Vaginosis symptoms treatment. Bacterial vaginosis: causes, symptoms and treatment

Bacterial vaginosis is one of the most common vaginal diseases and a common cause of unpleasant odor, vaginal discharge and itching in the intimate area.

Symptoms of bacterial vaginosis

Bacterial vaginosis often causes the following symptoms:

Unpleasant “fishy” odor from the vagina. The smell may be constant or appear during or after sex.
, sometimes resembling mucus. Discharge can be heavy or moderate.
Irritation, itching, discomfort, redness of the skin in intimate areas.
Pain and cutting during urination.
Dryness and...

You are more likely to have bacterial vaginosis if:

Have you recently taken antibiotics?
You recently changed your sexual partner
You have had two or more sexual partners in the past few weeks
You have
Have you recently used a jacuzzi or taken a bath?
Have you recently douched?
You don't comply

All of the above factors are not the direct cause of inflammation, but they disrupt the vaginal microflora and predispose to the development of bacterial vaginosis.

When does a smear indicate bacterial vaginosis?

Most women find out that they have bacterial vaginosis precisely by the result. If a woman has bacterial vaginosis, the following changes are detected in the smear:

many key cells
many cocco-bacillary forms (bacteria that look like rods and cocci)
abundant coccal flora
leukocytes are elevated or within normal limits
presence of mobiluncus
The pH of the secretions is above 4.5

Bacterial vaginosis is often combined with other infections, so the smear may contain changes characteristic of other diseases, for example, candidiasis (),.

Gardnerella and bacterial vaginosis

Sometimes bacterial vaginosis is mistakenly called gardnerellosis, since most often it is the bacterium Gardnerella vaginalis that causes inflammation in this disease.

However, gardnerella is often found in the vagina in healthy women who do not have inflammation. That is why, if you have been diagnosed with gardnerella, but there are no signs of inflammation (there are no symptoms of inflammation and the smear result is normal), then there is no question of any bacterial vaginosis, and you are fine.

Why is bacterial vaginosis dangerous?

The bacteria that cause inflammation in bacterial vaginosis are very sensitive to standard antibiotic treatment, and the disease is easily treatable. But if bacterial vaginosis is not treated, it can cause complications:

- inflammation of the uterus.
Salpingitis is inflammation of the fallopian tubes.
Adnexitis is inflammation of the uterine appendages (fallopian tubes and ovaries).
Infertility.

Bacterial vaginosis during pregnancy can lead to premature birth.

How to treat bacterial vaginosis?

If bacterial vaginosis appears for the first time:

Metronidazole 500 mg (Trichosept): one tablet 2 times a day for a week, or
Vaginal gel Metronidazole 0.75% (Rozex): insert one applicator into the vagina before bed for 5 days, or
Clindamycin vaginal cream 2% (Clindacin): insert one applicator into the vagina before bed for 7 days.

If bacterial vaginosis does not go away with the prescribed treatment, the gynecologist will prescribe an alternative treatment:

Tinidazole: 2g per day for 2 days, or 1g per day for 5 days, or
Clindamycin 300 mg: one tablet 2 times a day for a week.

Probiotics in the treatment of bacterial vaginosis

Probiotics are preparations that contain the same beneficial bacteria, which make up the normal microflora of the vagina and help protect against infections.

The following probiotics are used for bacterial vaginosis:

Gynoflor: vaginal tablets
Vagilak: tablets for oral administration

The regimen for taking probiotics for bacterial vaginosis is as follows:

7 days of daily use
7 days break
7 days of re-appointment

This regimen of taking probiotics will avoid the return of infection several months after the end of antibacterial treatment. According to the manufacturers, taking these drugs is not prohibited during pregnancy and breastfeeding.

Treatment of bacterial vaginosis during pregnancy

Bacterial vaginosis during pregnancy can cause it, so treatment is necessary. It is recommended to take medications prescribed to pregnant women from the second trimester of pregnancy (not earlier than 13 weeks):

Metronidazole 500 mg: one tablet 2 times a day for 7 days
Metronidazole 250 mg: one tablet 3 times a day for 7 days
Clindamycin 300 mg: one tablet 2 times a day for a week

Local treatment (vaginal ointments or creams) helps eliminate the symptoms of bacterial vaginosis, but does not reduce the risk of complications of the disease during pregnancy (premature birth).

Attention: These treatment regimens are indicative and may be changed by your doctor. Before using medications, be sure to consult your gynecologist!

Does my husband (sexual partner) need treatment?

It is known that in 80% of men whose sexual partners suffer from bacterial vaginosis, the main causative agent of this disease is found in the urethra Gardnerella vaginalis and other bacteria. This means that the bacteria "move" from the vagina into the man's urethra during unprotected sex.

And, nevertheless, men should be treated No need. Numerous studies have shown that treatment of sexual partners does not affect the recovery of women and does not reduce the chances of relapse.

Treatment for your partner necessary if this is not the first time you have developed bacterial vaginosis, or if you have been diagnosed with sexually transmitted diseases.

