Vaginosis - a pathological condition of the vaginal mucosa non-inflammatory origin, caused by replacement of normal microflora of anaerobes.Specific pathogens have no vaginosis.Among the reasons for provoking his present many different microorganisms, but their presence does not provoke local inflammatory changes in the vagina.It is this feature of the disease and is based differential diagnosis of vaginosis.
vaginosis reasons not well understood, but the question of his membership of the disease continues to be discussed.The only condition is considered to be a change of vaginosis normal vaginal microbiocenosis indicators and, consequently, a violation of mucosal defense mechanism against unwanted microorganisms.
To understand pathological processes at vaginosis, you need to have a clear idea of how the vaginal epithelium, and by what mechanisms it protects the reproductive system from potential infection.
vagina connects the uterus (and indirectly and appendages) with the e
vaginal wall is formed by three layers: connective tissue, muscle and epithelial.Vaginal epithelial cells formed in layers ranging flat shape, it is the top layer (the one that lines the inside of the uterine cavity) is in a constant state of renewal.Every month, according to cyclical changes in the other sex organs, the surface layer of vaginal epithelium rejected (exfoliate) and replaced by new cells.Thus, mucous "cleansed" of the potential causes of inflammation and protects the upstream organs from infection.
key to the success of the barrier function of the mucous is the constancy of the vaginal microenvironment.In a healthy vagina, it shows the number of dominant (98%) and a small population of lactobacilli opportunistic pathogens.The quantitative superiority lactoflora provides reliable protection from mucosal infection.If lactobacilli become smaller, their place is taken by opportunistic germs.
To ensure a numerical advantage, laktobekterii create conditions unsuitable for vegetation "bad" microorganisms.They are attached to the membrane surface epithelial cells exfoliated and "extract" of glycogen, and then the latter was synthesized from lactic acid.As a result, the vagina maintained a constant level of acidity (3.8 - 3.5).In the acidic environment of conditionally pathogenic flora can not compete with laktobekteriyami therefore remains of a small and safe.
Vaginosis formed if amid quantitative reduction in acidity and lactobacilli (pH) in the vagina begin to proliferate the population of conditionally pathogenic microorganisms, i.e.in fact, it is the local dysbiotic disorder.
Thus vaginosis is formed due to "their" microflora, which is always present in the vagina of any healthy woman.They can not be "infected" or committed partner during intimacy.
Acute vaginosis is diagnosed infrequently.Since vaginosis does not cause pronounced inflammation, the disease often has no active subjective complaints.The pathological process in the vaginal mucosa is able to flow erased, then sharpening, then fading again.
chronic vaginosis depletes local immunity and can cause inflammation, when the background of a significant reduction (or extinction) lactoflora vagina begin to multiply excessively undesirable mikoorganizmy.
Perhaps the only symptom of vaginosis are abnormal discharge.Their color and consistency depend on which displaces lactobacilli microflora much time there vaginosis, and what background processes occur in the surrounding tissues.
vaginosis Diagnosis is based on visual inspection of the mucous and laboratory studies of vaginal discharge.Studying the composition of the microbial vaginal cables, determine the severity of the disease: the lower the lactobacillus in the material, the harder vaginosis.
Therapy vaginosis has no clearly defined plan.Each regimen vaginosis is the result of individual study of the clinical situation.Generally, treatment is aimed at eliminating undesirable microbial flora and restore populations of Lactobacillus.Inside pills vaginosis appointed indicated.Preference is given to topical preparations (ointments, creams, suppositories).
Vaginosis often recurs.Prevention vaginosis and recurrence is the removal of precipitating factors and reasonable attitude towards sexuality.
vaginosis is the reason for the formation of its own opportunistic microflora present in the vagina of healthy women.Perhaps therein lies the uniqueness vaginosis: the body triggers the disease on their own, without outsourcing.
microbial composition of the vaginal environment at each individual woman is different, so called sole culprit of vaginosis is impossible.His provoke polymicrobial complexes, which consist mainly of anaerobic microorganisms (mainly coccal nature).Often when vaginosis in vaginal contents prevail Corynebacterium, Mycoplasma, Staphylococcus epidermidis, lactic acid streptococci and other bacteria.It should be noted that the earlier idea of a dominant role in the pathogenesis of Gardnerella vaginosis now disproved by numerous studies.It turned out that gardnerelly colonize the vagina over more than 50% of healthy women, without causing pathological changes dysbiotic habitat.Obviously, this microorganism serves as a pathological agent only when the association with other microflora.
