Vaginosis, colpitis and thrush: the signs are similar - the diseases are different

The most common infectious diseases of the vagina are bacterial vaginosis, colpitis and candidiasis (thrush). All of them are caused by the activity of pathogenic microorganisms, but the mechanism of occurrence of each disease and the characteristics of its course are different. Treatment methods vary accordingly. This is why self-diagnosis and self-medication almost always lead to the pathology becoming chronic.

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What is vaginosis, vaginitis (colpitis) and thrush

The content of the article

Bacterial vaginosis (gardnerellosis)

is a non-inflammatory disease, which is expressed in a change in the composition of the vaginal microflora, as a result of which the number of beneficial lactic acid bacteria decreases and the proportion of pathogenic and conditionally pathogenic flora increases. There are no leukocyte cells in vaginosis because inflammation does not occur.

Women who become ill with bacterial vaginosis note an increase in the volume of vaginal discharge, which takes on a sharp, disgusting smell of “rotten fish.” But unlike sexually transmitted diseases, in this case there is no itching, burning or inflammation. Because of its cause - a change in flora - the disease is called vaginal dysbiosis.

Vaginitis (colpitis)

is an inflammation of the mucous walls of the vagina caused by a change in the ratio of beneficial and pathogenic microflora in favor of pathogenic bacteria.

Signs of bacterial vaginitis do not always appear clearly, but the gynecologist during the examination will see that the vaginal mucosa is red with local hemorrhages.

Over time, colpitis spreads to the external genitalia, causing vulvitis - inflammation of the vulva with all the ensuing consequences.

Thrush (candidiasis)

is an infectious inflammatory disease caused by the activity of the yeast-like fungus Candida. The spores of this fungus are present in the normal microflora of a healthy person, but when the immune system is weakened, a pathogenic strain begins to develop in large numbers.

The waste products of bacteria are secretions in the form of cottage cheese, which is why the disease received the name thrush.

What contributes to vaginal dysbiosis and related diseases?

The main protection of the vagina from infections is the balance of the microbiota. The dominant lactobacilli maintain an acidic environment and control the number of all other microorganisms. Any disturbance in this balance can lead to changes in the acidity of the vagina and the appearance of problems.

There are several factors that put the balance of the vaginal microbiota at risk: taking antibiotics and hormonal drugs, unprotected sex, poor hygiene, reduced immunity due to other diseases. Diet can also affect the health of the vaginal microbiota.

What are the differences between the symptoms of vaginosis, vaginitis and thrush?

Let's compare the signs of colpitis, candidiasis and gardnerellosis:

Causes of vaginosis, vaginitis and thrush

All three diseases are united by the fact that not only unprotected sexual intercourse can provoke the development of infection). The disease is also often associated with changes in hormonal levels, decreased immunity, and other reasons.

The essence of the process is this: every woman who has reached puberty has a unique microflora composition. It is not constant - the bioflora is formed by various factors, including ovulation, ARVI, stress, taking hormonal contraceptives, wearing tight-fitting trousers made of thick fabric, etc. All these processes cause a change in the conditions necessary for the life of certain bacteria. For example, when wearing synthetic panties, air access to the genitals is stopped, and the air temperature and humidity increase. As a result, anaerobic (air-hungry) beneficial bacteria die, and bacteria such as candida develop rapidly.

Getting thrush in an hour of being in a wet swimsuit in the sun is a piece of cake.

The microflora of a healthy woman is dominated by beneficial lactic acid bacteria (lacto- and bifidobacteria). When the quantitative and qualitative composition of the microflora shifts, beneficial bacteria give way to pathogenic anaerobic (able to live in the absence of oxygen) and facultative anaerobic (which oxygen does not have a destructive effect on).

The natural acidity level of 3.8-4.2 pH increases, and therefore lactic acid bacteria die (disintegrate), releasing ammonia. This is why vaginitis and vaginosis are characterized by an unpleasant smell of discharge.

Colpitis (vaginitis) most often occurs due to infection with an STD. This distinguishes it from vaginosis and thrush. Candidiasis (thrush) occurs without sexual intercourse. It is quite possible to pick it up in a pool or sauna if you sit on a bench without a towel. Thrush manifests itself when wearing neoprene shorts during fitness classes, tight-fitting trousers made of thick fabric, or playing sports in clothes not intended for this purpose. This disease worsens during adolescence, when rapid hormonal changes occur. It is rare that candidiasis is transmitted directly through sexual contact.