Bacterial vaginosis is a disease associated with changes in the balance of vaginal microflora. Most often, women aged 25 to 40 suffer from this problem. According to statistics, every eighth girl had to face such a problem. Vaginal dysbiosis does not threaten the patient’s life, but can lead to disruptions in the functioning of the body’s reproductive system. Therefore, treatment for bacterial vaginosis should be started as soon as the first symptoms appear.

Features of the disease

A healthy woman's vagina contains a wide variety of bacteria. They form an acidic environment, which turns out to be unfavorable for the life of pathogenic microflora. Thanks to this, the reproductive system is protected from the development of inflammation.

Under the influence of negative external or internal factors, the number of lactic acid bacteria in the vagina decreases sharply, which leads to a decrease in the acidity of the environment. Thanks to this, pathogens of various diseases, including bacterial vaginosis, are able to actively reproduce.

Sometimes the disease occurs in a latent form. More often it is accompanied by a vivid clinical picture. The severity of symptoms will depend on the ratio of beneficial and pathogenic microorganisms in the vagina. The sooner adequate treatment is started, the greater the chance of quickly restoring health.

The disease does not belong to the group of venereal diseases. However, some pathogens of bacterial vaginosis are transmitted sexually. They do not become the main cause of the disease, but act as an aggravating factor.

Key reasons for the development of the disease

The causes of bacterial vaginosis lie in an imbalance of vaginal microorganisms. It is impossible to identify a specific pathogen that would provoke the development of the disease. More often, the appearance of pathology is affected by the active reproduction of the following microorganisms in the vagina:

Mycoplasmas.
Megaspheres.
Peptococci.
Gardnerellas.
Leptotrichus.
Bacteroides.
Atopobium.

Their entry into the human body does not cause bacterial vaginosis. Only in the presence of provoking factors does their active reproduction occur, which leads to the emergence of a problem.

Factors not related to disease

External factors that are not related to the woman’s health can give impetus to the development of the disease. Among them are:

Excessive hygiene of the genital organs, frequent douching with the use of products that have bactericidal properties. This leads to the death of most of the lactic acid bacteria and, as a consequence, the development of dysbacteriosis.
Use of an intrauterine device as a contraceptive. If the technology for its installation is violated, the risk of the inflammatory process spreading throughout all organs of the reproductive system increases significantly.
Poor nutrition. Eating large amounts of fatty foods, unhealthy foods and alcoholic beverages provokes severe dysbiosis.
Wearing tight synthetic underwear. Unnatural tissues contribute to the creation of a greenhouse effect in the genitals. As a result, an environment favorable for the active proliferation of microbes is formed.
Failure to comply with personal hygiene rules. If the genitals are washed too rarely, pathogenic microorganisms are able to multiply unhindered. It is important for women to toilet the vagina after each bowel movement to prevent infection from the intestines.

Treatment of the disease should begin with the elimination of provoking factors. It is important to accustom yourself to proper hygiene and a healthy lifestyle.

Diseases that cause vaginosis

The causes of vaginosis often lie in the progression of concomitant diseases. They provide comfortable conditions for the development of pathogenic microorganisms. These include:

Hormonal imbalances. Female hormones have a significant impact on the vaginal microflora. Related to this is the fact that dysbiosis often affects girls during adolescence and women who have entered the menopausal phase. Ladies carrying a baby often encounter this problem.
A sharp decrease in immunity. With such a problem, the body loses the ability to resist the vital activity of pathogenic microflora, against the background of which a strong inflammatory process develops.
Damage to the vagina or cervix. This often happens in emergency situations or during difficult births.
Intestinal dysbiosis. Changes in the microflora in the digestive system lead to the penetration of pathogenic microorganisms into the vagina, which gives impetus to the development of the disease.
Diseases for which long-term antibiotic therapy is used. The use of such provokes the death of beneficial bacteria, which stimulates the proliferation of dangerous microflora.

Read also on the topic

Treatment of nonspecific colpitis in women

The presence of such pathologies complicates therapy. Long-term complex treatment will be required. It must be carried out under the strict supervision of a specialist.

Symptoms

The characteristic symptoms of bacterial vaginosis help to recognize the development of the disease. Among them are the following:

The appearance of severe itching in the genital area.
Increased urge to go to the toilet. When urinating, an unbearable burning sensation occurs.
Unnatural discharge from the genitals. The secretion is white or has a grayish tint. After sex, their volume increases significantly. The discharge is characterized by a sharp, repulsive odor, reminiscent of slave aroma.
During sexual intercourse, a woman experiences discomfort. Because of this, libido gradually decreases.
In advanced forms of vaginosis, vaginal discharge becomes sticky. They turn yellowish in color, and their consistency becomes denser and thicker.

In the presence of aggravating factors, symptoms of vaginosis appear a day after sexual intercourse with a carrier of pathogenic microflora. If the disease occurs against the background of other pathologies or external factors, then its manifestations will in no way depend on sexual contacts. In 50% of cases, the disease does not reveal itself at all. Regular examinations with a gynecologist help identify its presence.

If acute vaginosis is not treated in a timely manner, the problem becomes chronic. Against this background, significant changes in hormonal levels occur, as well as atrophy of the vaginal mucosa. Therapy in such a situation will be especially difficult.

