Bacterial vaginosis(vaginal dysbacteriosis) is a clinical syndrome caused by the replacement of lactobacilli of the vaginal flora with opportunistic anaerobic microorganisms. Currently, bacterial vaginosis is not considered a sexually transmitted infection, but rather a vaginal dysbiosis.

However, bacterial vaginosis creates the prerequisites for the occurrence of infectious processes in the vagina, so it is considered together with inflammatory diseases of the genital organs. This is a fairly common infectious disease of the vagina, found in 21-33% of patients of reproductive age. Approximately half of them also have intestinal dysbiosis.

Vaginosis can be found not only in sexually mature women, but also in adolescents who do not live sexually. Causes can be poor hygiene and chronic diseases.

Symptoms of bacterial vaginosis

Bacterial vaginosis is much more common than thrush, but only a few women are aware of the existence of this disease.

Noticing vaginal discharge and itching, many women immediately "attribute" them to thrush, which they have heard a lot about from friends, on television and on the Internet, and begin treatment with antifungal drugs, which are completely ineffective for bacterial vaginosis.

The main symptoms of bacterial vaginosis are:

These symptoms can be a sign not only of bacterial vaginosis, but also of other diseases (for example, gonorrhea, trichomoniasis, candidiasis), therefore, an accurate diagnosis cannot be made only by the presence of symptoms. To clarify the cause of the disease, you must contact and take tests.

Treatment of bacterial vaginosis

Treatment of bacterial vaginosis is carried out in two stages.

At the first stage, the number of anaerobes is reduced, local and general immunity and endocrine status are corrected; on the second - the restoration of normal microbial biocenosis in the vagina by colonizing the vagina with lactic acid bacteria.

First stage

The first stage includes the following therapeutic measures:

Bacterial vaginosis in women. Bacterial vaginosis: causes of the disease, effects on pregnancy, treatment

What is bacterial vaginosis

Abnormal vaginal discharge is the most common symptom, occurring in about 1/3 of gynecological patients. It is known that among women with complaints of copious discharge from the genital tract the most common diseases are bacterial vaginosis, trichomonas vulvovaginitis, vaginal candidiasis, cervicitis due to chlamydial infection, herpes simplex virus, gonorrheal infection, and increased cervical secretion. The observed increase in vaginal infections, in particular bacterial vaginosis, which occupies a leading place in the structure of obstetric and gynecological morbidity, is largely due to economic, environmental reasons, immunological disorders, changes in hormonal homeostasis, massive and irrational use of various drugs, especially antibiotics.

It is important to note that at present, bacterial vaginosis has not been included in the ICD-X revision, apparently due to the fact that the role and place of bacterial vaginosis in the structure of infectious diseases of the lower genitalia has not been finally established. In the ICD-X, it can be found under the code N89.5 "White, unspecified as infectious" or under the code N76 - "Other types of inflammation of the vagina and vulva." Nevertheless, much attention is still paid to this problem, not only due to the widespread occurrence of bacterial vaginosis, but also the occurrence of severe pathology of the female genital organs and complications of pregnancy and childbirth. Studies by a number of authors have shown that bacterial vaginosis can lead to the development of chorioamnionitis, postpartum endometritis, premature birth and the birth of children with low body weight, inflammatory processes of the genital organs, purulent-septic complications in the mother and child in the postpartum period, etc., which affects the frequency of obstetric and neonatal pathology.

According to various authors, incidence of bacterial vaginosis varies from 30 to 60-80% in the structure of inflammatory diseases of the genital organs. So, according to Cyrus E.F., bacterial vaginosis occurs in 19.2% of women of reproductive age in the general population and in 86.6% of women with pathological whites. Bleker O.P. et al. found bacterial vaginosis in 38.1% of women, Von U.B. Houme diagnosed bacterial vaginosis in 62% of women. According to the Scientific Center of AG&P RAMS, bacterial vaginosis is detected in 24% of practically healthy non-pregnant women and in 61% of patients with complaints of abundant discharge from the genital tract. Among pregnant women, bacterial vaginosis occurs in 10-46% of cases. Thus, the literature review data indicate a significant prevalence of bacterial vaginosis, mainly in women of reproductive age.

Currently, bacterial vaginosis is considered as condition of vaginal dysbiosis, in which the elimination of lactobacilli and the colonization of the vagina by strict anaerobes and gardnerella occur. In some cases, against the background of the absolute predominance of microorganisms associated with bacterial vaginosis, lactobacilli may be present in low titer and, as a rule, these are anaerobic lactobacilli that are unable to produce hydrogen peroxide. At the same time, the level of anaerobic microorganisms can increase by 1000 times. Studies have shown that the proportion of lactobacilli is reduced to 30% of the total number of microorganisms.

Causes of bacterial vaginosis

Factors leading to the development of bacterial vaginosis First of all, prolonged, sometimes uncontrolled use of antibiotics should be attributed, which leads to dysbiosis not only of the vagina, but also of the gastrointestinal tract. According to a number of authors, in almost every second patient with bacterial vaginosis, violations of the intestinal microecology are detected. Thus, we can assume the presence of a single dysbiotic process in the body with its pronounced manifestation either in the reproductive or in the digestive system. In addition, as our studies have shown, bacterial vaginosis often occurs against the background of menstrual irregularities, mainly by the type of oligomenorrhea or an inferior luteal phase, and in women who use IUDs for a long time (more than 5 years). The occurrence of bacterial vaginosis may also be due to past or concomitant inflammatory diseases of the female genital organs. According to our data, among the transferred gynecological diseases in patients with bacterial vaginosis, vaginitis is the most common (63.9%). In addition, a high incidence of benign diseases of the cervix is revealed.

In recent years, there have been reports in the literature about the presence of an epidemiological relationship between bacterial vaginosis and neoplastic processes of the cervix. It has been shown that nitrosamines, which are metabolic products of obligate anaerobes, serve as coenzymes of carcinogenesis and may be one of the causes of the development of dysplastic processes and even cervical cancer.

We examined 128 women of reproductive age with complaints of copious discharge from the genital tract (mean age 24.3+0.9 years). Newly diagnosed bacterial vaginosis was noted in 59.4% of women (Group 1), while recurrent bacterial vaginosis for 2 or more years was detected in 40.6% of women (Group 2). An analysis of the state of the cervix showed that in the 1st group of patients with bacterial vaginosis, a normal transformation zone (NRT) was detected in 64.3%, while in the 2nd group - in 29.3% of women; ectopia of the cervix with NRT was detected in 21.4% in the 1st group and in 31.7% in the 2nd group; atypical transformation zone (AZT) - in 7.1% and 19.5%, respectively; leukoplakia of the cervix - in 7.1% and 14.6%; centraepithelial neoplasia (CIN) I-II stage was detected in the 2nd group of patients.

