HEALTH OF WOMAN. 2020.1(147): 61–68; doi 10.15574/HW.2020.147.61
V.V. Mehedko
Shupyk National Medical Academy of Postgraduate Education, Kiev

Bacterial vaginosis (BV) is significantly widespread in the population: its detection rate in women with inflammatory diseases of the urinary system is 35%, among pregnant women – 10-30%, among patients with sexually transmitted infection – 20-60%. The presence of BV leads to pregnancy complications, after gynecological surgery and the development of relapses of the disease. To achieve a full therapeutic effect, it is necessary not only to conduct antimicrobial therapy, but also to restore the vaginal biocenosis, which is a condition for preventing relapse.
A two-stage treatment for BV was studied using Limenda and Bioselak.
The use of the combined antimicrobial drug Limenda at the first stage of treatment of BV showed a high clinical effect (100%) with confirmation of cure according to microscopic examination (97.9%). But after the completion of antimicrobial therapy, only in 29.2% of cases the restoration of the rod vaginal microflora was noted.
The local use of the probiotic Bioselak at the second stage of treatment ensured the restoration of the biocenosis in all patients (100%) and a long relapse-free period.
The high clinical effectiveness of the proposed scheme allows us to recommend it for the treatment of BV and the prevention of relapse.
Key words: bacterial vaginosis, vaginal biocenosis, relapse prevention, local probiotic, Limenda, Bioselak.

REFERENCES

1. Radzinskiy VE, Hamoshina MB, Shelenina LA i dr. 2013. Terapiya vaginalnyih infektsiy: grani problemyi (mezhdunarodnyie realii i rossiyskiy opyit). Doktor Ru 7(85):13–17.

2. Ginekologiya: natsionalnoe rukovodstvo. Pod red. GM Savelevoy, GT Suhih, VN Serova i dr., 2-e izd., pererab. i dop. M, GEOTAR-Media:1008. 2017.

3. Hryanin AA, Reshetnikov OV. 2015. Bakterialnyiy vaginoz: novyie perspektivyi v lechenii. Meditsinskiy sovet. 9:26–32. Rezhim dostupu: https://doi.org/10.21518/2079-701X-2015-9-26-33

4. Gillet E et al. 2012. Assocoation between bacterial vaginosis and CIN: systematic review and meta-analisis. PLoS One. 7(10):e45201. https://doi.org/10.1371/journal.pone.0045201; PMid:23056195 PMCid:PMC3462776

5. Gomberg MA. 2010. Bakterialnyiy vaginoz i novyie infektsii, s nim assotsiirovannyie. Ros. vestnik akush.-gin. 10;2:32–34.

6. Lipova EV, Radzinskiy VE. 2012. Bakterialnyiy vaginoz: vsegda diskussii. Status Praesens. 7:27–34.

7. Turovskiy Y, Sutyak Noll K, Chikindas ML. 2011. The aetiology of bacterial vaginosis. J. Appl. Microbiol. 110(5):1105–1128. https://doi.org/10.1111/j.1365-2672.2011.04977.x; PMid:21332897 PMCid:PMC3072448

8. Pestrikova TYu, Porubova YaP. 2014. Sravnitelnaya harakteristika kriteriev Amselya i Nyudzhenta dlya diagnostiki bakterialnogo vaginoza. Byulleten fiziologii i patologii dyihaniya 51:106–111.

9. Rukovodstvo po ambulatorno-poliklinicheskoy pomoschi v akusherstve i ginekologii. Pod red. VN Serova, GT Suhih, VN Prilepskoy, VE Radzinskogo. M, GEOTAR-Media:1136. 2016.

10. Petersen EE. 2007. Infektsii v akusherstve i ginekologii. Eyko E Petersen: per. s angl.; pod obsch. red. VN Prilepskoy. M, MEDpress-inform:352.

11. Yaghmaei M et al. 2009. Accuracy of Amsel’s Criteria in the Diagnosis of Bacterial Vaginosis (Preliminary Report). The Iranian Journal of Obstetrics. Gynecology and Infertility. 12(3):17–22.

