Correction of recurrent disturbances of vaginal biocenosis in pregnant women with HPV infection
AbstractThe aim of the study was to compare the effectiveness of the use of antopically antibiotic and a combination of antiseptic with a preparation for the restoration of vaginal microflora in the treatment of recurrent disorders of mixed etiology in pregnant women with HPV infection.Material and methods. Out of 682 pregnant women with HPV, 86 were included in the study with a recurrent vaginal dysbiosis. In 1st group (
n=39), the patients received clindamycin, in 2nd group (
n=47) - dequal-inium chloride and after the end of the course - gynoflor E, in 3rd group comprised 25 pregnant women without HPV and dysbiosis (control). We used pH-metry, microscopy of vaginal smears, real-time PCR and cytological examination of cervical smears. Follow-up examination was performed 14 days and 3 months after treatment.
Results. HPV-positive pregnant women have a high risk of recurrent vaginal dysbiosis, characterized in most of them (65%) by infection with opportunistic microorganisms in various combinations, mostly anaerobic-aerobic. After the course of treatment, recovery was found in 82.1% and in 91.5% of patients in 1st and 2nd groups (p=0.486). Relapses for 3 months were in 38.5% and 14.9%, respectively (relative risk of RR=2.58, 95% CI: 1.17-5.69, p=0.025).
Conclusion. A two-stage treatment regimen (dequalinium chloride and gynoflor E) leads to a decrease in the frequency of recurrences of dysbiosis by a factor of 2 compared with the use of an antibiotic alone. Elimination of vaginal dysbiosis and restoration of normal microflora contributes to the disappearance of the inflammatory response of the cervix and the reduction of epithelial changes in ASC-US in 100% of patients.
Keywords:human papillomavirus, dysbiosis, bacterial vaginosis, vulvovaginal candidiasis, aerobic vaginitis, clindamycin, dequalinium chloride, gynoflor E
Obstetrics and Gynecology: News, Opinions, Training. 2018; 6 (3): 38-46. doi: 10.24411/2303-9698-2018-13004.