On the basis of the conducted studies, it can be assumed that long-term bacterial vaginosis with frequent relapses leads to the development of dystrophic processes in the cervix, as a result of which prerequisites are created for the development of pathological conditions in it.

Bacterial vaginosis in the form of a monoinfection occurs without signs of an inflammatory reaction and leukocytes in the vaginal discharge. Some authors attribute the absence of a leukocyte reaction to the metabolic product of bacteria of the genus Bacteroides - succinate, which is present in high concentrations in vaginal samples from women with bacterial vaginosis, and to gardnerella hemolysin, which disrupt the functional activity of leukocytes and thereby prevent a pronounced inflammatory reaction.

Clinic and diagnosis of bacterial vaginosis

Patients with bacterial vaginosis usually complain profuse discharge from the genital tract, white or gray, often with an unpleasant odor, especially after intercourse or during menstruation. The duration of the existence of these symptoms can be calculated for years. With the progressive process of discharge, they acquire a yellowish-greenish color, become thicker, slightly viscous and sticky, have the property of foaming, and are evenly distributed along the walls of the vagina. The amount of whiteness varies from moderate to very abundant. Other complaints, such as itching, dysuric disorders, dyspareunia, are less common and may be completely absent or appear intermittently. However, it should be noted that in 24-50% of cases, bacterial vaginosis can be asymptomatic, without any clinical manifestations of the disease, and the diagnosis of bacterial vaginosis can only be made on the basis of laboratory research methods.

To date diagnosis of bacterial vaginosis is not difficult: the diagnosis of bacterial vaginosis can be made on the basis of 3 of the 4 diagnostic tests proposed by Amsel R. et al.:

pathological nature of vaginal discharge;
pH of the vaginal discharge more than 4.5;
positive amine test;
identification of "key" cells by microscopy of wet, unstained preparations of vaginal discharge and Gram-stained smears.

Carrying out the cultural method of research, which is widely used in the practice of obstetrician-gynecologists, has no diagnostic value for the diagnosis of bacterial vaginosis, and currently priority is given to microscopy of Gram-stained smears. The presence in the smears of "key cells" - mature epithelial cells with adherent microorganisms associated with bacterial vaginosis (gardnerella, mobiluncus, gram-positive cocci) is an important diagnostic sign of bacterial vaginosis. The sensitivity and specificity of this method are close to 100%.

Bacterial vaginosis is characterized by a positive aminotest. The vaginal contents often have a rotten fish odor, which is the result of the formation of diamines (putrescine, cadaverine, trimethylamine) in the reaction of decarboxylation of amino acids by obligate anaerobes. The salts of these compounds are converted to volatile amines at alkaline pH values. As mentioned above, gardnerella, which is isolated with high frequency in bacterial vaginosis, does not produce these compounds. Therefore, in cases of complete dominance of gardnerella in the vaginal microcenosis, the aminotest will be negative. According to our data, the sensitivity and specificity of this diagnostic test is 79% and 97%, respectively.

pH value of vaginal discharge in bacterial vaginosis exceeds the standard values (> 4.5), which is caused by the elimination of lactoflora or a sharp decrease in its content. To perform pH measurements, you can use universal indicator paper with a reference scale or various modifications of pH meters. The material for the study can be either vaginal discharge or washing of the contents of the vagina with a sterile saline solution with a neutral pH value. The sensitivity and specificity of the test is 89% and 85%, respectively.

It should be remembered that for correct diagnosis of bacterial vaginosis when taking material for research, it is necessary to follow the basic rules: the sampling of material must be carried out before the start of antibiotic therapy; the day before, the patient should not have an intimate toilet or have sexual intercourse; microbiological examination should be carried out as quickly as possible in order to avoid the death of bacteria.

Treatment of bacterial vaginosis

Currently, obstetrician-gynecologists have in their arsenal a wide range of different drugs for the treatment of bacterial vaginosis, with anti-anaerobic activity. It should be noted that many clinicians today prefer vaginal route of administration of drugs in the treatment of bacterial vaginosis, which is not inferior in effectiveness to oral therapy. It is more preferable, since local drugs are injected directly into the focus, while there is less likelihood of adverse reactions. Topical drugs can be given pregnant and lactating women, as well as in extragenital pathology, when systemic drugs are contraindicated.

Among the drugs of local action, Dalacin vaginal cream (2% clindamycin phosphate) has found wide application. A distinctive feature of this broad-spectrum antibiotic is the effect on the anaerobic component of the vaginal microflora. The drug is available in tubes of 20 g with three single applicators attached. Its effectiveness is, according to various authors, from 86 to 92%.

Currently, practitioners also have Dalacin vaginal suppositories in their arsenal, with an applicator attached to it (1 suppository contains 100 mg of clindamycin phosphate). The drug is used 1 suppository in the vagina at night for 3 consecutive days. J. Paavonen et al. conducted a randomized study on the comparative study of the effectiveness of the use of dalacin (for 3 days intravaginally in the form of suppositories) and metronidazole (peros at a dose of 500 mg 2 times a day for 7 days). The effectiveness of dalacin in the form of suppositories was 68%, metronidazole - 67%. Studies by other authors (J.A. McGregor) showed that the use of dalacin vaginal suppositories for 3 days is not inferior in effectiveness to the use of dalacin vaginal cream for 7 days, amounting to 95%. Thus, dalacin in the form of suppositories has high efficacy and compliance (a three-day course as opposed to a 7-day course of metronidazole and dalacin vaginal cream), as well as good tolerability with a small percentage of side effects.

Another drug that is widely used in the treatment of bacterial vaginosis is flagyl (metronidazole), which has a high activity against anaerobic microorganisms. The drug is prescribed for 1 vaginal suppository in the vagina for 10 days.

