Dysbiotic processes in the vagina, in particular aerobic vaginitis, are closely related to the local immune status violations, interfere the cervical epithelium physiological metaplasia, and also create favorable conditions for sexually transmitted infections accession, in particular the human papillomavirus. This complex of disorders is one of the determining factors for both the prolonged complicated course of cervical ectopy and its recurrence. The objective: was to optimize the treatment tactics in patients with cervical ectopy complicated by aerobic vaginitis. Materials and methods. It was carried out a comprehensive examination and treatment of 70 women of reproductive age (18–49 years) with cervical ectopy complicated by the aerobic vaginitis presence. All patients were questioned with a study of the reproductive anamnesis, bacterioscopic, cytological examination, simple and advanced colposcopy, pH-metry of vaginal environment, vaginal microbiota investigation. Depending on the treatment regimen, the patients were randomly divided into 2 groups. Group 1 (main group, n=35) – included patients treated according to the proposed scheme: on the first stage patients were prescribed vaginal suppositories containing dexpanthenol and chlorhexidine bigluconate – 1 suppository intravaginally twice a day and a complex multi-strain probiotic – 1 capsule twice a day for 2 weeks. On the second stage the patients were prescribed pessaries containing Triticum vulgare according to the scheme – 1 pessary intravaginally at night for 10 days a month (with the start of the use immediately after the next menstruation end) for 3 months. Group 2 (comparison group, n=35) – women who received treatment according to the current recommendations of the Ministry of Health of Ukraine. Group 3 (control group, n=30) included conditionally healthy women who have applied for routine preventive gynecological examination. Results. Clinical evaluation of the treatment first stage effectiveness showed a reduction in the complaints in patients of both study groups in 100% of cases. Both after the first and after the second stage of the proposed treatment scheme effective vaginal mucous membranes decontamination was revealed, conditionally pathogenic bacteria were not found in diagnostically significant titers, the number of leukocytes and the vaginal secret pH were normalized, and the average score on the Donders G. et al. scale showed no signs of aerobic vaginitis in the patients of the main group. The cytological norm of Pap-smear was reached by 91.43±7.43% of main group and 71.43±7.64% of the comparison group women (p<0.05); and in case of evaluation using the Bethesda system (2001) – 97.14±2.82% of group 1 and 80.00±6.76% of group 2 patients (p<0.05). After the second stage of treatment the average size of cervical ectopy significantly (p<0.05) decreased in the patients of the main group compared to group 2 (by 32.68% compared to the average area before treatment). In 5 (14.29%) patients of the main group and 2 (5.71%) patients of the comparison group after the treatment cervical ectopy was not found during the control colposcopy. Сonclusion. In the part of women physiological cervical ectopy with the onset of sexual activity is complicated by the development of the vaginal dysbiotic processes and vaginitis, which create unfavorable conditions for the cervix epithelization and simultaneously increase the risk of sexually transmitted infections, in particular the human papillomavirus infection. Therapeutic measures aimed at normalizing the vaginal microbiota, recolonization of its lactoflora and the creation of favorable conditions for the physiological cervix epithelization are pathogenetically substantiated in this case. The proposed treatment scheme (complex application of vaginal antiseptic in combination with probiotic and on the next stage – of the reparative action drug) made it possible to reduce the complaints, eliminate the signs of aerobic vaginitis, normalize the vaginal microbiota state, reduce the cervical ectopy area, and in 14.29% cases – to achieve complete cervical epithelization. Key words: cervical ectopy, aerobic vaginitis, vaginal microbiota, vaginal suppositories, probiotic.

