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Initially, the disease is harmless and easily treatable, but during pregnancy or if medical attention is delayed, it can lead to very unpleasant consequences. How to diagnose, treat, and prevent bacterial vaginosis? We will examine this in this article.
What It Is
Bacterial vaginosis (BV) is an infectious, non-inflammatory disease in which the quantity of beneficial Lactobacillus (lactic acid bacteria) sharply decreases in the vagina, and the growth of other bacterial strains increases. The condition is very common, affecting virtually 80% of women of reproductive age.
The vagina contains a large number of bacteria—around 100 million. Moreover, they have a strict hierarchy. In this system, Lactobacilli account for up to 90%. One of the main functions of these bacteria is to protect the vaginal microflora from inflammatory processes. Therefore, when the number of Lactobacilli decreases, the population of other, less beneficial bacteria begins to increase.
Bacterial vaginosis is not classified as a sexually transmitted infection (STI). However, if a woman has vaginal dysbiosis at the time of sexual intercourse, she can transmit this condition to her partner.
However, in men, the symptoms and manifestations of bacterial vaginosis resolve very quickly because they have a different physiology and local immunity of the genital organ cells. Therefore, urologists and andrologists treat this infection merely by three days of sexual abstinence. In contrast, a woman must undergo a comprehensive course of treatment.
What are Lactobacilli and What are They Responsible for
Vaginal Lactobacilli are a group of bacteria that colonize the vaginal microflora of a woman. They play an important role in maintaining the health and balance of the vaginal environment. The bacteria belong to the genus Lactobacillus and include various strains, such as Lactobacillus crispatus, Lactobacillus jensenii, Lactobacillus iners, and others. They have the ability to synthesize lactic acid, which helps to maintain the acidic pH in the vagina (usually about 3.5–4.5). The main function of Lactobacilli is to prevent the onset and development of infections. They help maintain normal microflora by suppressing the growth and multiplication of pathogenic microorganisms, such as fungi, viruses, and harmful bacteria.
Pathogenesis
Bacterial vaginosis does not have one specific causative agent. The "offenders" can be entirely different microorganisms, for example, Gardnerella, Peptoniphilus, P. bivia, M. Mulieris, Prevotella, Fusobacterium, Peptostreptococcus, Atopobium vaginae. But, as a rule, the disease is caused by an increase in the population of 2–3 strains.
When any trigger occurs (taking antibiotics, stress, ignoring personal hygiene rules), the causative agents begin the process of active multiplication, thereby alkalinizing the vaginal environment and increasing the pH level. Only Lactobacilli, which secrete lactic acid, can stop the growth of pathogenic bacteria.
Causes
The causes of bacterial vaginosis can be quite diverse. They can include both a simple violation of intimate hygiene and other triggers:
• Hormonal imbalance, including menstrual cycle irregularity.
• Taking antibiotics.
• Weak immunity.
• Poor nutrition.
• Diseases of the gastrointestinal tract (intestinal dysbiosis) or the urogenital tract.
• Acute and chronic infectious diseases.
• Stress.
• Prolonged use of an intrauterine device (IUD).
• Abortion.
• Trauma during childbirth.
Symptoms
The most crucial and fundamental symptom of bacterial vaginosis is a white or gray, thick discharge with a sharp, unpleasant odor, similar to the smell of fish. The woman herself perceives this odor. The signs are exacerbated when the vaginal flora is alkalized—after unprotected sexual intercourse and before menstruation.
However, only about 50% of patients experience and notice atypical vaginal discharge. Therefore, in half of the cases, the disease may be asymptomatic.
Additional symptoms may include burning and itching both in the vagina itself and in the rectal area. Furthermore, impaired urination and painful sensations during intimacy (dyspareunia) frequently occur.
Bacterial vaginosis is easily confused with vaginitis. However, the latter is characterized by severe dryness, redness, and swelling of the vaginal lining.
Diagnosis
Diagnosis and treatment of bacterial vaginosis are performed by a gynecologist. The presence and severity of the disease can often be determined during the woman's first consultation. The diagnosis is based on the patient's complaints, examination, vaginal smear for flora, and pH-metry of vaginal discharge. If this is insufficient, an extensive clinical and laboratory examination will be prescribed.