Among the drugs of systemic action for the etiotropic therapy of bacterial vaginosis, metronidazole and clindamycin, which have an antianaerobic spectrum of action, should be mentioned. Metronidazole is an effective drug for the treatment of bacterial vaginosis. The drug for bacterial vaginosis is prescribed 500 mg 2 times a day for 7 days or 2 g once. It has been shown that a single oral administration of metronidazole at a dose of 2 g is as effective as a 5-7-day oral administration. It should be noted that oral administration of the drug often causes side effects, such as a metallic taste in the mouth, dyspeptic disorders, and allergic reactions.

wide use in the treatment of infectious diseases of the genitals found clindamycin, which is a chlorinated derivative of lincomycin and has an advantage over the latter because it has greater antibacterial activity and is more easily absorbed from the intestine. The drug binds to ribosomes and inhibits protein synthesis. It is active against obligate anaerobes. The drug is prescribed 300 mg 2 times a day per os for 7 days. It is important to note that oral administration of the drug may be complicated by diarrhea.

Ornidazole is also used to treat bacterial vaginosis. The drug is prescribed 1 tablet (500 mg) 2 times a day after meals for 5 days.

In 6-18% of cases against the background treatment of bacterial vaginosis with antibacterial drugs, vaginal candidiasis may occur. In this regard, for the prevention of vaginal candidiasis, it is advisable to prescribe antimycotic agents. It should be emphasized that antibacterial agents, having eliminated opportunistic microorganisms, are not able to create conditions for the rapid restoration of the normal microflora of the vagina. Therefore, it is necessary to prescribe biological preparations (acylactobacterin, bifidumbacterin, acilact, etc.), which stimulate the growth of the vagina's own lactoflora and help reduce the number of relapses of the disease by increasing the protective properties of the vagina. It is important to emphasize that the appointment of biological products is advisable after a control microbiological study confirming the absence of fungal flora.

In conclusion, I would like to note that treatment of patients should be individualized in each specific case. In this case, mandatory examination and treatment of the partner is necessary. Therapy can be considered successful with the complete elimination of the symptoms of the disease.

Errors in the diagnosis of bacterial vaginosis and its inadequate treatment often lead to serious consequences.

There is also the question of the need for treatment of bacterial vaginosis with its asymptomatic course. Treatment of bacterial vaginosis is advisable in case of asymptomatic course both outside and during pregnancy in order to prevent infectious and inflammatory diseases associated with bacterial vaginosis, as well as those complications during pregnancy that this disease can lead to.

Professor V.N. Prilepskaya, Ph.D. G.R. Bayramova

"Treatment of bacterial vaginosis, drugs, treatment regimens, diagnostics" - section

Daily treatment of the vagina with a 2-3% solution of lactic (or boric) acid (5 procedures for 5 minutes each). Such procedures are not contraindicated during pregnancy.

Introduction to the vagina of vaginal creams (2% dalacin cream) or suppositories containing metronidazole or tinidazole, tiberal (ornidazole). They are prescribed in parallel with the treatment of the vagina with acid. Candles are prescribed 2 times a day in the morning and in the evening for 2-3 hours. During pregnancy, the use of these creams is contraindicated.

In the treatment of bacterial vaginosis in pregnant women, terzhinan is prescribed - a fairly effective and safe drug. With its topical application, there are no allergic and other adverse reactions, as well as any fetal malformations. The duration of the first and second courses of treatment is 10 days.

To correct local immunity, kipferon is prescribed 1 suppository vaginally 2 times a day (morning and night) for 5 days.

Already in the middle of the first stage of treatment, women feel better, the amount of whiteness decreases, itching and burning disappear.

Additionally, at this stage of treatment, antihistamines (tavegil, suprastin, pipolfen) are prescribed and, if the patient is worried about pain, non-steroidal anti-inflammatory drugs (brufen, flugalin, voltaren) to suppress the production of prostaglandins that cause pain reactions.

A prerequisite for treatment is the exclusion of sexual, including orogenital, contacts, since sperm and saliva have an alkaline reaction, which negatively affects the results of treatment.

Second phase

The second stage of treatment - the restoration of the vaginal biocenosis - is carried out using biological preparations from lactic acid bacteria:

lactobacterin;
bifidumbacterin;
acylact;
zhlemik.

Conducting complex therapy allows you to get a good result in 93-95% of patients.

Relapse or exacerbation

Relapse or exacerbation often occurs against the background of genital (acute infections, exacerbations of chronic inflammatory processes) or extragenital diseases, as well as concomitant diseases (intestinal dysbacteriosis), leading to a decrease in general and local immunity and often proceeding against the background of endocrine pathology.

Often, an exacerbation occurs during menstruation, when the pH in the vagina rises significantly, the growth of microorganisms associated with bacterial vaginosis increases.

In order to avoid repeated relapses, there is a need to stimulate the mechanisms of immunological protection of the vaginal environment; This is especially true in terms of preparing for pregnancy. For this purpose, the Solcotrichovac vaccine is currently used, obtained from weakened lactobacilli (lactic acid bacilli) of patients who have recovered from trichomoniasis.

Such lactobacilli stimulate the production of antibodies in a woman's body. The production of antibodies against the background of vaccination with Solkotrikhovak contributes to the destruction of atypical forms of lactobacilli, Trichomonas and nonspecific pathogenic bacteria, promotes the growth of lactobacilli, restores normal microflora and normalizes the physiological pH value of the vaginal mucosa.

Vaccination with Solcotrichovac reduces the risk of recurrent infection and re-infection caused by Trichomonas and other pathogenic bacteria in 80% of patients with recurrent vaginal infections.

Vaccination is carried out three times at 0.5 ml with an interval between injections of 2 weeks, the fourth injection is made a year after the first injection of the vaccine. The vaccine is well tolerated and gives a stable positive effect with no relapses in 75% of patients in the future.

Solcotrikhovac is not recommended for use during pregnancy and lactation, since there are currently no data on clinical trials of the drug in this group of patients. When using Solcotrikhovac during the period of preparation for pregnancy, it is rational to make the last injection 2-3 months before the intended conception.

Causes of bacterial vaginosis

There are no specific causative agents of bacterial vaginosis. It is caused by polymicrobial complexes, among which there are gardnerella and mycoplasmas (opportunistic pathogens).

In bacterial vaginosis, microorganisms of the genus Lactobacillus (existing in the normal microflora of the vagina) are replaced by associations of various bacteria, including Gardnerella vaginalis, anaerobes (Bacteroides, Prevotella, Porphyromonas, Peptostreptococcus, Mobiluncus) and Mycoplasma hominis.

It was previously believed that the disease was caused by gardnerella based on the identification of the microorganism in women with bacterial vaginosis. However, it has been found that more than 50% of women without symptoms of the disease are colonized by gardnerella.

In addition to gardnerella, in the vaginal secretion of women with bacterial vaginosis, anaerobic bacteria are found in large numbers:

bacteroids;
peptococci;
peptostreptococci.