Diagnostic measures

The symptoms of bacterial vaginosis are similar to those of other diseases. Only a doctor can make an accurate diagnosis after the patient has undergone an appropriate medical examination. It includes the following activities:

History taking and visual examination. The doctor must study the patient’s medical history and her lifestyle to identify factors that provoke the problem. The condition of the vaginal mucous surfaces, the presence of characteristic symptoms, as well as the consistency and color of the vaginal secretion are assessed.
Examination of a smear from the genital organs. Biological material is collected, which also includes vaginal discharge. It is studied using a microscope and the number of pathogenic microorganisms is assessed.
pH-metry. This test determines the acidity of the vaginal environment. In a healthy woman, this figure can vary from 3.8 to 4.5. When the normative indicators are significantly exceeded, the disease develops.
Amine test. Vaginal discharge is mixed with sodium hydroxide. After this, the smell of the resulting mixture is assessed. If it emits an unpleasant fishy aroma, a conclusion is drawn about the presence of pathology.
Bacteriological research. A smear from the genital organs is placed in a special nutrient medium and left for several days. If there is a disease in the test sample, bacteria begin to actively multiply, forming colonies. They become clearly visible under a microscope.

Diagnosis of bacterial vaginosis is complemented by studying the sensitivity of the identified pathogenic microflora to modern antibiotics. This allows you to more accurately determine the drugs that will help you quickly cope with the problem.

Drug treatment

As soon as the first symptoms of vaginosis appear, it is necessary to begin treatment. The main method is taking various medications. The following groups of funds are used:

Oral antibiotics. The most commonly prescribed tablets for vaginosis are Metronidazole, Clindamycin, and Tinidazole. They show the greatest activity against anaerobic bacteria. The dosage and duration of taking the drugs is chosen by the attending physician.
Local medications. The use of creams and suppositories for bacterial vaginosis is preferable. Such formulations allow you to quickly deliver the active substance to the site of infection. They have fewer side effects compared to oral medications. Clindamycin cream, Metronidazole suppositories, Neo-penotran, Fluomizin help cure the disease. The suppository is used mainly before bedtime. The cream is injected into the genitals using a special applicator.
Medicines to restore microflora. After defeating pathogenic bacteria, you need to make up for the deficiency of beneficial microorganisms. To do this, a couple of days after finishing taking antibiotics, they start taking probiotics. Linex, Bifiform, Bifiliz are often prescribed. To achieve a quick effect, lactobacilli are used in the form of suppositories.
Medicines to support immunity. Treatment of vaginosis weakens the body's protective properties. The drug Viferon or its analogues helps restore immunity.

Your doctor will advise you on specific treatments for bacterial vaginosis based on your test results. Hospitalization for this disease is not required, since there is no threat to the patient’s life. But therapy should be carried out under the constant supervision of a specialist. Repeated testing will help determine the effectiveness of the chosen regimen. If necessary, medications should be replaced with potent analogues.

The disease is prone to relapse. Even with proper treatment, in 30% of women the problem returns after some time. A multi-stage therapy program helps to avoid this.

If a woman suffers from bacterial vaginosis, then pathogenic microorganisms are found in her regular sexual partner. When they become pathogens of STIs, the man will need appropriate treatment.

Today, one of the most common problems among women of reproductive age is bacterial vaginosis (abbreviated as bacvaginosis). Currently, this pathology is considered as a dysbiotic condition of the vaginal environment, which has characteristic clinical manifestations.

This material is devoted to the main causes of bakvaginosis, its clinical manifestations, laboratory diagnostics and drug therapy.

Introduction

The term “bacterial vaginosis” arose and began to be perceived as a separate pathology with its own pathogenesis only in the 80s of the twentieth century.

In the past, this condition was on the same level as infectious and inflammatory diseases of the external genitalia (in particular).

This pathology also had various “names”, such as hemophilic, gardnerella vaginitis, anaerobic vaginosis and many others.

The term acquired its modern name only in 1984 at the International Conference in Stockholm on the recommendation of a scientific group.

Indeed, it is difficult to classify it as inflammatory, since there are no symptoms characteristic of inflammation (hyperemia, edema, hyperthermia, leukocytosis).

Vaginosis is much closer to intestinal dysbiosis, and, as a rule, accompanies it. (according to L.G. Tumilovich, V.P. Smetnik 1997)

2. Epidemiology

The issue of the prevalence of bakvaginosis is quite acute at the moment. This is because:

1 First, in approximately 50% of women, this condition is asymptomatic and can be discovered incidentally during routine examination and smear taking;
2 Secondly, a large number of women have obvious symptoms of vaginosis, but do not contact their doctor and remain in this condition for years.

All this complicates not only timely diagnosis, but also further treatment.

One way or another, there is evidence that in the outpatient work of an obstetrician-gynecologist, the incidence of bacteriosis is approximately 15-19% of all cases, among pregnant women - 10-30%, among women with inflammatory diseases of the genitourinary system - about 35% of cases.

As you can see, the numbers are by no means small, so the relevance of the problem is quite high.

3. What is bacterial vaginosis?

Bacterial vaginosis is a non-inflammatory syndrome, which is characterized by a significant decrease in the number or complete absence of normal lactobacillary flora, followed by its replacement by polymicrobial associations of facultative flora. Or, in a nutshell, this is “vaginal dysbiosis.”

