On the diagnosis and treatment of refractory and recurrent vaginosis and vaginitis in the practice of a gynecologist

Abstract

The relevance of diseases accompanied by pathological secretions from the genital tract is undeniable. This is the leading reason for women to go to a gynecologist. Despite the routine nature of diseases associated with pathological secretions from the genital tract – bacterial vaginosis, aerobic vaginitis, candidiasis vulvovaginitis, mixed vaginitis – the issues of their diagnosis and treatment remain unresolved. In the treatment of vaginosis and vaginitis, we are increasingly faced with the formation of biofilms and, accordingly, a refractory response to treatment or a relapse of the disease. Research shows that refractory response and relapse of the disease are different conditions that require different therapeutic and preventive approaches, but in both cases their cause is often the formation of biofilm. Biofilm vaginitis is a problem of the new century. Biofilms are a difficult task in the treatment of bacterial infections and are one of the main causes of infection persistence. Currently, more than 80% of bacterial infections are caused by the formation of bacterial biofilms. Due to the biofilm, increased tolerance to antimicrobials is maintained for a number of reasons. The article discusses available methods of overcoming antibiotic resistance in bacterial vaginosis and vaginitis, the possibility of avoiding recurrence of the disease without causing significant harm to the vaginal microbiota. Special attention is paid to such an antiseptic as dequalinium chloride. Unlike antibiotics, dequalinium chloride is less toxic to lactobacilli and does not increase the risk of developing candidiasis vulvovaginitis. It works well both on the causes of bacterial vaginosis and on flora unrelated to bacterial vaginosis, which makes it a potentially effective drug for aerobic and mixed vaginitis.