Bacterial vaginosis - treatment and symptoms
Bacterial vaginosis - a complex of pathological changes in the vagina noninflammatory nature, flowing with the participation of anaerobic microflora in the background dysbiotic shifts.
essence barrier function of the vaginal environment is, to falling (or existing) therein various infectious agents are not able to penetrate through the riser into the uterus and appendages, and provoke a serious inflammation.Vaginal environment has the property of consistency, it does not allow pathogens to be long and multiply in the mucous layer.This contributes to a constant level of acidity (or pH) of the vaginal environment and its composition: the normal acidity of the vagina of the female ranges from 3.8 - 4.5, and a part is dominated by lactobacilli (Lactobacillus).Changing the pH of the vagina in the upward (greater than 4.5) and a decrease in the total number of lactobacilli composition creates favorable conditions for the multiplication of opportunisti
Bacterial vaginosis occurs without the expressed inflammation, can be both scarce and bright signs.With long-term recurrent talk about the process of chronic bacterial vaginosis.
disease can exist in the form of worn for a long time, and fade back again.Under adverse conditions, against the background of an existing dysbiosis vagina may increase the number of pathogens and develop an inflammatory process.Like any other state dysbiotic, untreated bacterial vaginosis can be the basis for other, more serious, pathological processes in the uterus and appendages.
Symptoms of bacterial vaginosis often found in pregnant women.For most of them with timely diagnosis, he is not dangerous and is easy to care.
Bacterial vaginosis is not related to sexually transmitted diseases and sexually transmitted.Talking about the presence of bacterial vaginosis in men correctly.The term "vaginosis" emphasizes the localization process into the vagina.Consequently, bacterial vaginosis males can not appear.
Management of patients is determined individually after inspection and testing.
Causes of bacterial vaginosis
only cause of bacterial vaginosis is a violation of the quantitative composition of microorganisms in the vaginal environment.
lactobacilli vaginal flora is represented (98%).Other potentially pathogenic bacteria are present in small quantities, it may be anaerobic cocci, Staphylococcus epidermidis, Corynebacterium, Mycoplasma, lactic acid Streptococci, Gardnerella and others.Lactobacilli are involved in the synthesis of large amounts of lactic acid that makes the vagina acidic environment is maintained constant, inhibits the growth of bacteria such as the adverse gardnerella, streptococci and anaerobic microorganisms.
vaginal environment maintains a constant composition by a developed system of self-regulation.Under the influence of unfavorable factors, the system can be compromised, and the vaginal flora loses its normal number of members.The number of lactobacilli decreases the acidity of the vaginal environment changes, begins uncontrolled proliferation of opportunistic pathogens.
specific pathogens of bacterial vaginosis does not exist.The cause of this condition is not one certain pathogen, and its association with other microorganisms.Among the bacteria associated with bacterial vaginosis, often referred to Gardnerella vaginalis (gardnerella), with a decrease in the number of lactobacilli is it increasingly takes its place and begins to multiply in the vagina.
negative factors contributing to the development of bacterial vaginosis can be internal or external.Abnormalities in the immune system, hormonal regulation, infectious processes, intestinal dysbiosis, endocrine diseases and some others may provoke disbiotic changes in the vagina from the "inside."Therapeutic and diagnostic manipulations, the use of antibacterial drugs (especially antibiotics), hormonal agents, irrigation, also have adverse effects on vaginal microflora.
menopausal bacterial vaginosis is caused by natural reasons: due to lower estrogen in the vagina reduces the growth of lactobacilli and increased pH.
During pregnancy the composition of the vaginal microflora violation may occur under the influence of hormonal changes.
Symptoms of bacterial vaginosis
absence of signs of inflammation of the vagina explains the scant symptoms of bacterial vaginosis.Lead and often the only symptom is an increased amount of discharge from the genital tract (cables).About 85% of women report their unpleasant odor, resembling the smell of fish.Very often the selection is not very concerned about the women, and they do not go to the doctor, believing such a state norm.
