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.
use of antibacterial drugs.
long-term use of intrauterine contraceptives.
use of tableted contraceptives.
previously transmitted 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.
impact of small doses of ionizing radiation.
stressful effects on the body.
In 60% of women suffering from bacterial vaginosis, violations of microecology of the colon are revealed (intestinal dysbacteriosis.
Manifestations of bacterial vaginosis.
The main sign of a complaint about discharge with an unpleasant smell, which is noted by only 50% of women. Allocations are more often mild, less abundant, in some cases they may be absent altogether. Allocations in bacterial vaginosis are grayish-white, homogeneous, without lumps, have a specific fishy smell, which can be permanent, absent, appear during menstruation and sexual intercourse.
The duration of these symptoms can last for years. With a long-term current process, the extracts acquire a yellowish-green color, become more dense, often resemble a cheesy mass, have the property of foaming, slightly viscous and sticky, evenly distributed along the walls of the vagina.
Other complaints, mainly on itching and urination disorders, are rare: they may be 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, 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 the gynecological examination. After the inspection, take the detachable from the lower vaginal vault.
The diagnosis can be made if there are 3 of the 4 listed symptoms.
the specific nature of the secretions.
Acidity 4,5 (in norm 3,8-4,5.
presence of key cells. The so-called key cells are mature epithelial cells (the surface layer of the vaginal epithelium), throughout which microbes are densely and in large numbers attached.
Performing one of the 4 tests is not enough to make a diagnosis.
Treatment of bacterial vaginosis.
With bacterial vaginosis, the best practice is to perform local therapeutic interventions. A good curative effect is indicated for drugs from the group of nitroimidazoles (metronidazole, trichopolum, metrogil, etc.), which are prescribed intravaginally in the form of tablets, tampons or candles.
There are various schemes of complex treatment of bacterial vaginosis, consisting of the use of nitroimidazoles, tableted and topical agents (1% hydrogen peroxide, antiseptic solution of tomicides, benzalkonium chloride compounds, etc.), which are used to irrigate the vagina.
When tablet appointing nitroimidazoles, 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 with the aim of general sanitation of the vaginal mucosa (clindamycin, oleandomycin, cephalosporins.
In the appointment of antibacterial drugs of a wide spectrum of action, a large number of side effects may occur, including dysbacteriosis of other cavities (intestines, etc.).
The effectiveness of treatment of bacterial vaginosis is assessed by the disappearance of subjective manifestations, the dynamics of clinical symptoms of the disease, the normalization of laboratory indicators. The first control clinical and laboratory examination should be performed one week after the completion of therapy, the second in 4-6 weeks.
During treatment and follow-up, the use of barrier methods of contraception should be recommended (condoms.
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 complete 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 inward, 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, such drugs as clotrimazole, pimafucin, gyno pevaril, dapnejin and others are widely used.
Another effective tool for bacterial vaginosis is the antiseptic drug povidone iodine (Betadine.
With all of the above treatment methods, there may be relapses occurring at different times after treatment. Apparently, this is due to the fact that antibiotic therapy, eliminating pathogenic microorganisms, often does not create conditions for a fairly rapid recovery of beneficial bacteria.
In this connection, it is necessary to include such biological preparations as acylactate, bifikol, bifidum and lactobacterin in the complex of therapy within 10 days after the main course of treatment, in view of their specific action aimed at restoring the normal ratio of lactobacilli in the vagina, and thus preventing the recurrence of this disease .