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4 . 2021

Bacterial vaginosis: paradox of the XXI century

Abstract

The review presents the results of recent studies on the problem of bacterial vaginosis (BV), indicating its widespread prevalence (from 7 to 70%), the diversity of microorganisms involved in its development and an increase in the proportion of A. vaginae to 54% in the structure of biofilms, as well as associations of BV with adverse consequences for a woman's reproductive health. The informational content of various diagnostic methods for BV, in particular, a microscopic smear of the vaginal discharge, and the significance of a quantitative study of the vaginal microflora by real-time PCR with a sensitivity and specificity of 99 and 93%, respectively, is shown. It is noted that the use of vaginal antiseptics is shown as an alternative means of therapy for BV and other genital infections. The article presents the advantages of povidone-iodine due to its broad spectrum of action on bacteria, fungi and viruses, high efficiency, no effect on lactobacilli, creating conditions for the growth of its own Lactobacilli, high safety and compliance. Due to its broad-spectrum antimicrobial properties and favorable risk/benefit profile, povidone-iodine is one of the drugs for the treatment of BV and the prevention of infectious and inflammatory complications after childbirth, surgery and instrumental manipulations. Understanding the potential of lactobacilli and further qualitative research is needed to assess the efficacy of vaginal probiotics and their modes of use.

Keywords:bacterial vaginosis, combined infections, antiseptics, probiotics, lactic acid

Funding. The authors received no financial support.

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

For citation: Dikke G.B., Baranov I.I., Bayramova G.R. Bacterial vaginosis: paradox of the XXI century. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2021; 9 (4): 52-62. DOI: https://doi.org/10.33029/2303-9698-2021-9-4-52-62 (in Russian)

REFERENCES

1. ROAG. Clinical guidelines for the diagnosis and treatment of diseases accompanied by pathological discharge from the genital tract of women. 2nd ed., revised and additional. Moscow, 2019: 56 p. (in Russian)

2. Orfanelli T., Jayaram A., Doulaveris G., Forney L.J., Ledger W.J., Witkin S.S. Human epididymis protein 4 and secretory leukocyte protease inhibitor in vaginal fluid: relation to vaginal components and bacterial composition. Reprod Sci. 2014; 21 (4): 538-42. DOI: https://doi.org/10.1177/1933719113503416

3. Muzny C.A., Laniewski P., Schwebke J.R., Herbst-Kralovetz M.M. Host-vaginal microbiota interactions in the pathogenesis of bacterial vaginosis. Curr Opin Infect Dis. 2020; 32: 59-65. DOI: https://doi.org/10.1097/QCO.0000000000000620

4. Kalia N., Singh J., Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob. 2020; 19 (1): 5. DOI: https://doi.org/10.1186/s12941-020-0347-4

5. Petersen C., Round J.L. Defining dysbiosis and its influence on host immunity and disease. Cell Microbiol. 2014; 16: 1024-33. DOI: https://doi.org/10.1111/cmi.12308

6. Khryanin A.A., Reshetnikov O.V. Bacterial vaginosis. New ideas about microbial biosocium and treatment options. Meditsinskiy sovet [Medical Council]. 2014; (17): 128-32. DOI: https://doi.org/10.21518/2079-701X-2014-17-128-133 (in Russian)

7. Reid G. Is bacterial vaginosis a disease? Appl Microbiol Biotechnol. 2018; 102 (2): 553-8. DOI: https://doi.org/10.1007/s00253-017-8659-9

8. Ranjit E., Raghubanshi B.R., Maskey S., Parajuli P. Prevalence of bacterial vaginosis and its association with risk factors among nonpregnant women: a hospital-based study. Int J Microbiol. 2018; 2018: 8349601. DOI: https://doi.org/10.1155/2018/8349601

9. Gergova R.T., Strateva T.V., Mitov I.G. Gardnerella vaginalis-associ-ated bacterial vaginosis in Bulgarian women. Braz J Infect Dis. 2013; 17: 313-8. DOI: https://doi.org/10.1016/j.bjid.2012.10.026