Mobiluncus spp. has also been associated with bacterial vaginosis. and Mycoplasma honunis, but the exact role of these bacteria in the etiology of the disease is unknown. In the process of metabolism, gardnerella forms amino acids, from which, under the influence of anaerobes, volatile amines (putrescine, cadaverine, triethylamine) are formed. These amines are responsible for an unpleasant odor reminiscent of rotten fish.

Causes of bacterial vaginosis

Until the end, the causes of bacterial vaginosis have not been clarified.

Doctors can identify only a few factors that most often provoke the replacement of normal microorganisms by pathogens.

These include:

The household route of transmission of bacterial vaginosis has not been proven. But the disease can be "received" with a frequent change of sexual partners and sexual intercourse without barrier methods of contraception.

Complications of bacterial vaginosis

A large body of evidence has accumulated to suggest that bacterial vaginosis is a risk factor for adverse pregnancy outcomes.

In addition, the following complications are associated with bacterial vaginosis:

The presence in the vagina of women with bacterial vaginosis of large amounts of various bacteria increases the likelihood of these microorganisms entering the urethra of men during sexual intercourse, followed by infection of the urethra and the development of nonspecific urethritis.

The disease may also play a role in the development of chronic prostatitis of unknown origin in men. It is commonly referred to as abacterial chronic prostatitis, emphasizing the absence of any infection that could be the cause of the chronic inflammatory process.

Recently, using the polymerase chain reaction (PCR) method, a connection was found between such prostatitis and bacteria involved in the development of bacterial vaginosis.

With further study of this problem, however, there will certainly be difficulties associated with the characteristics of chronic prostatitis in this patient, the anamnesis of his sexual life and the often intermittent nature of bacterial vaginosis.

Bacterial vaginosis and pregnancy

Bacterial vaginosis occurs in 15-20% of pregnant women and is a serious risk factor for the development of infectious complications. A pronounced relationship of the disease with premature termination of pregnancy and untimely rupture of the amniotic membranes was noted. The risk of developing these complications compared with healthy pregnant women in patients with bacterial vaginosis increases by 2.6 times.

It has been established that many bacteria detected in bacterial vaginosis (Fusobacterium, G. vaginalis, Peptostreptococcus, Micoplasma hominis, etc.) can lead to increased synthesis of prostaglandins, the development of preterm labor and untimely rupture of the amniotic membranes.

Moreover, an increase in the pH of the vaginal environment above 4.5, which is characteristic of the disease, in itself can lead to premature rupture of the amniotic membranes. Approximately 10% of preterm women give birth to gardnerella and other microorganisms from the amniotic fluid, while normally the amniotic fluid is sterile.

It is noted that women who gave birth at a gestational age of less than 37 weeks have a high probability of having bacterial vaginosis. Chorioamnionitis, detected in 1% of pregnant women, is a severe complication that threatens the life of the mother and fetus. The development of chorioamnionitis associated with bacterial vaginosis in the mother can subsequently lead to premature termination of pregnancy or premature rupture of amniotic fluid.

The presence of chorioamnionitis in patients is histologically confirmed by the identification of relevant pathogenic microorganisms in the placental tissue, which can also be the cause of preterm labor.

When studying amniotic fluid in patients, G. vaginalis, Fusobacterium nucleatum, Prevotella melaninogenica, ureaplasma, Candida albicans, E. coli are also most often detected.

There is also a connection between the presence of the disease and the development of postpartum endometritis, including after caesarean section. The microbial flora detected in the endometrium in patients with endometritis is often similar to that in bacterial vaginosis. This is especially true for anaerobic microorganisms.

In the normal course of the postpartum period on the 3rd day, the number of anaerobes decreases in a logarithmic progression. However, this does not happen in patients, since the contamination of the vagina with anaerobic bacteria in them many times exceeds normal values long before childbirth.

It has been established that the risk of developing postpartum endometritis in pregnant women with BV is several times higher than in healthy women. Mixed microflora can lead to the development of other inflammatory complications, such as breast abscess, inflammation of the umbilical wound, etc.

Thus, patients with bacterial vaginosis are at increased risk of developing:

inflammatory diseases of the pelvic organs;
premature termination of pregnancy;
untimely discharge of amniotic fluid;
occurrence of chorioamnionitis;
postpartum and postoperative endometritis.

A high concentration of virulent microorganisms in the vagina of patients is a risk factor for the penetration of bacteria into the higher parts of the genitourinary system.

Classification of bacterial vaginosis

There are several types of bacterial vaginosis that vary in severity:

In addition, along the course of bacterial vaginosis, there are:

spicy;
torpid;
erased (asymptomatic).

Diagnosis of bacterial vaginosis

A diagnosis of bacterial vaginosis is certain if a woman has at least three of the following four features:

In order to detect gardnerella and anaerobic microorganisms in a vaginal discharge smear for the diagnosis of bacterial vaginosis, staining with different colors is used according to special methods. Tissue culture is rarely used for this.

In recent years, patients with bacterial vaginosis are increasingly being given a sensitive and highly specific oligonucleotide test. Special reagent kits are available for this test.

Bacterial vaginosis in men

Bacterial vaginosis, by definition, is a dysbiosis of the vagina in women. Therefore, it is wrong to make such a diagnosis for men. The carriage of transient microflora is the most common option for them.

According to different authors, 50-70% of male sexual partners of women with bacterial vaginosis have colonization of the urethra by G.vaginalis and other pathogens. At the same time, the man is absolutely not worried about anything, and carriage is detected only when examined by high-precision laboratory methods.

These men are carriers of transient microflora and, with frequent casual sexual contacts, they are, as it were, the main reservoir and distributors of transient microorganisms among women.

The male urethra, unlike a healthy female vagina, has an alkaline environment, which is a favorable factor for the habitat and reproduction of transient vaginal microflora. However, not all of the strong half are susceptible to infection.

Men who have previously had venereal diseases, patients with chronic prostatitis and abusing the use of local antiseptics for the prevention of genital infections are at the greatest risk. Often, with bacterial inflammation of the head and inner leaf of the foreskin of the penis, representatives of the woman's vaginal flora are found.

Prognosis for bacterial vaginosis

Very often the disease acquires a chronic character, it can constantly recur. Gynecologists attribute this to the fact that antibiotics only kill pathogenic microflora, but at the same time do not provide a full restoration of beneficial microflora, which is necessary.

Therefore, it is very important after the completed course of therapy, for another 10 days to use drugs, which include bifidobacteria:

Bificol;
Bifidumbacterin;
Acylact;
Lactobacterin.

