Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова; 117997, Россия, Москва, ул. Академика Опарина, д. 4 Резюме Среди гинекологических заболеваний у женщин репродуктивного возраста ведущее место занимают воспалительные заболевания нижнего отдела генитального тракта (70%), значительную долю которых составляют воспалительные процессы влагалища и шейки матки. У ⅔ женщин цервицит чаще всего протекает бессимптомно, поэтому они не обращаются за лечением, а у 65-77,6% отмечается переход в хроническую форму. Так, хронический цервицит диагностируется почти у каждой третьей женщины, обращающейся за помощью к гинекологу в связи с лейкореей, тенденции к снижению частоты заболевания не отмечается. В статье представлен актуальный взгляд на проблему воспалительных заболеваний нижнего отдела полового тракта. Проведен анализ ряда исследований, посвященных влиянию локального иммунитета и состояния микрофлоры влагалища на развитие хронических воспалительных заболеваний. Представлены результаты протеомных исследований цервиковагинальной жидкости в ранней диагностике воспалительных заболеваний нижнего отдела полового тракта и возможность использования цитокиновых биомаркеров в клинической практике с целью прогнозирования патологического состояния и выбора дальнейшей тактики лечения пациентки. Рассмотрена эффективность использования комбинированного препарата на основе хлоргексидина и декспантенола, обладающего выраженным противомикробным, регенерирующим и метаболическим действием и применяемым в терапии острых и хронических вагинитов; бактериального вагиноза; эндо-, экзоцервицитов, что является актуальным в терапии воспалительных заболеваний нижнего отдела генитального тракта.Ключевые слова: вагинит, цервицит, хлоргексидин, декспантенол, лейкорея Для цитирования: Назарова Н.М., Некрасова М.Е., Довлетханова Э.Р., Абакарова П.Р. Вагиниты и цервициты: выбор эффективного метода терапии (обзор литературы). Медицинский совет. 2020;(3):17-23. AbstractAmong gynaecological diseases in women of reproductive age the leading place is occupied by inflammatory diseases of the lower part of the genital tract (70%), a significant proportion of which are inflammatory processes of the vagina and cervix uteri. In ⅔ of women, cervicitis is most often asymptomatic, so they do not seek medical treatment, and 65-77.6% have a transition to a chronic form. Thus, chronic cervicitis is diagnosed in almost one in three women who seek assistance from a gynaecologist due to leukorrhea, and there is no tendency for a decrease in frequency. The article presents an actual view on the problem of inflammatory diseases of the lower genital tract. The analysis of some researches devoted to the influence of local immunity and the state of vaginal microflora on the development of chronic inflammatory diseases is carried out. The results of proteomic researches of cervicovaginal fluid in early diagnostics of inflammatory diseases of the lower genital tract and the possibility of using cytokine biomarkers i...

Aim. To analyze an efficacy of monotherapy and combined therapy (an immunomodulator + radio wave ablation) in patients with low-grade squamous intraepithelial lesion (L-SIL) caused by HPV infection. Materials and methods. The study included 210 women with human papillomavirus infection which was identified using real-time polymerase chain reaction (PCR). All women underwent a comprehensive examination which included history taking, general and gynecological examinations, extended colposcopy and a bacterioscopy of Gram-stained vaginal smears. A quantitative determination of vaginal microflora composition by PCR was carried out. Conclusion on either inflammatory response is present or absent was made on the basis of an inflammation index magnitude: with a value of more than 60% indicating a presence of local inflammation signs. Based on cervical cytology data a group consisting of 79 women who had L-SIL was formed. Patients were divided into 2 subgroups: the main one (n=45) who received combined treatment with radio wave ablation + an immunomodulator and a control one (n=34) who received only local monodestruction of L-SIL foci followed etiotropic treatment. Results and discussion. An efficacy of combined treatment which included radio wave ablation + an immunomodulator was higher compared to monodestruction only - 86.7% vs 64,7% respectively. It is important that by 6th month of follow-up a relapse of human papillomavirus infection occurred in 4.5 and 23.5% of patients of main and control groups respectively. Local inflammation was assessed as positive with an inflammation index of more than 60%. So after 6 months of follow-up this indicator decreased by 83.3 and 54.2% in the 1st and 2nd groups respectively. Clinical manifestations of an inflammatory process in the cervix was observed only with CIN recurrence. In addition, combined therapy provides a higher rate of human papillomavirus elimination at 6 months and faster cervix epithelization followed treatment by ablation.

Lower genital tract inflammatory diseases, caused by opportunistic and pathogenic microorganisms (vulvovaginitis), occupy a leading place among gynecological diseases and are one of the most common reasons for women to consult an obstetrician-gynecologist. Vulvovaginitis is rarely caused by a single pathogen. In recent years, lower genital tract inflammatory diseases are characterized by the predominance of mixed infections, which, on the one hand, can lead to a more severe and prolonged course, frequent relapses, an ascending infection, and, on the other hand, can be asymptomatic, till the development of complications, and represent certain difficulties in the diagnosis and choice of therapy. Opportunistic pathogens and anaerobes-bacteroides play a major role in manifestations of mixed infections. Currently, in the treatment of mixed vulvovaginitis, preference is given to combined drugs that have an effect on a wide range of pathogenic microorganisms. One of them is Metromicon-Neo, which features of action and our experience of its use along with the features of mixed vulvovaginitis are summarized in the article.

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Topicality: vulvovaginal candidiasis (VVC) is a common disease caused by the infectious damage of the vulva and vagina by yeast-like fungi from Candida genus. According to the literature, a VVC episode occurs in 75% of women, and 5-8% of them get a recurring course of the disease. Frequent recurrences of the disease may result in the psychosexual disorder and reduce the women’s quality of life and recurrent vulvovaginal candidiasis (VVC) therapy is still a very difficult task.Purpose of the study: evaluate the efficacy of fluconazole (150 mg) in acute and recurrent vulvovaginal candidiasis.Materials and methods:A total of 89 women of reproductive age with acute and recurrent HCV were enrolled in the study, which were subdivided into 2 groups: the first group included women with acute vulvovaginal candidiasis (AVVC) (n = 51), and the second group - women with recurrent vulvovaginal candidiasis (RVVC) (n = 38). The Group I (AVVC) received fluconazole 150 mg once. Depending on the prescribed therapy, the second group (RVVC) was subdivided into two subgroups: patients in the IIa subgroup received fluconazole 150 mg intravenously, three times, at intervals of 2 days, and women in the IIb subgroup received fluconazole 150 mg for a period of 6 months in addition to the three-fold intake of fluconazole weekly. The follow-up period was 6 months after the end of therapy, during which the frequency of VVC recurrence and the effectiveness of the therapy was evaluated.Results of the study: our data showed that all patients with acute VVC had a discontinuation of symptoms of the disease and a normalization of laboratory parameters after treatment with fluconazole, and after the anti-relapse therapy course the incidence of VVC recurrences was significantly lower compared to the period before anti-relapse therapy (p = 0.038). It was shown that all the investigated strains of C. albicans (100%) were sensitive to fluconazole, and resistance was detected only in 1 strain of C. glabrata and 1 strain of C. krusei.