Integrated approach: pathogenetic and rational therapy of vulvovaginal candidiasis

Controversial body

In the human/microorganism system, the total number of human cells is 1013, and microbial cells are 1014-1015 (about 2 kg of weight).3 And each of these billions (one hundred billion billion!) microorganisms functions and metabilizes inside the macroorganism, that is, a person.
Without a doubt, this armada of microbes cannot but have a certain effect on the host organism.4 In recent years, many works have appeared that examine the organization of complex communities of microorganisms - biofilms, balanced in species and functional composition.

Without a doubt, this microecological system is extremely complex (in terms of the quantitative and qualitative composition of microorganisms), phylogenetically formed, and is of great interest for fundamental science.

From basic science to clinical practice

At the beginning of this century, ideas about human endoecology and its microbiota became the property of not only fundamental microbiology, but also clinical medicine, which was seriously concerned about the global growth of diseases called “civilizational” (cardiovascular, oncological, etc.).

Disturbances in the composition of a normal microecological system are now commonly called dysbiosis (dysbiosis), that is, a condition in which the composition and number of microflora are disrupted. Basic anaerobes disappear (or their number sharply decreases) - bifidobacteria, bacteroides, lactobacilli. The number of aerobes (primarily opportunistic and pathogenic) is growing. As a rule, dysbiotic changes disappear (self-healing) soon after the cause that caused them is eliminated (stress, concomitant diseases, surgery, acquired or inherited disorders of immune regulation, drug exposure, exposure to radiation, heavy metals, etc.). But with prolonged exposure to a provoking factor, a state of dysbiosis can form and clinical symptoms appear.

The most complete understanding to date has been formed about the largest pool of endosymbionts – the microbiota of the gastrointestinal tract. Much attention is paid to the microflora of the genital tract. Its norm is directly related to the homeostatic quality and quantity of the composition of “own” strains that do not cause a reaction of the immune system (inflammation). Like the normal intestinal flora, the microbiota of the genital tract performs important physiological functions and is involved in maintaining the homeostasis of the female body. It includes both nonspecific factors: physicochemical – pH, redox potential, viscosity; chemical - low molecular weight metabolites of the microbiota, as well as specific ones, in which neutrophils and other phagocytic cells participate. Only after the breakthrough of a specific link is the inclusion of all subsequent nonspecific and specific factors of protection of the macroorganism initiated.5 And the microorganisms included in this community produce numerous biologically active products: enzymes, antibiotics (actinomycetes, streptomycetes, fungi), regulatory factors, vitamins. They are involved in maintaining the pH of the environment and the balance of microelements.

A quantitative bacteriological analysis of the vaginal community of healthy women showed that 1 g of vaginal fluid contains 108 cells of aerobic and 109 cells of anaerobic bacteria.6 The leading microorganisms are Lactobacillus, Peptococcus, Bacteroides, Staphilococcus epidermidis, Corinebacterium spp., Peptostreptococcus spp., Eubacterium. These are the dominant microorganisms, whose concentration is more than 105 CFUg.

This is normal when the human/microbiota relationship is undoubtedly symbiotic. But under unfavorable conditions caused by various influences on the body (stress, etc.) or on the microbiota (antibiotic therapy), symbiosis can turn into a relationship of mutual aggression, when both of its participants can cause significant damage to the “opponent”: the epithelium can produce bacteriostatic and bactericidal enzymes (lysozyme, lactoferrin), activated phagocytic cells (neutrophils) begin to penetrate into it. And the bacteria, in turn, activate their own enzymatic apparatus (neuraminidases, hyaluronidases), endotoxins are released and other virulence factors are synthesized.

With this idea of ​​the nature of the relationship in the human/microbiota system, the difficulties that arise when treating, for example, patients with candidiasis become clear.

