Abstract
The aim. Reducing the recurrence of vulvovaginal candidiasis (VVC) in combination with bacterial vaginosis (BV) in women of reproductive age by studying the pathogenesis and improving the algorithm of treatment and prevention measures.
 Materials and methods. During the study, 150 women of reproductive age who had the same clinical manifestations of VVC and BV were selected and divided into 3 groups of 50 women: Group I was treated with an antimicrobial combination drug (miconazole with topical metronidazole), group II – the same drug in combination with probiotic (lactobacilli) in candles, group III – according to the algorithm improved by the authors. In addition, a control group was formed, which included healthy women of reproductive age.
 To establish the pathogenesis of VVC in combination with BV in the studied women, the concentration of cytokines and adhesion molecules in the blood before and after treatment was determined and compared with the control group.
 The clinical effect of different treatments was assessed at 3, 7, 10, 14 days, and the presence of relapses – 1, 3, 6 months after treatment.
 Results. The occurrence of a combination of VVC and BV in women of reproductive age is accompanied by a significant increase in the level of intercellular adhesion molecules (ICAM-1) and vascular cell adhesion molecules (VCAM-1) along with a statistically significant increase in proinflammatory cytokines (interleukin-6) (IL-6), interleukin-8 (IL-8)) and tumor necrosis factor (TNF) - TNF-α. As a result of the application of the algorithm improved by the authors, higher clinical efficiency and the ability to avoid recurrence of VVC in combination with BV in women of reproductive age were obtained.
 Conclusions. The authors' substantiated improvement of the algorithm of VVC treatment in combination with BV in women of reproductive age makes it possible to reduce the frequency of their recurrence and restore the biocenosis of the vagina to normal. In the case of this pathology there is an increase in the level of pro-inflammatory cytokines (IL-6, IL-8), TNF-α and ICAM-1 and VCAM-1.
Highlights
A woman’s reproductive health largely depends on the normal state of the microbiocenosis of the genital tract, in particular, infectious and inflammatory processes caused by vaginal dysbiosis can adversely affect maternal health, pregnancy, childbirth and fetal status [1, 2].In healthy women of reproductive age against the background of species diversity, the leading place in the vaginal microbiocenosis is occupied by lactobacilli of both aerobic and anaerobic origin, as well as the presence of a small amount of Peptostreptococcus, Bifidobacterium, Clostridium, Propionibacterium, Bacteroides, gardnerella and fungi of the genus Candida
The study of the level of cytokines and adhesion molecules in women of reproductive age with VVC in combination with BV included in group I before treatment showed a statistically
(2021), «EUREKA: Health Sciences» Number 1 significant increase in such women ICAM-1 and VCAM-1, along with a significant increase in IL-6, IL-8 and TNF-α in comparison with the corresponding indicators of the control group, which indicates the presence of an inflammatory process due to a violation of the microbiocenosis of the vagina
Summary
In healthy women of reproductive age against the background of species diversity, the leading place in the vaginal microbiocenosis is occupied by lactobacilli of both aerobic and anaerobic origin, as well as the presence of a small amount of Peptostreptococcus, Bifidobacterium, Clostridium, Propionibacterium, Bacteroides, gardnerella and fungi of the genus Candida. Lactobacilli inhabit the mucous membrane of a woman’s vagina and perform metabolic and barrier functions. Their protective role is manifested by antagonistic activity against other microorganisms, they synthesize lactic acid, peroxides and lysozyme with adhesive action. Dysbiosis is characterized by a significant reduction, in particular to the complete absence of lactobacilli, significant polymorphic gram-negative and gram-positive rod and coccal flora, as well as an increased number of fungi of the genus Candida, «key» cells, etc. Dysbiosis is characterized by a significant reduction, in particular to the complete absence of lactobacilli, significant polymorphic gram-negative and gram-positive rod and coccal flora, as well as an increased number of fungi of the genus Candida, «key» cells, etc. [5, 6]
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