Bacterial vaginosis is a violation of the microecology of the vagina. This is the most common condition in women of childbearing age.
The predisposing factors leading to the development of bacterial vaginosis include the following:
- the use of antibacterial drugs;
- long-term use of intrauterine contraceptives;
- use of pill contraceptives;
- previous inflammatory diseases of the urogenital tract;
- violation of the hormonal status, accompanied by a violation of the menstrual cycle;
- change in 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 large intestine (intestinal dysbiosis) are revealed.
The main symptom is complaints of discharge with an unpleasant odor, which is noted by only 50% of women. Allocations are often moderate, less often – abundant, in some cases they may be absent altogether. Discharge in bacterial vaginosis is grayish-white in color, homogeneous, without lumps, has a specific “fishy smell”, which may be constant, absent, appear during menstruation and intercourse.
The duration of these symptoms can be calculated in years. With a long-term current process of discharge, they acquire a yellowish-green color, become thicker, often resemble a curd mass, have the property of foaming, slightly viscous and sticky, evenly distributed along the walls of the vagina.
Other complaints, mainly itching and urinary disorders, are rare: they may be absent or appear intermittently. Often, women with bacterial vaginosis complain of heavy menstrual bleeding, pain in the lower abdomen, adnexitis.
At the same time, in some cases, some of the patients do not reveal any manifestations of the disease.
Irritation of the vulva and vagina is rare, which distinguishes bacterial vaginosis from candidiasis and trichomoniasis, which are usually accompanied by severe itching.
A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After examination, the discharge from the posterior fornix of the vagina is taken.
The diagnosis can be made in the presence of 3 of the 4 listed signs:
- 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 (the surface layer of the vaginal epithelium), over the entire surface of which microbes are tightly and in large numbers attached.
One of the 4 tests is not enough to make a diagnosis.
The same symptoms can be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to heal yourself – consult your doctor.
With bacterial vaginosis, local therapeutic measures are considered optimal. A good therapeutic effect is shown for drugs from the nitroimidazole group (metronidazole, trichopolum, metrogil, etc.), which are administered intravaginally in the form of tablets, tampons or suppositories.
There are various schemes for the complex treatment of bacterial vaginosis, consisting in the use of nitroimidazoles, prescribed by tablets and topical agents (1% hydrogen peroxide, antiseptic solution “tomicide”, benzalkonium chloride compounds, etc.), which are used to irrigate the vagina.
When prescribing nitroimidazoles in tablets, it is necessary to take into account the possibility of side effects in the form of dysfunction of the gastrointestinal tract, dizziness and headache.
In severe cases of bacterial vaginosis, the fundamental principle of treatment is the use of broad-spectrum antibiotics for the purpose of general sanitation of the vaginal mucosa (clindamycin, oleandomycin, cephalosporins).
When prescribing broad-spectrum antibacterial drugs, a large number of side effects may appear, including dysbiosis 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, and the normalization of laboratory parameters. The first control clinical and laboratory examination should be carried out one week after the end 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 most effective drugs for the treatment of bacterial vaginosis is dalacin vaginal cream, which is 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 common complications when using the above drugs, vaginal candidiasis should be noted. For its prevention, it is necessary to prescribe antifungal drugs – nystatin 2000 mg per day orally, simultaneously with the start of treatment. The most effective drug for non-pregnant women is fluconazole. At the same time, drugs such as clotrimazole, pimafucin, gyno-pevaril, dafnedzhin, etc. are widely used to treat vaginal candidiasis during pregnancy.
Another effective remedy for bacterial vaginosis is the antiseptic povidone-iodine (Betadine).
With all of the above methods of treatment, relapses may occur that occur at various times after treatment. Apparently, this is due to the fact that antibiotic therapy, eliminating pathogens, often does not create conditions for a sufficiently rapid recovery of beneficial bacteria.
In this regard, in the complex of therapy within 10 days after the main course of treatment, it is necessary to include such biological products as acylact, bificol, bifidum– and lactobacterin, due to their specific action aimed at restoring the normal ratio of lactobacilli in the vagina, and thereby preventing the frequency of relapses of this diseases.