Nonspecific vulvovaginitis of mixed etiology: local treatment – the treatment of choice
Abstract: Л.В. КАЛУГИНА д. мед. н., ведущий научный сотрудник отделения эндокринной гинекологии ГУ «Институт педиатрии, акушерства и гинекологии НАМН Украины» ORCID: 0000-0003-2263-6627 Т.Ф. ТАТАРЧУК д. мед. н., профессор, член-корр. НАМН Украины, заместитель директора по научной работе, заведующая отделением эндокринной гинекологии ГУ «ИПАГ НАМН Украины» ORCID: 0000-0002-5498-4143 И.Н. ШАКАЛО к. биол. н., младший научный сотрудник отделения эндокринной гинекологии ГУ «ИПАГ НАМН Украины»
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The main reason for visiting an obstetrician-gynecologist is the vaginal discharge syndrome (VDS) of infectious etiology. The most common causes of infectious vaginitis wich are identifed by European researchers are bacterial vaginosis (BV), aerobic vaginitis, vulvovaginal candidiasis and mixed infections. Treatment of VDS is a serious problem not only because of the pathogens’s resistance and frequent recurrences, but especially due to the COVID-19 pandemic which can complicate further patient`s examination for determination of infectious agent and the choice of individual approach to etiotropic therapy.Purpose of study: to investigate the structure of causes of pathological vaginal discharge in Ukrainian women, as well as assess the compliance and effectiveness of their treatment.Methods: 472 doctors of women's consultation centres, gynecological hospitals and centers of reproductive medicine from 23 regions of Ukraine were enrolled in multi-center study of vulvovaginal infections management. During the study, which lasted from August to December 2019, were examined 45,295 patients aged 18 to 59 years who complained for pathological vaginal discharge.Results: analysis of the structure of nosologies that caused VDS showed that the examined patients were most often diagnosed with BV (41.1%), colpitis of mixed etiology (26.59%) and vulvovaginal candidiasis (19.22%), trichomoniasis was confirmed in 8.44%. The interviewed gynecologists preferred topical therapy in 95,99% cases of BV and colpitis of mixed etiology. Topical combined medications were prescribed in 85,21% of cases, monoforms – in 14.79%. Among the combined vaginal dosage forms the combination of metronidazole 750 mg /miconazole 200 mg was preferred in 48.81% of cases with clinical efficacy 87.1% in patients with BV and 86,9% in women with mixed infection. Normalization of the vaginal biocenosis was observed in 93.50% of the examined patients. The study demonstrated the safety, good tolerability and compliance of patients to therapy with the combined medications metronidazole 750 mg / miconazole 200 mg in vaginal suppositories.Conclusion: BV, colpitis of mixed etiology and vulvovaginal candidiasis are predominated in structure of main causes of VDS in Ukraine. In the treatment of VDS, priority is given to vaginal forms with the most compliant (89.8%) regimen: once a day for a short period (7 days). The obtained high bacteriological (93.50%) and clinical (86,9%) efficacy of therapy of BV and vaginal mixed infections with the combined drug metronidazole 750 mg / miconazole 200 mg allows to recommend it as the drug of choice.
The main reason for visiting an obstetrician-gynecologist is the vaginal discharge syndrome (VDS) of infectious etiology. The most common causes of infectious vaginitis wich are identifed by European researchers are bacterial vaginosis (BV), aerobic vaginitis, vulvovaginal candidiasis and mixed infections. Treatment of VDS is a serious problem not only because of the pathogens’s resistance and frequent recurrences, but especially due to the COVID-19 pandemic which can complicate further patient`s examination for determination of infectious agent and the choice of individual approach to etiotropic therapy.Purpose of study: to investigate the structure of causes of pathological vaginal discharge in Ukrainian women, as well as assess the compliance and effectiveness of their treatment.Methods: 472 doctors of women's consultation centres, gynecological hospitals and centers of reproductive medicine from 23 regions of Ukraine were enrolled in multi-center study of vulvovaginal infections management. During the study, which lasted from August to December 2019, were examined 45,295 patients aged 18 to 59 years who complained for pathological vaginal discharge.Results: analysis of the structure of nosologies that caused VDS showed that the examined patients were most often diagnosed with BV (41.1%), colpitis of mixed etiology (26.59%) and vulvovaginal candidiasis (19.22%), trichomoniasis was confirmed in 8.44%. The interviewed gynecologists preferred topical therapy in 95,99% cases of BV and colpitis of mixed etiology. Topical combined medications were prescribed in 85,21% of cases, monoforms – in 14.79%. Among the combined vaginal dosage forms the combination of metronidazole 750 mg /miconazole 200 mg was preferred in 48.81% of cases with clinical efficacy 87.1% in patients with BV and 86,9% in women with mixed infection. Normalization of the vaginal biocenosis was observed in 93.50% of the examined patients. The study demonstrated the safety, good tolerability and compliance of patients to therapy with the combined medications metronidazole 750 mg / miconazole 200 mg in vaginal suppositories.Conclusion: BV, colpitis of mixed etiology and vulvovaginal candidiasis are predominated in structure of main causes of VDS in Ukraine. In the treatment of VDS, priority is given to vaginal forms with the most compliant (89.8%) regimen: once a day for a short period (7 days). The obtained high bacteriological (93.50%) and clinical (86,9%) efficacy of therapy of BV and vaginal mixed infections with the combined drug metronidazole 750 mg / miconazole 200 mg allows to recommend it as the drug of choice.
