Vaginal infectious diseases – Part 1

Infectious diseases of the vagina are most common in patients of the reproductive period. These include: bacterial vaginosis; non-specific vaginitis; vaginal candidiasis; Trichomonas vaginitis.

According to modern concepts, the development of an infectious disease of the vagina is as follows. After adhesion to the epithelial cells of the vagina, opportunistic pathogens begin to multiply actively, which causes the appearance of vaginal dysbiosis. Subsequently, as a result of overcoming the protective mechanisms of the vagina, infectious agents cause an inflammatory reaction (vaginitis).

Bacterial vaginosis (BV) is a non-inflammatory clinical syndrome caused by the replacement of lactobacilli of the vaginal flora by conditionally pathogenic anaerobic microorganisms. Currently, BV is considered not as a sexually transmitted infection, but as vaginal dysbiosis. However, BV creates the prerequisites for the occurrence of infectious processes in the vagina, so it is considered together with inflammatory diseases of the genital organs. BV is a fairly frequent infectious disease of the vagina, found in 21-33% of patients of reproductive age.

Etiology and pathogenesis. Previously, the cause of the disease was considered gardnerellas, therefore it was called gardnerella. However, it was further established that Gardnerella vaginalis is not the only causative agent of BV; In addition, this microorganism is part of normal microflora. Violation of the vaginal microecology is expressed in a decrease in the number of normally dominant lactobacilli and rapid proliferation of aaaaaa bacterium, Mycoplasma hominis), but above all – obligate anaerobes acteroides spp., Prevotella spp., Peptostreptococcus. and etc.). Not only the qualitative but also the quantitative composition of the vaginal microflora changes with an increase in the total concentration of bacteria.

Antibacterial drugs, including antibiotics, oral contraceptives and the use of IUD, hormonal disorders with a clinical picture of oligo-and opsomonorrhea, inflammatory diseases of the genital organs, frequent changes of sexual partners, reduced immunity, etc., predispose to the disease.

As a result of the disruption of the microbiocenosis of the vagina, the pH of the vaginal contents changes from 4.5 to 7.0-7.5, and the aerobes form volatile amines with an unpleasant smell of rotten fish. The described changes disrupt the functioning of natural biological barriers in the vagina and contribute to the occurrence of inflammatory diseases of the genital organs, postoperative infectious complications.

Clinical symptoms. The main problem in patients with BV is a complaint of abundant homogeneous creamy gray vaginal secretions that stick to the walls of the vagina (Fig. 12.2) and have an unpleasant “fishy” smell. It may cause itching, burning sensation in the vagina, discomfort during intercourse.

Microscopic examination of vaginal smears stained by Gram reveals “key” cells in the form of desquamated vaginal epithelial cells, to the surface of which microorganisms characteristic of BV are attached (Fig. 12.3). In healthy women, “key” cells are not detected. In addition, the typical bacterioscopic signs of the disease are a small number of white blood cells in the field of view, a decrease in the number or absence of Dederlein sticks.
BV diagnostic criteria (Amsel criteria) are: specific vaginal discharge; detection of “key” cells in the vaginal smear; pH vaginal> 4.5; positive amine test (odor of rotten fish when potassium hydroxide is added to vaginal secretions).

Diagnosis B C can be made in the presence of three of the listed criteria. Diagnostics are supplemented by a bacteriological method of research with the determination of the qualitative and quantitative composition of the vaginal microflora, as well as the microscopic assessment of the relative proportion of bacterial morphotypes in a vaginal smear (Nugent test).

Nonspecific vaginitis (colpitis) – inflammation of the mucous membrane of the vagina, caused by various microorganisms, may occur as a result of chemical, thermal, mechanical factors. Among the causative agents of vaginitis, conditionally pathogenic flora, primarily staphylococci, streptococci, E. coli, non-spore-forming anaerobes, are of the greatest importance. The disease occurs as a result of increased virulence of vaginal saprophytic microorganisms while reducing the immunobiological protection of the macroorganism.

In the acute stage of the disease, patients complain of itching, burning in the vagina, purulent or serous-purulent discharge from the genital tract, pain in the vagina during intercourse (dyspareunia). Vaginitis is often combined with vulvitis, endocervicitis, urethritis. During a gynecological examination, the swelling and hyperemia of the mucous membrane of the vagina, which bleeds easily when touched, purulent overlays and point hemorrhages on its surface, draw attention to themselves. In severe disease, desquamation of the vaginal epithelium occurs with the formation of erosions and ulcers. In the chronic stage, itching and burning become less intense, occur periodically, the main complaint remains on the serous discharge from the genital tract. Hyperemia and edema of the mucous membrane are reduced, in places of erosion infiltrates of the papillary layer of the vagina, which can be detected as point elevations above the surface (granular colpitis), can form.

An additional method for the diagnosis of vaginitis is colposcopy. helping to detect even mild signs of inflammation. To identify the causative agent of the disease using bacteriological and bacterioscopic examination of vaginal discharge, urethra, cervical canal. Microscopic examination of a vaginal smear reveals a large number of leukocytes, desquamated epithelial cells, abundant gram-positive and gram-negative flora.

local_offerevent_note February 21, 2019

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