DOI: https://doi.org/10.18370/2309-4117.2019.49.62-66

New principles of treatment of vaginal dysbiosis in reproductive aged womеn

Т. Г. Романенко, О. М. Суліменко

Abstract


Purpose of the study. To investigate the efficiency and safety of combined treatment and prevention of bacterial vaginosis recurrence in women of reproductive age.

Materials and methods. 78 women of reproductive age with diagnosed bacterial vaginosis were examined. 50 women are included in the main group, 28 women are included in

the comparison group. Women in the main group were offered complex therapy: Samitol (secnidazole 500 mg) 1 g 2 times a day per os for 3 days, Gynex Forte (1 vaginal suppository contains metronidazole 750 mg, miconazole nitrate 200 mg) 1 time a day (overnight) for 7 days, Serrata (serratiopeptidase tablets) 1 tablet (10 mg) 3 times a day for 20 days. After Gynex Forte treatment women received a probiotic per vaginum for 7 days. Comparison group received standard two-step therapy.

Results. Clinical effect of treatments was achieved in 49 (98%) patients of the main group in contrast to the comparison group where the effectiveness of treatment was 12 (42.9%). A direct positive treatment effect on 15th day in the main group was reported in 33 cases (66%) compared with control group – 9 (32.1%). 6 months after treatment main group did not have recurrence of bacterial vaginosis, while in the comparison group recurrence was diagnosed in 8 (28.6%) women.

Conclusions. The results showed the high efficacy and safety of complex therapy, which included drug Samitol (secnidazole), vaginal suppositories Gynex Forte (a combination of metronidazole and miconazole) and proteolytic drug Serrata (serratiopeptidase tablets) in women of reproductive age in the bacterial vaginosis treatment. The results of this clinical study suggest the recommended treatment of bacterial vaginosis in women of reproductive age for common use in gynecological practice

Keywords


reproductive age; vaginal dysbiosis; bacterial vaginosis; antimicrobial drugs; combined treatment; recurrence prevention

References


Sherrard, J., Wilson, J., Donders, G., et al. “European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge.” Int J STD AIDS 29.13 (2018): 1258–72. DOI: 10.1177/0956462418785451

Gillet, E., et al. “Association between bacterial vaginosis and CIN: systematic review and meta- analisis.” PLoS One 7.10 (2012): e45201.

Gomberg, M.A. “Bacterial vaginosis and new infections associated with it.” Russian Bulletin of Obstetrician-Gynecologist 10.2 (2010): 32–4.

Lipova, E.V., Radzinsky, V.E. “Bacterial vaginosis: always discussion.” Status Praesens 7 (2012): 27–34.

Schwebke, J.R., Muzny, C.A., Josey, W.E. “Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model.” J Infect Dis 210.3 (2014): 338–43. DOI: 10.1093/infdis/jiu089

Harwich, M.D. Jr., Alves, J.M., Buck, G.A., et al. “Drawing the line between commensal and pathogenic Gardnerella vaginalis through genome analysis and virulence studies.” BMC Genomics 11 (2010): 375. DOI: 10.1186/1471-2164-11-375

Ahmed, A., Earl, J., Retchless, A., et al. “Comparative genomic analyses of 17 clinical isolates of Gardnerella vaginalis provide evidence of multiple genetically isolated clades consistent with subspeciation into genovars.” J Bacteriol 194.15 (2012): 3922–37. DOI: 10.1128/JB.00056-12

Schellenberg, J.J., Paramel Jayaprakash, T., Withana Gamage, N., et al. “Gardnerella vaginalis Subgroups Defined by cpn60 Sequencing and Sialidase Activity in Isolates from Canada, Belgium and Kenya.” PLoS One 11.1 (2016): e0146510. DOI: 10.1371/journal.pone.0146510

Lewis, W.G., Robinson, L.S., Gilbert, N.M., et al. “Degradation, foraging, and depletion of mucus sialoglycans by the vagina- adapted Actinobacterium Gardnerella vaginalis.” J Biol Chem 288.17 (2013): 12067–79. DOI: 10.1074/jbc.M113.453654

Jain, J.P., Bristow, C.C., Pines, H.A., et al. “Factors in the HIV risk environment associated with bacterial vaginosis among HIV-negative female sex workers who inject drugs in the Mexico-United States border region.” BMC Public Health 18.1 (2018): 1032.

Haddad, L.B., Wall, K.M., Kilembe, W., et al. “Bacterial vaginosis modifies the association between hormonal contraception and HIV acquisition.” AIDS 32.5 (2018). Available from: [https://journals.lww. com/aidsonline/Fulltext/2018/03130/Bacterial_vaginosis_modifies_the_ association.7.aspx], last accessed Nov 4, 2019.

Brotman, R.M., Klebanoff, M.A., Tonia, R., et al. “Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection.” J Infect Dis 202 (2010): 1907–15.

