Therapy
Bacterial vaginosis (BV)
Bacterial vaginosis (BV) is a disturbance of balance in vaginal ecosystem consisting in loss of domination role of lactic acid bacteria (Lactobacillus spp.). This is usually accompanied by troublesome symptoms – discharge, itching, burning.
Vaginosis should be differentiated from vaginitis – the term concerning inflammatory process in the vaginal tissues. They are not equivalent, but they are often mistaken:
- Bacterial vaginosis (BV) is a usually autogenic infection concerning a change of qualitative and quantitative relations of bacterial flora of the vagina.
- Vaginitis is an inflammatory condition of the vagina.
In the course of BV, in the ecosystem of the vagina, the following bacteria start to dominate: Gardnerella vaginalis, Bacteroides spp., Prevotella spp., Mobiluncus spp., Peptostreptococcus spp., Mycoplasma hominis, Fusobacterium spp., Veillonella spp., Atopobium vaginae and Eubacterium spp. Also Ureaplasma urealyticum and Streptococcus viridans may be found.
In the course of BV, the following examinations are typically indicated:
- evaluation of vaginal pH,
- evaluation of vaginal ecosystem (identification of so-called clue cells and differentiation between a causative factor, i.e. finding presence of trichomonas or yeasts cells in visible field),
- culture of a smear taken from genital tract.
Treatment
Treatment includes orally or intravaginally administered antibacterial drugs such as Clindamycin and Metronidazole.
Systemically administered antibiotic besides killing pathogenic bacteria may disturb ecosystem of the vagina and intestine. Antibiotics of so-called wide spectrum of action while used for too long time cause proliferation of yeasts of Candida albicans genus leading to candidiasis of oral mucosa and the vagina. In the case of proliferation of bacteria of Clostridium difficile genus, which occurs as a result of disturbance of bacterial flora of gastrointestinal system, post-antibiotic diarrhoea may occur.
In all these conditions, vaginal microflora should be maintained in a balance or should be brought to this state after antibiotic therapy. In such situations, probiotic preparation may be given together with the antibiotic or after the end of its administration, if strains contained in the preparation are not resistant to a certain antibiotic.
Vaginal mycosis (Candidiasis)
The most common pathogen causing vaginal mycoses is yeast of Candida albicans genus. In order to diagnose mycotic infection, we carry out direct microscopic examination of pathological discharge, and then we carry out its culture.
Due to frequent recurrences of this condition, it is recommended to carry out the examination of susceptibility of fungi to various preparations. Due to this examination (micogram), efficacy of treatment significantly increases. Some conditions (decompensated diabetes, contraception, pregnancy) are predisposing factors for development of mycosis.
Treatment
In the case of infection with the above mentioned fungi, it should be remembered that both partners should be treated concomitantly.
Drugs of choice in treatment of vaginal candidiasis are the following intravaginal drugs: nystatin or drugs of azole group. Therapy with these drugs presented in the form of intravaginal tablets, globules, gels or creams lasts usually 3-14 days. Single therapy with the drug given at high dose is possible. Additionally, it is recommended to use external ointments or gels. In the case of recurrent or severe infections, antimycotic drugs used orally are indicated.
As an adjunct, in the treatment of mycotic infections, vaginal system should be supplemented with selected probiotic bacteria of Lactobacillus genus. We act the same as in the case of BV. Similarly as in the latter case, it is important that the used probiotic contain lactic acid bacteria (Lactobacillus genus), which are naturally isolated from healthy women.
Trichomoniasis
Trichomoniasis is at present a smaller epidemiological problem than 10-20 years ago.
Trichomonas is a protozoon transmitted mainly sexually and causes urogenital tracts infections. Infection with vaginal trichomonas (Trichomonas vaginalis) is transmitted with prostate gland secretion and infected semen.
In men, this disease in manifested by postthitis, inflammation of glans penis and urethra. Typical symptoms are thus itching, burning, pain of the urethra, pollakiuria. Trichomoniasis is thus a sexually-transmitted disease, however, indirect infection is also possible due to poor hygiene (using the same towels, sanitary equipment).
In the case of women, untreated trichomoniasis may cause infertility or complications of pregnancy (due to colonization of the uterus, and even uterine tube). Trichomonas may come through urethra to urinary bladder. Typical symptoms, besides the mentioned dysuric symptoms, are discharge, often foamy, of unpleasant smell and yellow or greenish colour. It should be remembered that the disease may have asymptomatic course.
Treatment
Similarly as in the case of BV, treatment of choice in trichomoniasis is metronidazole.
After treatment vaginal flora should be supplemented by lactic acid bacteria preparations.