Significant attention is also paid to collecting the patient history (anamnesis). The doctor will ask the woman about current or previous medications, methods of contraception, nutrition, lifestyle, harmful habits, stress level, childbirth, and operations on the genital organs. This data can play an important role in the diagnosis and treatment of the patient.
Vaginal pH-metry is a modern method for diagnosing vaginal acidity. A disposable test strip with a sensory layer is used for the study. Upon contact with vaginal discharge, it changes color depending on the pH value. The result is known within a couple of minutes. To ensure maximum effectiveness of the test, you must undergo it no earlier than 48 hours after the last sexual contact and no sooner than 72 hours after using any vaginal preparations.
Complications
The vaginal environment in bacterial vaginosis changes from acidic to alkaline, which can lead to difficulties with conception, as, without proper and timely treatment, this condition can cause inflammatory processes in the uterus and adnexa (salpingitis and oophoritis).
This leads to infertility, difficulties in gestation, and missed miscarriage.
If the disease appears during pregnancy, chronic endometritis develops under the influence of the vaginosis pathogens. This can threaten premature rupture of membranes (PROM) and fetal infection. The risk of preterm birth increases twofold.
Some scientists suggest that the toxins from vaginosis pathogens can affect the fetus by penetrating the placenta, which may later become one of the causes of child hyperactivity. Furthermore, the link between this condition and the human papillomavirus (HPV) was recently proven. It was found that patients with bacterial vaginosis are more susceptible to the risk of human papillomavirus infection.
Treatment Methods
The goal of therapy is to reduce the vaginal pH and increase the level of Lactobacilli.
Both local treatment and oral medications are used for bacterial vaginosis. They are roughly comparable in effectiveness, but topical therapy has fewer side effects. In the second stage of treatment, prebiotics are taken to restore the vaginal microflora. To reduce dryness and discomfort, various moisturizing gels with lactic acid may be prescribed.
Additionally, during the treatment of bacterial vaginosis, the following should be excluded from the diet: sweets, smoked foods, fatty and salty foods, fast food, carbonated drinks, alcohol, and juices.
Prevention
Bacterial vaginosis is very often a consequence of lifestyle and incorrect habits. Therefore, it makes sense to discuss its prevention in the context of this disease. Prevention includes:
• Washing (intimate hygiene) at least twice a day. However, using soap or shower gel is discouraged, as the vaginal pH may be compromised. Special intimate gels with lactic acid are ideal.
• Changing pads and tampons every 2 hours (at least 4–5 times a day).
• Avoiding sexual intercourse during the first days of menstruation.
• Using underwear made of natural fabrics.
• Infrequent consumption of alcohol.
• Balanced nutrition.
• Controlled consumption of sweets and empty carbohydrates.
• Visiting a gynecologist at least once every six months.
Is Bacterial Vaginosis Possible in Men?
A man cannot contract bacterial vaginosis. Firstly, the word "vaginosis" itself implies a pathological process in the vagina, meaning it concerns the female reproductive organs by definition. Secondly, the microflora of the male urethra is significantly different from that which inhabits the female vagina. It is not in the same state of precarious balance, and disorders in it do not lead to the same symptoms and complications. Bacterial vaginosis is not classified as a sexually transmitted infection (STI), although the bacteria associated with it may spread during sexual contact. However, this condition increases the risk of contracting STIs due to the impairment of protective mechanisms in the reproductive organs.
Can Men Spread Bacterial Vaginosis?
A sexual partner can "pick up" the microorganisms associated with bacterial vaginosis from a woman. Data on whether men can spread this condition between partners are quite contradictory, and scientists are not entirely certain about them. However, some studies confirm the possibility of such transmission. A 2015 study involving 165 uncircumcised men showed that having two or more female partners increased the likelihood of carrying bacterial vaginosis-associated microorganisms on the penis. Because of this, women who engage in unprotected sex with such men have an increased risk of developing BV. Similar conclusions were drawn from a study conducted two years earlier, in 2013. It involved 157 men. During this study, scientists found that men who had previously suffered from non-gonococcal urethritis (inflammation in the urethra) were more likely to be carriers of bacterial vaginosis-associated microorganisms.
