Bacterial vaginosis

Treatment of bacterial vaginosis

Bacterial vaginosis is a common, typically female problem that affects a very large percentage of women at least once a year.

The condition is characterized by a change in the vaginal flora, in which the balance between anaerobic and lactobacilli is disturbed with a predominantly increasing anaerobic population. As a result, the condition may be asymptomatic (detected by random microbiological examination) or with characteristic symptoms (tingling when urinating, pain during sexual intercourse, itching, vaginal discharge with a typical fishy odor).

The most common provoking factors of the condition are frequent change of sexual partner, lack of protection during sexual intercourse, use of vaginal deodorants, spermicides. Prolonged menstruation, use of tampons (instead of sanitary pads), smoking are also considered risk factors.

Hormonal changes that occur during pregnancy also lead to changes in the vaginal flora, which increases the risk of developing bacterial vaginosis. Regarding the risks for the normal course of pregnancy (premature birth, low birth weight, inflammation of the ovaries, fallopian tubes, uterus, etc.), it is important to frequently monitor the pregnant woman and prophylactic microbiological examination for early detection of bacterial vaginosis and determine adequate therapy tailored to the woman’s condition.

It is necessary to distinguish bacterial vaginosis from common fungal infections, since the conditions are similar in many symptoms, but differ in the type and characteristics of vaginal secretions. Bacterial vaginosis is successfully treated with antibiotics, while fungal infections require antifungal therapy, which is why an accurate diagnosis is necessary for successful and effective therapy.

Timely treatment of bacterial vaginosis reduces the risks of various types and severity of complications associated with bacterial vaginosis and chronic processes (pelvic-inflammatory diseases, sexual transmission, reproductive difficulties). diseases such as gonorrhea, herpes , chlamydia , syphilis.

Drugs for the treatment of bacterial vaginosis

Treatment of bacterial vaginosis is etiological (focused on the specific cause of the disease) and involves the use of appropriate antibiotics and chemotherapeutics. Medicines are prescribed by a doctor after examination and examination and microbiological examination of vaginal secretions and after the diagnosis of bacterial vaginosis. With adequate therapy, the effectiveness of treatment reaches 90 percent.

Strong medications are needed, often by both partners (in men, the disease is often asymptomatic).

Discontinuation of treatment before the time prescribed by the doctor (usually between 5 and 7 days), even after a visible and significant improvement in the health picture, carries a serious risk of recurrence of the disease.

When prescribing drug therapy, it is necessary to explain to patients the benefits and risks of side effects, as well as some precautions (such as abstinence from alcohol during and 48 hours after the use of imidazole). Depending on the severity of the infection, the general condition of the patient and a number of individual characteristics, the drugs are given orally (tablets or capsules for oral use) or vaginally (in the form of topical creams, globules or vaginal applications). suppositories.

Antibiotics and chemotherapeutics are used for treatment, which have a wide range and high efficiency against anaerobes that inhabit the normal vaginal environment.

The most commonly used means of choice in clinical practice are the following:

  • metronidazole : metronidazole is an extremely broad-spectrum nitroimidazole derivative and is used in a wide range of bacterial and protozoal infections, including bacterial infections of various localizations. Due to its high activity against anaerobes, the preparation is the drug of first choice for bacterial vaginosis. It works by destroying the DNA of anaerobes and inhibiting the synthesis of their vital nucleic acids. It is available for oral use (tablets) or topically (vaginal gel). Initially (in newly diagnosed bacterial vaginosis) it is used either in the form of 500 milligram tablets twice a day for seven days or in the form of a vaginal gel at a concentration of 0.75 percent intravaginally once a day for five days. . Applied topically, the drug also shows anti-inflammatory activity. In the absence of the effect or recurrence of the infection, as well as in chronic forms of the disease, longer use may be necessary, at the discretion of the attending physician. Patients should be warned about possible side effects, and stomach discomfort, allergic reactions, headaches, etc. often occur. When treating bacterial vaginosis during pregnancy or breastfeeding, it is recommended to avoid its use if possible (a safer alternative such as clindamycin is preferred). During treatment and up to 48 hours after its completion, alcohol use is contraindicated due to the risk of developing severe side effects (palpitations, nausea, vomiting, mental changes, shortness of breath)
  • tinidazole : tinidazole is an antimicrobial agent belonging to imidazole derivatives. It is available for use in the form of tablets for oral use, which are taken for two days at two grams or five days at one gram per day, with a course of therapy in both partners. Despite its good efficacy and high activity against anaerobes, often the cause of bacterial vaginosis, the drug is an alternative to metronidazole and is used in the absence of effect or contraindications to the use of metronidazole. It shows an identical risk of side effects after oral use, so caution is required in some groups of patients. Alcohol use is contraindicated during treatment and up to 72 hours thereafter due to the risk of developing a disulfiram reaction
  • clindamycin : clindamycin is an antibiotic from the lincosamide group, which inhibits the reproduction of sensitive bacteria (has the effect of bacteria). It is often used in combination with metronidazole or tinidazole in order to achieve greater efficiency of therapy and reduce the risk of developing resistance to drugs with clindamycin monotherapy. It is used in various dosage forms, most often as a vaginal cream, usually in a concentration of two percent (one full applicator of 5 grams per day, preferably in the evening before bedtime) for seven days. It is also available in the form of vaginal suppositories once a day (in the evening, before bedtime) for three days. The oral form (300 milligrams twice a day for seven days) is rarely used due to the risk of developing pseudomembranous colitis, which is a serious side effect. When using local, intravaginal forms of application, side effects are rarely noticed (tingling, itching, discomfort, increased flow, etc.). It is important to warn patients that topical clindamycin leads to less effective condoms and can lead to unwanted pregnancies or sexually transmitted diseases. Therefore, an alternative method of protection or abstinence from sexual intercourse is recommended during therapy
  • probiotics : Although there are conflicting results regarding the effectiveness of probiotics (topical and oral), many medical professionals prescribe them in parallel with antibiotic therapy to improve its effectiveness and increase lactobacilli in the vaginal flora. They are used in various dosage forms and are often prescribed for a longer period of time than a course of antibiotics