10. Lallar M., Nanda S., Nandal R. Lower genital tract infections in HIV-infected women: can we afford to miss? J Obstet Gynaecol India. 2015; 65: 45-9. DOI: https://doi.org/10.1007/s13224-014-0604-6

11. Ghiasi M., Fazaeli H., Kalhor N., Sheykh-Hasan M., Tabatabaei-Qomi R. Assessing the prevalence of bacterial vaginosis among infertile women of Qom city. Iran J Microbiol. 2014; 6: 404-8. URL: https://pubmed.ncbi.nlm.nih.gov/25926958/

12. Jacob L., John M., Kalder M., Kostev K. Prevalence of vulvovaginal candidiasis in gynecological practices in Germany: a retrospective study of 954,186 patients. Curr Med Mycol. 2018; 4 (1): 6-11. DOI: https://doi.org/10.18502/cmm.4.1.27

13. Peebles K., Velloza J., Balkus J.E., McClelland R.S., Barnabas R.V. High global burden and costs of bacterial vaginosis: a systematic review and meta-analysis. Sex Transm Dis. 2019; 46 (5): 304-11. DOI: https://doi.org/10.1097/OLQ.0000000000000972

14. Trichomoniasis Statistics. CDC, 2021. Content source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. URL: https://www.cdc.gov

15. Javed A., Parvaiz F., Manzoor S. Bacterial vaginosis: an insight into the prevalence, alternative treatments regimen and it's associated resistance patterns. Microb Pathog. 2019; 127: 21-30. DOI: https://doi.org/10.1016/j.micpath.2018.11.046

16. Bautista C.T., Wurapa E., Sateren W.B., Morris S., Hollingsworth B., Sanchez J.L. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016; 3: 4. DOI: https://doi.org/10.1186/s40779-016-0074-5

17. Melkumyan A.R., Priputnevich T.V., Ankirskaya A.S., Trofimov D.Yu., Muraveva V.V., Mullabaeva S.M., et al. The species composition of lactobacilli in various states of the vaginal microbiota in pregnant women. Klin-icheskaya mikrobiologiya i antimikrobnaya khimioterapiya [Clinical Microbiology and Antimicrobial Chemotherapy]. 2013; 15 (1): 72-9. URL: https://cmac-journal.ru/ (in Russian)

18. Savicheva A.M., Shalepo K.V., Nazarova V.V., Menuhova Yu.N. Are all lactobacilli equally beneficial? Completeness of recovery of vaginal microecology as a criterion of the effectiveness of two-stage therapy for bacterial vaginosis. StatusPraesens. Ginekologiya. Akusherstvo. Besplodniy brak [StatusPraesens. Gynecology. Obstetrics. Barren Marriage]. 2014; 3 (20): 33-7. (in Russian)

19. Voroshilina E.S., Plotko E.E., Khayutin L.V., Tishchenko N.A., Zornikov D.L. The predominance of Lactobacillus iners in the microbiocenosis of the vagina in women with moderate dysbiosis is associated with the presence of clinical signs of infectious and inflammatory vaginal pathology. Vestnik RGMU [Bulletin of Russian State Medical University]. 2017; (2): 47-51. URL: https://vestnik.rsmu.press/ (in Russian)

20. Budilovskaya O.V., Shipitsyna E.V., Gerasimova E.N., Safronova M.M., Savicheva A.M. Species diversity of vaginal lactobacilli in normal and dysbiotic states. Zhurnal akusherstva i zhenskikh bolezney [Journal of Obstetrics and Women's Diseases]. 2017; 66 (2): 24-32. DOI: https://doi.org/10.17816/JOWD66224-32 (in Russian)

21. Swidsinski A., Mendling W., Loening-Baucke V., Ladhoff A., Swidsinski S., Hale L.P., et al. Adherent biofilms in bacterial vaginosis. Obstet Gynecol. 2005; 106 (5 pt 1): 1013-23. DOI: https://doi.org/10.1097/01.AOG.0000183594.45524.d2

