Bacterial vaginosis is one of the most widespread infectious diseases of women, which is based on the violation of vaginal microbiocinosis, increased growth of aerobic and anaerobic microflora replacing lactobacillary microflora. Bacterial vaginosis is a new term in the classification of infections of the genito-urinary tract, formerly called “coronbacterial vaginitis”, “gardnerellez”, “anaerobic vaginosis”.
The wide spread of bacterial vaginosis, detected in 20-30% of women of reproductive age, the development of complications associated with this disease – miscarriage, amniotic infection, postpartum and postabortion endometritis, salpingitis, salpingoophoritis, wound infection, etc. – make the study of this problem urgent .
Etiology. In bacterial vaginosis, the vaginal microbiocenosis is imputed: a sharp decrease or disappearance of lactobacilli, a marked predominance of bacteroides, peptostreptococci, gardnerella, mycoplasmas, mobiluncus and other anaerobes (Gardnerella vaginalis, Mobiluncus, Mycoplasma hominis, Bacteroides).
Development of bacterial vaginosis can be facilitated by endogenous (changes in hormonal status, decreased immunological reactivity, intestinal microbiocenosis) and exogenous factors (previous antibiotic therapy, transferred and concomitant inflammatory diseases of the urinary tract, use of hormonal agents, immunosuppressants).
The question of the significance of the sexual way of transmission of bacterial vaginosis to date has not been finally resolved.
The main clinical manifestations of bacterial vaginosis are homogeneous creamy discharge of gray-white color adhered on the mucous membrane of the vagina, which have an unpleasant smell. Inflammatory reaction of the vaginal mucosa is not characteristic for bacterial vaginosis, but does not exclude this diagnosis, as it is detected in a third of patients. Subjective sensations in the form of itching and burning are possible.
Laboratory confirmation of the diagnosis of bacterial vaginosis is carried out by measuring the pH of the vaginal discharge, setting the aminotest, using a Gram stain smear microscopy and native drugs with the determination of key cells. The isolation of the pure culture of Gardnerella vaginalis is inadvisable, since this microorganism can also be found in healthy women.
The diagnosis of bacterial vaginosis is considered justified with at least 3 of 4 symptoms:
- presence of homogeneous creamy discharge, adhered on the mucous membrane of the vagina and having an unpleasant smell;
- detection of key cells (lean cells of flat epithelium, covered with gram-positive microorganisms);
- positive amino test (appearance of a fishy smell when mixed in equal amounts of vaginal discharge and 10% KOH solution);
- pH of the vaginal discharge> 4.5.
Prevention. The risk factors for the development of bacterial vaginosis are:
- frequent change of sexual partners;
- use of intrauterine contraceptives;
- inflammatory diseases of the genitourinary sphere;
- reception of antibacterial drugs and immunosuppressants.
During treatment and follow-up, the use of barrier methods of contraception should be recommended. Sexual partners of women with bacterial vaginosis should advise the examination and, if necessary, prescribe appropriate treatment. Treatment of men with sexual partners of women with bacterial vaginosis is not considered mandatory.