Bacterial vaginosis

　　The vaginal secretions of patients with the disease contain an increased number of bacteria such as Gardnerella vaginalis, anaerobic bacteria such as Bacteroides, Streptococcus lactic acid, Mobiluncus, and human mycoplasma, which are 100 to 1,000 times higher than normal. Due to the excessive growth of anaerobic bacteria, it inhibits the normal production of hydrogen peroxide by lactobacilli, which can kill bacteria. After the hydrogen peroxide that can kill bacteria decreases, anaerobic bacteria can increase more, forming a vicious cycle. The reduction in lactobacilli also reduces the production of lactic acid, affecting the reduction of vaginal pH value. Anaerobic bacteria can produce a large amount of amines (such as cadaverine, putrescine) and other salts (such as succinate), causing a change in the chemical composition of vaginal secretions, which can cause a special smell and an increase in pH value. The cause of the change in microorganisms in the vagina is still not fully understood. Although the disease is related to multiple sexual partners, it is still unclear whether it is caused by sexual transmission, so some people classify the disease as an endogenous disease.

　　1. Pelvic Inflammatory Disease It has been confirmed by surgery that the most commonly isolated flora in the upper genital tract secretions of women with pelvic inflammatory disease is consistent with the flora of bacterial vaginosis. The proportion of patients with bacterial vaginosis among those with pelvic inflammatory disease is 61.8%.

　　2. Abnormal Uterine Bleeding and Endometritis Abnormal uterine bleeding is often caused by endometritis. The abnormal uterine bleeding caused by endometritis is related to the abnormal response of infected endometrium to ovarian hormones or the direct destruction of the endometrium by infection or inflammation. Oral metronidazole treatment for patients with bacterial vaginosis can quickly relieve uterine bleeding.

　　3. Postoperative Infection after Gynecological Surgery In women who terminate pregnancy by surgery, the incidence of pelvic inflammatory disease in women with bacterial vaginosis is 3.7 times higher than that in women without bacterial vaginosis. Oral metronidazole treatment for bacterial vaginosis in women with surgical abortion can reduce the incidence of postoperative pelvic inflammatory disease by 70%. The risk of cellulitis at the vaginal stump, pelvic abscess, or both, after total hysterectomy in patients with bacterial vaginosis is increased.

　　4. Cervical cancer Bacterial vaginosis, cervical intraepithelial neoplasia, and human papillomavirus infection have the same epidemiological characteristics. The anaerobic metabolism of bacterial vaginosis can produce amines and nitrosamines with carcinogenic effects. There are high concentrations of phospholipase C and A2 in the vaginal discharge of patients with bacterial vaginosis, and the latter can increase the susceptibility to human papillomavirus infection, which may play a certain role in the transformation of cervical epithelial cells.

　　5. HIV infection Bacterial vaginosis can increase the risk of HIV (Human Immunodeficiency Virus) transmission between homosexuals. When the pH value increases, the survival and adhesion ability of HIV increase, and it may make transmission easier. At the same time, bacterial vaginosis can change other physical and chemical properties of vaginal discharge, which can change the host's defense mechanism, increasing the susceptibility to HIV.

　　6. Infertility and miscarriage The incidence of infertility due to tubal factors in patients with bacterial vaginosis is increased. In assisted reproductive treatment, the embryo implantation rate of patients with bacterial vaginosis is similar to that of patients with non-bacterial vaginosis, but the miscarriage rate in early pregnancy of patients with bacterial vaginosis is higher than that of patients with non-bacterial vaginosis.

　　7. Amnionitis, premature rupture of membranes, preterm birth, and low birth weight infants Bacteria in the vaginal cavity of patients with bacterial vaginosis can enter the amniotic cavity through the amniotic membrane, causing amnionitis and chorioamnionitis, and can further develop into premature rupture of membranes, preterm birth, and delivery of low birth weight infants.

　　8. Postpartum endometritis and incisional wound infection after cesarean section The incidence of postoperative abdominal wound infection and endometritis in patients with bacterial vaginosis after cesarean section delivery is higher than that in patients with non-bacterial vaginosis. The vaginal flora associated with bacterial vaginosis can often be cultured from the site of postpartum endometritis in these patients.

　　The prominent symptom of patients is an increase in vaginal discharge with a fishy odor, accompanied by a large amount of volatile amines. Especially for new patients, after sitting for a while and standing up to walk, they find this odor, which affects social activities and causes psychological burden. During sexual intercourse, alkaline prostatic fluid causes the volatilization of amines, exacerbating the odor. During physical examination, vaginal discharge is observed at the vaginal orifice, and with a speculum, it is found that the vaginal wall inflammation is not obvious, with uniform and consistent white discharge. The simplest method to measure the pH value of the secretion is to use a pH strip to touch the vaginal wall, or to use a cotton swab dipped in unsalted water to apply the secretion to the strip. The pH is often >4.5. Additionally, adding a drop of 10% potassium hydroxide solution to the secretion can produce an amine odor (amine test). Gram staining of vaginal discharge shows a decrease in lactobacilli and an increase in other bacteria. By observing 3 to 5 fields of view under a 1000-fold microscope, the average number of lactobacilli and Gardnerella in each field can be calculated, which can diagnose the disease. In addition, detecting bacterial metabolic products, normal adult women have lactic acid as the main organic acid in the vaginal cavity, and when BV occurs, succinic acid appears. Gas-liquid chromatography-mass spectrometry is used to detect vaginal fluid, with a critical value of succinate/ lactic acid >0.4 for diagnosing BV. Compared with clinical diagnosis, its sensitivity reaches 56% to 89%, and its specificity reaches 80% to 96%, but it requires gas phase detection instruments, so it is not widely used in clinical practice.