“Against” candida, “for” normal flora

The increase in the frequency and severity of a number of infectious diseases, the latent course and chronicity of inflammatory processes, associated by many specialists with microbiota disorders or dysbacteriosis, force clinicians to look for new and effective ways to correct them. And pharmacologists should offer them effective means for this. And an example of such a modern remedy can be an antifungal drug intended for the treatment of vulvovaginal candidiasis (VVC) with a prebiotic - Ecofucin® (AVVA RUS JSC, Russia).

VVC is caused by the overgrowth of yeast-like fungi of the genus Candida. But over the last decade, its frequency has almost doubled – reaching 30–45% in the structure of infectious lesions of the vulva and vagina. Up to 70–75% of women have at least one episode of VVC during their lifetime, while in 5–10% of cases the disease becomes recurrent (about 3 million cases per year).7-10

VVC negatively affects the quality of life, psychological state and sexual activity of women, requiring immediate treatment and taking into account the high risk of relapse.

As the name already implies, the etiological factor of the disease is fungi of the genus Candida (Candida albicans is the dominant causative agent of the disease, detected in 90% of patients with VVC; also representatives of Candida non-albicans, detected, as a rule, in recurrent VVC, occurring against the background of other diseases) , and in recent years there has been a clear trend toward an increase in the spread of VVC, caused specifically by Candida non-albicans species.7-8 These microorganisms are representatives of the normal human microbiome, that is, present in a healthy body as either symbionts or commensals along with lactobacilli.

But under the influence of exogenous and endogenous factors, which were already mentioned earlier, during pregnancy (an increase in glycogen in the vaginal epithelium), with a decrease in the body’s resistance, a noticeable deficiency of lactobacilli is formed and the number of C. albicans increases, its pathogenic properties begin to appear, provoking the onset and development of the disease .11-19 At the same time, experts note the difficulties in understanding the pathogenesis of the disease: strains of C. albicans isolated from patients with VVC and from healthy carriers do not differ significantly in a number of biochemical characteristics. Thus, the main role belongs not so much to the properties of the pathogen, but to the state of the macroorganism and its microbiome.13-14

Traditionally, the goal of drug treatment for VVC is eradication of the pathogen. Most cases can be treated with local antifungals and antiseptics. Intravaginal forms of drugs are safe (systemic absorption is practically absent), quickly provide relief of symptoms, and high concentrations of antifungals on the mucosal surface reduce the likelihood of developing resistance.

Ecofucin® is a polyene antibiotic with the active substance natamycin, which has a fungicidal effect on fungi and yeast by binding to the sterols of the fungal cell membrane, and is active against most yeast-like fungi, especially Candida albicans and Candida glabrata, often found in patients with VVC.

However, even adequate etiotropic therapy does not always prevent relapses of the disease.15-16 This, in particular, may be due to the fact that independent restoration of the vaginal microbiota is not always possible. Exacerbations can be prevented by restoring the vaginal biotope. Therefore, an important aspect of VVC therapy is the restoration of the normal vaginal microflora, so that the physiological mechanisms of colonization of the mucous membrane by saprophytes contribute to the suppression of the growth of pathogenic fungi.17 As is known, an important (and dominant) component of the resident vaginal microflora are lactic acid bacteria (L. acidophilus, L. plantarium, L. casei, etc.). They are the ones who prevent the growth of pathogenic microorganisms, acting as antagonists of fungi of the genus Candida, but not in the case of an oppressed and weakened microbiome.

Scientists have long noticed this. And in Europe, doctors recommend the use of suppositories with lactobacilli (probiotic) for topical use. This form is especially relevant for pregnant women with VVC.

Pro- and pre-

Preparations containing live bacteria and intended to correct various dysbiotic changes (probiotics) are widely used in our country. The safety of their use is a fairly well established fact. But clinical studies of probiotics have so far shown only short-term effects. According to a Cochrane review (2017), probiotics in the short term slightly improve the effectiveness of the antifungal agent and significantly reduce the frequency of relapses, but only within 1 month.20 The authors did not find a long-term protective effect.