22. Livengood C.H. Bacterial vaginosis: an overview for 2009. Rev Obstet Gynecol. 2009; 2: 28-37. URL: https://www.ncbi.nlm.nih.gov/

23. Schwebke J.R., Muzny C.A., Josey W.E. Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model. J Infect Dis. 2014; 210: 338-43. DOI: https://doi.org/10.1093/infdis/jiu089

24. Mendling W, Palmeira-de-Oliveira A, Biber S, Prasauskas V. An update on the role of Atopobium vaginae in bacterial vaginosis: what to consider when choosing a treatment? A mini review. Arch Gynecol Obstet. 2019; 300 (1): 1-6. DOI: https://doi.org/10.1007/s00404-019-05142-8

25. Medical Diagnostic Laboratories, L.L.C. URL: www.mdlab.com

26. Salinas A.M., Osorio V.G., Pacha-Herrera D., Vivanco J.S., Trueba A.F., Machado A. Vaginal microbiota evaluation and prevalence of key pathogens in ecuadorian women: an epidemiologic analysis. Sci Rep. 2020; 10 (1): 18358. DOI: https://doi.org/10.1038/s41598-020-74655-z

27. Dols J.A., Molenaar D., van der Helm J.J., Caspers M.P., de Kat An-gelino-Bart A., Schuren F.H., et al. Molecular assessment of bacterial vaginosis by Lactobacillus abundance and species diversity. BMC Infect Dis. 2016; 16: 180. DOI: https://doi.org/10.1186/s12879-016-1513-3

28. Srinivasan S., Morgan M.T., Liu C., Matsen F.A., Hoffman N.G., Fiedler T.L., et al. More than meets the eye: associations of vaginal bacteria with Gram stain morphotypes using molecular phylogenetic analysis. PLoS One. 2013; 8: e78633. DOI: https://doi.org/10.1371/journal.pone.0078633

29. Ness R.B., Kip K.E., Hillier S.L., Soper D.E., Stamm C.A., Sweet R.L., et al. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol. 2005; 162 (6): 585-90. DOI: https://doi.org/10.1093/aje/kwi243

30. Wiesenfeld H.C., Hillier S.L., Krohn M.A., Landers D.V., Sweet R.L. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2003; 36 (5): 663-8. DOI: https://doi.org/10.1086/367658

31. Martin H.L., Richardson B.A., Nyange P.M., Lavreys L., Hillier S.L., Chohan B., et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. J Infect Dis. 1999; 180 (6): 1863-8. DOI: https://doi.org/10.1086/315127

32. Cu-Uvin S., Hogan J.W., Caliendo A.M., Harwell J., Mayer K.H., Carpenter C.C.; HIV Epidemiology Research Study. Association between bacterial vaginosis and expression of human immunodeficiency virus type 1 RNA in the female genital tract. Clin Infect Dis. 2001; 33 (6): 894-6. DOI: https://doi.org/10.1086/322613

33. Atashili J., Poole C., Ndumbe P.M., Adimora A.A., Smith J.S. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS. 2008; 22 (12): 1493-501. DOI: https://doi.org/10.1097/QAD.0b013e3283021a37

34. Bautista C.T., Wurapa E., Sateren W.B., Morris S., Hollingsworth B., Sanchez J.L. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016; 3: 4. DOI: https://doi.org/10.1186/s40779-016-0074-5

35. Grueva E., Borisov I. The role of chlamydia trachomatis and some other associated microorganisms in endocervicitis. Akush Ginekol (So-fiia). 2006; 45 (5): 32-5. [in Bulgarian]. PMID: 17168494. URL: https://pubmed.ncbi.nlm.nih.gov/

36. Wang Z.L., Fu L.Y., Xiong Z.A., Qin Q., Yu T.H., Wu Y.T., et al. Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes. Taiwan J Obstet Gynecol. 2016; 55 (1): 40-4. DOI: https://doi.org/10.1016/j.tjog.2015.06.012