Allocation in bacterial vaginosis, liquid, white, in some cases, can acquire a grayish hue.The nature of the discharge affects the duration of the disease, and the presence of background processes accompanying changes.If a woman is sick for more than two years, discharge may change its appearance, texture and color - to become more malleable, acquire a yellowish tint due to involvement in the pathological process of secondary flora.
addition to discharge a woman may be concerned about discomfort in the vagina.When protracted course itching or burning sensation in the vagina, bladder disorders, discomfort, up to intense pain during intimacy.
official classification of bacterial vaginosis does not exist.Sometimes, by analogy with the specific reproductive tract infections, acute isolated, torpid (sluggish), and a chronic process, to highlight the severity of symptoms and duration of the process.
Asymptomatic (sluggish), bacterial vaginosis can become chronic.
Chronic bacterial vaginosis is characterized by a prolonged course with periods of exacerbation and remission.The longer the disease, the less remains of lactobacilli in the vagina, up to their complete disappearance.The protective function of the vagina is reduced, which can lead to secondary adherence of pathogenic organisms and the development of inflammation.The inflammatory process can "climb" up and cause inflammatory changes in the cervix, uterus and appendages.In this case, bacterial vaginosis becomes a background process for more serious gynecological diseases
have any healthy woman can be quantitative changes in the composition of the normal vaginal flora.If the changes are minor, and the woman is healthy, her body will solve this problem, ie compensates for and eliminates disturbances caused by the internal mechanisms of self-regulation.It is believed that bacterial vaginosis is experiencing episodes of every woman at least once in life, but not every developing pathological process in need of medical correction.
number of vaginal fluid in women each individual may vary depending on sexual activity, hormonal levels, age, condition of the nervous system, the presence neginekologicheskih disease and several other factors.Abundant selection may occur in healthy women on the eve of the monthly.Typically, a woman knows how much discharge is normal for it, especially if it is a regular preventive care in the antenatal clinic.Increasing the amount of discharge is not always associated with the pathological process.Reliable cause changes in the nature of vaginal discharge can be determined only after examination and laboratory examination.
Bacterial vaginosis in pregnancy
During pregnancy a woman's body physiological changes occur to ensure safe carrying of pregnancy and successful delivery.In some cases, these changes can lead to bacterial vaginosis.In the body of a pregnant woman, a new system of hormonal regulation with a predominance of progestogens, which are called "pregnancy hormone."They affect the amount of cervical mucus (takes its increase) and cause fluctuations in pH.As a result, the mechanism of self-regulation is disturbed vaginal microflora composition, the number of opportunistic bacteria grows and develops bacterial vaginosis.
Bacterial vaginosis occurs not every pregnant woman.In contrast, the number of cases of pregnant inferior to the number of those outside of pregnancy.It is assumed that this can be explained by a high content of lactobacilli in the vagina moms.
If the cause is bacterial vaginosis pregnancy, in most cases it does not cause a woman almost no discomfort, is easy to correct and goes away after childbirth.Quite different situation can develop if a woman is before pregnancy had a history of diagnosis of bacterial vaginosis.In these women the disease process on the background of pregnancy can worsen and lead to undesirable consequences.
Symptoms of bacterial vaginosis in expectant mothers are similar to those in non-pregnant women, and their degree of severity depends on the duration of the process and the presence of background and concomitant diseases.Discharge from the genital tract of varying intensity are often the only complaint.Bacterial vaginosis during pregnancy may be asymptomatic.
In what form would not flow in pregnant women pathological process, disregard it can not be.In the face of declining immunity process may be complicated by the addition of pathogens and the development of the inflammatory process.Then pathogens will flock to the cervix, and through it - in the pregnant uterus to the developing fetus.Rising infection can cause intrauterine fetal infection, complicate the normal course of childbirth and the postpartum period.
Such complications are rare, but even the slightest chance of their obligation to conduct a full medical examination of pregnant women for bacterial vaginosis, and carry out the necessary remedial measures if necessary.
diagnosis of bacterial vaginosis
Diagnosis begins with a general survey of the patient.Ask a question about the timing of the first signs of the disease, states the nature of the complaints.At this stage, it is important to know whether those episodes of illness before treatment was carried out there, and what drugs are used.No less important is information about gynecological diseases and extragenital pathology.
