Modern methods of diagnosis and treatment of vaginal dysbiosis caused by mushrooms of the genus Candida

Е. Н. Носенко, Е. П. Головатюк

Abstract


The article presents literature data on modern approaches to diagnosis and treatment of vaginal dysbiosis caused by fungi of the genus Candida and personal data on the effectiveness of vaginal dysbiosis treatment in women with recurrent miscarriage occurring in ART cycles by combined local therapy with sertaconazole and povidone-iodine.

240 patients of reproductive age with habitual miscarriage of pregnancy after ART and 30 conditionally healthy fertile women were examined. The state of vaginal microbiota was studied using PCR and culture. It were carried out a species identification of the fungi of the genus Candida and their susceptibility to antimycotics.

It has been established that among women with a recurrent miscarriage after cycles of ART that repeatedly receive antibacterial therapy in preparation in the ART cycles and after abortion, in the vaginal microbiota in 39.75% of cases Candida fungi are diagnosed in diagnostically significant quantities, including C. albicans registered in 75.79% of cases, and non-albicans – in 24.21%. Fungi of the genus Candida in diagnostically significant amounts in 92.63% of cases occurs against the background of aerobic, anaerobic or aerobic-anaerobic imbalance. In 87.36% of ART patients with recurrent miscarriage, the detection of fungi of the genus Candida in diagnostically significant amounts is not accompanied by clinical manifestations of the vaginal candidiasis, but proceeds according to the type of asymptomatic increased colonization by these yeasts.

For the treatment of patients prescribed vaginal suppositories Zalain (sertaconazole 0.3 g) per night once, after 7 days – suppositories Betadine (povidone-iodine) at night once a day for 14 days. The culture and PCR studies after the end of treatment showed normalization of the urogenital microbiota and the absence of fungi of the genus Candida in diagnostically significant amounts in all patients.

Thus, sertaconazole in combination with povidone iodine is a highly effective regimen of vaginal microbiota normalization in patients with ART with a recurrent miscarriage.


Keywords


candidiasis; habitual miscarriage; ART; sertaconazole

References


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GOST Style Citations


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7. Fidel, P.L. Jr, Cutright, J.L., Tait, L., Sobel, J.D. “A murine model of Candida glabrata vaginitis.” J Infect Dis 173.2 (1996): 425–31.

8. Barrenetxea, Z.G. “Vulvovaginitis candidiásica.” Rev Iberoam Micol 19 (2002): 22–4.

9. Carrillo-Muñoz, A.J., Tur-Tur, C., Giusiano, G., et al. “Sertaconazole: an antifungal agent for the topical treatment of superficial candidiasis.” Expert Rev Anti Infect Ther 11.4 (2013): 347–58.

10. Corrêa, P.R., David, P.R.S., Peres, N.P., et al. “Caracterização fenotípica de leveduras isoladas da mucosa vaginal em mulheres adultas.” Rev Bras Ginecol Obstet 31 (2009): 177–81.

11. Croxtall, J.D., Plosker, GL. “Sertaconazole: a review of its use in the management of superficial mycoses in dermatology and gynaecology.” Drugs 69.3 (2009): 339–59.

12. Fornari, G., Vicente, V.A., Gomes, R.R., et al. “Susceptibility and molecular characterization of Candida species from patients with vulvovaginitis.” Braz J Microbiol 47.2 (2016): 373–80.

13. Galle, L.C., Gianinni, M.J.S.M. “Prevalência e susceptibilidade de leveduras vaginais.” JBPML 40 (2004): 229–36.

14. Gondo, D.C.A.F., Duarte, M.T.C., Silva, M.G., et al. “Abnormal vaginal flora in low-risk pregnant women cared for by a public health service: prevalence and association with symptoms and findings from gynecological exams.” Rev Latino- Am Enfermagem 18 (2010): 919–27.

15. Palacín, C., Tarragó, C., Ortiz, J.A. “Sertaconazole: pharmacology of a gynecological antifungal agent.” Int J Gynaecol Obstet 71 Suppl 1 (2000): S37–46.

16. Mahmoudi, R., Zafarghandi, S., Abbasabadi, B., et al. “The epidemiology of Candida species associated with vulvovaginal candidiasis in an Iranian patient population.” Eur J Obstet Gynaecol Reprod Biol 155 (2010): 199–203.

17. Workowski, K.A., Bolan, G.A. “Sexually Transmitted Diseases Treatment Guidelines.” Recommendations and Reports 64.3 (2015): 1–137.

18. Sobel, J.D. “Vulvovaginal candidiasis.” Lancet 369 (2007): 1961–71.





DOI: https://doi.org/10.18370/2309-4117.2017.36.64-72

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