Update: October 2018
Probably, every woman is at least once
during the course of her life she encountered a disease like bacterial
vaginosis of the vagina. itт малоприятный спутник не столько опасен
its manifestations, how many complications, the appearance of which can
But the greatest danger this disease acquires during
pregnancy, therefore, requires the maximum rehabilitation of microflora
vagina and restore normal microbiocenosis.
What is this disease?
Speaking of a similar disease – bacterial vaginosis, have in
non-specific inflammatory syndrome in which
the microbiocenosis changes significantly in quantitative terms
the vagina in the direction of increasing opportunistic microflora for
by anaerobic bacteria and reducing lactic acid bacteria or
Other names for the disease are Gardnerella,
vaginal dysbiosis or anaerobic vaginosis. Considering that with
This process is observed diversity of microorganisms, the name
�”Bacterial” is fully justified. However, the lack of smears
signs of inflammatory reaction (leukocytes), the term “vaginitis”
has changed to “vaginosis.” ATстречается заболевание в 15 –
80% of cases.
Classification of vaginal dysbiosis
According to the severity of vaginal dysbiosis, there are:
- compensated or 1 degree (there is no microflora in the smear,
epithelial cells are present unchanged and stored
possibility of infection with other pathogens
- subcompensated or 2 degree (the content of sticks decreases
Doderlein, increases gram-negative and gram-positive
flora, found from 1 to 5 “key” cells, insignificant
increase in leukocytes – up to 15 – 25);
- decompensated or 3 degree (no lactic acid bacteria,
there is a clinical picture of the disease, the “key” cells are completely,
various pathogens and elective or conditionally pathogenic
With the flow of secrete acute, torpid or erased and
asymptomatic vaginal dysbiosis.
Causes and mechanism of development of vaginal dysbiosis
Lactic acid bacteria or lactic acid are known to colonize the vagina.
bacteria (Doderlein sticks), whose function is to
processing glycogen and synthesizing lactic acid from it,
which create an acidic environment, thus inhibiting reproduction
optional and pathogenic microflora.
Among other things, Doderlein sticks produce more and
hydrogen peroxide, providing a disinfecting effect. AT случае
reduce the content of sticks Doderleyn acid medium (3.8 – 4.5)
the vagina moves to the alkaline side, thus provoking
growth of conditionally pathogenic microorganisms.
If in normal vaginal microflora lactic acid bacteria
95% or more of all microorganisms,
the remaining percentages are conditionally pathogenic flora
(bacteroids, peptokokk, staphylococcus and others).
The causes of bacterial vaginosis are not reproduction
any one conditionally pathogenic microorganism, and in
microbial associations. These are primarily Gardnerella,
mobilinkus and mycoplasma. With this disease mainly
the amount of anaerobic (not needing oxygen) increases
ATсе факторы, которые способствуют возникновению заболевания
can be divided into 2 groups:
Endogenous or acting from the inside
- menopause (a decrease in estrogen inhibits the growth and
reproduction of lactic acid bacteria);
- pregnancy (an increase in progesterone synthesis causes
relative estrogen deficiency, reduced immunity for
prevent rejection of the fetus);
- abortions (consequences) and miscarriages (hormonal stress);
- Kraurosis of the vulva (atrophy of the vaginal mucosa);
- intestinal dysbiosis;
- hormonal imbalance;
- endocrine pathology.
Exogenous factors include
- treatment, especially long or uncontrolled
- administration of cytostatics, antimycotic drugs and radiation
therapy (weakening of the immune system);
- neglect of intimate hygiene rules;
- excessive desire for cleanliness (douching, frequent
washing away with soap and vaginal showers);
- deformation of the vagina, cervix and pelvic floor muscles after childbirth,
operations or exposure;
- foreign body in the vagina;
- hygienic tampons, diaphragm, IUD,
- spermicides (see non-hormonal contraceptive
- change of sexual partner;
- active sex life;
- a history of inflammatory processes in the reproductive system or
As can be seen from all these factors, the disease is not
is sexually transmitted, and, therefore, is not transmitted sexually.