And with the expansion of the range of indications for their use, information began to appear that their positive effect, even with long-term use, is often transient in nature. One of the main reasons for these failures, many authors consider the foreignness of the microorganisms included in their composition to humans, the high species, individual and anatomical specificity of the autochthonous microflora of patients (out of more than 10 species of lactobacilli found in vaginas, it is not possible to identify a single species that would be present in all women).18

Some experts believe that the collective immunity of the biofilm practically negates the result of correcting dysbacteriosis with probiotics. Sure, they create an effect, but not always and not in the way intended. Perhaps those authors are right who believe that each patient has his own unique (individual) strain landscape of indigenous microbiota, the constancy of which is ensured by the individual’s immune system. It is genetically determined.19

In addition, the widespread therapeutic and prophylactic use of probiotics has another limiting factor - economic, associated with the fairly high cost of the drugs.

Mechanisms of the positive effect of lactic acid bacteria and bifidobacteria on the body:6

• inhibition of the growth of potentially harmful microorganisms as a result of the production of antimicrobial substances; competition with them for adhesion receptors and nutrients; activation of immune-competent cells and stimulation of immunity;
• stimulation of growth of representatives of obligate microflora as a result of the production of vitamins and other growth-stimulating factors; normalization of pH, redox potential; neutralization of toxins;
• restoration and optimization of biofilm functioning;
• a change in microbial metabolism leading to an increase or decrease in the synthesis and activity of bacterial enzymes and, as a consequence, the production of corresponding metabolites (for example, VFA, glutamine, arginine, vitamins, peptidoglycans, etc.), which have the ability locally or after penetration into the blood and other biological fluids of the macroorganism directly interfere with the metabolic activity of the cells of the corresponding organs and tissues. Modulate its morphokinetic characteristics, physiological functions, biochemical and behavioral reactions.

An alternative and more promising approach aimed at restoring the microbiota can be considered the use of prebiotics, which, being a nutrient medium for the reproduction of one’s own normal flora, are capable of long-term stimulation and maintenance of its growth.22 These are drugs of non-microbial origin, belonging to various pharmacotherapeutic groups, but having a common property – the ability to have a positive effect on the host organism by selectively stimulating growth or activating the metabolic function of normal microbiota.

One of them is lactulose, a synthetic disaccharide. It is actively fermented by the normal microflora of the vagina, stimulating the growth of “its” bifidobacteria and lactobacilli. Lactulose has been used in pediatrics for more than 40 years to stimulate the growth of lactobacilli in infants.12

Mechanism of action of lactulose

In a recently published paper, the authors studied the in vitro response of lactobacilli, candida, and others to various prebiotics. According to the data obtained, lactulose most actively and selectively stimulates vaginal lactobacilli, including L. crispatus. It has also been shown that C. albicans does not metabolize lactulose when left without food. On this basis, scientists recommended including this disaccharide in combination therapy for VVC both in the acute process and in post-treatment.23

It was lactulose that became the second component of the drug Ecofucin® (100 mg of natamycin and a growth stimulator of normal vaginal microflora - prebiotic lactulose in a dosage of 300 mg).

The complex effect of this domestic drug Ecofucin® (vaginal suppositories), its effectiveness and safety were demonstrated in a multicenter open comparative randomized study conducted in clinical centers of St. Petersburg and the Omsk State Medical Academy.24

The study included patients aged 18 to 45 years with acute candidal vaginitis/vulvovaginitis. In the 1st group (n = 36), the main one, the observed patients took Ecofucin® , in the 2nd group (n = 36), the control group, a foreign-made drug with the active ingredient natamycin (100 mg), but without a prebiotic. Duration of therapy – 6 days.

Table. Number of patients with clinical manifestations after initiation of study drug therapy28

The effectiveness and safety of the study drugs were assessed based on the results of examination, laboratory tests, and according to patient diaries. Control visits were carried out on the 4th, 7th and 37th (± 2) days from the start of treatment.

Study results: 24 the combination of the antifungal drug natamycin and a prebiotic in the composition of intravaginal suppositories promotes faster achievement of clinical and microbiological remission, i.e. complete elimination of the pathogen, and also leads to intensive growth of lactobacilli (the content of vaginal Lactobacillus spp. before the start of therapy did not differ significantly - 0.3 and 0.6 lg CFU/ml; and on the 37th day, a significantly larger number of lactic acid bacilli were recorded in group of combined treatment: 4 lg CFU/ml compared to 2.1 lg in the 2nd, control group, a difference of almost 100 times), which are the main competitors of yeast-like fungi in the vaginal microbiota.