12. Capoccia R, Greub G, Baud D. 2013. Ureaplasma urealyticum, Mycoplasma hominis and adverse regnancy outcomes. Curr. Opin. Infect. Dis. 26(3):231–240. https://doi.org/10.1097/QCO.0b013e328360db58; PMid:23587772

13. Pestrikova TYu, Yurasov IV, Yurasova EA. 2009. Vospalitelnyie zabolevaniya v ginekologii: prakticheskoe rukovodstvo. M, Litterra:256.

14. Morrow LE, Kollef MH, Casale TB. 2010. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am. J. Respir. Crit. Care Med. 182:1058–1064. https://doi.org/10.1164/rccm.200912-1853OC; PMid:20522788 PMCid:PMC2970846

15. Periasamy S, Joo H-S, Duong AC et al. 2012. How Staphylococcus aureus biofilms develop their characteristic structure. Proceedings of the National Academy of Sciences of the United States of America. 109;4:1281–1286. https://doi.org/10.1073/pnas.1115006109; PMid:22232686 PMCid:PMC3268330

16. Whitchurch CB, Tolker-Nielsen T, Ragas PS, Mattick JS. 2002. Extracellular DNA required for bacterial biofilm formation. Science. 295:1487. https://doi.org/10.1126/science.295.5559.1487; PMid:11859186

17. Flemming H-C, Wingender J. 2010. The biofilm matrix. Nature Reviews Microbiology. 8;9:623-633. https://doi.org/10.1038/nrmicro2415; PMid:20676145

18. Australian STI Management Guidelines. Bacterial Vaginosis. (Electronic resource). URL: http://sti.guidelines.org.au/sexually-transmissible-infections/infections-associated-with-ex/bacterial-vaginosis (access date: 29.11.2018).

19. Dobrohotova YuE, Ivanova II. 2018. Ispolzovanie kombinatsii metronidazola i mikonazola v korrektsii disbioza vlagalischa. RMZh. Mat i ditya 1:82–87.

20. Kira EF. 2012. Bakterialnyiy vaginoz. M, OOO «Meditsinskoe informatsionnoe agentstvo»:472.

21. Buhmann M, Stiefel P, Maniura–Weber K, Ren Q. 2014. In vitro biofilm models for device – related infections. Science and Society 1:1–4.

22. Patterson J, Girerd P, Karjane N et al. 2007. Efect of biofilm phenotype on resistance of Gardnerella vaginalis to hydrogenperoxide and lacticacid. Am. J. Obstet. Gynecol. 197:170. https://doi.org/10.1016/j.ajog.2007.02.027; PMid:17689638 PMCid:PMC2020809

23. Verstraelen H, Swidsinski A. 2013. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment. Curr Opin Infect Dis. 26:86-89. https://doi.org/10.1097/QCO.0b013e32835c20cd; PMid:23221767

24. Lamont RF, Sobel JD, Akins RA et al. 2011. The vaginal microbiome: New information about genital tract flora using molecular based techniques. BJOG. 118(5):533-549. https://doi.org/10.1111/j.1471-0528.2010.02840.x; PMid:21251190 PMCid:PMC3055920

25. Hostev VV, Sydorenko SV. 2010. Bakteryalnie plenky i infektsii. Zhurn.ynfektol. 2(3):4–15.

26. Letyaeva OI. 2014. Kliniko-immunologicheskie, mikrobiologicheskie osobennosti techeniya i terapii urogenitalnyih mikst-infektsiy u zhenschin reproduktivnogo vozrasta. Diss. d-ra med. nauk. M.

27. Bradshaw C, Tabsiri S, Faerley C et al. 2006. The association of Atopobium vaginae and Gardnerella vaginalis with bacterial vaginosis and recurrence after oral metronidazole therapy. J. Infect. Dis. 194(6):828–36.

