Video: ❶ At A Gynecologist's Appointment: Gardnerellosis
About 50% of vulvovaginal infections are vaginal dysbiosis. It manifests itself in the form of bacterial vaginosis, previously known as gardnerellosis. At the same time, asymptomatic forms of the disease account for about 50%. Location: Location:
Gardnerella is a disease caused by Gardnerella vaginalis, which occurs due to their increased growth with a decrease in the number of lactobacilli characteristic of the normal microflora of the vagina. Gardnerella is normally found in 5-60% of healthy women, since they are opportunistic.
The composition of the vaginal microflora has been discussed since the second half of the 19th century. Previously, any inflammation in the vagina caused by nonspecific pathogens (that is, not Trichomaniacs, gonococci or Candida fungi) was classified as nonspecific vaginitis. Then they were successively renamed into Haemophilus vaginalis vaginitis, Corynebacterium vaginitis, then Gardnerella vaginitis (gardnerellosis), anaerobic vaginosis, nonspecific vaginosis.
Finally, in 1984. at the International Symposium on Vaginitis in Sweden, the term used today was introduced - bacterial vaginosis. Bacterial, as there is an excessive growth of bacteria with a predominance of anaerobes, and vaginosis, because there are no cells responsible for inflammation - leukocytes.
Normally, in healthy women, 1 ml of vaginal discharge contains 105-107 microorganisms. At the same time, up to 90-95% is lactobacilli, which produce hydrogen peroxide, ensuring the acidity of the environment. Peroxide secreted by lactobacilli inhibits the growth of anaerobes, maintaining the composition of the vaginal microflora.
With bacterial vaginosis, the situation is the opposite - anaerobes begin to prevail, dysbiosis develops. Vaginal dysbiosis occupies a fairly large proportion of vulvovaginal infections (up to 50%). At the same time, the ability of lactobacilli to produce hydrogen peroxide decreases, as a result, the acidity of the medium changes, the number of bacteria as a whole increases to 1011 per 1 ml. In this case, anaerobes begin to actively produce amines, which are the cause of the "fishy" smell of vaginal discharge. Also, amines, together with organic acids, have a toxic effect on the epithelial cells of the vagina, which are intensively exfoliated, which causes abundant discharge.
It is not known exactly what changes the composition of the vaginal microflora, concomitant infections, a violation of personal hygiene, a decrease in immunity, changes in hormonal levels, some drugs (mainly antibiotics), structural changes in the genital organs and even an active sex life can affect.
The disease can be manifest and latent. In 50% of women, clinical manifestations are not found. If there are symptoms, then it is a profuse discharge with an unpleasant odor (often described as the smell of "rotten fish"), grayish or whitish, sometimes yellowish-greenish, foaming, more abundant during menstruation or after unprotected intercourse. All of these symptoms can be observed for many years with varying degrees of severity.
The diagnosis is based on the detection of the following signs: an increase in the pH of the vaginal secretion more than 4.5, the identification of amines using tests, the detection of "key" cells in the vaginal discharge, microscopy of vaginal smears, chromatographic examination are used.
Treatment of the disease essentially consists in restoring the normal microflora of the vagina. To suppress the growth of anaerobes, metronidazole and clindamycin are used for seven days. The drugs can be given by mouth or as vaginal tablets. Oral forms and topical treatments can be used simultaneously to increase efficacy. If necessary, add antifungal drugs - fluconazole. Sometimes tinidazole, ornidazole are used.
To restore the flora of the vagina, eubiotics are prescribed - lactobacterin, acylact, bifidumbacterin locally in the form of suppositories.