Active sex life contributes only to the colonization of the vagina.
conditionally pathogenic microflora, its reproduction and growth inhibition
How vaginal dysbiosis is manifested
Symptoms of bacterial vaginosis, in most cases not
have specific signs. Often the only
manifestation of the disease are only:
complaints of copious vaginal discharge that have
Odor is described by patients as a rotten fishy “flavor” or
ammonia smell (see discharge with fish smell). It’s connected with
the release of some opportunistic bacteria, in particular
gardnerella, in the process of vital activity of volatile amines. AT
the beginning of the infectious process
consistency and have a white or grayish tint color.
if a woman has bacterial vaginosis for a long time
If the disease lasts a long time, more than 2 years, then:
- whites change their consistency, become more stingy or
resemble a cheesy mass
- the color of the discharge becomes dark green
- also for discharge with dysbacteriosis of the vagina characteristic
following signs: they become thick and sticky over time, and
their distribution along the vaginal walls evenly. Whites easy
removed from the walls with a cotton swab.
- the volume of vaginal discharge reaches 0.02 liters per day (if
take into account that normally the amount of whiter is not higher than 2 – 4 ml).
- in a number of situations to the described infectious process
joins pathogenic flora that contributes to the development
- with a long process, a number of patients impose
complaints of slight or moderate itching / burning in the area of the vulva
(see vaginal itching)
- pains during sexual intercourse (see pain during sexual intercourse
- sometimes urination disorders (frequent and
painful urination in women).
A distinctive feature of the disease is the absence of visible
signs of inflammation. That is, by visual inspection observed
physiological pink color of the vaginal mucosa. Only in
in some cases, women in menopause are marked
single reddish points.
When conducting colposcopy confirmed the absence
inflammatory manifestations (there is no local or common
hyperemia, chiseled hemorrhages are not observed, mucous
vagina without edema and infiltration). But a third of patients may
identification of background processes of the cervix (ectropion, ectopia,
cervicitis) and cicatricial deformity.
Vaginal dysbiosis during pregnancy
Very frequent cases of diagnosis of this disease with
of pregnancy. Features of the female body in
gestational period is such that the risk of
anaerobic vaginosis. AT первую очередь возросшие шансы
the onset of the disease is due to an increase in the body
future mother of progesterone products, which is responsible for
progression of pregnancy, an increase in mucus content
cervical canal and its thickening to prevent penetration into
uterine cavity pathogenic agents and pH shifts.
However, not all pregnant women are at risk of dysbacteriosis
vagina due to the high content of lactic acid
bacteria in it. The particular danger is a disease
diagnosed while waiting for a child that has taken place
еще до of pregnancy. AT любом случае, анаэробный вагиноз требует
лечения в период of pregnancy.
Symptoms of the disease during pregnancy are fewer than
differs from the clinical manifestations in non-pregnant women. Future
mother is disturbed by thick, homogeneous lecterns that have an unpleasant
the smell of fish and different foamy.
But dysbacteriosis of the vagina is dangerous with its consequences and
complications for both the wife and the unborn baby:
- AT ранних сроках заболевание может стать причиной
- ATо 2 – 3 триместрах может произойти инфицирование плода и/или
membranes that will lead to their premature rupture and
prenatal discharge of water.
- Preterm birth, complications of the birth process and
the occurrence of septic diseases after childbirth – here
incomplete list of dangers that conceals in Gardnerellosis.
How to recognize vaginal dysbacteriosis?
Differential diagnosis of the disease is carried out with
inflammatory processes of the vagina (nonspecific colpitis,
candidiasis, gonorrhea, trichomonas colpitis). To establish
diagnosis gynecologist collects a detailed history, examines complaints
Examination – during the inspection of the vaginal / cervical walls on
vaginal walls are found homogeneous (homogeneous)
cream or whitish or grayish cream
shade, with an unpleasant fish bouquet and in large quantities. it
one of the signs of vaginal dysbiosis.
Smear – the second characteristic is visualization
�”Key” cells in the native material. �”Key” cells
are desquamated epithelial cells with stuck to them
gramvariable bacteria (gardnerella, mobilinkus and others).
Carrying out smear microscopy in addition to the detection of “key” cells
allows to establish that epithelial cells predominate over leukocytes
(there is no inflammatory reaction, see the reasons for the increase in white blood cells in
smear) and the number of Doderlein sticks is less than 5 in a smear.
Acidity – it is also necessary to determine the pH of the vaginal environment.
For this, a special pH-sensitive strip is immersed with tweezers
in the back vaginal fornix, where there is the greatest accumulation
secretions. Anaerobic vaginosis will indicate
an increase in pH to 4.5 and above (the third sign).
