Bacterial vaginosis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
K76.0 Acute colpitis
K76.1 Subacute and chronic colpitis
ICD-10 online (WHO version 2019)

As bacterial vaginosis (BV, as aminocolpitis designated), the atypical colonization of the vagina (vaginal) especially with anaerobes refers to an infection in the vaginal area (a vaginitis leads), but also the female external genitalia can procedures involving and a vulvovaginitis causes.

Pathogen

The vagina of a sexually mature, healthy woman is colonized by a large number of aerobic and anaerobic germs. 100 million to 1 billion of these germs can be detected per milliliter of vaginal fluid. These mainly consist of different species of lactobacilli , so-called Döderlein bacteria , which, as commensals, prevent multiplication, usually in small numbers, of any facultatively pathogenic, i.e. potentially disease-causing, germs. In bacterial vaginosis, however, the balance of the vaginal flora is disturbed, so that a so-called mixed flora can be detected to an increased extent , which from Gardnerella vaginalis in over 90% and other anaerobes (such as Prevotella , formerly: Bacteroides spp. In 50-100%, Mobiluncus spp. In 8–85%, peptostreptococcus in approx. 30%) and genital mycoplasma in 60–90% of the women examined. Around 2006 a new pathogen ( Atopobium vaginae ) was described that can be detected in bacterial vaginosis and is resistant to metronidazole .

Epidemiology

Since half of the women examined (e.g. as part of a preventive check-up) are actually symptom-free, and existing symptoms are often misdiagnosed and treated as thrush colpitis, the number of women with bacterial vaginosis can only be estimated. In the US women a will prevalence of 10-20 million suspected. Globally, 15 to 50% of all women worldwide have bacterial vaginosis of their reproductive age. Bacterial vaginosis can be detected in two thirds of women with increased discharge . Bacterial vaginosis increases the risk of transmitting AIDS from husband to wife. An analysis of the US National Health and Nutrition Examination Surveys found a connection between the incidence of bacterial vaginosis and ethnicity (women of color 51.4%, Latin American women 31.9% and Caucasian women 23.2%). Poverty, poor education, smoking, obesity, number of sexual partners and lesbian relationships increase the risk. Oral contraception (birth control pills) was associated with a lower risk. A high shower frequency was also correlated with bacterial vaginosis, although it remains unclear what the cause and effect is. (Does frequent showering lead to vaginosis or do women with vaginosis feel the need to shower more often?) Since Gardnerella vaginalis can be found in the vaginal secretions of healthy, sexually active women (albeit to a lesser extent), but hardly in girls and virgins , and 75% of the urethra of the mostly symptom-free male sexual partners is also colonized, it can be assumed that it is transmitted through vaginal intercourse . BV is a " finding " to be collected worldwide .

Disease value

From what has been said, it follows that colonization with the corresponding germs does not yet have any disease value in itself and the previously common term "amine colpitis", which refers to vaginal inflammation, should actually be replaced by the more neutral term vaginosis. A connection to premature rupture of the bladder , an increased premature birth rate and a lower birth weight of the newborns was established if it was detected during pregnancy , but on the other hand this could not be prevented by prophylactic treatment of BV.

Associations have also been made with upper genital tract infections. It is therefore advisable to carry out surgery in this area, such as termination of pregnancy , insertion of a coil, etc. a. to get a vaginal smear .

Symptoms

Which factors are ultimately decisive for a change from BV to bacterial colpitis has not yet been clearly clarified. Bacterial adhesins and corresponding receptors on the surface of the vaginal epithelial cells are probably just as important as the type and absolute amount of the atypical germs found.

In the case of illness, a thin discharge occurs after an incubation period of less than a week . Symptoms such as “dryness” (despite discharge), itching or burning and the resulting dyspareunia are less common . The fact is that the “fish-like” smell, which is often noticed by women with few symptoms, is perceived as extremely annoying.