Drug therapy has shown high efficiency and good results, although the condition is often treated.

Caution is needed if you are pregnant or planning to become pregnant, because bacterial vaginosis can cause premature birth, low birth weight and weeks of pregnancy, pelvic inflammatory disease and other diseases.

For that reason, when diagnosing pregnancy and several times during pregnancy, microbiological examinations of vaginal secretions are performed in order to detect asymptomatic bacterial vaginosis and prescribe appropriate therapy.

If you have typical symptoms of the disease and you are pregnant (or suspect pregnancy), consult your doctor and do not self-medicate.

Measures to prevent bacterial vaginosis

Despite timely and effective treatment, bacterial vaginosis has shown a high tendency to recur, especially in the first three to nine months of therapy.

For that reason, increased caution, awareness of the disease (ways of infection, characteristic symptoms, first self-help measures, when to seek professional help) and health culture of the population, especially females, are recommended.

In general, to reduce the risk of infection or disease recurrence, it is recommended that:

  • safe sex practice : always use protective equipment (condoms) that will provide you with protection not only from unwanted pregnancy and a number of sexually transmitted diseases, but also significantly reduce the risk of developing and developing bacterial vaginosis
  • Regular testing for sexually transmitted diseases : As in many cases sexually transmitted diseases are asymptomatic for a long time, regular testing (especially for HIV, gonorrhea, chlamydia) is recommended, especially when changing partners (partner screening is also recommended). Basic, asymptomatic sexually transmitted infections can cause a variety of complications, including reproductive problems
  • monogamy : frequent change of sexual partner, as well as sexual intercourse with several partners at the same time carries serious risks of developing bacterial vaginosis, so monogamy is recommended 
  • good personal intimate hygiene : personal hygiene, the use of appropriate intimate care products, appropriate disinfectants and quality laundry reduces the risk of vaginal infections. It is recommended that you do not share your towels, underwear and clothes and do not use someone else’s, because in some cases the infection can come this way, although rarely
  • do not use deodorants either : regular use of vaginal deodorants adversely affects the vaginal microflora and reduces the natural balance between lactobacilli and anaerobic bacteria, including the risk of bacteria and nature may be ineffective if you continue vaginal rinsing
  • smoking cessation : smoking in women is one of the leading risk factors (with the use of vaginal douching and frequent changes of sexual partners) for the development of bacterial vaginosis. Seek help from your doctor or other specialist, join the appropriate support groups, because smoking cessation has many health benefits.
  • timely consultation with a specialist in case of symptoms : in case of the first symptoms of the disease (burning when urinating, unpleasant vaginal odor, discomfort during sexual intercourse, vaginal discharge, etc.) specialist to take timely measures and determine appropriate drug therapy, because chronicity of the process creates difficulties in treatment bacterial vaginosis

Effective treatment of bacterial vaginosis is often long-lasting, persistent and requires effective drug therapy in both partners.

Timely therapy significantly reduces the risks of various types of complications associated with altered vaginal flora, which often require much more serious and invasive therapy.

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