37. Dikke G.B. Polymicrobial associations in the etiology of inflammatory diseases of the genital organs in women. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2017; (6): 151-8. DOI: https://doi.org/10.18565/aig.2017.6.151-8 (in Russian)

38. I§ik G., Demirezen §., Donmez H.G., Beksag M.S. Bacterial vaginosis in association with spontaneous abortion and recurrent pregnancy losses. J Cytol. 2016; 33 (3): 135-40. DOI: https://doi.org/10.4103/0970-9371.188050

39. Leitich H., Bodner-Adler B., Brunbauer M., Kaider A., Egarter C., Husslein P. Bacterial vaginosis as a risk factor for preterm delivery: a metaanalysis. Am J Obstet Gynecol. 2003; 189 (1): 139-47. DOI: https://doi.org/10.1067/mob.2003.339

40. Soper D.E. Bacterial vaginosis and surgical site infections. Am J Obstet Gynecol. 2020; 222 (3): 219-23. DOI: https://doi.org/10.1016/j.ajog.2019.09.002

41. Il'ina I.Yu., Dobrokhotova Yu.E. Bacterial vaginosis. Possible solutions to the problem. RMZh [Russian Medical Journal]. 2020; (11): 75-8. URL: https://www.rmj.ru/ (in Russian)

42. Hemalatha R., Ramalaxmi B.A., Swetha E., Balakrishna N., Mastro-marino P. Evaluation of vaginal pH for detection of bacterial vaginosis. Indian J Med Res. 2013; 138 (3): 354-9. URL: https://www.ncbi.nlm.nih.gov/

43. Chavoustie S.E., Eder S.E., Koltun W.D., Lemon T.R., Mitchell C., Nyirjesy P., et al. Experts explore the state of bacterial vaginosis and the unmet needs facing women and providers. Int J Gynaecol Obstet. 2017; 137: 107-9. DOI: https://doi.org/10.1002/ijgo.12114

44. Madhivanan P., Krupp K., Li T., Ravi K., Selezneva J., Srinivas V., et al. Performance of BVBlue rapid test in detecting bacterial vaginosis among women in Mysore, India. Infect Dis Obstet Gynecol. 2014; 2014; 908313. DOI: https://doi.org/10.1155/2014/908313

45. Redelinghuys M.J., Geldenhuys J., Jung H., Kock M.M. Bacterial vaginosis: current diagnostic avenues and future opportunities. Front Cell Infect Microbiol. 2020; 10: 354. DOI: https://doi.org/10.3389/fcimb.2020.00354

46. Sherrard J., Wilson J., Donders G., Mendling W., Jensen J.S. European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS. 2018; 2018: 956462418785451. DOI: https://doi.org/10.1177/0956462418785451

47. van den Munckhof E.H.A., van Sitter R.L., Boers K.E., Lamont R.F., Te Witt R., le Cessie S., et al. Comparison of Amsel criteria, Nugent score, culture and two CE-IVD marked quantitative real-time PCRs with microbiota analysis for the diagnosis of bacterial vaginosis. Eur J Clin Microbiol Infect Dis. 2019; 38 (5): 959-66. DOI: https://doi.org/10.1007/s10096-019-03538-7

48. Bebneva T.N., Dikke G.B. The risk of miscarriage and premature pregnancy in women with HPV infection and recurrent disorders of the vaginal biocenosis. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2019; (2): 135-42. DOI: https://doi.org/10.18565/aig.2019.2 (in Russian)

49. Guidelines for the Treatment of Chlamydia trachomatis. WHO, 2016. URL: https://apps.who.int/

50. Kira E.F., Gamirova E.V., Gaytukieva R.A., Belyakina I.V. Results of a randomized study of the efficacy and safety of chlorhexidine and metronidazole in the treatment of bacterial vaginosis. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2010; (6): 123-9. URL: https://aig-journal.ru (in Russian)

