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4 . 2021

Long-term results of two-stage treatment of bacterial vaginosis using antiseptics and probiotics

Abstract

Aim - to assess the Long-term results of two-stage treatment of bacterial vaginosis (BV) using the antiseptic DequaLinium chloride (Fluomizin) and the vaginal probiotic Gynoflor E.

Material and methods. The study involved 128 non-pregnant women of reproductive age from 18 to 45 years old with complaints of discharge from the genital tract. The clinical material for the study was the vaginal discharge obtained from the lateral arches using a gynecological speculum. A microscopic method was used to assess the vaginal microbiocenosis and to detect "clue cells" and according to the Nugent score. In addition, we used the Femoflor 16 test (DNA technology, Moscow) with the detection of lactobacilli, a large number of facultative and obligate anaerobes, as well as real-time PCR to identify lactobacilli (test system for research purposes, which allows to determine the total the amount of DNA of Lactobacillus spp., 6 of the most common types of vaginal lactobacilli and one biotechnogenic (L. crispatus, L. iners, L. jensenii, L. gasseri, L. johnsonii, L. vaginalis and L. acidophilus) (DNA-Technology, Moscow, Russia).

According to Nugent's criteria, a group of women with a score from 7 to 10 was identified, which indicates the presence of bacterial vaginosis. There were 27% of such women (34 out of 128). The rest of the patients had either physiological vaginal microbiocenosis or an intermediate type of microbiocenosis.

All patients with BV were prescribed a drug containing dequalinium chloride 10 mg (Fluomizin) for 6 days at the first stage, followed by the use of Gynoflor E for 6 days to restore the vaginal microflora.

Clinical and microbiological assessment of long-term results of two-stage therapy was carried out both after the first stage of therapy and immediately after the second stage of therapy, 1 month and 6 months after the end of treatment.

Results. After the first stage of treatment, the number of women complaining of vaginal discharge decreased significantly. After treatment with Fluomisin, there was not a single woman complaining of profuse vaginal discharge. After treatment with Fluomizin, complaints of an unpleasant odor of discharge disappeared in 92% of women, and in almost all women soreness in the vaginal area disappeared. Immediately after treatment with Fluomisin, no key cells were found in all women during microscopic examination of vaginal samples, according to the Nugent scale, 40% of patients had 1-3 points, 60% - 4-6 points. No patient had a Nugent score of 7-10, which would indicate BV. However, both according to microscopic examination and according to the Femoflor test, a deficiency of lactobacilli was noted with a predominance of other microorganisms. At the same time, the concentration of all facultative and obligate anaerobic bacteria was reduced, because Fluomisin acts on these bacteria.

Immediately after the use of the drug Gynoflor E, lactobacilli, according to microscopic examination, prevailed in 77% of women. A month after the end of therapy, lactobacilli prevailed in 68% of women who used Gynoflor E, and after 6 months - in 69%. According to the Femoflor test, we determined the quantitative content of lactobacilli in relation to the total bacterial mass. The content of lactobacilli in the amount of 70-100% before treatment was not in any woman, in 54% their number was 10-30%, and in 41% of women lactobacilli were absent altogether. Immediately after treatment, in most women, the number of lactobacilli in the vaginal biotope was 70-100%, and this percentage also remained high in the study of vaginal discharge after 1 month and after 6 months - from 56 to 62%.

An important criterion for evaluating the effectiveness of therapy for bacterial vaginosis is the appearance of lactobacilli producing hydrogen peroxide, and this is, first of all, Lactobacillus crispatus.

It should be emphasized that both immediately after treatment and 1 and 6 months after the end of the two-stage therapy, the detection rate of Lactobacillus iners decreased to 67-70%, but remained quite high. Apparently, this type of lactobacilli is prevalent in all conditions of vaginal microbiocenosis. It should be emphasized that the species Lactobacillus crispatus immediately after treatment began to be detected significantly more often than before treatment (23.5 vs 5.9%) and the frequency of its detection was stable during 6 months of observation (29% after 1 month and 26.5% in 6 months)

As for the clinical symptoms of BV, there were no recurrences of BV among these women within 6 months of observation.

Conclusion. A study to evaluate the long-term results of two-stage treatment of bacterial vaginosis (BV) with the use of the antiseptic Dequalinium chloride (Fluomizin) and the vaginal probiotic Gynoflor E showed the high efficiency of this therapy.

During 6 months of observation, recurrence of BV was not observed in any case, the physiological microbiocenosis of the vagina persisted in more than 70% of women. During the species identification of lactobacilli, it was noted that the species Lactobacillus crispatus, which produces hydrogen peroxide and lactic acid and characterizes the stability of the vaginal microbiocenosis, is detected immediately after treatment 4 times more often than before treatment and the frequency of its detection is stable for 6 months. The Lactobacillus iners species after treatment and observation for six months is detected in most women.

The drug Gynoflor E helps to restore the physiological microbiocenosis of the vagina at the second stage of treatment for bacterial vaginosis and maintains a stable microbiocenosis for 6 months of observation.

Thus, the vaginal tablets Gynoflor E, taken 1 tablet once a day for 6 days, can restore the vaginal microflora, especially Lactobacillus crispatus, after the treatment of bacterial vaginosis, which is a reliable protection against recurrence of bacterial vaginosis.

Keywords:bacterial vaginosis, two-stage treatment, antiseptic Fluomizin, probiotic Gynoflor, lactobacilli

Funding. The authors received no financial support.

Conflict of interest. The authors declare no conflict of interest.

Contribution. Research concept and design - Savicheva A.M., Tapilskaya N.I.; collection and processing of material - Kry-sanova A.A., Budilovskaya O.V., Khusnutdinova T.A., Shalepo K.V.; statistical data processing - Krysanova A.A., Budilovskaya O.V., Khusnutdinova T.A., Shalepo K.V.; text writing - Savicheva A.M., Tapilskaya N.I.

For citation: Savicheva A.M., Tapilskaya N.I., Krysanova A.A., Budilovskaya O.V., Khusnutdinova T.A., Shalepo K.V. Long-term results of two-stage treatment of bacterial vaginosis using antiseptics and probiotics. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2021; 9 (4): 19-28. DOI: https://doi.org/10.33029/2303-9698-2021-9-4-19-28 (in Russian)

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CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University

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