How is Bacterial Vaginosis Transmitted?
Bacterial vaginosis is not an STI, and a woman does not even need to be sexually active to contract it. Nevertheless, high sexual activity and the presence of multiple partners, as well as frequent partner changes, increase the risk of developing the disease. It is known that Gardnerella (Gardnerella vaginalis) plays a significant role in the development of the condition. Generally, these microorganisms are not considered contagious. But it is not entirely clear how actively they can spread from one person to another during sexual contact. Upon entering the vagina, Gardnerella creates an environment favorable for the multiplication of opportunistic bacteria. Notably, Gardnerella vaginalis is found in the vagina in 50% of cases without symptoms. This means that, in principle, this microorganism can be considered a normal representative of the vaginal microflora, and its excessive multiplication and the development of pathological changes are facilitated by additional factors. In any case, the multiplication of opportunistic microorganisms disrupts the protective mechanisms in the vagina, leads to the production of toxins and inflammatory molecules (cytokines), and impairs the function of local immunity. As a result, it becomes easier for other pathogenic bacteria to infect the organs of the reproductive system, and the risk of contracting STIs increases.
Classification and Stages of Bacterial Vaginosis Development
Depending on the symptoms of bacterial vaginosis and laboratory indicators, three forms of the disease are often distinguished:
• Compensated – when the number of Lactobacilli decreases, and the probability of pathogens entering the vagina from the external genitalia increases. Symptoms are minimal.
• Subcompensated – when the number of Lactobacilli is reduced, and a considerable number of pathogens are noted. The clinical picture is more pronounced compared to the compensated form.
• Decompensated – when Lactobacilli are practically absent, and there are many representatives of the pathogenic flora. The symptomatology is maximally expressed.
Depending on the nature of the course of bacterial vaginosis, terms such as "acute vaginosis," "recurrent vaginosis" (4 or more episodes of the disease per year), and "chronic vaginosis" (symptoms persist for longer than two months) are used. Depending on the presence of complications, uncomplicated and complicated forms of the disease are distinguished.
Furthermore, a classification was proposed in 1995 that distinguishes four types of vaginal biotope:
• Normocenosis – the normal state of the vaginal microflora, where Lactobacilli predominate.
• Intermediate type – also often noted in healthy women and not accompanied by symptoms. In this case, the number of Lactobacilli decreases, and there are Gram-negative rods and Gram-positive cocci, epithelial cells, leukocytes, macrophages, and monocytes.
• Vaginal dysbiosis – characterized by a very low number of Lactobacilli or their complete absence, and a varying number of leukocytes. This picture corresponds to bacterial vaginosis.
• Vaginitis – manifests as the presence of various pathogenic microorganisms, a large number of epithelial cells, leukocytes, macrophages, and monocytes. Clinically, this is non-specific vaginitis.
What is the Danger of Bacterial Vaginosis?
First and foremost, bacterial vaginosis is dangerous because it is one of the causes of infectious complications after the insertion of intrauterine contraceptives, gynecological surgeries, and abortions. The development of infectious and inflammatory processes in the pelvic organs is possible: salpingo-oophoritis (inflammation of the uterine adnexa), endometritis (inflammation in the uterine cavity), abscess (a pus-filled cavity), and peritonitis (inflammation in the abdominal cavity). During pregnancy, complications such as premature rupture of amniotic membranes, chorioamnionitis, preterm birth, and postpartum endometritis are possible. The risks are highest with a long course if adequate treatment for bacterial vaginosis in women is not provided.
What Indicators are Important for the Diagnosis of Bacterial Vaginosis?
