DOI: https://doi.org/10.18370/2309-4117.2020.53.105-108

Rational therapy of candidous vulvovaginitis in pregnancy

Т. Г. Романенко, Л. Ю. Стаселович, О. М. Суліменко

Abstract


Objective of the study: was to evaluate the efficacy and safety of the Clofan® drug (clotrimazole, vaginal suppositories 500 mg) for treatment of candidiasis vulvovaginitis (CVV) in the third trimester with multiple pregnancy after using assisted reproductive technologies.

Materials and methods. 32 women with multiple pregnancies were examined after using assisted reproductive technologies with CVV symptoms in the third trimester. General clinical research methods, vaginal smear microscopy, and culture studies using culture media were used to confirm the diagnosis. Spores and yeast fungal cells were isolated by smear microscopy of vaginal contents in all women. Examination was carried out before treatment, 1 week and 4 weeks after treatment. A single intravaginal suppository Clofan® 500 mg was used at night.

Results. 7 days after Clofan® use clinical recovery was observed in 30 (93.8%) patients, and a significant symptoms reduction in 2 (6.2%) patients. Elimination of concomitant pathogenic and conditionally pathogenic bacterial microflora was achieved in 27 patients (84.4%). The absence of Candida albicans DNA in vaginal secretion after treatment was also noted in 27 patients (84.4%). The threat of preterm birth was observed in 2 cases (6.2%), premature discharge of amniotic fluid in 3 (9.4%) cases, candidal postpartum endometritis and joint discrepancy in the postpartum period were absent in all cases.

Conclusions. The study showed the high efficiency of Clofan® in the treatment of CVV in the III trimester in multiple pregnancy after assisted reproductive technologies. This helped to reduce the frequency of the threat of premature birth, premature discharge of amniotic fluid and postpartum complications. Clofan® is an effective and safe topical preparation for CVV, and it also has a pronounced therapeutic effect on gram-positive bacteria and anaerobes. A low incidence of side effects against the background of its use was found.


Keywords


pregnancy; candidiasis; Candida albicans; multiple pregnancy; assisted reproductive technologies; clotrimazole

References


Paladine, H.L., Desai, U.A. “Vaginitis: diagnosis and treatment.” Am Fam Physician 97.5 (2018): 321–9.

Rogovskaya, S.I. “To the question of optimizing the treatment of vulvovaginal candidiasis.” Doctor.ru. Gynecology. Endocrinology 1.89 (2014): 25–32.

Nnadi, D.C., Singh, S. “The prevalence of genital Candida species among pregnant women attending antenatal clinic in a tertiary health center in North-west Nigeria.” Sahel Med J 20 (2017): 33–7. DOI: 10.4103/1118-8561.20433

Olowe, O.A., Makanjuola, O.B., Olowe, R., Adekanle, D.A. “Prevalence of vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis among pregnant women receiving antenatal care in Southwestern Nigeria.” European Journal of Microbiology and Immunology 4 Suppl. 4 (2014): 193–7. DOI: 10.1556/EUJMI-D-14-00027

Farr, I.H.A., Kiss, H., Hagmann, M., Petricevic, L. “The colonization with Candida species is more harmful in the second trimester of pregnancy.” Archives of Gynecology and Obstetrics 295 Suppl. 4 (2017): 891–5. DOI: 10.1007/s00404-017-4331

Turner, S.A., Butler, G. “The candida pathogenic species complex.” Cold Spring Harb Perspect Med 4.9 (2014): a019778. DOI: 10.1101/cshperspect.a019778

Palmeira-de-Oliveira, R., Palmeira-de-Oliveira, A., Martinez-de-Oliveira, J. “New strategies for local treatment of vaginal infections.” Advanced Drug Delivery Reviews 92 (2015): 105–22. DOI: 10.1016/j.addr.2015.06.008

Sardi, J.C.O., Scorzoni, L., Bernardi, T., et al. “Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options.” J Med Microbiol. 2013;62(1):10–24. DOI: 10.1099/jmm.0.045054-0..

Silva, S., Negri, M., Henriques, M., et al. “Candida glabrata, Candida parapsilosis and Candida tropicalis: biology, epidemiology, pathogenicity and antifungal resistance.” FEMS Microbiology Reviews 36.2 (2012): 288–305. DOI: 10.1111/j.1574-6976.2011.00278.x

Pazos, M., Sperling, R.S., Moran, T.M., Kraus, T.A. “The influence of pregnancy on systemic immunity.” Immunol Res 54.1–3 (2012): 254–61.

Kraus, T.A., Engel, S.M., Sperling, R.S., et al. “Characterizing the pregnancy immune phenotype: results of the Viral Immunity and Pregnancy (VIP) study.” J Clin Immunol 32.2 (2012): 300–11.