Bacterial vaginosis is not a serious disease if it is treated on time and correctly. It is very important to adhere to the rules of hygiene, for the purpose of prevention, be constantly observed by a gynecologist, especially after a long course of antibiotic treatment.

If you notice an unpleasant smell of discharge in yourself, you must definitely pass all the necessary smears. If bacterial vaginosis is not treated, it can cause the development of various diseases, it is especially dangerous during pregnancy and can affect the baby.

Prevention of bacterial vaginosis

In order to prevent bacterial vaginosis, a woman needs:

avoid promiscuity;
carefully observe personal hygiene;
visit a gynecologist at least once a year.

Questions and answers on the topic "Bacterial vaginosis"

Question:Hello. The husband has already been treated, because. in my femoflor analysis, they found gardnerella vaginalis and streptococcus. Now I am being treated. I was prescribed a 10 day treatment for ciprolet, pimafucin, bion3 and gynoflor e suppositories. I drank it for 6 days, but it so happened that I caught a cold, had a temperature and stopped treatment for 2 days. There was itching, discharge, but no smell. Your gynecologist does not have the opportunity to ask, on vacation. Is treatment worth it?

Answer: Hello! Probably, the husband was undergoing treatment for another reason. Gardnerella is a symptom of bacterial vaginosis. This is not an inflammatory process of the vagina against the background of a violation of the vaginal microflora. Therefore, there must be indications for the treatment of a sexual partner. However, if there are reasons for joint treatment, then it is carried out simultaneously. Continue the treatment prescribed by the gynecologist. But in parallel, interferon preparations with antioxidants C, E (Viferon) and local sanitation of the vagina (tantum rose, epigen intima) can also be used. A control examination is carried out 4 weeks after the end of treatment.

Question:Hello. Periodically, signs of bacterial vaginosis appear. There are many leukocytes in the smear. According to the results of the analysis for the biogenocenosis of the vagina, there are very few lactobacteria - from 31 to 53 percent. There are many enterobacteria - 43-58 percent. Everything else is normal (analysis for 23 groups of microorganisms). The analysis for sexual infections is negative (IFA and PCR method). Candida and gardnerella were never found. Torment periodically (once every few months) curdled discharge without an unpleasant odor, severe itching and burning. The doctor constantly prescribes pimafucin or something else antifungal, although candida is never found in smears. The rest of the time, the discharge is pale greenish, not abundant, and does not torment you in any way. How to kill these opportunistic bacteria (enterobacteria) and increase lactobacilli in the vagina? How to prevent the normal content of lactobacilli? I have erosion and a polyp in the uterine cavity. The sexual partner is permanent. As I understand it, first you need to restore the microflora in the vagina, then cauterize the erosion and remove the polyp.

Answer: Hello! With so many white blood cells in a smear, antibiotics are usually prescribed both to drink and in the vagina. It is possible to connect more and metronidazole. After treatment, pass a control smear, and if it is good, then then remove the polyp and treat erosion.

Question:Hello. My husband and I are planning a pregnancy. In this regard, I turned to a gynecologist to advise on tests for preparation. Of the complaints, there were only not very abundant discharges and there is a slight erosion, which so far they said not to touch. A microscopic examination of the smear was carried out, as a result of which vaginosis was found (increased levels of leukocytes, coccobacilli, blastospores and g.vaginalis). The gynecologist prescribed terzhinan and vagilak. After the treatment, menstruation began, and after them an unbearable itching, burning sensation and copious discharge appeared. Has addressed to other doctor. Appointed or nominated research femoflora. She was also diagnosed with cervical erosion, bacterial vaginosis and urogenital vaginosis. (Lactobacilli below normal, g.vaginalis + prevotella bivia + porphyromonas spp. 10 in 6.8, candida spp 10 in 5 and ureaplasma 10 in 5.6). Ornidazole, neo-penotran (itching gone), then femilex, bifiform, unidox solutab and fluconazole were prescribed. Plus treatment for her husband. A smear in a month. Everything was done as prescribed by the doctor. Menstruation passed, after them 2 days everything was perfect. Now the discharge began again, dense, white, cheesy. There is no itch. Is it normal to have such discharge again? Or is it a process? Should I wait a month before a smear?

Answer: Hello! Yes, just wait for the next analysis. Now you can conduct a second course to restore the vaginal microflora. These are immunocorrectors (Viferon) and probiotics (Acipol). Since you are planning a pregnancy, you should donate blood for the extended TORCH complex and homocysteine. It is also advisable to visit an endocrinologist and discuss the intake of iodine and folic acid preparations. Check the condition of your teeth.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Bacterial vaginosis is one of the most common obstetric and gynecological diseases. Recently, it occupies 30 - 50% of all vaginal pathologies and requires great attention from gynecologists. The incidence of bacterial vaginosis in non-pregnant women during puberty ranges from 4 to 61%. This wide spectrum of incidence must be due to the lack of objective criteria used to diagnose bacterial vaginitis. The probability of occurrence in pregnant women is 14 - 20%. Bacterial vaginosis most often occurs in women under the age of 35 - 40 years.

causative agents of the disease

Many experts are of the opinion that bacterial vaginosis is nothing more than a violation of the vaginal ecosystem, which is provoked by the increased growth of pathogenic, often anaerobic bacteria. A very rapid decrease in the acidity of the vagina and the quantitative concentration of lactobacilli (inhabitants of the normal microflora of the vagina) is carried out not by one pathogenic microorganism, which later becomes predominant, but by a combination of several microorganisms at once. For example, they may be: Gardnerella vaginalis, Bacteroides sp., Peptococcus sp., Mycoplasma hominis, Mobiluncus and others. Bacterial vaginosis refers to polymicrobial diseases, therefore, it is impossible to isolate any dominant pathogen from this group of microorganisms - any of them can be contained in small amounts in the vaginal contents of healthy women. Vaginal discharge normally contains from 105 to 107 microorganisms per 1 ml.

What is bacterial vaginosis?

This is a disease that occurs as a result of the replacement of lactobacilli of the normal microflora of the woman's vagina with opportunistic anaerobic microorganisms. This is a qualitative change in the composition of the vaginal flora under the influence of various factors. Bacterial vaginosis creates favorable conditions for the occurrence of various infectious processes in the vagina.

How does the disease develop?