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Cervical ectopy is one of the most common benign processes, characterized by relatively high recurrence rate, and in the case of vaginal microbiota violations in the conditions of HPV infection combination deserves the aimed attention, particularly in the context of reproductive health care and cancer prevention. The objective: to study the vaginal microbiota features in patients withcervical ectopy relapsein the conditions of HPV infection. Materials and methods. The study included 98 women of reproductive age (18 to 46 years). Three groups were formed: a control group (n=30), in which conditionally healthy women were included, group 1 (n=33) – patients with firstly diagnosed cervical ectopy, group 2 (n=35) – patients with cervical ectopy relapse. All women wereexamined with a bacterioscopic, cytological, microbiological study of the vaginal biocenosis, as well as a determination of the vaginal environmentpH level. Results. In patients with cervical ectopy relapse the pH of the vaginal environmentwas significantly higher than that in women of the control group (p<0.001) and of the group 1 patients (p<0.05). About 9% of patients in both study groups had signs of bacterial vaginosis; in about 70% of group 2 patients the signs of mild and moderate severity aerobic vaginitis were found, significantly (p<0.05) more often than in patients with firstly diagnosed cervical ectopy. In group 2 patients a significant polymorphism of infects was detected in 40.00±8.28% of cases, the associations of 3 or more microorganisms determined simultaneously were significantly (p<0.001) more often foundin group 2 in comparison with patients with firstly diagnosed cervical ectopy. Сonclusion. The use of the short-term test system A.F.GENITAL SYSTEM (Liofilchem®, Italy) has a number of advantages for clinical practice: results being ready in short time, the detection of a wide range of infections, the possibility of quantifying M. hominis and U. urealyticum, and then determining the sensitivity to the most frequently used antibacterial drugs. Recurrent cervical ectopy often occurs in the conditions of colpitis, vaginitis, vaginal microbiota disorders with significant polymorphism of microorganisms and alkalization of the vaginal environment, which complicates the processes of ectopy epithelialization and can predispose to its recurrence. The observed cytological features in this cohort of patients suggest that long-term violations of the vaginal biocenosis in combination with the inflammatory processes of the vagina and cervix create favorable conditions for the realization of dysplastic changes caused by HPV. When determining the tactics of treatment of recurrent cervical ectopy, in particular in the conditions of HPV infection, first of all it is necessary to achieve both the cytological norm and the normalization of the vaginal biocenosis before any intervention, if necessary. Key words: relapse of cervical ectopy, vaginal biocenosis, vaginitis, cervicitis, HPV.

Preservation of a significant frequency of cervical pathology and a tendency to long-term recurrent course, the possibility of malignant transformation predetermine the urgency of finding effective methods of treatment. The objective: develop and evaluate the effectiveness of managing algorithm for patients with complicated form of cervical ectopy. Patients and methods. Was carried comprehensive examination and treatment of 68 women aged 18–35 years with cervical ectopy.Were performed pelvic organs ultrasound, simple and advanced colposcopy, investigation of thyroid function, D-status, hormonal balance, vaginal microbiota, cytological examination of cervical smears. By blind method, depending on treatment method patients were divided into two groups of 34 women. Patients of the main group underwent systemic correction of D-deficiency, dyshormonal disorders by Epigalin 1 capsule three times a day, Aquadetrim at a dose of 3000 MО/day and topical application of Depantol suppositories (twice a day for 10 days before and 10 days after intervention, starting from 5 days), in the group of comparison, examination and management of patients were carried out according to the current recommendations of Ukraine Ministry of Health. Results. After 10-day course of systemic and topical therapy by Depantol in the main group we observed a reduction in the frequency of endocervicitis from 41.2% to 5.9%, an increase of vagina normocenosis percentage from 8.8% to 88.2% with normalization of the cytological pattern – an increase in the percentage of I type of Pap smear from 29.4% to 94.1%; visually and with colposcopy, healing of cervical ectopia (first detected) was found in 40.0% of women at 25.0% in the comparison group. Conclusion. Complex pre- and postoperative therapy with topical application of Depantol in patients with cervical ectopy allows to achieve a stable correction of dysbiotic disorders due to a decrease in bacterial contamination, qualitative and quantitative changes in microflora, and an increase in the number of endogenous lactobacilli. Normalization of hormonal homeostasis, correction of D-status due to the synergistic effect of Epigaline, Aquadetrim allows to increase the effectiveness of topical therapeutic measures, which allows reducing the time of cervix epithelization, to reduce frequency of complications after destruction and to reduce the frequency of recurrences of cervical ectopy. The management of patients with cervical ectopy based on the proposed diagnostic treatment measures aimed correction of the microflora of the vaginal biotope, activation of immunity, normalization of the hormonal balance, enhancement of the reparative processes of the cervix and helps to improve the effectiveness of treatment for both newly diagnosed and complicated forms of cervical ectopy from 84.0% to 95.5%, reduces need in lesion destruction. Key words: cervical ectopy, radio wave destruction, Depantol, Epigaline, vitamin D deficiency.

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