Рецидивуючий бактеріальний вагіноз: варіативний підхід з урахуванням можливих патогенетичних аспектів

Abstract

Purpose - to evaluate the effectiveness, duration of the clinical result, safety and tolerability of the complex treatment of recurrent bacterial vaginosis (BV) with the sequential use of an antibacterial agent and probiotic suppositories. Materials and methods. 91 women of reproductive age with a symptomatic course and a diagnosis of recurrent BV participated in the study. Primary decontamination of the vaginal tract was performed by all subjects and consisted of a 10-day intravaginal administration of the drug Terzhinan. Subsequently, the participants were randomized into three comparable groups. After primary remediation, no additional medication was prescribed to patients in the Group 1 (n=30). Subjects of the Groups 2 (n=30) and 3 (n=31) were recommended daily administration of vaginal probiotic suppositories Bifolak for a 10-day course, followed by prolongation of their use twice a week for 2 months in the Group 3. The effectiveness of BV therapy was evaluated immediately after antibacterial treatment and after a 6-month follow-up period based on the results of clinical examination, microscopic analysis of smears, and determination of vaginal pH with litmus strips. Results. At the end of the 10-day course of vaginal sanitation, subjective and objective signs of bacterial infection were not detected among all study participants, the pH of the vaginal secretion was within physiological limits and did not differ statistically between the Groups. At the stage of the sixth month of observation, data from a gynecological examination, smear microscopy and pH-metry confirmed 4 recurrences of the disease in the Group 1. In the Group 2, whose women additionally received a ten-day course of probiotic therapy, the number of episodes of repeated development of the disease was significantly lower, and amounted to 1 case for the entire observation period. Patients of the Group 3 did not notice manifestations of reinfection during the study and had no objective signs of BV. The use of a probiotic for a continuous course of 10 days in the Group 2, as well as its prolongation in a maintenance regimen (twice a week for 2 months) in the Group 3, was combined with a stable normalization of the acidity of the vaginal secretion, which was evidenced by the preservation of optimal pH until the end of the observation period (4.07±0.14 and 3.94±0.17, respectively, in the Groups 2 and 3 against 4.43±0.14 in the Group 1, p<0.05). The complete absence of repeated cases of BV and the lower pH values (p>0,05) in the Group 3 allowed us to consider the greater anti-relapse effectiveness of the long-term use of the probiotic at the trend level. Conclusions. Traditional schemes for the use of antibacterial agents in the treatment of BV allow to achieve a clinical and laboratory effect at the end of the course, but do not ensure its complete preservation for a long period of time. The disadvantage of the etiotropic approach to the treatment of BV is the lack of attention to the competitive properties of the indigenous flora as a factor in countering dysbiosis. Taking into account the pathogenetic essence of BV, which consists in the violation of the growth balance between conditionally pathogenic microorganisms and its own flora, classical antibacterial schemes can be successfully supplemented by the external introduction of eubiotic strains. Our study showed the benefits of complex therapy with an antibacterial agent and a probiotic, which consisted in stabilizing the acidity of the vaginal space and reducing the rate of disease recurrence, with a tendency to increase the effect in parallel with the duration of treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.