Treatment of bacterial vaginosis

The treatment of bacterial vaginosis is the elimination of all symptoms and the normalization of the vaginal microflora. Bacterial vaginosis has several forms and can be designated by the following diagnostic synonyms: nonspecific vaginosis, vaginal lactobacillosis, anaerobic vaginosis, gardnerellez, aminocolpitis and even vaginal dysbiosis. Such a large 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 the ICD-10. Accordingly, a single standard therapeutic regimen also does not exist, treatment of bacterial vaginosis involves several options that depend on the type of pathogen, the form and symptoms of vaginosis.

Vaginosis of bacterial etiology is an imbalance in the microflora of the vaginal mucosa, when the number of pathogenic bacteria, which should not be more than 2 percent, significantly exceeds the number of lactobacilli. Lactosreda maintains optimal protection for the mucosa by creating a certain level of acidity. Cells of local immunity also rise to protect the mucosa from bacterial infection.

Among the main causes of bacterial bacterial disease, called hormonal dysfunction, drug factor (antibiotic treatment), decreased immune defense, intestinal dysbacteriosis. The main goal pursued by the treatment of bacterial vaginosis is the neutralization of harmful bacteria to restore equilibrium in the microflora of the vagina.

The treatment of bacterial vaginosis directly depends on the type of pathogenic microbes, among which the most frequently detected gardnerella and manifestations of symptoms.

Symptoms of vaginosis of bacterial etiology: 

• The asymptomatic course of the disease is the most dangerous form, since the vaginosis passes into a chronic stage; 
• Allocations - viscous consistency, white hue, having a characteristic smell (fishy); 
• Feeling of constant itching in the vagina; 
• Painful or uncomfortable sensations in sexual intercourse; 
• Rarely - painful urination.

Bacterial vaginosis is one of the most common infections of female genital organs, which unlike other bacterial pathologies is not transmitted sexually. Annually only in European countries with complaints of vaginosis, more than 10 million women apply to doctors. The disease does not know the age, national or status boundaries and can develop in every third woman. Such epidemiological statistics is explained by a general decrease in immune protection in the population of civilized countries, another reason is that the medicine does not yet make

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

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

The general scheme of treatment, recommended by American gynecologists and adapted to 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; 
• Clindacine (clindafer, clindamycin) in the form of ointment applied for the night intravaginally, the course is not less than a week, the ointment can be replaced with the form of a suppository; 
• Metronidazole in tablet form - twice a day for 500mg, course not less than a week; 
• Metronidazole is often replaced by a more active counterpart - ornidazole, in which case the course of treatment is five days.

Antibacterial treatment of vaginosis precludes the use of any alcohol-containing beverages. Treatment of bacterial vaginosis should be complete, if the course of therapy is interrupted, recurrence of the disease is possible. It should be noted that the metronidazole group of drugs can provoke an allergic reaction, therefore oral therapy can be replaced with local applications with clindamycin. The gel based on metronidazole should not be prescribed, since its intolerance is systemic in nature.

Treatment of bacterial vaginosis in the second stage involves the use of bioactive drugs containing lacto- and bifidobacteria. They are appointed either topically or orally. The population of "useful" vaginal bacteria is expedient only after antibacterial treatment, the complex use of antimicrobial and bioactive drugs is not effective. The following probiotics (eubiotics) are considered effective:

• Lactobacillus. 
• Lactobacterin in tableted or ampoule form has a high bioavailability, as it is a dry mass of natural intestinal symbionts. Lactobacterin restores microbiocenosis, normalizes the mucous membrane of the vagina. 
• Gastroparm is a combination of Lactobacillus, nucleic acids, lactic acids and polypeptides.
• Bifidobacteria. 
• Bifidumbacterin - this eubiotic has a high activity, suppressing the activity of staphylococci, shigella, yeast microorganisms and gardnerella.
• Combined preparations. 
• Bifiform - a probiotic containing bifidobacteria in optimal combination with enterococci. 
• Lineks is a probiotic, which consists of three different types of milk bacteria in equal amounts. Lactobacillus acidophilus harmoniously "neighbors with bifidobacteria and enterococci.

Treatment of bacterial vaginosis with probiotics and eubiotics is advisable to be carried out three to four days after the end of antibiotic therapy, thus eliminating the possibility of confrontation of probiotics and antimicrobial elements. Bacterial infection, as a rule, is treated within 7-10 days, with strict adherence to medical recommendations, the effectiveness of therapeutic measures is about 95%. Relapses are possible due to discontinuation of the course of antibiotic therapy, or a violation of the dosage and mode of administration of medicines. Neutralization of bacterial vaginosis also implies the observance of a proper diet and elimination of the main etiological cause of infection - restoration of hormonal balance and treatment of intestinal dysbiosis.