Vaginose

The bacterial vaginose or vaginose an imbalance of the microbial flora of the vagina. It is characterized by the disappearance of the lactobacilles and the multiplication of anaerobic germs such as the Gardnerella vaginalis . Although it requires a treatment of the partner, it is not a Sexually transmitted disease. She testifies rather to an imbalance of the vaginal flora with disappearance of the protective effect of the Bacille of Döderlein.

Epidemiology

It is the specific cause most frequent of vaginal infection.
the rate of prevalence is higher among active women sexually.
Of many women is asymptomatic; however, certain women are more at the risk to suffer from complications, in particular during the pregnancy.

Clinical signs

vaginal Écoulement liquidates white-grisâtre, often abundant more frequent having an odor of " fish pourri". The flow often increases after the sexual relationships.
There does not exist prurit or of redness of the vagina in the noncomplicated cases of vaginose bacterial

Clinical examination

the installation of the speculum highlights a noninflammatory vagina.

Helps of the laboratory

Symptomatology is sufficiently evocative to start the treatment. however, and in particular in the expectant mothers, Vaginose Bactérienne remains asymptomatic. In the event of taking away, the direct examination confirms the presence of gardnerella vaginalis with a change in the vaginal flora, that is to say a fall of the number of large bacillus S positive Gram and a clear increase in the number of Coccobacille S smaller variable Gram, pH vaginal superior with 4,5. There exists a release of amine after addition of Potasse to 10% with a terrible odor.

Complications

In the expectant mother, the bacterial vaginose can have many potentially serious consequences.

* It is responsible for bleedings, especially with the first and the second quarters of the pregnancy. * It doubles the risk of miscarriage. * It strongly increases the risk of premature birth, especially if it is detected in the first quarter of the pregnancy. * It increases strongly also the risk of rupture of the pocket of water before 7 months of pregnancy * The germs responsible for the vaginose can involve infections of the amniotic liquid - it is the chorioamniotite - then to go to infect the child, causing problems pumlonaires and neurological with the birth * It increases also the risk of delay of growth in utero of the child. * It would be at the origin of abscess of the scalp of the child to the birth. * It causes infections in the mother in continuation of layer - endométrite and abscess of the wall after Cesarean.

Apart from the pregnancy, the rise of the germs of the vagina to the top female genital apparatus can be at the origin of a " inflammatory disease pelvienne". Although the bacterial vaginose is not a disease sexually trasmissible, it would be related to a greater frequency of the infections sexually trasmissibles - as the AIDS - by lowering the natural defenses lavished by the lactobacilles. It would be at the origin of salpingites which is noxious in the field of the fertility. One also observes true cellulitises of the vaginal dome after hysterectomy.

Treatment

It is necessary to treat, especially in the event of

high-risk Grossesse of premature birth
Pose of coil
Before a gynaecological intervention, a I.V.G, any act requiring of the operations in the uterus.

the Métronidazole is constantly effective. The vaginal way not having proven its effectiveness, it is imperatively necessary to make an oral treatment the amount of 1 gram per day in two catches during seven days. The treatment of the partner is essential.

the Clindamycin, 300 Mg per bone twice a day during seven days is also very effective.

It is necessary to advise with the patients not to consume alcoholic beverages during the treatment the métronidazole nor in the 48 hours which follow in order to prevent the reactions of the type “antabuse”.

Sources

Canadian Guiding lines for the sexually transmitted diseases
Definition and risks related to the bacterial vaginose
Consequences Obstétricales of Vaginose Bacterial, Updates of the National College of the Gynecologists and French Obstétriciens, 1 {{er}} December 2006

Random links: