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Bacterial vaginosis: symptoms, treatment


One of the main indicators of female reproductive health is the microbiocenosis (composition of microflora) of the vagina, which plays an important role in the stable support of microecological status. The interaction between the cells of the vaginal epithelium and the bacteria living in it is constantly monitored by the body at both the cellular and molecular levels. As a result, the resistance of epithelial cells to colonization of pathogenic and conditionally pathogenic microflora is developed. In the event of a decrease in colonization resistance, bacterial vaginosis develops.

What is bacterial vaginosis?

Bacterial vaginosis Bacterial vaginosis is a non-inflammatory process that occurs as a result of disruption of the normal vaginal microbiocenosis. It is customary to allocate it in a separate nosological group, characterized by violations of the quantitative and qualitative composition of microflora, not associated with the presence of STDs, as well as the presence of protozoa or fungal microorganisms. With the development of the pathological condition, the number of permanent inhabitants of the vagina and lactic acid bacteria producing hydrogen peroxide is significantly reduced. At the same time, the number of gram-negative anaerobic bacteria ( gardnerella , mobiluncle, peptostreptokokk, bacteroid, mycoplasma , ureaplasma, fuzobakteriya) significantly increases.

Useful lactic acid bacteria create an acidic environment in the vagina, stimulate local immunity and compete with other microflora for adhesion (adhesion) to epithelial cells.

With the development of bacterial vaginosis, another representative of the normal microflora of the vagina, Gardnerella, normally inhabiting the female genital tract in insignificant amounts, begins to multiply strongly, displacing the beneficial lactobacilli. In the course of its life, it releases pyruvic acid and amino acids, which are a nutrient substrate for another vaginal microflora. As a result, anaerobic conditionally pathogenic bacteria are activated, producing amines and giving the vaginal secretions an unpleasant fishy smell.

Causes of bacterial vaginosis

Today, science is not fully aware of what actually provokes the development of a non-inflammatory syndrome. Nevertheless, the relevance of this problem is increasing every year. 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.

Factors provoking the development of the disease include:

  • weakening of local and general immunity;
  • poor nutrition;
  • long-term antibacterial and hormonal therapy;
  • frequent douching;
  • use of local contraceptives (condoms, creams and suppositories) which include 9 nonoxynol;
  • frequent change of sexual partners;
  • wearing synthetic underwear;
  • endocrine and gynecological pathologies;
  • failure to follow basic rules of personal hygiene;
  • bowel disease.

Symptoms of bacterial vaginosis

The most characteristic symptom of bacterial vaginosis is an abundant white or grayish discharge with an unpleasant fishy smell, aggravated during menstruation and after sexual contact. With a long-lasting inflammatory process, the vaginal secretion acquires a thicker consistency and greenish staining. Often the discharge becomes frothy, sticky and stingy. Their number can vary from moderate to abundant (on average, up to 20 ml per day).

In bacterial vaginosis, pruritus, burning and dysuric disorders occur quite rarely (only 15-22% of cases). Also for this condition is not characterized by the presence of the inflammatory process on the walls of the vagina. Many women lack any subjective feelings, but, at the same time, a certain group of patients have severe pain in the lower abdomen during menstruation and heavy menstrual bleeding.

Diagnosis of bacterial vaginosis

The diagnosis is carried out taking into account the clinical signs and anamnesis. In gynecological practice, several criteria are taken into account in the diagnosis of bacterial vaginosis: the alkaline environment of the vaginal discharge, the homogeneous structure, the whitish or gray color of the vaginal secretions, the presence of the smell of rotten fish, the change in the composition of the vaginal microflora.

Diagnostic procedures include microscopic examination of the detachable vagina (the native drug and smear stained by Gram). These are the most accessible and reliable methods to obtain information about the composition of the vaginal microflora, as well as the number of leukocytes (as a rule, there is no leukocytosis in bacterial vaginosis) and the state of epithelial cells.