Due to the fact that the symptoms of bacterial vaginosis lean and has a unique, the most valuable in the diagnosis data are gynecological examination and laboratory tests.
important diagnostic criterion for the inspection is the lack of signs of inflammation of the vaginal mucosa.If bacterial vaginosis, it has the usual pink color.Selections are evenly distributed on the walls of the vagina, the number and the color may be different.Sometimes the discharge has a peculiar odor similar to the smell of fish.
During the inspection of the measurement is the pH of the vaginal contents.For this purpose, special test strips with scale division.Shift in pH to the alkaline side (above 4.5) is characteristic of bacterial vaginosis.
Along with pH - meters of wire amine test.Vaginal discharge was mixed with 10% KOH solution.If the interaction with alkali appears or gets worse, "fishy" smell test is considered positive and indicates the presence of bacterial vaginosis.
30% of patients with bacterial vaginosis is combined with cervical pathology.If during the inspection of the patient revealed changes cervical mucus, appointed by colposcopy.
Laboratory examination begins with smear from the region posterior vaginal fornix.We study the composition of the vaginal microflora: an increase in populations of opportunistic bacteria on the background of the quantitative reduction (up to a total absence) of lactobacilli, a large number gardnerellas testify in favor of bacterial vaginosis.
One of the important diagnostic features is the presence of smear "clue cells."They look like desquamated cells (exfoliating) stratified squamous epithelium of the vagina with the bacteria on the membrane.
Thus, in the diagnosis are crucial:
- change in pH of the vagina;
- the reduction or absence of lactobacilli;
- positive aminotest;
- a large number of microbial flora (especially gardnerellas);
- «key cells" in the smear;
- the absence of inflammation of the vagina.
If bacterial vaginosis is associated with other diseases, the doctor prescribes additional methods of inspection to determine the tactics of the patient.
Based on laboratory analysis data it can be concluded about the severity of bacterial vaginosis:
- Compensated process I is determined to be a complete absence of microflora in the background material on the unmodified cells of the vaginal epithelium.There is a possibility of settling outside the vagina falling flora;
- Bacterial vaginosis II degree of gravity there is a quantitative reduction of lactobacilli, increased conditional - pathogenic microflora, the appearance of individual 'key' cells;
- III degree of severity of the clinical picture of severe bacterial vaginosis.The material can not be detected lactobacilli, many different organisms, "core" cells are present in large numbers.
Differential diagnosis of bacterial vaginosis is made between non-specific vaginitis, vaginal fungal infections, sexually transmitted infections (gonorrhea, trichomoniasis), chlamydia.
Pregnant pass the examination is mandatory, regardless of the existence of complaints several times during the first visit to the doctor once a trimester and before birth.
volume survey determines the physician.In most cases the diagnosis of bacterial vaginosis is not a problem and does not require a large number of surveys.
treatment of bacterial vaginosis
For each case of bacterial vaginosis doctor is individual treatment.No standard treatment schemes does not exist.
Any selected treatment plan should take into account that the pathological process in bacterial vaginosis develops due to changes in the composition of the normal vaginal microflora and quantitative increase in opportunistic microbes.The therapy involves two main stages - antibacterial therapy and recovery microbiocenosis vagina.
volume of treatment depends on several factors:
- the severity of complaints;
- the form in which the disease occurs;
- disease duration;
- concomitant gynecological diseases;
- the presence of inflammatory processes;
- extragenital pathology and so on.
Before treatment with the patient interviewed on compliance with certain rules that the treatment was effective.During therapy to avoid alcohol, spicy, and spicy food.If the patient is being treated for another illness, it must notify the doctor as some medications can interfere with the effect of treatment.At the time of therapy, patients are encouraged to sexual rest.
During the first stage of treatment using a local antibiotic therapy.Medications are selected based on the data of laboratory examination (smear microscopy of vaginal contents).Antibacterials eliminate unfavorable vaginal flora and create favorable conditions for the growth of "good" flora.For this purpose, administered vaginal creams and suppositories for bacterial vaginosis.