Drawing. Contents of Lactobacillus spp. in smears of patients who used natamycin + lactulose and natamycin before the start of therapy and 37 days after the start of therapy28

Ecofucin® was well tolerated by patients; no side effects were recorded during the study.24

Ecofucin® is an innovative combination of natamycin and lactulose and has the following advantages:

• actively eliminates fungi of the genus Candida (Candida albicans and Candida non-albicans);
• restores the vaginal microbiota, increasing the level of lactobacilli, and prevents the development of relapses of the disease;
• can be used from the first days of pregnancy and for various concomitant pathologies, since there is no systemic effect;
• ease of use – once a day;
• included in the standards for the treatment of candidiasis.

To summarize, it should once again be emphasized how important the microbiota of the female genital organs is as a physiological partner of the host organism. It is homeostatic, participates in metabolic processes on the mucosa and protection from external pathogens. At the same time, it can show hostility if its composition is disrupted.

Therapy of candidiasis, a disease caused by fungi of the genus Candida and whose pathogenic activity is provoked by similar disorders, taking into account new scientific knowledge about the relationships between the human / microbiota system, should be comprehensive and include not only the elimination of the pathogen, but also the restoration of the natural protective barrier. Both of these areas of treatment were successfully taken into account by the creators of the antifungal drug with the prebiotic Ecofucin® , intended for adequate treatment of candidiasis. Effective and safe, it shortens the duration of treatment of the disease, prevents the development of its relapses, making the vaginal use of lactulose together with standard local treatment with antifungal drugs a promising direction in the treatment of VVC.

Literature:

1Voevodin D.A., Rozanova G.N., Stenina M.A. Dysbacteriosis and immunopathological process. Journal of microbiology, epidemiology and immunobiology. No. 2, 2005, p. 89-92.2Ivanova V.V. An integrated approach to the restoration of microflora. A modern view on the correction of dysbiosis. / Ed. A.V. Molokeeva. Novosibirsk, 2011.3Sidorenko S.V. The infectious process as a “dialogue” between the host and the parasite. Clinical microbiology and antimicrobial chemotherapy. T. 3, No. 4, 2001, p. 301-315.4Isenberg HD Pathogenicity and virulence: another view. Clin. Microbiol. Rev. 1988, 1, p. 4053.5Casadevall A., Pirofski LA Host-Pathogen Interactions: basic concepts of microbial commensalism, colonization, infection, and disease. Infect. Immun. 2000, Dec., 68 (12), p. 6511-6518.6 Shenderov B.A. Medical microbial ecology and functional nutrition / In 3 volumes. M., Ed. Grant, 1998.7 Chereshnev V.A., Morova A.A., Ryamzina I.N. Biological laws and human vitality (method of multifunctional restorative biotherapy). Russia - Czech Republic. 2000.8Korshunov V.M., Volodin V.V., Efimov B.A. Intestinal dysbacteriosis. Children Hospital. No. 1, 2000, p. 66-74.9 Beyul E.A., Kuvaeva I.B. Intestinal dysbacteriosis and their clinical significance. Wedge. honey. No. 11, 1986, p. 37-44.10 Domaradsky I.V., Khokhoev T.Kh., Kondrakova O.A., Dubinin A.V. et al. Controversial microecology. J. Ross. chem. about-va them. DI. Mendeleev. T. XLVI, No. 3, 2002, p. 80-89.11Bartlett JG, Onderdonk AB, Drude E. et al. Quantitative bacteriology of the vaginal flora. J. Infect. Dis., 1977, 136, p. 271-277.12Federal clinical guidelines for the management of patients with urogenital candidiasis. M. 2015.13 Guide to outpatient care in obstetrics and gynecology / Ed. V.N. Serova, G.T. Sukhikh, V.N. Prilepskoy, V.E. Radzinsky. M. GEOTAR-Media, 2016, 1136 p. 14Rosa MI, Silva BR, Pires PS et al. Weekly fluconazole therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2013, 167 (2), p. 132–136. 15Savicheva A.M., Shipitsyna E.V. Recurrent urogenital candidiasis: features of diagnosis and treatment. Medical advice. No. 9, 2015, p. 12–15.16 Kirilenko O.V., Bril Yu.A. Correction of the vaginal biotope in case of vulvovaginal candidiasis. StatusPraesens. Gynecology, obstetrics, infertile marriage. No. 2 (55), 2022, p. 93–97.17 Rybalkin MV Biotechnological description of technologies for obtaining antigens of Candida genus fungi. Annals of Mechnikov's Institute. 2014, 2, p. 20–24.18Brown GD Innate antifungal immunity: the key role of phagocytes. Annu Rev Immunol. 2011, 29, p. 1–21.19Esim BE, Kars B., Karsidag AY et al. Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis. Arch. Gynecol. Obstet. 2010, vol. 282(5), p. 515–519.20Fidel P. History and update on host defense against vaginal candidiasis // Am. J. Reprod. Immunol. 2007, vol. 57 (1), p. 2–12.21 Blaser MJ The theory of disappearing microbiota and epidemics of chronic diseases. Nat. Rev. Immunol. 2022, 17 (8), p. 461–463.22Taggart H., Bergstrom L. An overview of microbiome and the effects of antibiotics. J. Nur Pract. 2014, 10, p. 150–170.23van Oostrum N., De Sutter P., Meys J., Verstraelen H. Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis. Hum. Reprod. 2013, 28 (7), p. 1809–1815.24Tokareva N.A. Correction and prevention of dysbiosis. New approaches to the treatment of diseases of the gastrointestinal system. Effective pharmacotherapy. Gastroenterology. No. 3, 2011, p. 77-84.25 Intestinal microflora: a view from the inside. / Innovative collection of scientific articles. / Chicherin I.Yu., Pogorelsky I.P., Darmov I.V. Issue No. 2, 2013, p. 4-15.26Zodzika J., Rezeberga D., Jermakova I. et al. Factors related to elevated vaginal pH in the first trimester of pregnancy. Acta Obstet. Gynecol. Scand. 2011, 90 (1), p. 41–46.27Collins SL, McMillan A, Seney S, van der Veer C, et al. Promising prebiotic candidate established by evaluation of lactitol, lactulose, raffinose, and oligofructose for maintenance of a lactobacillus-dominated vaginal microbiota. Appl. Environ Microbiol. 2022, 84 (5), p. 1-15.28 Krotin P.N., O.V. Kirilenko O.V. Combination of an antifungal drug and a prebiotic in the treatment of acute vulvovaginal candidiasis. RMJ. Mother and child. No. 2 from 05.29.2019, p. 120-125.