28. Myasnikova AV, Potaturkina-Nesterova NI, Nemova IS i dr. 2011. Morfologicheskiy sostav bioplenki biotopa vlagalischa pri vospalitelnyih zabolevaniyah reproduktivnogo trakta. Vestn. novyih med. tehnologiy 18(4):21–4.

29. Strategiya i taktika ratsionalnogo primeneniya antimikrobnyih sredstv v ambulatornoy praktike. Evraziyskie klinicheskie rekomendatsii. 2016 g. Pod red. SV Yakovleva, VV Rafalskogo, SV Sidorenko i dr. Spravochnik poliklinicheskogo vracha. 1:6–54. 2017.

30. Beigi RH, Austin MN, Meyn LA et al. 2004. Antimicrobial resistance associated with the treatment of bacterial vaginosis. Am. J. Obstet. Gynec. 191:1123–29. https://doi.org/10.1016/j.ajog.2004.05.033; PMid:15507930

31. Lebedenko EYu. 2011. Na grani materinskih poter («near miss»). Pod red. VE Radzinskogo. M.

32. Catriona S, Bradshaw Jack D. 2016, Sobel. Current Treatment of Bacterial Vaginosis–Limitations and Need for Innovation. The Journal of Infectious Diseases: S14–S20. Aguin TJ, Akins RA, Sobel JD. 2014, Apr. High-dose vaginal metronidazole for recurrent bacterial vaginosis – a pilot study. J Low Genit Tract Dis. 18(2):156-61. https://doi.org/10.1097/LGT.0b013e31829a5558; PMid:23994951

33. Yankovskiy DS, Dyiment GS. 2005. Sovremennyie aspektyi problemyi mikroekologii i disbiozov. Zdorove zhenschinyi 4(24):209–218.

34. Yankovskiy DS, Dyiment GS. 2006. Problema rezistentnosti mikrofloryi k antibiotikam i rol sovremennyih probiotikov v ee realizatsii. Zdorove zhenschinyi 2 (26).

35. Potapov VA. 2016. Probiotiki v ginekologii: ocherednaya moda ili osoznannaya neobhodimost (analiticheskiy obzor). Uchastkovyiy vrach. Spetsialnyiy vyipusk #5. Ginekologiya.

36. Bradshaw CS, Morton AN, Hocking J et al. 2006. High recurrence rates of bacterialvaginosis over the course of 12 months after oral metronidazole therapy and factorsassociated with recurrence. J Infect Dis. 193:1478-86. https://doi.org/10.1086/503780; PMid:16652274

37. Ventskovskiy BM, Tovstanovskaya VA, Gutsulyak RV i dr. 2001. Primenenie probiotikov v kompleksnoy terapii i profilaktike vospalitelnyih zabolevaniy v akusherstve i ginekologii: Metod. rekom. K:28.

38. Yankovskiy DS. 2005. Mikrobnaya ekologiya cheloveka. Sovremennyie vozmozhnosti ee podderzhaniya i vosstanovleniya. K, Ekspert LTD:362.

39. Yankovskiy DS, Dyiment GS. Ispolzovanie probiotikov s tselyu uluchsheniya reproduktivnogo zdorovya zhenschinyi. Rezhim dostupa: http://old.medexpert.org.ua/modules/myarticles/article_storyid_326.html

40. Yankovskiy DS. 2005. Mikrobnaya ekologiya cheloveka. Sovremennyie vozmozhnosti ee podderzhaniya i vosstanovleniya. K, Ekspert LTD:362.

41. Swidsinski A, Mendling W, Loening-Baucke V et al. 2008. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol. 198(97):e1—6. https://doi.org/10.1016/j.ajog.2007.06.039; PMid:18005928.

42. Swidsinski A, Dörffel Y, Loening-Baucke V et al. 2011. Response of Gardnerella vaginalis biofilm to 5 days of moxifloxacin treatment. FEMS. Immunology and Medical Microbiology 61;1:41–46. https://doi.org/10.1111/j.1574-695X.2010.00743.x; PMid:20955467