To correctly establish the diagnosis, the doctor must evaluate the clinical picture and the results of laboratory tests (vaginal smears). In global gynecological practice, the Amsel criteria are often used. To confirm the diagnosis, the presentation must correspond to at least three out of four criteria:
1. Thin, homogeneous vaginal discharge that is white, gray, or yellow.
2. The smear shows the presence of vaginal epithelial cells with Gram-variable microorganisms densely attached to their surface (clue cells). Leukocytes are absent. And Lactobacilli are reduced, even to complete absence.
3. pH level greater than 4.5.
4. Upon adding an alkali (10% potassium hydroxide) to the test tube, the discharge emits a specific, unpleasant "fishy" odor (whiff test).
According to the modified Amsel criteria, only two factors from this list are sufficient. The sensitivity of this diagnostic method is 70%, and the specificity is 94%.
Alternatively, the Nugent method is sometimes used. It involves treating vaginal discharge with special stains (Gram staining) to identify the predominant bacterial strains. The result is evaluated on a scale from 0 to 10 points. The higher the score, the more microorganisms associated with bacterial vaginosis are present in the sample. This technique is most often used in scientific research; its application in clinical practice is extremely limited.
Is Sexual Intercourse Possible with Bacterial Vaginosis?
Since bacterial vaginosis is not sexually transmitted, there are no prohibitions on sexual activity. However, it is important to remember a few points. Firstly, sexual rest contributes to faster recovery. Secondly, the topical medications used for treatment can affect condoms and other contraceptives, reducing their effectiveness. Thirdly, frequent changes of sexual partners and unprotected sex are highly discouraged, as they not only contribute to the disruption of the vaginal microflora but also facilitate the contraction of STIs.
Advantages of Treatment at Expert Clinics
Leading medical specialists in the field of integrative medicine, including world-renowned experts:
• Can understand the deep-seated causes of diseases and the many complex interconnections in the body. When every nuance is taken into account, this makes the treatment maximally effective and helps prevent the recurrence of the disease in the future.
• Will develop individualized therapy regimens depending on the specific characteristics of bacterial vaginosis in each case, as well as any co-occurring health issues.
• Utilize the latest medical advancements. They work in accordance with modern standards and prescribe medications with proven effectiveness. Our goal is not only to rid you of the symptoms of the disease but also to preserve your health for many years.
What It Is
Bacterial vaginosis (BV) is an infectious, non-inflammatory disease in which the quantity of beneficial Lactobacillus (lactic acid bacteria) sharply decreases in the vagina, and the growth of other bacterial strains increases. The condition is very common, affecting virtually 80% of women of reproductive age.
The vagina contains a large number of bacteria—around 100 million. Moreover, they have a strict hierarchy. In this system, Lactobacilli account for up to 90%. One of the main functions of these bacteria is to protect the vaginal microflora from inflammatory processes. Therefore, when the number of Lactobacilli decreases, the population of other, less beneficial bacteria begins to increase.
Bacterial vaginosis is not classified as a sexually transmitted infection (STI). However, if a woman has vaginal dysbiosis at the time of sexual intercourse, she can transmit this condition to her partner.
However, in men, the symptoms and manifestations of bacterial vaginosis resolve very quickly because they have a different physiology and local immunity of the genital organ cells. Therefore, urologists and andrologists treat this infection merely by three days of sexual abstinence. In contrast, a woman must undergo a comprehensive course of treatment.
What are Lactobacilli and What are They Responsible for
Vaginal Lactobacilli are a group of bacteria that colonize the vaginal microflora of a woman. They play an important role in maintaining the health and balance of the vaginal environment. The bacteria belong to the genus Lactobacillus and include various strains, such as Lactobacillus crispatus, Lactobacillus jensenii, Lactobacillus iners, and others. They have the ability to synthesize lactic acid, which helps to maintain the acidic pH in the vagina (usually about 3.5–4.5). The main function of Lactobacilli is to prevent the onset and development of infections. They help maintain normal microflora by suppressing the growth and multiplication of pathogenic microorganisms, such as fungi, viruses, and harmful bacteria.
Pathogenesis
Bacterial vaginosis does not have one specific causative agent. The "offenders" can be entirely different microorganisms, for example, Gardnerella, Peptoniphilus, P. bivia, M. Mulieris, Prevotella, Fusobacterium, Peptostreptococcus, Atopobium vaginae. But, as a rule, the disease is caused by an increase in the population of 2–3 strains.
