Small granulation at vaginal opening

If small granulations grow inside the vaginal opening and there are no special symptoms, the patient does not need any treatment. She should observe her physical condition more and take relevant treatment if any bad symptoms occur. This can prevent some drugs from causing harm to her body. Some patients must undergo local vaginal treatment and examination, which is also very critical.

The treatment principles of bacterial vaginosis are: ① Asymptomatic people do not need treatment; ② Sexual partners do not need treatment; ③ Bacterial vaginosis during pregnancy should be actively treated; ④ Those who need uterine cavity operation, such as curettage, artificial abortion, hysteroscopy, IUD insertion and removal, hysterosalpingography, if bacterial vaginosis is found before the operation, need active treatment.

Goals of treatment

BV is characterized by a disordered vaginal ecological environment, in which the normal flora dominated by hydrogen peroxide-producing lactobacilli is replaced by an overgrowth of mixed microorganisms. Therefore, the goal of treatment is to kill pathogenic microorganisms and restore the normal vaginal ecological environment. Treatment can relieve vaginal symptoms and signs, reduce the risk of BV-related infectious complications during pregnancy, reduce the risk of premature birth or low birth weight, and reduce the risk of infectious complications after miscarriage or hysterectomy. Although treatment can achieve a cure rate of more than 80%, there can be an 80% recurrence rate within 1 year.

Treatment

There are two types of treatments for BV: systemic treatment and local vaginal treatment. Systemic treatment mainly involves oral medications, which are suitable for BV patients who are unwilling to use local medications or have complications. However, the dosage of the medication is large, and there are more and more obvious chances of systemic side effects.

Local vaginal treatment is the use of medications inside the vagina to directly kill or inhibit BV-related mixed microorganisms. It is suitable for BV patients who cannot tolerate the adverse reactions of oral drugs and have no complications. It has the advantages of small dosage and mild or unobvious adverse reactions, so local medication is more popular.

Treatment considerations

During the treatment of BV, sexual intercourse or condom use should be avoided. During local treatment, long sitting baths should also be avoided. Condoms must still be used within 4 weeks after the end of treatment. The time for local medication should be chosen between two menstrual periods. Follow-up is required after treatment, generally 1 week, 4 weeks, 3 months, and 9 months after treatment. The cure criterion is that all indicators in the diagnostic criteria return to normal, and the recurrence criterion is the reappearance of most or all indicators in the diagnostic criteria after cure.

Anti-anaerobic drugs are mainly metronidazole and clindamycin. Metronidazole inhibits the growth of anaerobic bacteria without affecting the growth of lactobacilli. It is an ideal therapeutic drug, but has poor effect on mycoplasma.