The normal microflora of the vagina is dominated by lactobacilli. If the microecology of the vagina is disturbed, the number of predominant lactobacilli decreases sharply, and the growth and development rates of opportunistic anaerobic bacteria increase. Previously, scientists claimed that the causative agent of bacterial vaginosis is Gardnerella vaginalis. But later it turned out that there are other causes of vaginosis and that gardnerella is part of the normal microflora of the vagina.

Factors predisposing to the development of bacterial vaginosis include:
Long-term treatment with antibacterial drugs, including antibiotics
Postponed inflammatory diseases of the genital organs
Oral and intrauterine contraception
Frequent change of sexual partners
Hormonal disorders
Decreased immunity
Chronic bowel disease and other diseases that can cause dysbacteriosis
Irrational nutrition - lack of dairy products in the diet
Excessive use of panty liners and tampons
Frequent wearing of tight-fitting, tight-fitting synthetic underwear and trousers.

If the balance of the vaginal microflora is disturbed, the pH of the vaginal contents changes from 4.5 to 7.0 - 7.5. As a result of the vital activity of pathogenic microorganisms, complex chemical compounds (volatile amines) are formed in the vagina, which contributes to the release of the unpleasant smell of "rotten fish". These pathological mechanisms disrupt the normal functioning of natural biological barriers in the vagina and favor the development of various inflammatory diseases of the genital organs, postoperative infectious complications.

Clinical manifestations

The main complaint is numerous homogeneous creamy grayish-white frothy vaginal discharge, slightly viscous. Allocations stick to the walls of the vagina and are evenly distributed along its walls. The discharge is accompanied by an unpleasant smell of "rotten fish"

Itching and burning in the vaginal area

Dyspareunia - discomfort and pain during intercourse

Urination disorder

How is bacterial vaginosis diagnosed?

Bacterial vaginosis can be diagnosed if at least 3 of 4 of the following are present:
1. Homogeneous vaginal discharge
2. pH of the vaginal discharge above 4.5
3. positive amine test
4. The presence of "key cells" (desquamated vaginal epithelial cells densely covered with gram-variable rods) in smears of vaginal discharge, Gram-stained and examined under a microscope. Normally, "key cells" are not found in the vagina.

The bacterioscopic method can also detect a small number of leukocytes in the field of view, a reduced number or the complete absence of Dederlein sticks.

Sowing on the microflora of the vagina

Antibiogram - determination of the sensitivity of the pathogen to antibiotics

Polymerase chain reaction - to determine the genetic material of Gardnerella vaginalis

Complications of the disease

Frequent uterine bleeding
The development of inflammatory diseases of the small pelvis (reproductive system and urinary tract)
Infertility
Premature rupture of membranes during childbirth and their inflammation
Endometritis in the postpartum period
Stopping the development of a newborn

How to treat bacterial vaginosis?

Treatment of bacterial vaginosis must necessarily take place under the strict supervision of the attending physician. All attempts at self-treatment are excluded.
In the treatment of this disease, two directions can be distinguished:

The first direction is to destroy pathogens and pathogens and restore the balance of the normal microflora of the vagina. For this, vaginal suppositories and gels are used, which include antibiotics and antiseptics - Metronidazole, Ornidazole, Clindamycin. Use drugs such as Macmiror and Terzhinan in the form of vaginal suppositories or tablets.

The second direction involves the use of eubiotics - preparations containing lactobacilli (Lactobacterin, Bifidum-bacterin, Acylact). Apply inside or locally - in the vagina. Recommended yogurt, biokefir.
Vitamin therapy and biogenic stimulation - to increase the overall resistance of the body.
Immunotherapy and immunoprophylaxis - Solko Trikhovak vaccine containing special strains of lactobacilli. As a result of the introduction of the vaccine, antibodies are formed that successfully destroy pathogens, normalize the vaginal microflora and create immunity that prevents the development of relapses of bacterial vaginosis.

The main drugs used to treat bacterial vaginosis:
Metronidazole (Metrogil, Trichopolum, Flagyl) helps stop the growth of harmful bacteria. This kind of drugs are prescribed five hundred milligrams in the morning and evening. The course of treatment is seven days. Against the background of the use of these medications, such side effects as: allergic reactions, digestive disorders, vomiting, nausea and others can make themselves known.

Clindamycin is an antibiotic drug that tends to inhibit both the growth and reproduction of pathogenic bacteria. You can buy this medicine both in the form of capsules, and in the form of a vaginal cream or vaginal suppositories. As for the vaginal cream, it should be inserted into the vagina using a special applicator once a day before going to bed. The course of therapy is six days.

Prevention

Compliance with the hygiene of the genital organs

Proper and nutritious nutrition

Timely treatment of inflammatory diseases of the urinary-genital organs

Exclusion of abuse in antibiotic treatment

Wearing comfortable underwear made from natural fabrics

Before use, you should consult with a specialist.

Reviews

I "brought" bacvaginosis from the sea, not the first time, by the way, such nonsense. Treatment was prescribed in two stages: first, vaginal tablets, and then lactose capsules. Everything went without consequences, otherwise it happened that then the thrush still got out. I think this is thanks to dlaktozhinal, tk. he restores the flora.

I have treated vaginosis several times, I know firsthand what kind of muck it is. At first, courses were prescribed for ten days, but there were still relapses. The most successful treatment was the last time, only salvagin gel was prescribed, but there was no relapse after this appointment, although almost a year had passed

Vaginosis is of course a tin, especially when you do not have time to be treated, and after a couple of months it reappears. Salvagin helped me get rid of it, it is an intravaginal gel. Five tubes were enough to completely restore the flora, the immune system got stronger quite well, it apparently copes with bacteria and there are no more relapses.

I treated vaginosis with Metronidazole, it helped a lot, though it still needs a good probiotic, because it kills all the microflora indiscriminately.

Tell me, please, passed medical examination revealed bac.vaginosis. Are they allowed to work with such a diagnosis? Or only after treatment?

Hello! Tell me please! Can bacterial vaginosis contribute to the development of ovarian cysts?

Julia,
Vaginosis is NOT sexually transmitted! This is a natural disease (infection) of the vagina, or rather, vaginal dysbacteriosis. And yet, a man can NOT get sick with vaginosis, vaginosis and the name from "vagi" - vagina, vagina. The man doesn't have it.

Pauline,
In my observation, the patients did not experience chest pain. Go to a mammologist or gynecologist about breasts. There may be a seal.

