Bacterial vaginosis: Pathogenesis, diagnosis, treatment, and prevention

Objective. To carry out a systematic analysis of scientific researches, international and Russian clinical practice guidelines on bacterial vaginosis (BV). Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on vaginal microbiocenosis in healthy women and in patients with BV, as well as the clinical practice guidelines by the Centers for Disease Control and Prevention (CDC) (2015), the International Union against Sexually Transmitted Infections (IUSTI) (2011), and the Russian Society of Obstetricians and Gynecologists (2016) for the management of BV. Results. BV is characterized by complex vaginal microbiocenotic changes, the basis for which is the replacement of hydrogen peroxide-producing lactobacilli by a large number of predominantly anaerobic bacteria, which is accompanied by watery, cream gray discharge with an amine odor. BV can be diagnosed using Amsel’s criteria. The derivatives of nitroimidazole and lincosamide are drugs of choice for the treatment of BV. There are no universal recommendations for the prevention of its recurrences today, which is due to the multifactorial pattern of causes and to the polymorphism of BV pathogens, therefore alternative agents and methods are being sought for. But despite the large number of scientific publications and constantly updated foreign and Russian clinical practice guidelines, practitioners are often guided by outdated approaches when managing women with complaints of vaginal discharge. Conclusion. The paper analyzes main myths about BV in practitioners and presents an update on its diagnosis, pathogenesis, treatment and prevention. © 2018, Bionika Media Ltd. All rights reserved.