4. Composition of vaginal microflora

To fully understand the pathology you need to know. It is represented not only by lactobacilli; in addition to them, minor, facultative flora is found, which is necessary to maintain local immunity.

Such accompanying flora is called opportunistic.

Normally, the vaginal biocenosis is represented by the following types of microorganisms:

Type of flora	Microorganisms
	Lactobacillus (dominant); Lactococcus; Bifidobacterium; Aerococcus.
	Propionbacterium; Eubacterium; Bacteroides; Prevotella; Peptococcus; Peptostreptococcus; Gardnerella; Corynebacterium spp.
	Clostridium; Veilonella; Fusobacterium; Enterococcus;
	Mycoplasma; Ureaplasma; Chlamydia; Mobiluncus; Leptotrichia; Candida; E. coli;
	Enterbacteriacaea; Micrococcus; Neisseria spp. Campilobacter

Table 1 - Composition of normal vaginal microflora

In addition to species diversity, the number of microorganisms in the vaginal biotope is of great importance.

Their total amount is permissible in the range of up to 10 8 - 10 12 CFU/ml, among which facultative anaerobic microorganisms account for 10 3 - 10 ⁵ CFU/ml, aerobes - 10⁵ -10⁹ CFU/ml.

As can be seen from the table, the main place in the vaginal biocenosis belongs to lactobacilli. This is due to their ability to maintain not only the pH of the environment, but also local protective forces due to:

1 Ability to reproduce quickly in the vaginal environment;
2 Tight attachment to the surface of epithelial cells;
3 Breakdown of glycogen to organic acids;
4 Synthesis of natural bactericidal substances (lysozyme, bacteriocins, hydrogen peroxide).

There is another, often forgotten, ability of microorganisms to form so-called biofilms by creating a special matrix when isolated communities come into contact with each other and combining into a common structure.

In biofilms, microorganisms are practically inaccessible to antimicrobial agents and other unfavorable factors, including cells of the immune system.

This ability can both protect and harm the body. It all depends on which microorganisms participated in the formation of biofilms.

5. Risk factors

The formation of bacterial vaginosis has a significant difference from the classical course of the infectious disease.

Here the leading role belongs to the inhibition of the body's defenses, a decrease in the number or complete disappearance of Dederlein bacilli (lactic acid bacteria, lactobacilli) and their replacement by facultative flora.

The following conditions may be the reason for this:

1 Endocrine diseases, hormonal imbalance;
2 Immunosuppression;
3 Somatic diseases that contribute to the development of the conditions listed above;
4 Diseases of the genitals, accompanied by the entry of a large number of foreign microorganisms into the vagina;
5 Violation of mechanical protection factors (damage to the perineum, genital tract, intrauterine contraceptives);
6 Massive, frequent and inadequate antibacterial therapy.

Another difference between bakvaginosis and an infectious disease is the absence of any one pathogen (staphylococcus, etc.).

When comfortable conditions arise, the amount of a more aggressive opportunistic environment increases, the number of lactobacilli decreases, and the acidity of the vaginal environment shifts to the alkaline side.

All this leads to intensive growth of facultative flora, the formation of pathological biofilms, and the appearance of discharge with a specific unpleasant odor.

During the life of opportunistic microorganisms, amines (putrescine, cadaverine, trimethylamine and others) are released. One of the tests aimed at identifying vaginal dysbiosis, the amine test, is based on this feature.

6. Clinical manifestations

As mentioned earlier, signs of inflammation in bakvaginosis are usually not found.

The leading clinical symptoms of bacterial vaginosis are:

1 Homogeneous, with a grayish tint, foamy, viscous, moderate or abundant (on average no more than 20 ml per day). Such discharge can accompany a woman for many years, over time changing its color to yellowish-green, becoming cheesy, and thicker.
2 One of the leading symptoms of bakvaginosis is characteristic. This is what most often confuses women who go to the doctor. This “aroma” arises due to the release of volatile amines during the life of opportunistic microbes.
3 Symptoms such as burning, irritation are noted by almost 23% of patients. At the same time, there is no accurate evidence that such symptoms are caused precisely by dysbiosis and not by some other process. The opinions of different authors on this issue differ radically.
4 In rare cases, there may be a change in the nature and duration of menstruation, irregular nagging pain, mainly in the lower abdomen. Such manifestations are more often observed with long-term dysbiosis and indicate possible complications.

7. Diagnostic methods

1 Complaints with which the woman first approached the doctor. Most often - discharge from the genital tract, more abundant than normal, with a characteristic “fishy” odor.
2 When examined in a mirror, the color of the mucous membrane is not changed, the usual pink color. The only warning symptom is heavy discharge, evenly covering all vaginal vaults, with possible involvement of the cervix. Colposcopy can rarely reveal dystrophic changes in the cervical mucosa.

7.1. Amine test

An elementary test that reliably proves the presence of pathological growth of facultative flora in the vagina. The principle of the test is based on the detection of amine waste products of microbes formed during the life activity of opportunistic microbes.

The essence of the test is to add an alkaline solution (10% potassium hydroxide solution) in a 1:1 ratio. If the result is positive, the characteristic “fishy” smell intensifies. This method is accessible, economical and reliable.