Hello! I am a gynecologist. Write questions, I will answer. About vaginosis! My daughter (11 years old) has a whitish discharge and is clear, without gas bubbles, not foamy, there is no itching, no burning, urination is normal according to my observations. She put her finger in there and let me smell it. Silly, of course ... I didn’t smell like anything! And she says either some kind of onion, or garlic, or she already stinks of iron. Who knows what it is, tell me please!! Although I myself am a gynecologist, but I can’t figure it out until the end. I think it's normocenosis.

Hello, I would like to know if there are chest pains and bloating in the lower abdomen with vaginosis? (Other symptoms of vaginosis are present)

Not true microflora can be restored! I drank Laktofiltrum + Terzhinan vaginal suppositories. and everything will be fine! I advise...

Girls, for the most part, you are advised to consult a doctor without fail. Like, the doctor will definitely help to competently cure this very vaginosis. Doctors have not been able to cure me for three years now. Prescribe different antibiotics, then probiotics. And that's it. The same scheme with the difference only in the names of the drugs. Atsilakt in my case, on the contrary, provokes thrush (although, in theory, it should prevent it), sometimes I have to give up everything halfway, because terrible itching and discomfort begin. In general, the microflora is not restored to any. That's exactly why I'm roaming the forums in order to subtract at least some other options for possible treatment (and healing, without relapses), because the schemes prescribed by doctors do not bring any benefit.

Vaginosis is a very nasty thing, she got sick herself =(((Oh, how I suffered with it ... I ran to the doctors until they prescribed Vaginorm-S. It was my savior! Discharges with an unpleasant odor were already tired, and vaginorm eliminated them in just 6 days! I recommend it to everyone!

Vaginosis is a terrible attack!! I had it several times in my life, there were, so to speak, relapses, I was treated with Vagilak. Until one fine day I went to the doctor and they prescribed Vaginorm there for a week - it does not cause any inconvenience, nothing interferes “there”)) A week later I was terribly glad that it was all over !! Six months have already passed, but for now, pah-pah, no relapses ... I recommend it in general))

Thanks to the authors for the article! In vain, they just didn’t mention oral probiotics, which restore the microflora of the vagina. Because yogurts and kefirs are certainly good, but from the stomach they enter the intestines and affect the intestinal microflora, and not the vagina. There are modern drugs (for example, vagilak) that restore the female microflora!

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

Probably it will seem strange to someone (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. Because it had to be prevented.

I have a rather complicated pregnancy, the cervix could not stand it and they put stitches on it (I already). And the sutures are a foreign body, and doctors feared that BV could 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 beautiful half of humanity suffers from it, as well as the drugs that doctors prescribe for treatment (antibiotics), I decided that I should write a post about how you can and should treat BV with natural remedies. Effective and safe, without harm to its microflora and without side effects.

What is Bacterial Vaginosis?

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

Particularly susceptible to BV:

having an active sex life
pregnant
immunocompromised women

Women with BV also have a higher risk of:

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

Cause of Bacterial Vaginosis

BV occurs due to a violation of the normal microflora of the vagina. Yes, sometimes it's hard to believe, but our vagina is its own ecosystem. With its own bacteria and yeast.

The overgrowth of any microorganisms or imbalance of bacteria just 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 commonly, but it may be other microorganisms.

Symptoms

So the symptoms (and they may not be - more on that below) of Bacterial Vaginosis begin to appear when the pH of the vaginal environment changes. The normal pH inside is slightly acidic 3.8-4.2. Anything above 4.5 is already BV, that is, too alkaline.

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

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

Causes of Bacterial Vaginosis

As with any other condition, BV can be caused by a variety of causes.

The most common:

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

On my own behalf, I can add that Bacterial Vaginosis is a systematic disease of the whole ecosystem of a woman. Doctors often prescribe antibiotics, but this does not help with the real problem and cause! It only relieves the symptoms. BV should be treated comprehensively.

How to Treat Bacterial Vaginosis

Avoid and use soaps and intimate hygiene products

Yes, I understand that this sounds like very strange advice. But! Ordinary 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 sorts of foams, sprays and other products that are advertised for feminine hygiene. The best hygiene for this delicate area is minimal with natural type soap. And no more than once a day. We do not want to disturb the microflora. And soap does just that.

Apple vinegar

Apple cider vinegar helps detoxify and fight bacteria. And restore the normal acidity of the vagina.

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 inside. But for this you need only (cloudy) - 1 teaspoon per glass of water, 2 times a day 30 minutes before meals.

Soda

Another effective remedy is simple soda.

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

Tea tree oil

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

The most effective way to apply in this case is to dip the swab in any liquid oil (ideally coconut as it has antibacterial activity) and then apply 3 drops of tea tree essential oil to the swab. We insert at night and repeat the week.

Do not douche

In general, douching our intimate place is not a useful thing. For those who may be in doubt, the vagina has the ability to cleanse itself. And douching simply disrupts the normal bacterial balance.

Do not use scented pads or tampons during your period. Better 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 refuse tampons altogether and switch to a silicone cap, for example.

Probiotics

Yes, without them. Since the main cause of BV is also in the intestines, it will be necessary to increase the beneficial bacteria there as well. Especially for the vaginal environment, logs 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 for someone, but the sugar that we consume completely destroys our microflora. And intestines and vagina. The fact is that pathogenic organisms (as well as cancer cells) simply adore, bloom on it and smell. Therefore, it is necessary to reduce the consumption of sugar as much as possible!

Bacterial vaginosis - the first symptoms and treatment regimen

Bacterial vaginosis (gardnerellosis, vaginal dysbacteriosis, vaginal dysbiosis) is a common disease in women associated with a violation of the composition of the normal microflora of the vagina and an increase in the number of other microbes in it, including gardnerella.

The nature of the disease depends on many factors, so when the state of health improves, the symptoms disappear completely. The disease is not a sexually transmitted disease and does not affect men. Unprotected sexual intercourse has a certain role in causing the disease. Frequent change of partner contributes to changes in the microflora of the vagina.

What it is?

Bacterial vaginosis is a condition of the vaginal microflora, in which the number of beneficial lactobacilli decreases significantly, and pathogenic ones increase. It can develop for many reasons - from the presence of a sexual infection to a banal decrease in immunity.

Causes

To date, science does not fully have information about what actually provokes the development of non-inflammatory syndrome. However, the urgency of this problem is increasing every year.

The factors provoking the development of the disease include:

weakening of local and general immunity;
irrational nutrition;
long-term antibiotic and hormonal therapy;
frequent douching;
the use of local contraceptives (condoms, creams and suppositories) which include 9-nonoxynol;
frequent change of sexual partners;
wearing synthetic underwear;
endocrine and gynecological pathologies;
non-observance of elementary rules of personal hygiene;
bowel disease.

