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Bacterial Vaginosis Remember - Bacterial Vaginosis (BV) is the most common cause of vaginal discharge. - Medication can cure BV, but remember to take ALL of it-even if the symptoms go away. - BV can come back even if you take medication. - Using condoms lessens the chance of getting a BV infection. Bacterial vaginosis or "BV" is a type of vaginal infection that is poorly understood. Women at any age can have it - even teens and women who have never been sexually active. It tends to be more common among girls and women who have had sex with one or more partners. What causes bacterial vaginosis? Bacterial vaginosis is a vaginal infection caused by an overgrowth of anaerobic bacteria and an organism called Gardnerella vaginalis. "Anaerobic" means the bacteria doesn't need any oxygen to survive or grow. Small amounts of these anaerobic bacteria and Gardnerella can normally be found in your vagina. Bacterial vaginosis occurs when the balance of organisms in your vagina is upset and the anaerobic bacteria overgrow. The good, protective bacteria Lactobacilli are then outnumbered and not able to do their normal job, which is to make a natural disinfectant which helps keep organisms at the normal, healthy balance in your vagina. When this happens, an infection occurs. The exact reasons that bacteria overgrow are not known. Bacterial vaginosis (often called BV) is not considered a sexually transmitted infections but it is more common in women with multiple sexual partners. BV may also occur after sexual intercourse with a new partner and after douching. Lesbian women also get bacterial vaginosis, and even women who have never been sexually active can have BV. What are the signs/symptoms of bacterial vaginosis (BV)? It's a fact that 50-75% of women who have BV don't have any symptoms but those who do often complain of a fishy smelling vaginal odor and a milky-white, or gray vaginal discharge. The discharge may be light or heavy. The odor may get worse around the time of menstruation or after unprotected sexual intercourse. When semen (male sperm) mixes with vaginal secretions, the odor becomes stronger. Less common symptoms include: vaginal itchiness, redness, and pain with intercourse. Your health care provider may notice vaginal discharge or odor during your routine pelvic exam and do a test of the vaginal fluid to see if you have BV or any other vaginal infections. If you do have BV, your health care provider will give you a prescription to treat it. How is bacterial vaginosis (BV) diagnosed? The only way to diagnose BV is by an exam by your health care provider (HCP) and testing the vaginal discharge. Your HCP will use a cotton swab to take a sample of your vaginal discharge. He/she can then measure the acidity of the discharge with pH paper. If your vagina is less acidic than it should be (pH of more than 4.5), this may be a sign that you may have bacterial vaginosis. Your HCP can look at the sample under a microscope. If the normal bacteria (lactobacilli) are not there but many "clue" cells (cells from the vaginal lining that are coated with bacteria) are present, you have bacterial vaginosis. How is bacterial vaginosis (BV) treated? If you have bacterial vaginosis, your health care provider will likely either give you a prescription for a cream or gel that you put into your vagina with an applicator or a prescription for pills that you take by mouth. You should let your health care provider know about any other medications that you are taking. If you use a vaginal cream or gel, you should NOT use tampons during the treatment because it will absorb the medication and make it less effective. Metronidazole or clindamycin are two antibiotics used to treat bacterial vaginosis. The medication works pretty quickly to cure BV, but you need to make sure that you take ALL of the medication for it to work. Many women choose the vaginal gel because the pills can cause nausea and a metal taste in your mouth. Others prefer the oral medication because they don't want to insert a cream in the vagina. Both are effective. - You should not use douches or vaginal deodorant sprays. Although they may help cover up the odor, they will not cure the infection, and they might make your infection worse. - Condoms may help to lessen the chance of getting BV if you are sexually active because the semen doesn't change the bacteria in the vagina. Even though BV is more common in young women who have sexual intercourse with many partners, treatment of a male partner does not prevent future BV infections. Can I get bacterial vaginosis again? Unfortunately, bacterial vaginosis often comes back, even if you take all of your medication and follow the advice from your health care provider (HCP). If your symptoms come back, see your HCP. You may need to be treated twice a week for a longer time. Can bacterial vaginosis cause any other problems? Bacterial vaginosis can increase your chance of getting a serious pelvic infection called pelvic inflammatory disease (PID), or an infection after a vaginal or uterus operation. It can also increase your chance of having problems with pregnancy such as low-birth weight babies or premature delivery (delivery before the normal 9 months). Treatment is important in pregnant women who have had premature babies in the past. If bacterial vaginosis is treated early, the risk of getting any of these problems are low. Are there any complications from bacterial vaginosis if it's not treated? Most of the time BV is treated and doesn't cause any problems. However, there are some serious risks you should know about. Having BV can put you at risk for other sexually transmitted infections. If left untreated, BV can cause pelvic inflammatory disease, which can damage your reproductive organs and cause fertility problems later. Pregnant women who have BV are more likely to have premature babies or babies that have a low birth weight (<5.5 pounds). Health care providers and scientists don't completely understand BV, but they do know that there are some basic ways to lower the chance of getting it, which includes: abstinence and avoiding douching. If you do get BV, be sure to take ALL of the medicine your HCP prescribes even if your symptoms go away. Related Guides: Anyone who has had sexual contact can get an STI. Men and women of all ages, regions, ethnic backgrounds, and economic levels can get them. One out of four Americans between ages 15 and 55 will catch at least one STI... PID is an infection of the female reproductive organs (the fallopian tubes, uterus, and ovaries). It is usually caused by an STI....
