Bacterial vaginosis is a violation of the vaginal microecology. This is the most common condition in women of childbearing age.
The predisposing factors leading to the development of bacterial vaginosis include the following:
- use of antibacterial drugs;
- long-term use of intrauterine contraceptives;
- use of preformed contraceptives;
- previous inflammatory diseases of the urogenital tract;
- violation of the hormonal status, accompanied by violation of the menstrual cycle;
- changing the state of local immunity;
- exposure to low doses of ionizing radiation;
- stressful effects on the body.
In 60% of women suffering from bacterial vaginosis, violations of the microecology of the colon are detected (dysbiosis intestine).
The main symptom is complaints about discharge with an unpleasant smell, which are noted by only 50% of women. Discharge is more often moderate, less often – plentiful, in some cases they may be absent altogether. Secretions in bacterial vaginosis grayish-white, uniform, without lumps, have a specific “fishy smell”, which can be permanent, absent, appear during menstruation and sexual intercourse.
The duration of these symptoms can be calculated for years. With a long current process discharge they acquire a yellowish-green color, become thicker, often resemble a curd, have the property of foam, are slightly friable and sticky, and are evenly distributed along the walls of the vagina.
Other complaints, mainly of itching and urination disorders, are rare: they may be completely absent or appear periodically. Often women with bacterial vaginosis complain of heavy menstrual bleeding, pain in the lower abdomen, adnexitis .
At the same time, in some cases in some patients do not reveal any manifestations of the disease.
Vaginal and vaginal irritation is rarely observed, which distinguishes bacterial vaginosis from candida and trichomoniasis, which are usually accompanied by severe itching.
A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After the inspection, a discharge of the vaginal discharge from the back of the body is taken.
The diagnosis can be made in the presence of 3 out of 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 (surface layer of the vaginal epithelium), over the entire surface of which microbes are tightly and in large numbers attached.
Performing one of the 4 tests is not enough for a diagnosis.
In case of bacterial vaginosis, local therapeutic measures are considered optimal. A good therapeutic effect is indicated for drugs from the group of nitroimidazoles ( metronidazole , trichopolum , metrogyl , etc.), which are administered intravaginally in the form of tablets, tampons, or suppositories.
There are various schemes of complex treatment of bacterial vaginosis, consisting in the use of nitroimidazoles , prescribed by tablet and topical agents (1% hydrogen peroxide, antiseptic solution of tomicid , benzalkonium chloride compounds , etc.), which irrigate the vagina.
In case of tablet administration of nitroimidazoles, it is necessary to take into account the possibility of side effects such as dysfunction of the gastrointestinal tract, dizziness and headache.
In severe cases of bacterial vaginosis, the underlying principle of treatment is the use of broad-spectrum antibiotics for the purpose of general sanation of the vaginal mucosa ( clindamycin , oleandomycin , cephalosporins).
When prescribing broad-spectrum antibacterial drugs, a large number of side effects may occur, including dysbacteriosis of other cavities (intestines, etc.).
The effectiveness of the treatment of bacterial vaginosis is assessed by the disappearance of subjective manifestations, the dynamics of the clinical symptoms of the disease, the normalization of laboratory parameters. The first follow-up clinical and laboratory examination should be carried out a week after the completion of therapy, repeated – after 4-6 weeks.
During treatment and follow-up, the use of barrier methods of contraception (condoms) should be recommended.
Currently, one of the effective drugs for the treatment of bacterial vaginosis is dalacin vaginal cream, applied once a day for 3 days. The course of treatment is 3 days. One full applicator corresponds to a single dose of the drug.
Among the most frequent complications in the application of the above drugs should be noted vaginal candidiasis. For its prevention it is necessary to prescribe antifungal drugs – nystatin 2000 mg per day inside, simultaneously with the start of treatment. The most effective drug for non-pregnant women is fluconazole.At the same time, for the treatment of vaginal candidiasis during pregnancy, drugs such as clotrimazole , pimafucine , gino – mevoril , dafnedzhin , etc. are widely used .
Another effective remedy for bacterial vaginosis is the antiseptic drug Povidone – iodine ( Betadine ).
With all of the above methods of treatment, there may be relapses that occur at different times after treatment. Apparently, this is due to the fact that antibiotic therapy, eliminating pathogens, often does not create the conditions for a sufficiently rapid recovery of beneficial bacteria.
In this regard, the complex treatment within 10 days after the main course of treatment must include such biological products as acylact, bifikol , bifidum – and lactobacterin , because of their specific action, aimed at restoring the normal ratio of lactobacilli in the vagina, and thereby preventing the frequency of recurrences of this diseases.