Currently, bacterial vaginosis is one of the most common diseases among women of active reproductive age (from 23 to 33 years). According to statistics, about 30-35% of women suffer from vaginosis, but only half of the total number of cases are aware of their problem due to the presence of a characteristic odor. The rest, as a rule, do not even know about it.

Symptoms

Often the only symptom of bacterial vaginosis is the presence of copious vaginal discharge with an unpleasant smell of stale fish, which can bother you for a long time. At the beginning of the disease, the discharge is liquid, white or grayish.

Common symptoms of bacterial vaginosis include:

discharge with an unpleasant odor (fishy), which occurs as a result of the breakdown of amines produced by anaerobic bacteria.
copious homogeneous creamy vaginal discharge of a grayish-white color, sticking to the walls of the vagina.
sometimes there is vulvovaginal irritation in the form of itching and burning, discomfort during intercourse.
signs of inflammation of the vagina (attachment of vaginitis) are observed in half of the patients.
rarely - urination disorders and pain in the perineum.

If the disease continues for a long time, more than 2 years, then the following symptoms occur:

the color of the discharge becomes dark green;
whites change their consistency, become more viscous or resemble a curdled mass;
Also, the discharge during vaginal dysbacteriosis is characterized by the following signs: they become thick and sticky over time, and their distribution along the vaginal walls is even. Whites are easily removed from the walls with a cotton swab;
with a long-term process, a number of patients complain of slight or moderate itching / burning in the vulva (see itching in the vagina);
pain during sexual intercourse (see pain during intercourse);
the volume of vaginal discharge reaches 0.02 liters per day (given that the amount of leucorrhoea is normally not higher than 2 - 4 ml);
in a number of situations, pathogenic flora joins the described infectious process, which contributes to the development of vaginitis;
sometimes there are disorders of urination (frequent and painful urination in women).

A distinctive feature of the disease is the absence of visible signs of inflammation. That is, during visual examination, a physiological pink color of the vaginal mucosa is observed. Only in some cases, single reddish dots are noted in women who are in menopause.

Severity

According to the severity in vaginal dysbacteriosis, there are:

Along the course, acute, torpid or erased and asymptomatic vaginal dysbacteriosis is distinguished.

Diagnostics

A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After examination, a discharge from the posterior lower vaginal fornix 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 (normally 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.

Performing one of the 4 tests is not enough to make a diagnosis.

What is the treatment for bacterial vaginosis?

Initially, a woman is prescribed antibiotics for the treatment of bacterial vaginosis: they have a detrimental effect on non-specific bacteria and cleanse the vaginal mucosa from them.

The drugs of choice are Metronidazole, Tinidazole, Clindamycin, as they are active against anaerobes. Local use of antibiotics is preferable to avoid systemic side effects, but in some cases the gynecologist is forced to resort to tablet forms.

The treatment regimen is selected individually:

Tinidazole 2.0 in the form of tablets is taken orally 1 time per day for 3 days;
Metronidazole in the form of a 0.75% gel is injected into the vagina once a day for 5 days;
Candles with Clindamycin 100 mg are injected into the vagina 1 time per day for 3 days;
Cream with 2% content of Clindamycin is injected into the vagina 1 time per day for 7 days;
Metronidazole 2.0 tablets is taken orally once.

For the duration of antibiotic therapy and the day after its completion, it is necessary to exclude alcohol intake, even in minimal doses. The drugs disrupt the metabolism of ethyl alcohol in the body, due to which the accumulation of toxic metabolites occurs and severe intoxication develops. In its course, it resembles a severe hangover: a woman experiences severe weakness, limbs tremble, blood pressure rises, a severe throbbing headache occurs, excruciating nausea and vomiting develop.

Clindamycin cream contains fat and may damage condoms or latex contraceptive membranes. All local forms of drugs are administered immediately before bedtime to prevent them from running down the walls of the vagina.

In case of intolerance to antibiotics or the presence of contraindications to their use, the first stage of treatment is carried out with local antiseptics:

Hexicon 1 suppository is administered 2 times a day for 7-10 days;
Miramistin in the form of a solution irrigates the vagina once a day for 7 days.

Preparations for bacterial vaginosis used in the second stage of treatment contain lactobacilli and create favorable conditions for the restoration of the vaginal microflora. They are used 2-3 days after the completion of antibiotic therapy:

Atsilakt 1 suppository 2 times a day is injected into the vagina for 5-10 days;
Bifiliz 5 doses are taken orally 2 times a day for 5-10 days.

Antifungal suppositories for bacterial vaginosis are usually not prescribed. The need for them arises if candidiasis, a fungal infection, joins the conditionally pathogenic microflora. In this case, clotrimazole suppositories are prescribed 1 time per day intravaginally for 6 days.

Treatment during pregnancy

How to treat bacterial vaginosis in case of pregnancy? In the first trimester of gestation, systemic therapy for the disease is not performed (metronidazole and other drugs are toxic to the embryo). Local administration of etiotropic drugs in the early stages is used with caution.

Metronidazole or clindamycin is started from the second trimester and is carried out in short courses. Metronidazole 0.5 gr. (2 tablets) twice a day for 3-5 days, and clindamycin is prescribed at a dosage of 0.3 g. 2 times a day for 5 days.

Complications during pregnancy that may occur due to the disease include:

miscarriage - loss of a fetus during the first 23 weeks;
preterm birth - when a baby is born before the 37th week of pregnancy;
chorioamnionitis - infection of the membranes of the chorion and amnion (the membranes that make up the fetal bladder) and the amniotic fluid (the fluid surrounding the fetus);
premature rupture of the fetal bladder - a bladder with fluid in which the fetus develops;
postpartum endometritis - infection and inflammation of the tissues of the uterus after childbirth.

If you are pregnant and have symptoms of vaginosis, contact your gynecologist as soon as possible. Although the risk of complications is low, treatment can further reduce the risk.

Prevention

the use of barrier methods of contraception, wearing underwear only from natural fabrics;
regular examination by a gynecologist and timely treatment of diseases;
treatment of chronic pathologies of internal organs;
strengthening immunity in natural ways: physical activity, hardening, etc.;
avoiding douching and other similar procedures.

Bacterial vaginosis is a pathology that reflects a decrease in the level of protection of the body at the moment. Often proceeding asymptomatically, gardnerellosis is always detected during examination by a gynecologist. Only a doctor can prescribe the most effective bacterial vaginosis tablets, suppositories, or other forms. Do not delay treatment!