　　1, Wear cotton underwear, change them frequently, and keep the towels and basins used to clean the vulva separate. After washing, the underwear should be dried in the sun, not hung in the bathroom.

　　2, Wear clothing that breathes, and do not wear tights or tight jeans continuously.

　　3, The direction of wiping after defecation should be from front to back to avoid carrying bacteria from the anal area to the vagina.

　　4, If you used to like to sit by the poolside and chat in a swimsuit, you'll have to change that. Don't just sit down in places like public swimming pools and bathrooms, and this also applies to public toilets.

　　5, Try to maintain a cheerful mood, as psychological factors can also reduce body immunity, allowing pathogens to take advantage of the opportunity to invade.

　　6, Do not use disinfectants or various cleaning agents to frequently rinse the vulva and vagina. It is best to use clean water to clean the private parts, rather than various types of washes.

　　1, Trichomonas vaginitis: Vulvar itching is severe, and the vaginal discharge is not paste-like but foamy, without a fishy smell, and microscopic examination shows an increase in leukocytes and the presence of active trichomonads.

　　2, Candidal vaginitis: It can also be accompanied by obvious vulvar itching, with vaginal discharge being relatively thick white or yellowish curd-like or dreg-like; the vaginal wall is often congested, and microscopic examination shows an increase in leukocytes, and Candida spores and hyphae can be found and cultured.

　　3, Gonococcal cervicitis: During the onset of gonococcal cervicitis, the cervix is obviously congested, and a large amount of yellow, thick, purulent vaginal discharge can be seen at the cervix opening and vagina. Patients often have urinary tract irritation symptoms, and microscopic examination shows the presence of Gram-negative cocci within the epithelial cells.

　　4, Abnormal sexual psychology or sexual disease suspicion: Patients often have a history of unprotected sexual activity or know that their spouse has a history of transmitting diseases, and feel discomfort in the vulva, with varying degrees of itching and pain, and a feeling of insect bite, but the vaginal discharge is normal, without线索 cells or occasionally seen, and no other pathogens are detected.

　　5, Vulvar pruritus: There may be a history of unprotected sexual activity, with subjective vulvar pruritus, but no abnormal discharge and no pathogen detection. This disease is mainly related to psychological factors and individual quality, and is a skin disease rather than a sexually transmitted disease.

　　(1) Avoid spicy foods. Excessive consumption of spicy foods (such as chili, ginger, scallion, garlic, etc.) can easily cause dryness and heat, leading to internal heat-toxin accumulation, symptoms such as swollen and painful gums, canker sores on the tongue and lips, short and red urine, burning sensation around the anus, and pruritus vulvae and perineum, which can exacerbate the symptoms of the disease.

　　(2) Avoid seafood. Products with a fishy and pungent smell, such as mandarin fish, yellow croaker, hairtail, black fish, shrimp, crab, and other aquatic products, can promote damp-heat, causing exacerbation of pruritus vulvae after consumption, which is not conducive to the regression of inflammation, so they should be avoided.

　　(3) Avoid sweet and greasy foods. Greasy foods such as lard, fatty pork, butter, beef fat, mutton fat, etc., high-sugar foods such as chocolate, candy, sweet pastries, cream cakes, etc., these foods have the effect of promoting dampness and heat, which can increase the secretion of leukorrhea and affect the effectiveness of treatment.

　　(4) Avoid smoking and drinking. Smoking can exacerbate the disease, as nicotine in tobacco can weaken the binding force of arterial blood and oxygen, and alcohol can promote damp-heat, so it should be avoided. Similarly, alcoholic beverages such as wine should also be avoided.

　　Fermented drinks such as wine should not be consumed.

　　(5) Pay attention to diet and nutrition; eat more fresh vegetables and fruits to keep the bowels smooth; drink more water; prevent urinary tract infections.

　　Western Medicine Treatment:

　　1. Oral Medication Therapy

　　a. Metronidazole: It is currently generally believed to have reliable efficacy. The dosage is 0.2-0.4 grams taken orally two to three times a day. If the dose is large or to avoid gastrointestinal reactions, vitamin B6 can be added, and the course of treatment is 7-10 days.

　　b. Itraconazole (Ketoconazole) 2 tablets taken twice a day, for a total of three days.

　　c. Thiophenicol (Ximycin) is effective against a variety of Gram-positive and Gram-negative bacteria, and has a good curative effect on anaerobic bacteria, so it can also be chosen. The dosage is 10 tablets taken at once, or 1-2 tablets taken each time, three times a day, for a total of three days.

　　In addition, chlorhexidine and ampicillin can also be chosen. However, it is not recommended to use broad-spectrum antibiotics for a long time and in large quantities to avoid causing a disorder of the normal vaginal flora. There are also those who advocate that asymptomatic individuals do not need treatment.

　　2. Local Therapy

　　Vaginal lavage with vinegar and acidic solutions can be performed regularly, which can improve symptoms and is conducive to controlling the disease. Additionally, metronidazole suppositories can be inserted into the vagina, one per night, for a total of one week.

　　3. Treatment for Complications

　　For those with other pathogenic organisms detected, they must use drugs against other pathogenic organisms, but they must avoid the abuse of antibiotics. When selecting drugs for reproductive tract or other systemic complications, attention must be paid to systemic medication, and supportive and immune-enhancing therapies can be used simultaneously, and adverse reactions of the drug system should be noted.

　　4. Treatment for Sexual Partners

　　There are主张 for male sexual partners to have a course of medication at the same time, and there are also reports that this treatment cannot prevent female patients from relapsing.