Treatment of bacterial vaginosis

Treatment of bacterial vaginosis is the elimination of all symptoms and normalization of the vaginal microflora. Bacterial vaginosis has several forms and types and can be designated by the following diagnostic synonyms - nonspecific vaginosis, vaginal lactobacillosis, anaerobic vaginosis, gardnerellosis, aminocolpitis and even vaginal dysbacteriosis. Such a wide variety of designations is due to the fact that the disease was formalized and described terminologically after the adoption of the International Classification of Diseases of the Tenth Revision, that is, it was not included in ICD-10. Accordingly, there is also no single standard therapeutic regimen, the treatment of bacterial vaginosis provides for several options that depend on the type of pathogen, the form and symptoms of vaginosis.

Bacterial vaginosis is a disturbance in the balance of the microflora of the vaginal mucosa, when the number of pathogenic bacteria, which should be no more than 2 percent, significantly exceeds the number of lactobacilli. The lactose environment maintains optimal protection for the mucosa by creating a certain level of acidity. Local immune cells also protect the mucosa from bacterial infection.

The main causes that provoke bacterial bacteriosis include hormonal dysfunctions, medication factors (antibiotic treatment), decreased immune protection, and intestinal dysbacteriosis. The main goal of bacterial vaginosis treatment is to neutralize harmful bacteria to restore balance in the vaginal microflora.

Treatment of bacterial vaginosis directly depends on the type of pathogenic microbes, among which gardnerella are most often detected, and the manifestation of symptoms.

Symptoms of bacterial vaginosis:

• Asymptomatic course of the disease, the most dangerous form, since vaginosis becomes chronic;
• Discharge is of a viscous consistency, white in color, and has a characteristic odor (fishy);
• A feeling of constant itching in the vagina;
• Painful or uncomfortable sensations during sexual intercourse;
• Rarely - painful urination.

Bacterial vaginosis is one of the most common infections of the female genital organs, which, unlike other bacterial pathologies, is not transmitted sexually. Every year, over 10 million women in European countries alone seek medical attention with complaints of vaginosis. The disease knows no age, national or status boundaries and can develop in every third woman. Such epidemiological statistics are explained by a general decrease in immune protection in the population of civilized countries; medicine has not yet suggested another reason

Treatment of bacterial vaginosis takes place in two stages – elimination of bacterial damage and normalization of the microbiocenosis (stable balance of microorganisms).

The initial stage is aimed at eliminating pathogenic microorganisms. Antibacterial therapy is indicated, which is prescribed locally in the form of suppositories and ointments. Treatment of bacterial vaginosis is usually carried out with metronidazole, in parallel with this group of drugs, immunomodulators and antihistamines are prescribed. The use of local anesthetics is also indicated to reduce the sensation of itching and burning.

The general treatment regimen recommended by American gynecologists and adapted for use in the CIS countries looks like this:

• Hexicon (chlorhexidine) – twice a day in the form of suppositories, a course of at least a week;
• Clindacin (clindafer, clindamycin) in the form of an ointment, applied intravaginally at night, for a course of at least a week, the ointment can be replaced in the form of a suppository;
• Metronidazole in tablet form - twice a day, 500 mg, course of at least a week;
• Metronidazole is often replaced by a more active analogue – ornidazole, in which case the course of treatment is five days.

Antibacterial treatment of vaginosis excludes the use of any alcoholic beverages. Treatment of bacterial vaginosis should be complete, if the course of therapy is interrupted, relapses of the disease are possible. It should be taken into account that the metronidazole group of drugs can provoke an allergic reaction, so oral therapy can be replaced by local applications with clindamycin. Metronidazole-based gel should not be prescribed, since its intolerance is systemic.

Treatment of bacterial vaginosis at the second stage involves the use of bioactive drugs containing lacto- and bifidobacteria. They are prescribed either locally or orally. Population of the vagina with "useful" bacteria is advisable only after antibacterial treatment; the combined use of antimicrobial and bioactive drugs is not effective. The following probiotics (eubiotics) are considered effective:

• Lactobacilli.
• Lactobacterin in tablet or ampoule form has high bioavailability, as it is a dry mass of natural intestinal symbionts. Lactobacterin restores microbiocenosis, normalizes the condition of the vaginal mucosa.
• Gastrofarm is a combination of Lactobacillus, nucleic and lactic acids and polypeptides.
• Bifidobacteria.
• Bifidumbacterin – this eubiotic has high activity, suppressing the activity of staphylococci, shigella, yeast microorganisms and gardnerella.
• Combination drugs.
• Bifiform is a probiotic containing bifidobacteria in optimal combination with enterococci.
• Linex is a probiotic that contains three different types of lactic acid bacteria in equal quantities. Lactobacillus acidophilus harmoniously coexists with bifidobacteria and enterococci.

Treatment of bacterial vaginosis with probiotics and eubiotics is advisable to carry out three to four days after the end of antibacterial therapy, thus eliminating the possibility of confrontation between probiotics and antimicrobial elements. Bacterial infection is usually treated within 7-10 days, with strict adherence to medical recommendations, the effectiveness of therapeutic measures is about 95%. Relapses are possible due to interruption of the course of antibacterial therapy, or violation of the dosage and regimen of drug use. Neutralization of bacterial vaginosis also involves adherence to a proper diet and elimination of the main etiological cause of infection - restoration of hormonal balance and treatment of intestinal dysbacteriosis.