7.2. Laboratory diagnostics

The material for assessing the condition of the vaginal flora is a smear from the posterior fornix and cervix. The most common, economical and accessible is the bacterioscopic method.

In recent years, there has been an active search for more specific markers of dysbiosis. For example, in 1992 it was first found in vaginal contents, and in 1996, a representative of the facultative flora Atopobium vaginae was described.

In 2006, Australian scientists proved that this microorganism is a highly sensitive marker of bacterial vaginosis.

7.2.1. Bacterioscopy

Characteristic for bakvaginosis. One of the leading signs.

These are desquamated epithelial cells of the mucosa, along the edge of which gram-variable bacteria, rods and cocci are adhered. These bacteria give the cells a vague outline and a granular appearance, which is clearly visible under microscopy.

Figure 1 - Key cells in a vaginal smear for bakvaginosis

By microscopy of a smear, the number of leukocytes can be assessed. With dysbiosis, their number will be within normal limits, and an increase in their level indicates an inflammatory process.

With bacterioscopy, the acidity of the vaginal environment can be assessed. In the absence of pathological growth of facultative flora, the pH of the vagina varies between 3.8 -4.5. Alkalinization of the environment with pH values greater than 4.5 confirms the dysbiotic state.

7.2.2. Bacteriological research

This is the inoculation of vaginal discharge obtained during the process onto a nutrient medium. More complex, labor-intensive and time-consuming research. In this case, the probability of detecting opportunistic bacteria is high, and the sensitivity of microorganisms to antibacterial agents can be immediately assessed.

If with bacterioscopy there is a possibility of subjective assessment of the quantitative and qualitative composition of the flora, then with bacteriology this is not possible.

When performing bacterial culture, it is necessary to remember that the material is taken under aseptic conditions (that is, with a sterile instrument in a sterile tube with a nutrient medium). If this condition is violated, the study is considered invalid and the result is incorrect.

Due to its labor-intensive nature and high requirements for research conditions, bacterial culture of vaginal discharge is rarely performed.

7.2.3. PCR diagnostics

The most popular type of PCR diagnostics is. With its help, you can analyze not only the species, but the quantitative composition of the vaginal flora. This, in turn, allows you to prescribe adequate etiotropic therapy.

It is possible to identify criteria confirming the diagnosis of bacterial vaginosis A:

1 Presence of homogeneous grayish discharge from the genital tract with a characteristic “fishy” odor;
2 Increased pH level of the vaginal environment (above 4.5);
3 Positive amine test with 10% KOH solution;
4 Presence of key cells during smear microscopy for flora.

8. Possible complications

The disease may be complicated by:

1 Inflammatory diseases of the reproductive system (vulvovaginitis, endometritis, salpingoophoritis);
2 Cystitis, urethritis in both the woman and the sexual partner;
3 Reduced resistance to sexually transmitted infections, including, etc.

9. Treatment regimens

Despite the fact that bakvaginosis is not considered an inflammatory disease, it is treated. Treatment of bacterial vaginosis is two-stage.

The first stage is antibacterial therapy; it can be local (more often) or systemic (less often).

The purpose of prescribing antibiotics is to suppress the growth of sensitive opportunistic flora.

The second step in the treatment of bacterial vaginosis is the restoration of the normal composition of the vaginal biocenosis and its colonization with lactoflora.

Tables 2-4 below list the most commonly used drugs for local and systemic treatment of bakvaginosis.

Table 2 shows the main treatment regimens recommended by Russian and foreign (CDC) guidelines.

Table 2 - Basic and alternative regimens of antibacterial therapy for bakvaginosis

Other drugs are also being studied for the treatment of bacterial vaginosis, in particular, suppositories based on chlogexidine and combination drugs (antibiotic of the nitroimidazoles group + antifungal) have a good effect.

There is a certain logic in this, as we remember, bakvaginosis is a violation of the relationship between different representatives of the vaginal microflora.

The drugs listed in Table 3 have not yet taken a confident position in clinical recommendations. Experience in their use is accumulating.

Table 3 - Other drugs for the treatment of bakvaginosis. To view, click on the table

The second stage - restoration of the pH of the vaginal environment and the use of lactobacilli - is widely used only in the Russian Federation. Table 4 shows the main schemes for using drugs based on lactobacilli. Whether there is a future for this stage of correction of vaginal dysbiosis, time and adequate research will tell.

Table 4 - Correction of vaginal dysbiosis with drugs based on lactobacilli and lactic acid

So, we have looked at how and how to treat bacterial vaginosis in women, and then we will move on to the prevention of pathology.

10. Prevention

10.1. Vaccination

Currently, nonspecific vaccination is possible, aimed at activating specific and nonspecific immunity using the SolkoTrichovak vaccine.

Vaccination involves three intramuscular injections of the vaccine with an interval of 14 days. The first injection is performed the day after the end of the course of antibiotic therapy. The method is experimental, but, according to the authors, quite effective.