Provoking disbiotic disorder in the vagina factors are:
- Incorrect hygienic measures.Some patients are too often using irrigation during which the "good" microflora simply mechanically washed away from the surface of the mucous.Also negatively on the vaginal epithelium are aggressive cosmetic products (soaps, gels) are not suitable composition for intimate care.
lack of adequate personal hygiene and can cause vaginosis, because the mucous accumulates a lot of unwanted germs and their metabolic products.
- Irrational antibiotic.Free access to the acquisition of antibiotics (including a very "strong") has very negative consequences: without the participation of a qualified medical examination ill treated independently, not always correctly choosing and taking medicines.
Antibiotic, appointed experts, always involves prevention dysbiotic disorders and leads to the formation vaginosis often.
- hormonal dysfunction.All the processes in the mucous membranes of the vagina is closely linked to the cyclic hormonal fluctuations.The condition of the vaginal microflora influences estrogen levels, they support the processes of renewal of the mucous layer of the surface, providing a sufficient number of lactobacilli glycogen.In the context of hypoestrogenism (especially long) mucous layer becomes thinner, reduced size of the population of lactobacilli and opportunistic microorganisms begin to vegetate vigorously.
altering the normal hormonal levels often explains vaginosis in pregnant women, women in menopause or have recently undergone an abortion.
Reception gormonosoderzhaschih drugs or contraceptives may also contribute to the emergence of vaginosis.
- unprotected intimate relations with different partners.In addition to the increased chance of getting a venereal infection, promiscuity leads to major changes in the composition of the vaginal microflora and depletes local immunity.Moreover, the number of sexual partners increases the risk of vaginosis much more than the number of unprotected sexual intercourse.
- intestinal dysbiosis.Symmetrical dysbiosis the intestinal mucosa and the vagina is diagnosed frequently, especially against the background of endocrine diseases or antibiotic therapy.Every second patient with vaginosis is diagnosed intestinal dysbiosis.
- Disturbances of immunological reactivity.The reason vaginosis may be systemic allergic disease or transient local allergic reaction, such as hygiene products (vaginal tampons, soap, etc.), a personal lubricant contained condom latex or talc.
- Intrauterine contraception (spiral).It provokes appearance vaginosis often (52%).Obviously, spiral mucous perceived as a foreign body, and they respond to the presence of its local allergic reaction.In addition, any (even the "good") intrauterine contraception is the source of a local non-infectious inflammation.To intrauterine fulfilled its intended purpose without the accompanying negative phenomena, it is necessary to comply with simple medical advice and do not leave it in the uterine cavity longer due.
Vaginosis may become final infectious and inflammatory processes in the organs of the urogenital system.
Whatever the reason vaginosis, short-term changes in the composition of the normal vaginal microflora in most healthy patients is eliminated by means of self-regulation mechanisms.The disease develops only when the body's inability to liquidate local self dysbiosis.
Symptoms and signs of vaginosis
Vaginosis distinguishes lean symptoms and the absence of specific clinical signs.Often, the disease occurs without the expressed subjective symptoms and causes the patient to see a doctor.
leading, and sometimes the only symptom of vaginosis are abnormal discharge (leucorrhoea).Their number and appearance are dependent on several factors, one of which is the duration of the disease.
Acute vaginosis accompany abundant liquid bleach white, sometimes vaginal discharge has a grayish hue and odor.Most acute process occurs after hypothermia, severe emotional distress, allergic reactions due to antibiotics.
chronic vaginosis can exist for years.If disbiotic violations in the vagina last more than two years, the discharge becomes thick and sticky, and their color changes to yellow-green.The changing nature of cables in chronic vaginosis is associated with a degree of local dysbiosis: the longer vaginosis, the less remains of lactobacilli in the vagina, and the more pronounced the effect of pathogenic microflora.Long vaginosis significantly depletes existing local protection mechanism mucous and can often cause connection secondary pathological microflora and development of infectious inflammation.
emitted during vaginosis have one specific difference - an unpleasant odor, resembling the smell of stale fish.His "provide" competing lactoflora anaerobic bacteria.They synthesize substances (amines), which decompose with the release of unpleasant "rotten" smell.Often, the patient brings to the doctor is not the presence of cables and their unusual odor.