Features of vaginosis and its difference from vaginitis and thrush

Vaginosis occurs in young and inexperienced girls who have just entered into sexual relations. There are several reasons for this: an allergy to latex may occur, the vagina may be injured during sexual intercourse because it does not produce enough lubrication due to feelings of fear and novelty, etc. Vaginosis also occurs in those who have not yet had sexual intercourse.

The difference between vaginosis and thrush and vaginitis is that with vaginosis the vaginal walls do not become inflamed. Otherwise, the routes of infection for vaginitis, vaginosis and thrush are approximately the same:

• Aggressive hygiene with caustic agents - soap, solutions (intestinal bacteria are transferred from the anus to the vagina, and when douching, beneficial microflora is washed out).
• Lack of normal hygiene (bacteria accumulate in the vulva, causing inflammation).
• Uncontrolled use of antibiotics (antibiotics destroy everything indiscriminately, including beneficial flora, and change the composition of the microflora).
• Hormonal imbalances. A low level of one of the hormones negatively affects the structure of the mucous membrane - it becomes thinner, and its protective functions weaken. For this reason, vaginosis in pregnant women is observed very often.
• Frequent changes of sexual partners and unprotected sex are an exchange of microflora, and not always favorable ones.
• Diarrhea and diarrhea - 1/2 of patients with vaginosis suffer from stomach upset.
• Local allergy - sometimes a change in the bacterial background occurs as a reaction to a tampon, pad, or synthetic underwear.
• Use of hormonal contraception or self-selected intrauterine device. Hormones should be prescribed based on the results of sex hormone tests.
• Inflammation of the genitourinary system - thrush - a companion to uterine fibroids, vaginosis - cystitis.
• Diabetes mellitus (diabetes interferes with the production of glycogen, which feeds lactic acid bacteria)

What is the connection between diet, gut bacteria and vaginal health?