10.2. General preventive measures

1 Maintaining normal immune status.
2 Limiting the harmful effects of the environment on the body, minimizing stress.
3 A woman’s control and maintenance of her gynecological health: regular visits to a gynecologist, timely treatment of diseases, maintaining a healthy sex life with a regular partner, maintaining personal hygiene, wearing natural underwear made from natural materials that does not restrict movement.
4 Often, the proliferation of an opportunistic infection is caused by the patient’s uncontrolled use of systemic antibiotics to treat concomitant pathologies. Therefore, the prescription and administration of antibacterial drugs should be carried out under the strict supervision of the attending physician.
5 Restoring hormonal balance.
6 Suppression of disease relapses: it is necessary to monitor the effectiveness of therapy 1 week and 4-6 weeks after the end of the course.

Type of flora	Microorganisms
Predominant obligate (obligate) permanent (resident) flora	Lactobacillus (dominant); Lactococcus; Bifidobacterium; Aerococcus.
Facultative resident flora (with high adaptation to a given organism)	Propionbacterium; Eubacterium; Bacteroides; Prevotella; Peptococcus; Peptostreptococcus; Gardnerella; Corynebacterium spp.
Opportunistic optional-resident	Clostridium; Veilonella; Fusobacterium; Enterococcus; Staphylococcus (coagulase negative); Streptococcus (alpha and gamma hemolytic, greening)
Potentially pathogenic facultative resident	Mycoplasma; Ureaplasma; Chlamydia; Mobiluncus; Leptotrichia; Candida; E. coli; Streptococcus (beta-hemolytic, GBS)
Potentially pathogenic, poorly adapted to a given macroorganism, some species are pathogenic	Enterbacteriacaea; Micrococcus; Neisseria spp. Campilobacter

What natural remedies and methods can be used effectively and safely treat bacterial vaginosis Houses.

It will probably seem strange to some (and to be honest, it’s hard for me to believe), but I only learned about the term Bacterial Vaginosis when I was pregnant. And not even because I had it. But because its appearance had to be prevented.

I have a rather difficult pregnancy, my cervix could not stand it and stitches were put on it (I already). And the sutures are a foreign body, and doctors were afraid that BV might occur and further complicate the course of pregnancy. But everything went well and I did not develop Bacterial Vaginosis.

When I started reading what it is and how often the fair half of humanity suffers from it, as well as the medications that doctors prescribe for treatment (antibiotics), I decided that I needed to write a post about how BV can and should be treated with natural remedies. Effective and safe, without harm to your microflora and without side effects.

What is Bacterial Vaginosis?

Bacterial Vaginosis is a common gynecological disease. Usually among young and middle-aged women. And in terms of frequency, according to statistics, 1 out of 5 has definitely suffered from it or will suffer from it.

Particularly susceptible to BV:

leading an active sex life
pregnant women
women with reduced immunity

Also, women suffering from BV have a higher risk of:

venereal diseases
other pathological conditions of the vagina
complications during pregnancy and childbirth

Cause of Bacterial Vaginosis

BV occurs due to disruption of the normal vaginal microflora. Yes, sometimes it’s hard to believe, but our vagina is its own whole ecosystem. With its bacteria and yeast.

The growth of any microorganisms or an imbalance of bacteria leads to Bacterial Vaginosis. The main culprit in this case is Gardnerella vaginalis, which has the ability to change the pH of the vagina. But it is important to understand that BV does not always develop because of it. Less common, but these can be other microorganisms.

Symptoms

So, the symptoms (or there may not be any - more on that below) of Bacterial Vaginosis begin to appear when the pH environment of the vagina changes. The usual internal pH is slightly acidic 3.8-4.2. Anything above 4.5 is BV, that is, too alkaline.

Many simply do not have any symptoms. But if there is one, then usually it is:

white or grayish discharge
the amount of discharge with an unpleasant odor increases
sometimes pain when urinating, during or after intercourse
red and inflamed, sensitive skin around the vagina

Causes of Bacterial Vaginosis

As with any condition, BV can have a variety of causes.

The most common:

dysbacteriosis/disturbed intestinal microflora
excess sugar in the diet
synthetic chemicals and odors
reception
stress

On my own behalf, I can add that Bacterial Vaginosis is a systematic disease of a woman’s entire ecosystem. Doctors often prescribe antibiotics, but this does nothing to help with the real problem and cause! This only removes the symptoms. BV needs to be treated comprehensively.

How to treat Bacterial Vaginosis

Avoid using soap and intimate hygiene products

Yes, I realize this sounds like very strange advice. But! Regular soap, aka unnatural soap, has an alkaline pH, which, as we already know, is not suitable for our vagina.

For the same reason, you should avoid all kinds of foams, sprays and other products that are advertised for feminine hygiene. The best hygiene for this delicate area is minimal with natural soap like . And no more than 1 time a day. We don't want to disturb the microflora. And that’s exactly what soap does.

Apple vinegar

Apple cider vinegar helps remove toxins and fight bacteria. And restore normal vaginal acidity.

It is very effective to sit in a basin - 1/2 cup of apple cider vinegar in a medium bowl of warm water. We sit for about 20 minutes. And also use it internally. But for this you only need (cloudy) - 1 teaspoon per glass of water, 2 times a day 30 minutes before meals.

Soda

Another effective remedy is simple soda.