Rathod, S.D., Krupp, K., Klausner, J.D., et al. “Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis.” Sex Transm Dis 38 (2011): 882–6.

Eastment, M.C., McClelland, R.S.

“Vaginal microbiota and susceptibility to HIV.” AIDS 32.6 (2018): 687–98.

Esber, A., Vicetti Miguel, R.D., Cherpes, T.L., et al. “Risk of Bacterial Vaginosis Among Women With Herpes Simplex Virus Type 2 Infection: A Systematic Review and Meta-analysis.” J Infect Dis 212.1 (2015): 8–17. DOI: 10.1093/infdis/jiv017

Cohen, C.R., Lingappa, J.R., Baeten, J.M., et al. “Bacterial vaginosis associated with increased risk of female to male HIV-1 transmission: a prospective cohort analysis among African couples.” PLoS Med 9 (2012): e1001251.

Boyko, G.B. “Bacterial vaginosis: a modern perspective on the problem.” Ukrainian Medical Journal 5.91 (2012).

E. De Backer, et al. “In vitro activity of secnidazole against Atopobium vaginae, an anaerobic pathogen involved in bacterial vaginosis.” CMI 16.5 (2010): 470–2. DOI: 10.1111/j.1469-0691.2009.02852.x

Thulkar, J., et al. “A comparative study of oral single dose of metronidazole, tinidazole, secnidazole and ornidazole in bacterial vaginosis.” Indian Journal of Pharmacology 44.2 (2012): 243–5. DOI: 10.4103/0253-7613.93859

Stout, M.J., Zhou, Y., Wylie, K.M., et al. “Early pregnancy vaginal microbiome trends and preterm birth.” American Journal of Obstetrics and Gynecology 217.3 (2017): 356–7.

Pirogovа, V.I., Veresniuk, N.S., Shchuruk, N.V. “The efficiency of complex treatment of bacterial vaginosis.” In: Collection of scientific papers of the Association of Obstetricians-Gynecologists of Ukraine. Kyiv. Polygraph Plus (2012): 315–8.

Machado, D., Castro, J., Palmeira-de-Oliveira, A., et al. “Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions.” Front Microbiol 6 (2016): 1528. DOI: 10.3389/fmicb.2015.01528

Schwebke, J.R., Marrazzo, J., Beelen, A.P., Sobel, J.D. “A Phase 3, Multicenter, Randomized, Double-Blind, Vehicle-Controlled Study Evaluating the Safety and Efficacy of Metronidazole Vaginal Gel 1.3% in the Treatment of Bacterial Vaginosis.” Sex Transm Dis 42 (2015): 376.

Oduyebo, O.O., Anorlu, R.I., Ogunsola, F.T. “The effects of antimicrobial therapy on bacterial vaginosis in non- pregnant women.” Cochrane Database Syst Rev 3 (2009): CD006055. DOI: 10.1002/14651858.CD006055.pub2

Papa, R., Artini, M., Cellini, A., et al. “A new anti-infective strategy to reduce the spreading of antibiotic resistance by the action on adhesion-mediated virulence factors in Staphylococcus aureus.” Microb Pathog 63 (2013): 44–53. DOI: 10.1016/j. micpath.2013.05.003


GOST Style Citations


1.         Sherrard, J., Wilson, J., Donders, G., et al. “European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge.” Int J STD AIDS 29.13 (2018): 1258–72. DOI: 10.1177/0956462418785451

2.         Gillet, E., et al. “Association between bacterial vaginosis and CIN: systematic review and meta- analisis.” PLoS One 7.10 (2012): e45201.

3.         Гомберг, М.А. Бактериальный вагиноз и новые инфекции, с ним ассоциированные / М.А. Гомберг // Рос. вестник акуш.-гин. – 2010. – Т.10, № 2. – С. 32–34.

4.         Липова, Е.В. Бактериальный вагиноз: всегда дискуссии / Е.В. Липова, В.Е. Радзинский // Status Praesens. – 2012. – № 7. – С. 27–34.

5.         Schwebke, J.R., Muzny, C.A., Josey, W.E. “Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model.” J Infect Dis 210.3 (2014): 338–43. DOI: 10.1093/infdis/jiu089

6.         Harwich, M.D. Jr., Alves, J.M., Buck, G.A., et al. “Drawing the line between commensal and pathogenic Gardnerella vaginalis through genome analysis and virulence studies.” BMC Genomics 11 (2010): 375. DOI: 10.1186/1471-2164-11-375

7.         Ahmed, A., Earl, J., Retchless, A., et al. “Comparative genomic analyses of 17 clinical isolates of Gardnerella vaginalis provide evidence of multiple genetically isolated clades consistent with subspeciation into genovars.” J Bacteriol 194.15 (2012): 3922–37. DOI: 10.1128/JB.00056-12