When any trigger occurs (taking antibiotics, stress, ignoring personal hygiene rules), the causative agents begin the process of active multiplication, thereby alkalinizing the vaginal environment and increasing the pH level. Only Lactobacilli, which secrete lactic acid, can stop the growth of pathogenic bacteria.
Causes
The causes of bacterial vaginosis can be quite diverse. They can include both a simple violation of intimate hygiene and other triggers:
• Hormonal imbalance, including menstrual cycle irregularity.
• Taking antibiotics.
• Weak immunity.
• Poor nutrition.
• Diseases of the gastrointestinal tract (intestinal dysbiosis) or the urogenital tract.
• Acute and chronic infectious diseases.
• Stress.
• Prolonged use of an intrauterine device (IUD).
• Abortion.
• Trauma during childbirth.
Symptoms
The most crucial and fundamental symptom of bacterial vaginosis is a white or gray, thick discharge with a sharp, unpleasant odor, similar to the smell of fish. The woman herself perceives this odor. The signs are exacerbated when the vaginal flora is alkalized—after unprotected sexual intercourse and before menstruation.
However, only about 50% of patients experience and notice atypical vaginal discharge. Therefore, in half of the cases, the disease may be asymptomatic.
Additional symptoms may include burning and itching both in the vagina itself and in the rectal area. Furthermore, impaired urination and painful sensations during intimacy (dyspareunia) frequently occur.
Bacterial vaginosis is easily confused with vaginitis. However, the latter is characterized by severe dryness, redness, and swelling of the vaginal lining.
Diagnosis
Diagnosis and treatment of bacterial vaginosis are performed by a gynecologist. The presence and severity of the disease can often be determined during the woman's first consultation. The diagnosis is based on the patient's complaints, examination, vaginal smear for flora, and pH-metry of vaginal discharge. If this is insufficient, an extensive clinical and laboratory examination will be prescribed.
Significant attention is also paid to collecting the patient history (anamnesis). The doctor will ask the woman about current or previous medications, methods of contraception, nutrition, lifestyle, harmful habits, stress level, childbirth, and operations on the genital organs. This data can play an important role in the diagnosis and treatment of the patient.
Vaginal pH-metry is a modern method for diagnosing vaginal acidity. A disposable test strip with a sensory layer is used for the study. Upon contact with vaginal discharge, it changes color depending on the pH value. The result is known within a couple of minutes. To ensure maximum effectiveness of the test, you must undergo it no earlier than 48 hours after the last sexual contact and no sooner than 72 hours after using any vaginal preparations.
Complications
The vaginal environment in bacterial vaginosis changes from acidic to alkaline, which can lead to difficulties with conception, as, without proper and timely treatment, this condition can cause inflammatory processes in the uterus and adnexa (salpingitis and oophoritis).
This leads to infertility, difficulties in gestation, and missed miscarriage.
If the disease appears during pregnancy, chronic endometritis develops under the influence of the vaginosis pathogens. This can threaten premature rupture of membranes (PROM) and fetal infection. The risk of preterm birth increases twofold.
Some scientists suggest that the toxins from vaginosis pathogens can affect the fetus by penetrating the placenta, which may later become one of the causes of child hyperactivity. Furthermore, the link between this condition and the human papillomavirus (HPV) was recently proven. It was found that patients with bacterial vaginosis are more susceptible to the risk of human papillomavirus infection.
Treatment Methods
The goal of therapy is to reduce the vaginal pH and increase the level of Lactobacilli.
Both local treatment and oral medications are used for bacterial vaginosis. They are roughly comparable in effectiveness, but topical therapy has fewer side effects. In the second stage of treatment, prebiotics are taken to restore the vaginal microflora. To reduce dryness and discomfort, various moisturizing gels with lactic acid may be prescribed.
Additionally, during the treatment of bacterial vaginosis, the following should be excluded from the diet: sweets, smoked foods, fatty and salty foods, fast food, carbonated drinks, alcohol, and juices.