Objectives: to determine the status of connective tissue and ionized magnesium value before and after complex treatment of atrophic colpitis with the CO2 laser in menopausal women. Materials and methods. 160 women with atrophic colpitis took part in this prospective study and were divided into three groups depending on the therapy. The main group included 55 patients who underwent CO2 laser therapy. The comparison group included 40 women who underwent CO2 laser therapy and local hormonal treatment with suppositories containing estriol and magnesium saturation by magnesium lactate dihydrate. The control group consisted of 65 women who received only suppositories containing estriol. The duration of treatment was 12 months. In addition to general clinical studies, markers of collagen synthesis (Total PINP, Total PІІІNP), collagen resorption marker (Pyriliks-D), as well as the ionized magnesium value in blood serum were determined in all patients.Results. A significant increase and steady retention at the physiological level of the average value of the Total PINP in the comparison group was revealed. The average level of the Total PIІІNP in patients of this group underwent a significant decrease and remained steadily at the upper limit of the physiological norm. A significant decrease and stable retention at the physiological level of the Pyriliks-D was noted in the comparison group against the background of the proposed therapy. Correction of magnesium status in the comparison group leads to a reliable and stable increase in the Mg+ ions concentration in blood serum.Conclusions. The inclusion CO2 laser in combination with local hormonal therapy and long-term correction of mineral metabolism in the treatment of the comparison group led to the stable normalization and prolonged retention at the physiological level for 12 months of the procollagen type I N-terminal propeptide, procollagen type III N-terminal propeptide, collagen resorption marker Pyriliks-D and a significant increase in magnesium concentration. This is confirms the effectiveness of the proposed complex.
The objective: to study and evaluate the colpocytological state of the mucous membrane and the biocenosis of the vagina in women with atrophic vaginitis (AV) before CO2 laser therapy. Materials and methods. A prospective clinical and statistical examination of 160 patients with AV was conducted. The main group was formed from 55 women of menopausal age with clinical manifestations of AV, who were treated only by the therapy with CO2 laser. The comparison group included 40 women of menopausal age who had for the correction of AB manifestations CO2 laser therapy in combination with local hormonal therapy – suppositories which contain 0.5 mg of estriol. The control group included 65 women of menopausal age who were treated with the therapy with the local application of suppositories with 0.5 mg of estriol once a day. The standard hormonal colpocytology was performed in all the women to assess the colpocytological state of the vaginal mucosa. Diagnostic test strips were used to determine the condition of the vagine (pH). In the case of a shift in the pH of the vaginal contents ≥ 4.4, the degree of vaginal purity and the number of leukocytes were studied using a microscopic examination. An amine test was performed to determine the presence of bacterial vaginosis in patients with AB. The microbiological study was performed using the “Femoflor-16” method. Results. The hypoestrogenic and atrophic types of smears were found in all 160 (100.0 %) women. The inflammatory type of colpocytological smear was determined in 116 (72.5 %) patients, cytolytic type – in 14 (8.6 %), mixed type of vaginal smears – in 30 (18.6 %) persons. In 126 (78.6 %) women, the pH index shifted to the alkaline side and ranged from 4.9 to 5.6, and the average value was 5.2±0.31. The bacterioscopic analysis of vaginal discharges indicates that in 83 (65.9 %) women with pathological pH values, the third degree of purity of the vaginal smear according to Herlin was found. In every third of women – 37 (29.4 %) – the presence of Candida fungi was determined. A significant decrease in the number of Lactobacillus spp. was established, a sufficient number of which was found in 9 (10.8 %) of the examined women. Facultative anaerobic microorganisms were found in 34 (40.6 %) women with AB. Obligate anaerobic microflora – Gardnerella vaginalis in combination with Prevotella bivia and Porphyromonas spp., which was found in 23 (27.7 %) women, was in the first place among the detected microorganisms; Mobiluncus spp. in association with Corynebacterium spp. were in the second place in prevalence, and were determined in 18 (21.7 %) persons, in third place – Atopobium vaginae, which was diagnosed in 10 (12.0 %) of the examined women. A qualitative analysis of the culture study results demonstrates a high level of cultivation of facultative anaerobic and obligate anaerobic microorganisms in women with AB, the quantitative value of which reached lg 3.1 – lg 3.9 CFU/ml and lg 3.4 – lg 4.7 CFU/ ml, respectively. Conclusions. A one hundred percent predominance of hypoestrogenic and atrophic types of colpocytological smears was established in women with atrophic vaginitis. The frequency of detection of inflammatory, cytolytic and mixed types of colpocytological smears was 116 (72.5 %) cases, 14 (8.6 %) cases and 30 (18.6 %) cases, respectively. The initial examination of the vaginal pH demonstrates a shift in the alkaline side of this indicator in 126 (78.6 %) women, which ranged from 4.9 to 5.6, and the average value was 5.2±0.31. Bacterioscopic analysis of vaginal discharges established that in 83 (65.9 %) women with pathological pH values there was the third degree of vaginal purity according to Herlin. A significant decrease in the number of lactobacilli Lactobacillus spp. (lg 2.1±0.21 CFU/ml) on the background of an increase in the level of obligate anaerobic microorganisms in the microflora – Gardnerela vaginalis in associations with Prevotella bivia+Porphyromonas spp (lg 4.7±0.38 CFU/ml) in combination with Mobiluncus spp. in association with Corynebacterium spp. (lg 4.0±0.35 CFU/ml), and Atopobium vaginea (lg 3.4±0.28 CFU/ml) were determined.
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