8.         Schellenberg, J.J., Paramel Jayaprakash, T., Withana Gamage, N., et al. “Gardnerella vaginalis Subgroups Defined by cpn60 Sequencing and Sialidase Activity in Isolates from Canada, Belgium and Kenya.” PLoS One 11.1 (2016): e0146510. DOI: 10.1371/journal.pone.0146510

9.         Lewis, W.G., Robinson, L.S., Gilbert, N.M., et al. “Degradation, foraging, and depletion of mucus sialoglycans by the vagina- adapted Actinobacterium Gardnerella vaginalis.” J Biol Chem 288.17 (2013): 12067–79. DOI: 10.1074/jbc.M113.453654

10.       Jain, J.P., Bristow, C.C., Pines, H.A., et al. “Factors in the HIV risk environment associated with bacterial vaginosis among HIV-negative female sex workers who inject drugs in the Mexico-United States border region.” BMC Public Health 18.1 (2018): 1032.

11.       Haddad, L.B., Wall, K.M., Kilembe, W., et al. “Bacterial vaginosis modifies the association between hormonal contraception and HIV acquisition.” AIDS 32.5 (2018). Available from: [https://journals.lww. com/aidsonline/Fulltext/2018/03130/Bacterial_vaginosis_modifies_the_ association.7.aspx], last accessed Nov 4, 2019.

12.       Brotman, R.M., Klebanoff, M.A., Tonia, R., et al. “Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection.” J Infect Dis 202 (2010): 1907–15.

13.       Rathod, S.D., Krupp, K., Klausner, J.D., et al. “Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis.” Sex Transm Dis 38 (2011): 882–6.

14.       Eastment, M.C., McClelland, R.S.

“Vaginal microbiota and susceptibility to HIV.” AIDS 32.6 (2018): 687–98.

15.       Esber, A., Vicetti Miguel, R.D., Cherpes, T.L., et al. “Risk of Bacterial Vaginosis Among Women With Herpes Simplex Virus Type 2 Infection: A Systematic Review and Meta-analysis.” J Infect Dis 212.1 (2015): 8–17. DOI: 10.1093/infdis/jiv017

16.       Cohen, C.R., Lingappa, J.R., Baeten, J.M., et al. “Bacterial vaginosis associated with increased risk of female to male HIV-1 transmission: a prospective cohort analysis among African couples.” PLoS Med 9 (2012): e1001251.

17.       Бойко, Г.Б. Бактеріальний вагіноз: сучасний погляд на проблему / Г.Б. Бойко // Український медичний часопис. – 2012. – № 5 (91).

18.       E. De Backer, et al. “In vitro activity of secnidazole against Atopobium vaginae, an anaerobic pathogen involved in bacterial vaginosis.” CMI 16.5 (2010): 470–2. DOI: 10.1111/j.1469-0691.2009.02852.x

19.       Thulkar, J., et al. “A comparative study of oral single dose of metronidazole, tinidazole, secnidazole and ornidazole in bacterial vaginosis.” Indian Journal of Pharmacology 44.2 (2012): 243–5. DOI: 10.4103/0253-7613.93859

20.       Stout, M.J., Zhou, Y., Wylie, K.M., et al. “Early pregnancy vaginal microbiome trends and preterm birth.” American Journal of Obstetrics and Gynecology 217.3 (2017): 356–7.

21.       Пирогова, В.І. Ефективність комплексного лікування бактеріального вагінозу /

В.І. Пирогова, Н.С. Вереснюк, Н.В. Щурук // Зб. наук. Праць Асоціації акушерів-гінекологів України. – К.: Поліграф плюс, 2012. – С. 315–318.

22.       Machado, D., Castro, J., Palmeira-de-Oliveira, A., et al. “Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions.” Front Microbiol 6 (2016): 1528. DOI: 10.3389/fmicb.2015.01528

23.       Schwebke, J.R., Marrazzo, J., Beelen, A.P., Sobel, J.D. “A Phase 3, Multicenter, Randomized, Double-Blind, Vehicle-Controlled Study Evaluating the Safety and Efficacy of Metronidazole Vaginal Gel 1.3% in the Treatment of Bacterial Vaginosis.” Sex Transm Dis 42 (2015): 376.

24.       Oduyebo, O.O., Anorlu, R.I., Ogunsola, F.T. “The effects of antimicrobial therapy on bacterial vaginosis in non- pregnant women.” Cochrane Database Syst Rev 3 (2009): CD006055. DOI: 10.1002/14651858.CD006055.pub2

25.       Papa, R., Artini, M., Cellini, A., et al. “A new anti-infective strategy to reduce the spreading of antibiotic resistance by the action on adhesion-mediated virulence factors in Staphylococcus aureus.” Microb Pathog 63 (2013): 44–53. DOI: 10.1016/j. micpath.2013.05.003





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)