Prevention
Bacterial vaginosis is very often a consequence of lifestyle and incorrect habits. Therefore, it makes sense to discuss its prevention in the context of this disease. Prevention includes:
• Washing (intimate hygiene) at least twice a day. However, using soap or shower gel is discouraged, as the vaginal pH may be compromised. Special intimate gels with lactic acid are ideal.
• Changing pads and tampons every 2 hours (at least 4–5 times a day).
• Avoiding sexual intercourse during the first days of menstruation.
• Using underwear made of natural fabrics.
• Infrequent consumption of alcohol.
• Balanced nutrition.
• Controlled consumption of sweets and empty carbohydrates.
• Visiting a gynecologist at least once every six months.
Is Bacterial Vaginosis Possible in Men?
A man cannot contract bacterial vaginosis. Firstly, the word "vaginosis" itself implies a pathological process in the vagina, meaning it concerns the female reproductive organs by definition. Secondly, the microflora of the male urethra is significantly different from that which inhabits the female vagina. It is not in the same state of precarious balance, and disorders in it do not lead to the same symptoms and complications. Bacterial vaginosis is not classified as a sexually transmitted infection (STI), although the bacteria associated with it may spread during sexual contact. However, this condition increases the risk of contracting STIs due to the impairment of protective mechanisms in the reproductive organs.
Can Men Spread Bacterial Vaginosis?
A sexual partner can "pick up" the microorganisms associated with bacterial vaginosis from a woman. Data on whether men can spread this condition between partners are quite contradictory, and scientists are not entirely certain about them. However, some studies confirm the possibility of such transmission. A 2015 study involving 165 uncircumcised men showed that having two or more female partners increased the likelihood of carrying bacterial vaginosis-associated microorganisms on the penis. Because of this, women who engage in unprotected sex with such men have an increased risk of developing BV. Similar conclusions were drawn from a study conducted two years earlier, in 2013. It involved 157 men. During this study, scientists found that men who had previously suffered from non-gonococcal urethritis (inflammation in the urethra) were more likely to be carriers of bacterial vaginosis-associated microorganisms.
How is Bacterial Vaginosis Transmitted?
Bacterial vaginosis is not an STI, and a woman does not even need to be sexually active to contract it. Nevertheless, high sexual activity and the presence of multiple partners, as well as frequent partner changes, increase the risk of developing the disease. It is known that Gardnerella (Gardnerella vaginalis) plays a significant role in the development of the condition. Generally, these microorganisms are not considered contagious. But it is not entirely clear how actively they can spread from one person to another during sexual contact. Upon entering the vagina, Gardnerella creates an environment favorable for the multiplication of opportunistic bacteria. Notably, Gardnerella vaginalis is found in the vagina in 50% of cases without symptoms. This means that, in principle, this microorganism can be considered a normal representative of the vaginal microflora, and its excessive multiplication and the development of pathological changes are facilitated by additional factors. In any case, the multiplication of opportunistic microorganisms disrupts the protective mechanisms in the vagina, leads to the production of toxins and inflammatory molecules (cytokines), and impairs the function of local immunity. As a result, it becomes easier for other pathogenic bacteria to infect the organs of the reproductive system, and the risk of contracting STIs increases.
Classification and Stages of Bacterial Vaginosis Development
Depending on the symptoms of bacterial vaginosis and laboratory indicators, three forms of the disease are often distinguished:
• Compensated – when the number of Lactobacilli decreases, and the probability of pathogens entering the vagina from the external genitalia increases. Symptoms are minimal.
• Subcompensated – when the number of Lactobacilli is reduced, and a considerable number of pathogens are noted. The clinical picture is more pronounced compared to the compensated form.
• Decompensated – when Lactobacilli are practically absent, and there are many representatives of the pathogenic flora. The symptomatology is maximally expressed.
Depending on the nature of the course of bacterial vaginosis, terms such as "acute vaginosis," "recurrent vaginosis" (4 or more episodes of the disease per year), and "chronic vaginosis" (symptoms persist for longer than two months) are used. Depending on the presence of complications, uncomplicated and complicated forms of the disease are distinguished.