The external genitalia (the vulva) is rarely affected, and the vagina itself shows only mild signs of inflammation. As a sexually transmitted disease (at this point in time), a mostly mild and short-lasting balanoposthitis is also found in the partner .

diagnosis

With the microscope , after staining with 1% methylene blue solution, the bacterial colonization can be assessed even at low magnification (40 x). During the examination, so-called key cells ( clue cells ) as an indication of a Gardnerella infection and leukocytes (> 10 / visual field ) are found. The so-called comma cells provide an indication of an anaerobic infestation ( Mobiluncus spp. ) .

Key cells are cells of the vaginal membrane ( squamous epithelia of the intermediate cell type ), which are covered by tightly packed short basophilic rods (a so-called bacterial lawn ). As a result, they already appear dark blue in the overview microscopy. Lactobacillus and cocci can cause a similar picture. The cytological findings only allow a suspected diagnosis.

However, the value of microscopic examination alone is seriously questionable.

therapy

Symptomatic bacterial vaginosis is usually treated outside of pregnancy with the antibiotics metronidazole (tablets or vaginal cream) or clindamycin (vaginal cream). During pregnancy, clindamycin should only be prescribed after the first trimester (then as an oral therapy); If treatment is indicated in the first trimester, metronidazole is used. Metronidazole has been found carcinogenic in several studies in mice and rats. Those who don't want to use antibiotics can try prebiotics . Prebiotics contain nutrients that are supplied to the body's own lactic acid bacteria. This allows these bacteria to multiply until they are present in a dominant amount and consequently produce the acid that forms a healthy vaginal flora. Documentation for the effects of lactose for this purpose are consumer tests.

literature

Web links

Individual evidence

  1. ↑ a b Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 923.
  2. ↑ CS Bradshaw et al .: The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. In: The Journal of Infectious Diseases. Volume 194, Number 6, September 2006, pp. 828-836, ISSN  0022-1899 . doi: 10.1086 / 506621 . PMID 16941351 .
  3. ↑ Werner Mendling: Vaginal infections
  4. ↑ Jenifer E. Allsworth, Jeffrey F. Peipert: Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data . In: Obstetrics and Gynecology . tape 109 , no. 1 , January 2007, ISSN  0029-7844 , p. 114–120 , doi : 10.1097 / 01.AOG.0000247627.84791.91 , PMID 17197596 .
  5. ↑ Craig R. Cohen, Jairam R. Lingappa, Jared M. Baeten, Musa O. Ngayo, Carol A. Spiegel: Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples . In: PLoS medicine . tape 9 , no. 6 , 2012, ISSN  1549-1676 , p. e1001251 , doi : 10.1371 / journal.pmed.1001251 , PMID 22745608 , PMC 3383741 (free full text).
  6. ↑ Emilia H. Koumans, Maya Sternberg, Carol Bruce, Geraldine McQuillan, Juliette Kendrick: The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health . In: Sexually Transmitted Diseases . tape 34 , no. 11 , 2007, ISSN  0148-5717 , p. 864-869 , doi : 10.1097 / OLQ.0b013e318074e565 , PMID 17621244 .
  7. ↑ A. Schwiertz, D. Taras, K. Rusch, V. Rusch: Throwing the dice for the diagnosis of vaginal complaints? In: Annals of clinical microbiology and antimicrobials. Volume 5, 2006, p. 4, ISSN  1476-0711 . doi: 10.1186 / 1476-0711-5-4 . PMID 16503990 . PMC 1395331 (free full text).
  8. ↑ W. Mendling, A. Schwiertz: Recurrent infections and premature births due to changed Döderlein flora? In: The gynecologist. Munich 2007, pp. 936-939. ISSN  0016-0237
  9. ^ S1 guideline for bacterial vaginosis in gynecology and obstetrics of the German Society for Gynecology and Obstetrics (DGGG). In: AWMF online (as of 2013)
  10. ↑ FDA Drug Safety Datasheet for Flagyl
  11. ↑ SJ Emery, MJ Tomlinson, ID Hansen, Sex Transm. Infect. June 2012 Vol 88 Suppl 1.p A27.