Draw a bath, add 1/2 cup of soda to it and lie in it for 15-20 minutes.

Tea tree oil

Tea tree essential oil has a strong antifungal and antiseptic effect. Helps get rid of unnecessary bad bacteria.

The most effective method of use in this case is to dip a tampon in any liquid oil (ideally coconut as it has antibacterial activity) and then apply 3 drops of tea tree essential oil to the tampon. Insert overnight and repeat for a week.

Don't squirt

In general, douching our intimate area is not a useful thing. For those who may have doubted it, the vagina has the ability to clean itself. And douching simply disrupts the normal bacterial balance.

During menstruation, do not use pads or tampons with any scent. Better yet, switch to organic, natural options. You can buy these on iHerb, or for example, I bought Naty pads (I needed them after giving birth). Ideally, it is better to give up tampons altogether and switch to a silicone mouth guard, for example.

Probiotics

Yes, you can’t go anywhere without them. Since the main cause of BV also lies in the intestines, it will be necessary to increase beneficial bacteria there too. Especially suitable for the vaginal environment are Lactobacillus reuteri and rhamonosus. Here is a good probiotic containing these strains.

Garlic

Or as I like to call it - (and also very cheap and safe!). I even found a study stating that taking garlic tablets can be successfully used to treat BV. During pregnancy I took this garlic.

Blood Sugar Balance

It may be a secret to some, but the sugar we consume completely destroys our microflora. And the intestines and vagina. The fact is that pathogenic organisms (as well as cancer cells) simply adore it, bloom on it and smell. Therefore, it is necessary to reduce your sugar intake as much as possible!

One of the most common reasons for visiting a gynecologist is the clinical manifestations of bacterial vaginosis. However, cases of erased forms of the disease are not uncommon. Women do not observe pronounced symptoms and do not consult a doctor. Vaginosis that is not treated in time entails a number of unpleasant consequences. There are many factors that cause the disease, and sometimes they are harmless.

Cause of illness

Bacterial vaginosis, or dysbiosis, occurs in women aged 15 to 50 years. The disease is not considered a sexually transmitted disease, but it is transmitted through sexual contact.

The microflora of a woman’s vagina contains a set of microorganisms. Normally, lactobacilli predominate. They convert glycogen into lactic acid. As a result, the acid-base balance decreases, and the female body prevents an increase in the number of anaerobic microorganisms, gonococci, gardnerella, staphylococci, trichomonas and others.

If the volume of lactobacilli decreases, they cannot cope with the protective function, and the number of harmful microbes increases. Among them is gardnerella, the causative agent of bacterial vaginosis.

Risk factors

The following factors can provoke an increase in the number of opportunistic bacteria:

Taking antibiotics. Medicines destroy harmful and beneficial bacteria.
Long-term use of intrauterine contraceptives.
Hormonal disbalance.
Decreased immunity.
Poor hygiene or washing out lactobacilli by douching.
Multiple changes of sexual partners.
Medical procedures - termination of pregnancy, curettage.
Disturbance of intestinal microflora, which causes dysbacteriosis.
Radiation therapy.
Wearing synthetic underwear, pads and tampons. This prevents oxygen from entering.
Diet limited in fermented milk products.

Bacterial vaginosis does not appear from going to the pool, contact with bedding or toilet seats.

Symptoms

The disease is not accompanied by an inflammatory process at the initial stage. For bacterial vaginosis, the characteristic symptoms are light-colored liquid discharge that causes itching and discomfort. If you do not contact a gynecologist at the first signs, the discharge acquires a thick consistency, becomes viscous and foamy. The amount increases before the start of the menstrual cycle or after sexual intercourse.

With the further course of the disease, urogenital infections and pyogenic microbes are added. At this stage, inflammation develops and the discharge changes. They acquire a green tint, a uniform consistency with streaks of blood. A characteristic sign of vaginosis is the smell of “rotten fish.”

Why is bacterial vaginosis dangerous?

Vaginosis not only worsens the quality of life, but also weakens the immune system. Women are at risk of contracting more serious illnesses.

Among patients there is a predisposition to inflammatory processes of the genital organs and cervical dysplasia. Vaginal dysbiosis can provoke an unfavorable pregnancy outcome and problems during recovery. Creates a favorable environment for the development of sexually transmitted diseases: HIV infection, papillomavirus infection, hepatitis. Infectious complications after gynecological procedures occur more often in women with untreated vaginosis.

When overcoming infertility, the likelihood of successful fertilization of an egg outside the mother's body decreases in patients with bacterial vaginosis.

Vaginal dysbiosis negatively affects women's reproductive health. At risk are young girls, expectant mothers or women in labor, as well as women who are infected with sexually transmitted diseases.

Diagnostics

Having discovered the characteristic symptoms of vaginosis, you need to visit a gynecologist. Already during the examination, the doctor will preliminarily evaluate the microflora of the vagina. However, an accurate diagnosis can only be made with an integrated approach. To do this, the patient’s complaints, the condition of the vagina during a gynecological examination are taken into account, and laboratory diagnostics are performed.

According to the Amsel criteria, bacterial vaginosis is diagnosed if 3 out of 4 signs are present:

Amine test. With dysbacteriosis, the discharge has a “rotten fish” smell. If they are mixed in equal proportions with potassium hydroxide and the stench intensifies, then the amine test is considered positive. This laboratory method accurately determines the disease in 94% of patients.
Homogeneous discharge that adheres to the walls of the vagina is endowed with a foul odor.
The pH of vaginal secretions is above 4.5. To carry out pH measurements, indicator paper with a standard scale or various modifications of pH meters are used.
Identification of “key” cells by examining Gram-stained smears of vaginal discharge.

Bacterioscopy of smears is performed. If epithelial cells predominate over leukocytes, less than 5 lactobacilli are detected during enlargement with immersion, the accuracy of the study is close to 100%.

A diagnosis based on one of the criteria is inaccurate. Among all methods, the most sensitive is the detection of “key” cells.

Treatment of bacterial vaginosis

The success of therapy depends on timely and correct diagnosis of the disease. The goal is to stop the proliferation of harmful microbes and restore the balance of the vaginal microflora. How to cure bacterial vaginosis without relapse is an incompletely studied topic. The proposed medications do not always help.

Complex therapy includes treatment with antibacterial drugs and eubiotics. The action of antibiotics is aimed at eliminating dangerous microorganisms that cause vaginosis.

Metronidazole quickly fights bacteria. The drug enters the pathogen cell, contacts DNA, and stops the connection of nucleic acids. Metronidazole is effective in single doses and in 7-day courses of treatment. Oral use of the medicine may cause adverse reactions: allergic manifestations, disorders in the digestive system, metallic taste in the mouth. Studies have shown that the vaginal route of treatment with metronidazole does not cause unwanted side effects. Sometimes doctors recommend combining oral and vaginal administration of tablets.

Clindamycin actively fights the disease. Used topically and orally.

After a course of antibiotics or at the same time, eubiotics are prescribed. They restore favorable vaginal microflora and stimulate the growth of their own lactobacilli. The most common are acylact, lactobacterin, bifidumbacterin. Eubiotics reduce the likelihood of relapse by increasing the protective functions of the vagina.

While taking medications, it is advised to abstain from sexual intercourse or use barrier contraception. After completing treatment, the effectiveness of therapy can be assessed after 14 days.

ethnoscience

Folk remedies will help speed up recovery.

To restore the acidic environment of the vagina, douching is used. The procedure is carried out 1-2 times a day. This requires 200 ml of the prepared composition.

There are many douching recipes, here are some of them:

1 tbsp. oak bark is poured with 1 glass of boiling water;
2 tbsp. chamomile and cinquefoil are poured with a liter of boiling water;
1 tbsp. Bird cherry fruits are poured with 2 cups of boiling water.

To reduce itching and burning, use a tampon. It is soaked in a mixture of aloe juice and olive oil. After which it is placed in the vagina for 7 hours.

Teas and decoctions with birch leaves, lavender flowers, thyme, and geranium leaves strengthen the immune system - recovery occurs faster. Contraindicated for use in case of individual intolerance. Before use, you should consult your doctor.

Prevention

If a woman has encountered bacterial vaginosis, it is recommended to complete the prescribed treatment, otherwise relapses are inevitable. Infections of the genitourinary system provoke the development of the disease. Therefore, they need to be treated on time, without waiting for complications.

It has been proven that people who regularly consume probiotics rarely experience dysbiosis. This happens because probiotics consist of living beneficial bacteria that restore the normal microflora of the vagina and digestive system.

Maintaining intimate hygiene, avoiding promiscuity and hypothermia are the main preventive measures, and strong immunity increases the body's resistance to an increase in the number of harmful bacteria.

If dysbiosis develops, you should not self-medicate. Only the doctor can determine how to treat vaginosis. Otherwise, complications are likely to occur.

Pregnant women are less likely to suffer from bacterial vaginosis. The disease can cause the following problems:

early spontaneous abortion;
early birth, before 37 weeks of pregnancy;
early rupture of membranes;
postpartum infection of uterine tissue.

To avoid complications, the expectant mother must visit a gynecologist who will prescribe the correct treatment. Until the 20th week of pregnancy, local therapy is prescribed. This is due to the fact that medications can negatively affect the development of the fetus.

In the second half of pregnancy, the doctor may resort to systemic therapy.

A diet containing fermented milk products increases the effectiveness of treatment. Moderate physical activity, strengthening the immune system and good mood help normalize the vaginal microflora.

Bacterial vaginosis in men

Men become infected with vaginosis from a sexual partner. A woman may not know that she has dysbiosis. After all, symptoms do not always appear, and gardnerella is present in the vaginal microflora and is safe with minimal content.

Symptoms appear no earlier than a week after sexual intercourse. A man experiences discomfort when urinating. A green discharge with a rotten odor appears on the head of the penis, and the genitals become covered in a rash. If treatment is not started, cystitis, epididymitis, and pyelonephritis cannot be ruled out.

Therapeutic methods in men include taking immunomodulators, antibiotics and bifidobacteria. For effectiveness, instillation into the urethra or a series of physiotherapy procedures are prescribed.

Bacterial vaginosis can be transmitted even through shared hygiene products. To avoid infection, you need to eliminate risk factors.