Furthermore, a classification was proposed in 1995 that distinguishes four types of vaginal biotope:
• Normocenosis – the normal state of the vaginal microflora, where Lactobacilli predominate.
• Intermediate type – also often noted in healthy women and not accompanied by symptoms. In this case, the number of Lactobacilli decreases, and there are Gram-negative rods and Gram-positive cocci, epithelial cells, leukocytes, macrophages, and monocytes.
• Vaginal dysbiosis – characterized by a very low number of Lactobacilli or their complete absence, and a varying number of leukocytes. This picture corresponds to bacterial vaginosis.
• Vaginitis – manifests as the presence of various pathogenic microorganisms, a large number of epithelial cells, leukocytes, macrophages, and monocytes. Clinically, this is non-specific vaginitis.
What is the Danger of Bacterial Vaginosis?
First and foremost, bacterial vaginosis is dangerous because it is one of the causes of infectious complications after the insertion of intrauterine contraceptives, gynecological surgeries, and abortions. The development of infectious and inflammatory processes in the pelvic organs is possible: salpingo-oophoritis (inflammation of the uterine adnexa), endometritis (inflammation in the uterine cavity), abscess (a pus-filled cavity), and peritonitis (inflammation in the abdominal cavity). During pregnancy, complications such as premature rupture of amniotic membranes, chorioamnionitis, preterm birth, and postpartum endometritis are possible. The risks are highest with a long course if adequate treatment for bacterial vaginosis in women is not provided.
What Indicators are Important for the Diagnosis of Bacterial Vaginosis?
To correctly establish the diagnosis, the doctor must evaluate the clinical picture and the results of laboratory tests (vaginal smears). In global gynecological practice, the Amsel criteria are often used. To confirm the diagnosis, the presentation must correspond to at least three out of four criteria:
1. Thin, homogeneous vaginal discharge that is white, gray, or yellow.
2. The smear shows the presence of vaginal epithelial cells with Gram-variable microorganisms densely attached to their surface (clue cells). Leukocytes are absent. And Lactobacilli are reduced, even to complete absence.
3. pH level greater than 4.5.
4. Upon adding an alkali (10% potassium hydroxide) to the test tube, the discharge emits a specific, unpleasant "fishy" odor (whiff test).
According to the modified Amsel criteria, only two factors from this list are sufficient. The sensitivity of this diagnostic method is 70%, and the specificity is 94%.
Alternatively, the Nugent method is sometimes used. It involves treating vaginal discharge with special stains (Gram staining) to identify the predominant bacterial strains. The result is evaluated on a scale from 0 to 10 points. The higher the score, the more microorganisms associated with bacterial vaginosis are present in the sample. This technique is most often used in scientific research; its application in clinical practice is extremely limited.
Is Sexual Intercourse Possible with Bacterial Vaginosis?
Since bacterial vaginosis is not sexually transmitted, there are no prohibitions on sexual activity. However, it is important to remember a few points. Firstly, sexual rest contributes to faster recovery. Secondly, the topical medications used for treatment can affect condoms and other contraceptives, reducing their effectiveness. Thirdly, frequent changes of sexual partners and unprotected sex are highly discouraged, as they not only contribute to the disruption of the vaginal microflora but also facilitate the contraction of STIs.
Advantages of Treatment at Expert Clinics
Leading medical specialists in the field of integrative medicine, including world-renowned experts:
• Can understand the deep-seated causes of diseases and the many complex interconnections in the body. When every nuance is taken into account, this makes the treatment maximally effective and helps prevent the recurrence of the disease in the future.
• Will develop individualized therapy regimens depending on the specific characteristics of bacterial vaginosis in each case, as well as any co-occurring health issues.
• Utilize the latest medical advancements. They work in accordance with modern standards and prescribe medications with proven effectiveness. Our goal is not only to rid you of the symptoms of the disease but also to preserve your health for many years.
+7 (495) 154-21-44 
admin@expertclinics.ru 
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