheme of treatment is defined individually taking into account expressiveness of symptoms, duration and a form of a bacterial vaginosis, existence of the accompanying inflammatory processes, changes of reproductive system, somatic and endocrine diseases. Treatment includes two stages: reception of antibacterial means and restoration of normal microflora. For the entire period of therapy to the patient with a bacterial vaginosis recommend to exclude alcoholic beverages, to limit reception of spicy and spicy food.
At the first stage appoint metronidazole or orally or intravaginalno, in the form of vaginal tablets, candles or creams. Duration of reception of the transferred funds at a bacterial vaginosis makes 7-10 days. If necessary immunoproofreaders and antihistamines at the same time apply. For prevention of candidiasis (it is especially urgent – in the presence of fungal defeat in the anamnesis) use antifungal medicines. For correction pH enter local means with the high content of lactic acid.
1-2 weeks later after end of the first stage of treatment perform repeated inspection and laboratory tests for assessment of efficiency of therapy of a bacterial vaginosis. Still 2-3 days later begin the second stage which main objective is restoration of normal lactoflora. Apply a probiotics and eubiotik. In 90% of cases normalization of vaginal microflora becomes result of treatment. Tests are repeated in 10 days and 1-1,5 months after end of the second stage of therapy. At the persistent course of a bacterial vaginosis appoint additional inspections for identification of the pathogenic factors promoting development of a recurrence of a disease.
Refer observance of rules of intimate hygiene, the thought-over use of hygienic means, an exception of frequent syringings and rational selection of ways of protection taking into account intensity of sex life, the state of health and a hormonal background of the patient to number of measures for prevention and timely detection of a bacterial vaginosis. It is necessary to avoid uncontrolled reception of antibacterial and antifungal medicines, to see in due time a doctor at emergence of symptoms of inflammatory diseases, to regularly visit the gynecologist for performing routine inspections, to perform treatment of an intestinal dysbiosis.