51. Verstraelen H., Verhelst R., Roelens K., Temmerman M. Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review. BMC Infect Dis. 2012; 12: 148. DOI: https://doi.org/10.1186/1471-2334-12-148

52. Petersen E.E., Weissenbacher E.R., Hengst P., Spitzbart H., Weise W., Wolff F., et al. Local treatment of vaginal infections of varying etiology with dequalinium chloride or povidone iodine. A randomised, doubleblind, active-controlled, multicentric clinical study. Arzneimittelforschung. 2002; 52 (9): 706-15. DOI: https://doi.org/10.1055/s-0031-1299955

53. Logutova L.S., Budykina T.S., Dub N.V., Gasparyan N.A., Babu-nashvili E.L. The use of betadine for the treatment of bacterial infections in women of reproductive age. Rossiyskiy vestnik akushera-ginecologa [Russian Bulletin of Obstetrician-Gynecologist]. 2005; (6): 46-8. URL: https://medi.ru/info/1216/ (in Russian)

54. Tyutyunnik V.L., Kan N.E., Lomova N.A. Modern aspects of treatment of nonspecific vulvovaginitis during pregnancy. Meditsinskiy sovet [Medical Council]. 2018; (7): 102-5. DOI: https://doi.org/10.21518/2079-701X-2018-7-102-105 (in Russian)

55. Gimes G., Peter F. Terhesek Betadine huvelykup kezelesenek klinikai jelentosege [Clinical significance of betadine vaginal suppository treatment in pregnancy]. Acta Pharm Hung. 1997; 67 (6): 249-53. [in Hungarian]. PMID: 9480620.

56. Roeckner J.T., Sanchez-Ramos L., Mitta M., Kovacs A., Kaunitz A.M. Povidone-iodine 1% is the most effective vaginal antiseptic for preventing post-cesarean endometritis: a systematic review and network meta-analysis. Am J Obstet Gynecol. 2019; 221 (3): 261.e1-20. DOI: https://doi.org/10.1016/j.ajog.2019.04.002

57. Haas D.M., Morgan S., Contreras K., Kimball S. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2020; 4 (4): CD007892. DOI: https://doi.org/10.1002/14651858.CD007892.pub7

58. Tikhomirov A.L., Sarsania S.I., Tuskaev K.S. The relevance of the use of povidone iodine in the practice of an obstetrician-gynecologist. RMZH Mat' i ditya [RMJ. Mother and Child]. 2014; (1): 50-6. URL: https:// www.rmj.ru/articles/ (in Russian)

59. Nosenko E.N., Moskalenko T.Ya., Rutinskaya A.V. Povidone-iodine (Betadine®) in modern obstetric and gynecological practice. Akusherstvo, ginekologiya, reproduktologiya [Obstetrics, Gynecology, Reproductology]. 2018; 3 (31): 34-8. URL: https://health-ua.com/ (in Russian)

60. De Backer E., Verhelst R., Verstraelen H., et al. Antibiotic susceptibility of Atopobium vaginae. BMC Infect Dis. 2006; 6: 51. DOI: https://doi.org/10.1186/1471-2334-6-51

61. Neut C., Verriere F., Nelis H.J., Coenye T. Topical treatment of infectious vaginitis: effects of antibiotic, antifungal and antiseptic drugs on the growth of normal vaginal lactobacillus strains. Open J Obstet Gynecol. 2015; 5: 173-80. DOI: https://doi.org/10.4236/ojog.2015.53024

62. Wewalka G., Stary A., Bosse B., Duerr H.E., Reimer K. Efficacy of povidone-iodine vaginal suppositories in the treatment of bacterial vaginosis. Dermatology. 2002; 204 (1): 79-85. DOI: https://doi.org/10.1159/000057731

63. Bogomazova I.M., Belousova V.S., Maksimov M.L. The effectiveness of using the drug Betadine® for bacterial vaginosis. RMZh [Russian Medical Journal]. 2014; (19): 1390. URL: https://www.rmj.ru/articles/ (in Russian)