Research shows that there is a connection between the microbiota of the gut and vagina. For example, adding probiotics to the diet has a positive effect on the health and diversity of the vaginal microbiota.

A diet that supports healthy gut bacteria is also good for your vaginal flora. Fiber in the diet stimulates the production of fatty acids, which fight inflammation in the intestines and support overall immunity. Mandatory components of such a diet will be vegetables and fruits, fermented foods, a sufficient amount of water and protein.

You can find out which of this set you need and in what proportion using the Atlas Microbiota Test. It will provide information about the gut microbiota, but it may also be important for vaginal health.

Composition of a smear for microflora: norm and pathology

To identify the composition of the flora, you need to take a smear from a gynecologist. A smear on the flora is taken from the urethra (U), from the cervix (C) and the vaginal wall (V).

In a healthy woman, the composition of the microflora will look like this:

• Flat epithelium
  . If it lines the walls of the vagina in layers, this indicates vaginitis, because normally there should be single digits of squamous epithelial cells. If there are no squamous epithelial cells at all, this indicates atrophic vaginitis.
• Leukocytes
  . They are designed to neutralize the causative agent of infection, therefore they are characteristic of inflammation. White blood cells are absent only in vaginosis.
• Gram-positive rods
  (staining blue during the Gram test). These are lactobacilli and Dederlein bacilli, which maintain optimal alkaline balance in the vagina. They feed on glycogen, a polysaccharide that gives life to beneficial microorganisms. When glycogen breaks down, lactic acid is formed, which prevents pathogenic bacteria from multiplying. With a decrease in immunity, gram-positive bacilli are reduced in quantity and are unable to resist infections. The more gram-positive rods in the composition, the better.
• Slime
  . It is needed to maintain a moist environment of the vaginal mucosa. Mucus is secreted by the glands of the cervical canal. Normally, the volume of mucus secreted is equal to the amount absorbed (about 5 ml), and an increase in the norm indicates inflammation of the cervix.
• Key cells
  . It is a squamous epithelial cell surrounded by bacteria. This only happens when the vaginal microflora is disrupted.

On a note

• A woman’s vagina is a separate ecosystem inhabited by different types of microorganisms.
• Normally, lactobacilli predominate in the vagina, which secrete lactic acid and maintain an acidic environment. It is what protects against most infections and prevents inflammation.
• Itching, discharge or odor from the vagina indicate a disruption in the normal balance of vaginal microflora. This happens due to hormonal imbalances, general decline in immunity, damage to the mucous membrane or infections.
• Vaginal dysbiosis can lead to bacterial vaginosis, thrush or candidiasis or vaginitis. These are all different conditions with different causes and main symptoms.
• Bacterial vaginosis occurs because the number of lactobacilli decreases and other bacteria take their place. The cause of thrush or candidiasis is the abnormal growth of fungi. Vaginitis can be caused, for example, by sexually transmitted infections.
• All conditions are treatable, but to get rid of thrush, vaginosis and unpleasant symptoms, it is better to consult a doctor. The gynecologist will conduct an examination, do the necessary tests and prescribe the best combination of drugs.
• To maintain a healthy vaginal microflora, it is useful to pay attention to your diet and the state of your intestinal microbiota, because they are related.
• Taking probiotics and enriching your diet will help regulate different bacteria, support your immune system, and fight inflammation.

To learn more about the health of your gut bacteria and understand what dietary changes will benefit you, you can take the Atlas Microbiota Test.

Sources:

• Khoudia Diop et al., Exhaustive repertoire of human vaginal microbiota, 2018
• Emmanuel Amabebe, Dilly OC Anumba, Female Gut and Genital Tract Microbiota-Induced Crosstalk and Differential Effects of Short-Chain Fatty Acids on Immune Sequelae, 2020
• Chris Kenyon, The global epidemiology of bacterial vaginosis: A systematic review, 2013
• Bacterial Vaginosis - CDC Fact Sheet
• Andrew B. Onderdonk, Mary L. Delaney, Raina N. Fichorova, The Human Microbiome during Bacterial Vaginosis, 2016
• NHS, Bacterial Vaginosis
• Mayo clinic, Vagintis symptoms and causes
• BBC, Oral sex linked to vaginal condition bacterial vaginosis
• Wilson J, Managing recurrent bacterial vaginosis, Sexually Transmitted Infections, 2004
• Сleveland Clinic, Vaginitis
• Ziyue Wang et al., Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis, 2019
• Gregor Raid et al., Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. 2003
• Sarah Cribby et al., Vaginal Microbiota and the Use of Probiotics, 2009

Tags

• Lifestyle
• Microbiota

Comparative analysis of the results of a smear on microflora from the vagina

What are the dangers of vaginosis, vaginitis and candidiasis?

