Recurrent vulvovaginitis and vaginosis. Possibilities of effective therapy

Aim: to increase the effectiveness of combination therapy and reduce frequency of recurrences of inflammatory diseases in the lower genital tract of combined etiology.Materials and Мethods. There was conducted a prospective, randomized, blind, comparative clinical study. 80 women with vaginal microbiota disorders were examined randomized into 2 groups: group I (n = 40) – antibiotic therapy was carried out in combination with the preparation Superlimph, group II (n = 40) – a standalone antibacterial therapy; group III consisted of 20 patients lacking gynecological diseases considered to provide with control laboratory parameters. Clinical and laboratory methods were used: microscopy of vaginal smears, detection of viruses and sexually transmitted infections, measurement of serum cytokine levels – interleukins (IL-1â, IL-2, IL-4, IL-6, IL-8, IL-10), tumor necrosis factor alpha, (TNF-á), interferon gamma (IFN-ã).Results. It was found that clinical recovery occurred in 90.0 and 70.0 % of patients in group I and group II (р = 0.02), respectively. Microbiological recovery was observed in 100.0 and 67.5 % of patients, respectively (р = 0.003). In group I, the isolation of herpes simplex virus type 2 was found in 80.0 and 45.2 % of patients before and after treatment (p < 0.001), respectively, whereas in group II – in 82.5 and 77.5 %, respectively (p = 0.58), between groups – p < 0.001. Before treatment the level of all cytokines, excepting IFN-ã, was higher than the reference values in both groups: in group I, their magnitude decreased after treatment (p < 0.001) and corresponded to the reference values; in group II no changes occurred. Three months after treatment, no relapses were observed in group I, whereas frequency of relapses in group II was 22.5 %, within 1 year – 0 and 35.1 %, respectively. Predictors of recurrent dysbiosis (IL-2, IL-6 and TNF-á in increased concentrations after a course of treatment) were identified.Conclusion. Treatment with a combined broad-spectrum antimicrobial drug along with topical immunomodulatory agent containing exogenous cytokines is an effective strategy for treating concomitant dysbiosis and preventing relapse.

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Immune-mediated mechanisms of the inflammatory response in women with combined infections of the lower genital tract

Dikke

Sukhanov

Kukarskaya

et al. 2021

Akušerstvo, ginekologiâ i reprodukciâ

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Prevention of dysbiotic and inflammatory diseases of the vagina and vulva after surgical correction of genital prolapse and stress urinary incontinence

et al. 2020

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Normal vaginal microflora consists of a wide range of microorganisms that maintain optimal vaginal milieu, preventing the development of infectious and inflammatory diseases of the vulva and vagina. However, the use of drugs, changes in hormonal status, urinary incontinence and pelvic floor dysfunction can disrupt the optimal balance of the vaginal microbiota, which leads to the development of dysbiotic pathological processes. The first-line treatment for stress urinary incontinence is the installation of suburethral slings. If incontinence is combined with a cystocele, it is advisable to perform reconstructive surgery for anterior vaginal wall, which has high both anatomical and functional efficacy. Surgical correction of genital prolapse and stress urinary incontinence requires bladder catheterization, which further increases the risk for dysbiotic and inflammatory diseases of the urogenital tract. The widespread use of antibiotic therapy leads to the formation of resistant strains of microorganisms and is not always fully realized, especially in the presence of post void residual urine in the postoperative period. Vaginal Zalain suppositories are highly sensitive to Candida species, and the use of Zalagel Intim gel is associated not only with antifungal, but also anti-inflammatory effect. Complex therapy with Zalain suppositories and Zalagel Intim gel is highly effective in the treatment of cytolytic, bacterial vaginosis, vulvovaginal candidiasis, and can also be used as the prevention of infectious complications after corrective interventions for pelvic organ prolapse and stress urinary incontinence.

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What should be considered when choosing a drug for local therapy of nonspecific vaginitis and bacterial vaginosis

Мамчур

Khomiak²

2022

RHW

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Vaginal infections are highly spread among the female population and they impact the woman’s organism, fetal development and child health. They remain an important medical and social problem, so the optimizing the treatment is very important. The article is a review of the modern domestic and foreign publications about the etiological factors, pathogenesis, and local pharmacotherapy of nonspecific and candidiasis vaginitis and bacterial vaginosis, including their manifestation during pregnancy. The issues of vaginal infections in non-pregnant and pregnant women, the main risk factors for their development, the range of pathogens of infectious lesions of the vagina, which are the most common - bacterial vaginosis (G. vaginalis and A. vaginae), nonspecific vaginitis (Streptococcus spp., S. aureus, coagulase-negative staphylococci, E. coli, etc.), candidiasis vaginitis (C. albicans and C. non-albicans), and the importance of changes in the composition of the vaginal microbiome in the development of these diseases are demonstrated. Based on the data from scientific publications, the article presents the analysis of the sensitivity of pathogenic flora to anti-infective methods. The attention is drawn to the risks of nonspecific and candidiasis vaginitis and bacterial vaginosis during pregnancy (miscarriage and premature birth, placental insufficiency, etc.), the advantages and disadvantages of systemic and local therapy for these diseases, the comparative characteristics of individual drugs for topical therapy are given, taking into account the composition and pharmacodynamics of their components.The clinical and pharmaceutical benefits of a complex preparation that includes ternidazole, neomycin sulfate, nystatin and prednisolone sodium metasulfobenzoate and has the bactericidal (including antianaerobic), fungicidal, antiprotozoal, and anti-inflammatory effects have been analyzed. Data on the microbiological and clinical efficacy of the drug, its storage effect on the vaginal microbiome, and features of innovative technology for the manufacture of its dosage form are presented.

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Recurrent vulvovaginitis and vaginosis. Possibilities of effective therapy

Cited by 3 publications

References 14 publications

Immune-mediated mechanisms of the inflammatory response in women with combined infections of the lower genital tract

Immune-mediated mechanisms of the inflammatory response in women with combined infections of the lower genital tract

Prevention of dysbiotic and inflammatory diseases of the vagina and vulva after surgical correction of genital prolapse and stress urinary incontinence

What should be considered when choosing a drug for local therapy of nonspecific vaginitis and bacterial vaginosis

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