According to medical indications, PCR analysis can be prescribed (polymerase chain reaction), which allows to determine the type and quantity of a particular microorganism. Currently, this study is widely used in clinical practice in the diagnosis of urogenital pathologies.

If necessary, to exclude the presence of sexually transmitted infections, is assigned a cultural examination of vaginal secretions.

The degree of purity of the vagina and microbial contamination is estimated by 4-point system:

  • 1 (+) - an insignificant number of bacteria in one microscope field of view (up to 10 cells);
  • 2 (++) - a moderate number of microbial cells (11-100 in the field of view);
  • 3 (+++) - a large number (100-1000);
  • 4 (++++) - massive seeding (over 1000 copies in sight).

Bacterial Vaginosis Treatment

Patients who have been diagnosed with bacterial vaginosis, depending on the degree and nature of the pathological process, may be prescribed local or systemic antibiotic therapy. In this situation, using etiotropic agents with anti-anaerobic effect.

Currently, one of the most effective drugs is Clindamycin, which has a bacteriostatic and bactericidal action. The drug is available in injectable and tablet form, as well as 2% vaginal cream in an applicator (Dalacin). The latter is allowed for use by pregnant women.

Also well proven in the treatment of bacterial vaginosis Metronidazole (broad-spectrum drug), quite effective against anaerobic bacteria. Before using it, you should read the instructions, as it has contraindications, one of which is pregnancy. Metronidazole gel can be used as a topical agent. Experts estimate its effectiveness in 85-90%.

In recent years, Flagyl has become widely used in the treatment of bacterial vaginosis (a drug produced in the form of vaginal suppositories). Metrogil (vaginal gel) is also recommended as an external agent.

The combined drugs used in the treatment of disorders of the vaginal microbiocenosis include Ternzhinan (vaginal tablets). It consists of the antimycotic nystatin, ternidazole, which affects the anaerobic microflora, prednisone (micro dose), rapidly relieving inflammation, and neomycin sulfate, which affects gram-negative and gram-positive bacteria.

After reducing the number or complete elimination of aggressive microflora, to restore the normal microbiocenosis of the vagina, patients are given probiotic preparations to correct the amount of vaginal microflora, as well as activating cellular and humoral immunity. In this case, it is recommended to use Lactobacterin, Bifidumbacterin, Biovestin, Acilact, etc. These biologically active data stimulate the growth of beneficial lactobacilli and increase the protective properties of the vagina.

Biologics should be appointed only after a control microbiological study (in the absence of fungal microflora).

Patients with impaired vaginal microbiocenosis should investigate the quantitative and qualitative composition of the intestinal microflora and, if necessary, simultaneously correct the intestinal dysbiosis.

Possible complications

  • Inflammation of the ovaries (salpingitis);
  • Inflammation of the cervix (cervicitis);
  • Postoperative infectious complications;
  • Yeast (fungal) infection;
  • Trichomoniasis;
  • Bacteremia (a condition that develops when bacteria enter the blood). May occur after childbirth and invasive gynecological procedures;
  • Genital infections;
  • Urinary tract infections.

Prevention of bacterial vaginosis

In order to prevent the development of the pathological process and reduce the frequency of recurrence of the disease, it is necessary, if possible, to eliminate the factors provoking its occurrence. It is not recommended to take antibiotics on your own, without medical supervision, you should refuse frequent douching, decide whether to use an intrauterine device, liquid soap for intimate hygiene that can disrupt the normal microflora of the vagina, and avoid frequent promiscuous sex.

| 30 June 2015 | | 4,075 | Diseases in women
Leave your feedback

Jessica Lovett: I have been dealing with this for 20 years. I have seen many doctors and have tried everything. Still have issue! Any help would be appreciated

Alicia Australian1833: I get it from different types of soap. Can I just randomly add.... Woman should not be ashamed about expressing their sexuality. We just need to know about treating the consequences. It’s like sneezing in a elevator. Plus men need to stop slut shaming. How else r they meant to get any? I mean Woman like sex. If we didn’t there would be no human race. Why does the world discount logic?

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