And confirms the diagnosis of the occurrence of a rotten fishy smell when
mixing white vaginal and 10% potassium alkali (KOH) in equal
quantities (as a result of a chemical reaction, volatile substances are released
The diagnosis is established with three positive signs of
Treatment of vaginal dysbiosis
Immediately when diagnosing bacterial vaginosis
start treatment The success of the therapy of this disease, as well as
any other, directly depends on correct and timely
diagnostics and prescriptions of effective drugs.
Therapy of vaginal dysbiosis is carried out in 2 stages:
- Первый этап – следует добиться улучшения
physiological conditions of the vagina, local and common
body defenses, as well as normalize hormonal status,
and of course eliminate anaerobic bacteria as pathogens
- ATторой этап заключается в восстановлении
normal vaginal microflora.
Principles of treatment include the return of normal microbiocenosis.
vagina, the creation of the physiological, that is acidic environment in it, and,
certainly suspend the growth and reproduction of bacteria that are not
characteristic of a healthy vaginal microflora.
- In addition, the treatment regimen should include
desensitizing and immunocorrective drugs
- Prescribing treatment to a sexual partner is inexpedient.
How to treat anaerobic vaginosis?
- Tablets and Candles
Most often, he is the drug of choice, used
metronidazole (Trichopolum, or its derivatives, which is effective in
against anaerobic bacteria. Tinidazole may also be used.
or Ornidazole, Clindamycin. Dosage for all listed
drugs is 0.5 grams. twice a day with a duration of
week (maximum 10 days).
In the treatment of metronidazole and other active against
anaerobic drugs should consider the possibility of
adverse reactions (nausea, metal taste in the mouth), and
warn patients about drinking alcohol
(it is prohibited to take alcohol during the course of treatment and in
for another day after the end).
Does not lose positions on the effectiveness of systemic use
drugs their local use, especially when pronounced adverse
reactions. Such candles from bacterial vaginosis are used as:
Neo-Penotran or Klion-D, Metrogil, Flagil, Trihopol, Clindacin (by
1 candle intravaginally per day, lasting 7 days) or
tampons with gels or creams (Metrogil-gel, Dalatsin, Rozamet,
Rosex) see anti-inflammatory candles in gynecology.
- Vitamin C
At the same time prescribed vitamin C (1 tablet three times a day),
which not only stimulates the immune system, but also improves the regeneration
tissue, reduces the permeability of the walls of blood vessels, resulting in
the transudation of fluid in the vagina is reduced.
- Vaginal instillations
Also, the first stage of therapy involves vaginal instillations of 2%.
lactic or boric acid once a day for a week.
Such manipulations contribute to the creation of an acidic environment that
unfavorable for reproduction of anaerobes.
- You should also take antiallergic drugs
(suprastin, tavegil, tsetrin, see allergy pills).
Restoration of microflora
In the second stage, begin using biologics.
(intravaginal administration). Apply apilac, acylact,
Bifidumbacterin, Lactobacterin and others. For this 2 – 3 doses
diluted with 5 ml of boiled water, blot with the resulting solution swab
and administered intravaginally twice a day (after 10 – 12 hours).
The duration of treatment is 7 to 10 days.
You can use candles:
- Bifidumbacterin (live bifidobacteria) 1 suppository 2
p / day 5–10 days.
- Bifikol (dried bifidobacteria) 7 – 10 days.
- Azilakt 10 days (110 rubles).
- Laktozhinal (450 rubles), Vagilak (500 rubles) lactobacilli, 1 each
vaginal capsule 10 days in the morning and evening.
Treatment of bacterial vaginosis during pregnancy
How to treat bacterial vaginosis in case of pregnancy? In the first
trimester of gestational systemic therapy of the disease is not performed
(metronidazole and other drugs are toxic to the embryo). Local
the introduction of etiotropic drugs in the early stages is used with
Taking metronidazole or clindamycin starts from the second
trimester and spend 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 grams. 2 times a day for
To prevent recurrent recurrences
promiscuous sexual relationships should be excluded, and in case of random
have sex using condoms. Also needed
strengthen immunity, regulate hormonal imbalance and
endocrine diseases, undergo medical examinations
gynecologist at least 2 times a year.
A vaccine has been used to strengthen local immunity.
Solko-Trichovac, the introduction of which is carried out intramuscularly, 3 times
In 2 weeks. One year later, a single revaccination is performed.
Vaccine administration creates immunity against vaginal dysbiosis for 2
of the year.