64. Potapov V.A. Ways to overcome antibiotic resistance in the treatment of vaginal infections. Akusherstvo, ginekologiya, reproduktologiya [Obstetrics, Gynecology, Reproductology]. 2018; 3 (31): 29-34. URL: https://health-ua.com/ (in Russian)

65. Bebneva T.N., Dikke G.B. Correction of recurrent disorders of the vaginal biocenosis in pregnant women infected with the human papillomavirus. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2018; 3 (21): 38-46. DOI: https://doi.org/10.24411/2303-9698-2018-13004 (in Russian)

66. Malova I.O., Afanas'eva I.G. Bacterial vaginosis: is there an alternative to traditional drugs? Meditsinskiy sovet [Medical Council]. 2019; (7): 93-103. DOI: https://doi.org/10.21518/2079-701X-2019-7-93-103 (in Russian)

67. van de Wijgert J., Verwijs M.C. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG. 2020; 127 (2): 287-99. DOI: https://doi.org/10.1111/1471-0528

68. Faught B.M., Reyes S. Characterization and treatment of recurrent bacterial vaginosis. J Womens Health (Larchmt). 2019; 28 (9): 1218-26. DOI: https://doi.org/10.1089/jwh.2018.7383

69. Kulikov I.A. A promising treatment for endlessly recurring vulvovaginal candidiasis. Meditsinskiy sovet [Medical Council]. 2020; (13): 61-9. DOI: https://doi.org/10.21518/2079-701X-2020-13-157-165 (in Russian)

70. Chee W.J.Y., Chew S.Y., Than L.T.L. Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microb Cell Fact. 2020; 19: 203. DOI: https://doi.org/10.1186/s12934-020-01464-4

71. Heczko P.B., Tomusiak A., Adamski P., Jakimiuk A.J., Stefanski G., Mikotajczyk-Cichonska A., et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health. 2015; 15: 115. DOI: https://doi.org/10.1186/s12905-015-0246-6

72. Bohbot J.M., Darai' E., Bretelle F., Brami G., Daniel C., Cardot J.M. Efficacy and safety of vaginally administered lyophilized Lactobacillus crispatus IP 174178 in the prevention of bacterial vaginosis recurrence. J Gynecol Obstet Hum Reprod. 2018; 47: 81-6. DOI: https://doi.org/10.1016/j.jogoh.2017.11.005

73. Russo R., Superti F., Karadja E., De Seta F. Randomised clinical trial in women with recurrent vulvovaginal candidiasis: efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses. 2019; 62: 328-35. DOI: https://doi.org/10.1111/myc.12883

74. Plummer E.L., Bradshaw C.S., Doyle M., Fairley C.K., Murray G.L., Bateson D., et al. Lactic acid-containing products for bacterial vaginosis and their impact on the vaginal microbiota: a systematic review. PLoS One. 2021; 16 (2): e0246953. DOI: https://doi.org/10.1371/journal.pone

75. Khmel' I.A. Biofilms as a factor in the pathogenicity of Staphylococcus aureus: approaches to therapy. In: A.R. Kaumov (ed.). Kazan': Izdatel'stvo KFU, 2017: 99 p. (in Russian)

76. McMillan A., Dell M., Zellar M.P., Cribby S., Martz S., Hong E., et al. Disruption of urogenital biofilms by lactobacilli. Colloids Surf B Biointerfaces. 2011; 86: 58-64. DOI: https://doi.org/10.1016/j.colsurfb.2011.03.016

77. Nosenko О.М., Moskalenko T.J., Rutinskaya A.V. Povidon-iodine (betadine) in modern obstetric-gynecological practice. Reproduktivnaya endokrinologiya [Reproductive Endocrinology]. 2018; (44): 43-8. DOI: https://doi.org/10.18370/2309-4117.2018.44.43-48 (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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