Clinic vaginosis also depends on the state of hormonal function, in particular - on the level of estrogens.Lower (in comparison with progesterone) concentration of estrogen leads to a decrease in glycogen in the vaginal epithelium.As for the processing of small amounts of glycogen requires less lactic acid bacteria, their number decreases, and the vacant place on a competitive basis takes anaerobic microflora.The prolonged absence of adequate estrogen effect of provoking thinning of the vaginal mucous layer (atorfiya).The vagina becomes "dry", easily vulnerable, so the number of cables in the background vaginosis is reduced and the patient appear subjective complaints of discomfort, dryness, burning and / or itching.These symptoms are typical for vaginosis women with physiological (old age) or artificial (oophorectomy) menopause.
Diagnostics vaginosis does not require a large number of surveys, but analysis of the data is associated with certain difficulties.Vaginosis should be distinguished from vaginitis, which, unlike the latter, is the result of an infectious inflammation of the mucous membranes of the vagina.Often, patients treated with a non-existent for years vaginitis, using antibiotics, which only aggravate vaginal dysbiosis and lead to the development of chronic vaginosis.
vaginosis diagnosis is confirmed by several reliable criteria:
- lack of inflammatory changes in the vaginal mucosa.Visual inspection of the mucosa has a normal "healthy" look and the color pink.In the vagina there is an increased amount of light discharge with no external signs of pus, often (87%) felt when viewed from their odor.
- Changes in the acidity of the vaginal environment.To quantitatively measure the pH, using special test indicator strip.Coating them with the scale division vaginosis indicates acidity characteristic shift to the alkaline side (more than 4.5).
dominant presence of anaerobic microflora in the vagina can detect "amine test."Content vagina mixed with 10% - ing solution of KOH (base).Have vaginosis catching confirms strong "fishy" odor.
- Changes in the microbial composition of the vaginal fluid on the results of laboratory diagnostics.In smears no increased number of white blood cells, the inherent inflammatory diseases, but there is a quantitative shift in the microbial composition: against the background of the decrease (or complete lack) lactoflora there is excessive growth of populations of opportunistic pathogens.
Among other anaerobic bacteria often found a large number of gardnerella.The permissible amounts of their population completely harmless to the mucous, but expressed in a dysbiosis gardnerelly enter the composition of microbial associations and "help" maintain the pathological process.Independent values easy detection in a smear gardnerella not.
- The presence of a smear so-called "clue cells."At microscopy detachable vagina at vaginosis often rendered a large number of cells desquamated epithelium adhering to the membranes of microbes.They are called "key".
Thus, the diagnosis is confirmed vaginosis:
- specific vaginal discharge (usually with the "fish" smell);
- increased above 4.5 vaginal pH;
- positive "amine test";
- key cells in the smear.
However, self-diagnostic value of each criterion is not mentioned, vaginosis diagnosis is made only if at least three of these symptoms.
40% of patients with symptoms of vaginitis when viewed from the cervix are detected background diseases (cervicitis, ectropion, scars), more pseudo.They often change clinic vaginosis and require additional colposcopy.
Despite scant symptoms, the presence of vaginosis can be suspected of being studied clinical symptoms.Often, in an interview the patient indicate a long, unsuccessful treatment of so-called "inflammation" of the vagina.They may also note that another course of anti-inflammatory therapy does not eliminate, and exacerbates negative symptoms.
In recent years, patients are often faced with the conclusion of "cytology vaginosis."In contrast to the usual, cytological vaginosis is the result of excessive reproduction of lactobacilli.This condition often provoke a means of intimate hygiene with an acidic pH, especially if they contain lactobacilli.Sometimes this kind of vaginosis may appear on the background hyperestrogenism.Excess estrogen stimulates the excessive production of glycogen, which is required for the disposal of more than lactobacilli.