Особливості тактики ведення пацієнток з ектопією шийки матки на тлі аеробного вагініту

Abstract

Dysbiotic processes in the vagina, in particular aerobic vaginitis, are closely related to the local immune status violations, interfere the cervical epithelium physiological metaplasia, and also create favorable conditions for sexually transmitted infections accession, in particular the human papillomavirus. This complex of disorders is one of the determining factors for both the prolonged complicated course of cervical ectopy and its recurrence. The objective: was to optimize the treatment tactics in patients with cervical ectopy complicated by aerobic vaginitis. Materials and methods. It was carried out a comprehensive examination and treatment of 70 women of reproductive age (18–49 years) with cervical ectopy complicated by the aerobic vaginitis presence. All patients were questioned with a study of the reproductive anamnesis, bacterioscopic, cytological examination, simple and advanced colposcopy, pH-metry of vaginal environment, vaginal microbiota investigation. Depending on the treatment regimen, the patients were randomly divided into 2 groups. Group 1 (main group, n=35) – included patients treated according to the proposed scheme: on the first stage patients were prescribed vaginal suppositories containing dexpanthenol and chlorhexidine bigluconate – 1 suppository intravaginally twice a day and a complex multi-strain probiotic – 1 capsule twice a day for 2 weeks. On the second stage the patients were prescribed pessaries containing Triticum vulgare according to the scheme – 1 pessary intravaginally at night for 10 days a month (with the start of the use immediately after the next menstruation end) for 3 months. Group 2 (comparison group, n=35) – women who received treatment according to the current recommendations of the Ministry of Health of Ukraine. Group 3 (control group, n=30) included conditionally healthy women who have applied for routine preventive gynecological examination. Results. Clinical evaluation of the treatment first stage effectiveness showed a reduction in the complaints in patients of both study groups in 100% of cases. Both after the first and after the second stage of the proposed treatment scheme effective vaginal mucous membranes decontamination was revealed, conditionally pathogenic bacteria were not found in diagnostically significant titers, the number of leukocytes and the vaginal secret pH were normalized, and the average score on the Donders G. et al. scale showed no signs of aerobic vaginitis in the patients of the main group. The cytological norm of Pap-smear was reached by 91.43±7.43% of main group and 71.43±7.64% of the comparison group women (p<0.05); and in case of evaluation using the Bethesda system (2001) – 97.14±2.82% of group 1 and 80.00±6.76% of group 2 patients (p<0.05). After the second stage of treatment the average size of cervical ectopy significantly (p<0.05) decreased in the patients of the main group compared to group 2 (by 32.68% compared to the average area before treatment). In 5 (14.29%) patients of the main group and 2 (5.71%) patients of the comparison group after the treatment cervical ectopy was not found during the control colposcopy. Сonclusion. In the part of women physiological cervical ectopy with the onset of sexual activity is complicated by the development of the vaginal dysbiotic processes and vaginitis, which create unfavorable conditions for the cervix epithelization and simultaneously increase the risk of sexually transmitted infections, in particular the human papillomavirus infection. Therapeutic measures aimed at normalizing the vaginal microbiota, recolonization of its lactoflora and the creation of favorable conditions for the physiological cervix epithelization are pathogenetically substantiated in this case. The proposed treatment scheme (complex application of vaginal antiseptic in combination with probiotic and on the next stage – of the reparative action drug) made it possible to reduce the complaints, eliminate the signs of aerobic vaginitis, normalize the vaginal microbiota state, reduce the cervical ectopy area, and in 14.29% cases – to achieve complete cervical epithelization. Key words: cervical ectopy, aerobic vaginitis, vaginal microbiota, vaginal suppositories, probiotic.