All three pathologies are very unpleasant and cause serious damage to a woman’s health.

Vaginosis

. Despite the fact that bacterial vaginosis does not cause inflammation, it is fraught with a serious danger, which will definitely make itself felt when planning a pregnancy. A woman must be cured of bacterial vaginosis, otherwise she will not be able to get pregnant or carry a baby to term. The key cell, at the moment the sperm moves towards the egg, easily transmits the infection with it. Inflamed reproductive organs are not the place for a normal pregnancy. And even if conception occurs, pathogens will penetrate the placenta or amniotic fluid. This will provoke an early miscarriage or premature birth in the 3rd semester. A baby whose mother suffered from vaginosis during pregnancy is born with congenital infections, pneumonia, encephalitis, etc.

Vaginosis and vaginitis.

Many scientists argue that these diseases indirectly provoke oncology - cancer of the genital organs. It has long been known that weak microflora is the best environment for the development of herpes and HPV. They, in turn, weaken the body's immune system. As viruses actively develop, they secrete a carcinogenic protein that accumulates and provokes the development of cancer.

Vaginitis

. This disease, which has become chronic, is also a cause of infertility. Having an inflammatory nature, vaginitis covers the cervix, and from it the organ itself. Affecting the mucous surface, vaginitis causes the development of endometritis (inflammation of the endometrium), adhesions of the fallopian tubes, inflammation of the bladder, etc. During conception, vaginitis interferes with the normal attachment of the embryo to the endometrium. This prevents the fetus from developing normally, causing various developmental pathologies and premature birth.

Candidiasis (thrush).

The fungus does not affect the reproductive system and, unlike vaginitis and vaginosis, does not directly lead to infertility. But by weakening the overall flora, candida creates excellent conditions for the development of the most dangerous pathogens. In addition, frequent relapses of thrush indicate that there are problems in the body. Perhaps candidiasis is caused by uterine fibroids or ovarian cysts, low-grade pneumonia or hyperglycemia. And what can we say about a woman’s condition during an exacerbation of thrush - you can forget about your personal life these days.

Treatment of vaginosis, vaginitis and candidiasis

Whether or not to treat these diseases is up to you to decide. All three pathologies may not give unpleasant signs for a long time and the woman may well come to terms with the state of affairs. Another option is to self-medicate, which, as you know, will definitely not lead to anything good.

Treatment of all three diseases is carried out with antiseptics in the form of suppositories, tablets or ointments. It is prescribed exclusively by a doctor and selected according to individual indications.

If you still made the right decision and chose treatment from a gynecologist, come to the Diana clinic in St. Petersburg. Here you can get tested inexpensively and be cured of any gynecological disease.

Thrush during pregnancy

The development of vaginal candidiasis during pregnancy is dangerous for the expectant mother and the fetus. There is an increasing threat of the development of inflammatory processes during pregnancy, postpartum complications, and infection of the fetus, which can lead to fungal infection of its organs and even death. It is possible that the baby may become infected during childbirth. Treatment of thrush in pregnant women is complicated by the ban on taking antifungal drugs orally. Local treatment with vaginal tablets and suppositories is acceptable (Pimafucin is considered the safest among them during pregnancy). All the more important is the observance of personal hygiene rules, as well as protection from stress, proper nutrition with sufficient vitamins, walks, healthy sleep, which help strengthen the natural immune defense. If signs of thrush appear in a pregnant woman, she should immediately contact an obstetrician-gynecologist in order to carry out timely, adequate treatment and avoid complications.

For diagnosis and successful treatment of vaginal candidiasis, come to the Clinical Hospital on Yauza. You can see
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