What causes bacterial vaginosis to come back

Nonspecific bacterial vaginal infection

Nonspecific bacterial vaginal infection(bacterial vaginosis, amine colpitis, Gardnerella vaginosis, non-specific colpitis): Frequent infection and inflammation of the vagina due to a combination of different bacteria (mixed infection), mostly the result of an unfavorable vaginal environment, but can also be transmitted through sexual intercourse. This is to be distinguished from the specific bacterial infections of the vagina, cervix and urethra, in each of which a Bacterium is responsible for the disease process. These include, above all, genital chlamydial infections and gonorrhea.

Leading complaints

Half of the women affected have no symptoms. The following symptoms indicate an infection:

Nonspecific bacterial vaginal infections offer the doctor little clue for a correct diagnosis. In the example shown of a 34-year-old patient, only reddening of the labia can be seen
Family Drs. Med. Claudia and Arne Schäffler, Augsburg

  • Discomfort and increased wetness in the vagina
  • Thin, gray discharge with an unpleasant fish-like smell, the smell of which increases after sexual intercourse (because of the alkaline prostate secretion) or when mixed with menstrual blood
  • Increased pH value of the vaginal flora (pH scale measuring strips are available in the pharmacy)
  • Itching and painful intercourse.

When to the doctor

In the next few days if

  • discharge with a fish-like smell occurs, even if there are no other symptoms.

The illness

Disease emergence

The germ Gardnerella vaginalis was formerly known as Haemophilus vaginalis and is found in the vagina in around 40% of all women. It only causes an infection if anaerobic bacteria (which can reproduce without air) are present in large numbers at the same time. The pathogens produce amines containing ammonia, which irritate the vaginal wall and cause the discharge odor to be fishy. Itching and reddening of the vaginal entrance rarely occurs, and often no symptoms are noticed at all. Since the germs on the internal genital organs such as the uterus, fallopian tubes and ovaries can cause severe infections and endanger an existing pregnancy, treatment is absolutely necessary if a discharge that smells like a fish is noticed. However, relapses are common.

Vaginal infection with thin discharge. The smell is fishy and a little unpleasant.
Georg Thieme Verlag, Stuttgart

Risk factors

  • Chronic stress
  • Excessive or incorrect intimate hygiene in the form of vaginal showers or frequent sitz baths
  • Smoke
  • Sexual relationship with women
  • Medical interventions such as an abortion or the insertion and wearing of an IUD or pessary.

Complications

A non-specific bacterial vaginal infection increases the risk of developing a wide variety of gynecological inflammations:

  • Inflammation of the lining of the cervix (cervicitis)
  • Inflammation of the external female genital area and the vaginal entrance (vulvitis)
  • Inflammation of the lining of the womb (endometritis)
  • Inflammation of the fallopian tubes (salpingitis)
  • Foci of pus on the ovaries or fallopian tubes (tubo-ovarian abscess)
  • Inflammation of the Bartholin glands (Bartholinitis).

In pregnant women, as a result of the biochemical interaction between the fetus and the uterus, there is a risk of:

  • Infection of the embryonic envelope (amnionitis)
  • Premature labor, premature amniotic sac and premature birth
  • Low birth weight of the child

After the delivery, due to the vaginal infection:

  • In the case of a perineal incision: inflammation and delayed healing of the perineal incision wound
  • During caesarean section: abdominal wall abscess
  • Inflammation of the lining of the womb (endometritis).

Diagnostic assurance

If the symptoms are not clear, the characteristic fish odor can be intensified by the doctor dripping a small amount of potassium hydroxide on the discharge. The microscopic examination of the secretion shows the cells typical for the infection (key cells). At the same time, the doctor creates a culture to rule out or diagnose other accompanying infections.

Nonspecific bacterial vaginal infections offer the doctor little clue for a correct diagnosis. In the example shown of a 34-year-old patient, only reddening of the labia can be seen.
Family Drs. Med. Claudia and Arne Schäffler, Augsburg

The diagnosis of bacterial vaginosis is confirmed if at least 3 of the following 4 findings are correct in the course of the gynecological examination:

  • Gray-white, homogeneous discharge
  • pH in the vagina above 4.5
  • Fishy smell of the fluorine
  • Microscopic detection of clue cells (key cells), these are vaginal cells covered with a thick carpet, so that individual cells are no longer recognizable.

treatment

The duration and intensity of the treatment depend on the severity of the disease and the regenerative capacity of the vaginal flora.

The treatment is mainly carried out with the antibiotics metronidazole (e.g. Clont® vaginal tablets) or clindamycin (e.g. Sobelin® vaginal cream). Local treatment is therefore possible, but internal ingestion is more successful. Co-treatment of the partner is no longer recommended today, as in this case the relapse rate is only reduced for a short time by partner treatment.

forecast

With the appropriate treatment, the prognosis is good.

Your pharmacy recommends

What you can do yourself

Use - preferably in consultation with your doctor - vaginal preparations with lactic acid (e.g. Eubiolac Verla®), Döderlein bacteria (e.g. Vagiflor®) or vitamin C (Vagi-C®).

Complementary medicine

Homeopathy recommends, among other things. Kreosotum, Pulsatilla and Sepia for acute treatment, better is an individually tailored holistic therapy, which takes into account the physical, mental and spiritual characteristics of the patient after a detailed anamnesis (constitution therapy).

Since chronic stress is the greatest risk factor for the occurrence of a non-specific bacterial vaginal infection, sport, yoga and relaxation techniques such as autogenic training or progressive muscle relaxation according to Jacobson help to reduce this.

prevention

  • Wear heat-resistant, breathable cotton laundry.
  • Use only water for intimate hygiene.
  • The use of condoms offers protection.
  • According to medical studies, the "pill" also offers protection.

Authors

Dr. med. Astrid Waskowiak, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Symptoms and leading complaints", "The disease", "Confirmation of diagnosis", "Treatment", "Prognosis" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 11:35


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.