| Abstract | Bakterijska vaginoza (BV) vrlo je čest problem s kojim se žene javljaju u ginekološku ambulantu. Ona je uz gljivičnu infekciju rodnice, najčešći uzrok pojačanog vaginalnog iscjetka i najčešća upala rodnice u žena reproduktivne dobi. U normalnim uvjetima, u rodnici prevladavaju laktobacili koji pomažu održati pH rodnice između 3,5 i 4,5. Međutim kada se smanji njihov broj, gubi se zaštitni pH uslijed čega poraste broj anaerobnih bakterija, prvenstveno Gardnerella vaginalis. Brojni su predisponirajući čimbenici koji doprinose ovom stanju poput uzimanja OHK ili antibiotika, korištenje intrauterinog uloška, česta ispiranja rodnice ili veći broj seksualnih partnera i dr. Razdoblja u kojima je veća učestalost bakterijske vaginoze su pretpubertet, trudnoća i postmenopauza zbog hipoestrogenizma. Karakteristični simptomi uključuju već spomenuti vodenasti sivkasto bijeli iscjedak koji ima karakterističan neugodan miris po ribi. Simptomi poput svrbeža, dizurije i dispareunije obično se ne uklapaju u kliničku sliku bakterijske vaginoze već mogu upućivati na pridruženu gljivičnu, trihomonasnu ili drugu infekciju. Međutim, čak polovica žena nema nikakve simptome. Dijagnoza se najčešće postavlja korištenjem Amselovih kriterija koji uključuju: 1) pojačani vodenasti iscjedak bijele do mliječnosive boje po stjenkama i dnu rodnice; 2) pH rodnice > 4,5; 3) nalaz tzv. clue cells koji je patognomoničan za infekciju Gardnerell-om vaginalis; 4) pozitivan "whiff" / "sniff" test - dodatkom 10% KOH na iscjedak dolazi do intenzifikacije neugodnog karakterističnog mirisa na pokvarenu ribu. Pri čemu je potrebno istodobno postojanje 3 od 4 nabrojanih kriterija za definitivnu dijagnozu. Iako u većini slučajeva bakterijska vaginoza u trudnoći ne izaziva komplikacije, njena prisutnost može povećati rizik od spontanog pobačaja, infekcije plodovih ovoja i prijevremenog poroda. Terapija bakterijske vaginoze uključuje metronidazol i/ili klindamicin lokalno u obliku vaginaleta ili krema ili sistemski u obliku tableta, obično u trajanju od sedam dana. Ovo stanje ženama može umanjiti kvalitetu života jer se ponekad teško liječi i izaziva neugodne simptome. S obzirom da su vrlo česti recidivi ove infekcije, važno je održavati pravilnu intimnu higijenu, odlaziti redovito na ginekološke preglede uključujući papa-test, koristiti pamučno i prozračno donje rublje te uz terapiju antibiotikom preventivno koristiti probiotike. |
| Abstract (english) | Bacterial vaginosis (BV) is one of the most common reason women visit a gynecologist. In addition to vulvovaginal candidiasis, it is the most common cause of increased vaginal discharge and the most frequent cause of vaginitis in women of reproductive age. Under normal conditions, lactobacilli predominate in the vagina, helping to maintain the pH of the vagina between 3.5 and 4.5. However, when their number decreases, the protective pH is lost, resulting in an increase in the number of anaerobic bacteria, primarily Gardnerella vaginalis. There are many risk factors that contribute to this condition such as taking OHK or antibiotics, wearing an IUD, douching or having multiple sex partners, etc. Periods where bacterial vaginosis is more common are prepuberty, pregnancy and postmenopause due to hypoestrogenism. Characteristic symptoms include the already mentioned watery greyish-white discharge that has a strong fishy smell. Symptoms such as itching, dysuria, and dyspareunia do not usually fit the clinical picture of bacterial vaginosis but may indicate an associated fungal, trichomonas, or other infection. However, 50% of women with bacterial vaginosis do not have any symptoms. The diagnosis is most often made using Amsel's criteria, which include: 1) increased watery discharge of white to milky gray color on the walls and bottom of the vagina; 2) vaginal pH> 4.5; 3) the finding of the so-called clue cells that are pathognomonic for Gardnerella vaginalis infection; 4) positive "whiff" / "sniff" test - the addition of 10% KOH to the discharge intensifies the unpleasant characteristic odor on rotten fish. Where the coexistence of 3 of the 4 listed criteria for a definitive diagnosis is required. Although in most cases bacterial vaginosis in pregnancy does not cause complications, its presence can increase the risk of miscarriage, infection of the amniotic sac and premature birth. Treatment of bacterial vaginosis includes metronidazole and / or clindamycin topically in the form of a vaginalet or cream or systemically in the form of tablets, usually for seven days. This condition can reduce a woman's quality of life because it is sometimes difficult to treat and causes unpleasant symptoms. Since recurrences of this infection are very common, it is important to maintain proper intimate hygiene, go to gynecological examinations regularly including a Pap test, use cotton and breathable underwear and use probiotics preventively with antibiotic therapy. |