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Bakterijska vaginoza – uzroci, simptomi, dijagnoza i liječenje Bakterijska vaginoza je sindrom koji označava neravnotežu između laktobacila (Dӧderleinerov bacil; gram pozitvna bakterija koja čini fiziološku floru vagine, održavi kiseli pH i štiti sluznicu vagine) i anaerobnih bakterija, posebno Gardnerelle vaginalis, u korist anaeroba. Nekad se spomenuti sindrom nazivao specifičnim vaginitisom, koji je sukladno nastavku –itis upućivao na upalu, međutim budući da nema sve osobine prave upale termin se napustio. Bakterijska vaginoza može biti spolno prenosiva bolest s inkubacijom 5 do 10 dana, međutim može se nalaziti i u žena koje nisu spolno aktivne. Najčešće ju nalazimo u žena reproduktivne dobi, rijetko u postmenopauzi, a iznimno u djevojčica. Gardnerella vaginalis Gardnerella vaginalis je mali, gram pozitivni, nepokretni bacil. Sastavni je dio fiziološke flore maternice i debelog crijeva, a prilikom njenog prekomjernog razmnožavanja (stres, promjena spolnog partnera, gubitak fiziološke flore) nastaje bakterijska vaginoza. Kao vodeći uzročnik navedenog sindroma, najvjerojatnije produkcijom sukcinata omogućava rast i razmnožavanje drugih anaerobnih bakterija (Bacteroides spp, Peptococcus spp, Peptostreptococcus spp, Fusobacterium nucleatum, Mobiluncus spp, Veillonela parvula). Rizični čimbenici kod bakterijske vaginoze Bakterijska vaginoza je uglavnom kronična, ponavljajuća bolest. Rizični čimbenici bakterijske vaginoze su: - promiskuitet - nezaštićeni spolni odnos sa rizičnom osobom - česta ispiranja rodnice - korištenje spermicida - smanjena razina estrogena - intrauterini uložak (spirala) - antibiotska terapija Simptomi i klinički znakovi bakterijske vaginoze Uglavnom se radi o tihim, asimptomatskim upalama koje nastaju međudjelovanjem anaeroba i Gardnerelle. Smatra se da čine čak 50% svih upala rodnice. Kad anaerobi porastu za 10 puta, a Gardnerella za čak 1000 puta u 1ml vaginalnog iscjetka, govorimo o simptomatskoj bakterijskoj vaginozi, koja je istodobno praćena izrazitim padom laktobacila. Najčešći simptom je pojačani vaginalni iscjedak, sivkaste do mliječne boje, bez svrbeža i žarenja. Ukoliko se svrbež i žarenje pojave, najčešće su znak pridružene trihomonasne, gljivične ili drugih infekcija. Iscjedak ima vrlo neugodan miris (po ribi), koji se pojačava nakon menstruacije i spolnog odnosa. Sjeme partnera koje je alkalično (visok pH) u doticaju s niskim pH rodnice oslobađa aromatske amine i na taj način pojačava miris. Ostali simptomi vaginitisa izostaju, zato i ne govorimo o upali u pravom smislu riječi. Komplikacije bakterijske vaginoza Bakterijska vaginoza najčešće ne dovodi do komplikacija, međutim osobe u kojih se ne otkrije i ne liječi, zbog pada imuniteta, mogu se lakše zaraziti i drugim spolno prenosivim bolestima (Herpes simplex 2, Chlamidia trachomatis, Neisseria gonorrhoeae..), uključujući i HIV, te ih mogu prenijeti i na spolnog partnera. Ukoliko se upala proširi na gornji dio genitalnog trakta (jajovodi), povećava se mogućnost izvanmaterične trudnoće. U trudnica Gardnerella vaginalis može dovesti do prijevremenog poroda i rađanja hipotrofičnog novorođenčeta (novorođenče manje porođajne mase u odnosu na većinu novorođenčadi odgovarajućeg spola i dobi). Dijagnoza bakterijske vaginoze Dijagnoza se postavlja na osnovu kliničkih kriterija ili laboratorijskih nalaza, nakon bojanja po Gramu. Klinički (Amselovi kriteriji) tijekom pregleda u zrcalima, podrazumijevaju prisutnost sljedećih znakova ili simptoma: - pojačani vodenasti mliječno – sivkasti iscjedak po dnu i stijenkama rodnice - prisutnost tzv. “clue cells”, stanica poput klupka u mokrom ili nativnom preparatu - pH rodnice iznad 4,5 - vaginalni iscjedak neugodnog mirisa po ribi koji se pojačava nakon dodatka 10% kalijeve lužine (“whiff” ili “sniff” test) Liječenje bakterijske vaginoze Bakterijska vaginoza liječi se kao anaerobna upala. Zato je najbolje liječenje metronidazolom kroz 7 dana, koje daje bolje rezultate od jednodnevnog liječenja (75 – 95% izlječenja). Drugi lijek izbora je klindamicin ili ampicilin. Većina stručnjaka smatra da obavezno treba liječiti i spolnog partnera, inače će asimptomatska vaginoza u 50 do 70% pacijentica u roku od 1 do 2 godine prijeći u simptomatsku, što nosi određene komplikacije. Ako se ne liječi partner, recidivi su češći. Recidivi u roku od jednog do dva mjeseca su dosta česti, čak u 5 do 15% slučajeva. Nakon liječenja za mjesec dana provodi se test izlječenja. Budući da su Gardnerella vaginalis i anaerobi sastavni dio fiziološke flore vagine, ne smije se očekivati njihovo potpuno iskorijenjenje. Oni će uvijek biti nazočni, ali u puno nižim, fiziološkim koncentracijama koje su 100 do 1000 puta niže. U trudnoći se znakovi bakterijske vaginoze javljaju u 15 do 40% slučajeva. Zbog već opisanih opasnosti, simptomatske bakterijske vaginoze obavezno je liječiti. Liječenje treba biti sistemski (metronidazol ili klindamicin), najbolje nakon 20. tjedna trudnoće.