Mgeryan, A.N. “Vulvovaginal candidiasis: the effectiveness of clotrimazole therapy.” Effective pharmacotherapy 15.26 (2019): 36–41. DOI: 10.33978 / 2307-3586-2019-15-26-36-41

Deorukhkar, S.C., Saini, S., Mathew, S. “Non-albicans Candida Infection: An Emerging Threat.” Interdiscip Perspect Infect Dis 2014 (2014): 615958. DOI: 10.1155/2014/615958

Nobile, C.J., Johnson, A.D. “Candida albicans biofilms and human disease.” Annu Rev Microbiol 69 (2015): 71–92. DOI: 10.1146/annurev-micro-091014-104330

Ramage, G., Rajendran, R., Sherry, L., Williams, C. “Fungal biofilm resistance.” Int J Microbiol 2012 (2012): 528521. DOI: 10.1155/2012/528521

Sherry, L., Kean, R., McKloud, E., et al. “Biofilms formed by isolates from recurrent vulvovaginal candidiasis patients are heterogeneous and insensitive to fluconazole.” Antimicrob Agents Chemother 61.9 (2017): e01065–17. DOI: 10.1128/AAC.01065-17

Blostein, F., Levin-Sparenberg, E., Wagner, J., Foxman, B. “Recurrent vulvovaginal candidiasis.” Annals of Epidemiology 27.9 (2017): 575–82. DOI: 10.1016/j. annepidem.2017.08.010

Roberts, C.L., Rickard, K., Kotsiou, G., Morris, J.M. “Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open label pilot randomized controlled trial.” BMC Pregnancy Childbirth 11 (2011): ID 18.

Roberts, C., Algert, C., Morris, J., Rickard, K. “Treating vaginal candidiasis for the prevention of preterm birth: protocol for a systematic review and meta-analysis.” Systematic Review 4 (2015): 31. DOI: 10.1186/s13643-015-0018-2

Workowski, K.A., Bolan, G.A. “Sexually transmitted diseases treatment guidelines, 2015.” The MMWR Recommendations and Reports 64.RR3 (2015): 1–137.

Sherrard, J., Wilson, J., Donders, G., et al. European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge (2018).

Bebneva, T.N., Dikke, G.B. “Modern features of candidal vulvovaginitis and the choice of rational therapy outside and during pregnancy.” RMJ “Mother and childe” 1 (2018): 49–56. DOI: 10.32364/2618-8430-2018-1-1-49-56

Czeiel, А.E., Toth, M., Rockenbauer, M. “No teratogenik effect after clotrimazole therapy during pregnancy.” Epidemiology 10 (1999): 437–40.

World Health Organization. Model List of Essential Medicines. 20th List (March 2017). Available from: [http://www.who.int/].

World Health Organization. Antimicrobial resistance: global report on surveillance. Available from: [https://apps.who.int/iris/bitstream/han dle/10665/112642/9789241564748_eng.pdf], last accessed Feb 11, 2020


GOST Style Citations


1.            Paladine, H.L., Desai, U.A. “Vaginitis: diagnosis and treatment.” Am Fam Physician 97.5 (2018): 321–9.

2.            Роговская, С.И. К вопросу об оптимизации лечения вульвовагинального кандидоза / С.И. Роговская // Доктор.ру. Гинекология. Эндокринология. – 2014. – № 1 (89). – С. 25–32.

3.            Nnadi, D.C., Singh, S. “The prevalence of genital Candida species among pregnant women attending antenatal clinic in a tertiary health center in North-west Nigeria.” Sahel Med J 20 (2017): 33–7. DOI: 10.4103/1118-8561.20433

4.            Olowe, O.A., Makanjuola, O.B., Olowe, R., Adekanle, D.A. “Prevalence of vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis among pregnant women receiving antenatal care in Southwestern Nigeria.” European Journal of Microbiology and Immunology 4 Suppl. 4 (2014): 193–7. DOI: 10.1556/EUJMI-D-14-00027

 

5.            Farr, I.H.A., Kiss, H., Hagmann, M., Petricevic, L. “The colonization with Candida species is more harmful in the second trimester of pregnancy.” Archives of Gynecology and Obstetrics 295 Suppl. 4 (2017): 891–5. DOI: 10.1007/s00404-017-4331

6.            Turner, S.A., Butler, G. “The candida pathogenic species complex.” Cold Spring Harb Perspect Med 4.9 (2014): a019778. DOI: 10.1101/cshperspect.a019778

7.            Palmeira-de-Oliveira, R., Palmeira-de-Oliveira, A., Martinez-de-Oliveira, J. “New strategies for local treatment of vaginal infections.” Advanced Drug Delivery Reviews 92 (2015): 105–22. DOI: 10.1016/j.addr.2015.06.008

8.            Sardi, J.C.O., Scorzoni, L., Bernardi, T., et al. “Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options.” J Med Microbiol. 2013;62(1):10–24. DOI: 10.1099/jmm.0.045054-0..

9.            Silva, S., Negri, M., Henriques, M., et al. “Candida glabrata, Candida parapsilosis and Candida tropicalis: biology, epidemiology, pathogenicity and antifungal resistance.” FEMS Microbiology Reviews 36.2 (2012): 288–305. DOI: 10.1111/j.1574-6976.2011.00278.x

10.          Pazos, M., Sperling, R.S., Moran, T.M., Kraus, T.A. “The influence of pregnancy on systemic immunity.” Immunol Res 54.1–3 (2012): 254–61.

11.          Kraus, T.A., Engel, S.M., Sperling, R.S., et al. “Characterizing the pregnancy immune phenotype: results of the Viral Immunity and Pregnancy (VIP) study.” J Clin Immunol 32.2 (2012): 300–11.

12.          Мгерян, А.Н. Вульвовагинальный кандидоз: эффективность терапии клотримазолом / А.Н. Мгерян // Эффективная фармакотерапия. – 2019. – Т. 15, № 26. – С. 36–41.

13.          Deorukhkar, S.C., Saini, S., Mathew, S. “Non-albicans Candida Infection: An Emerging Threat.” Interdiscip Perspect Infect Dis 2014 (2014): 615958. DOI: 10.1155/2014/615958

14.          Nobile, C.J., Johnson, A.D. “Candida albicans biofilms and human disease.” Annu Rev Microbiol 69 (2015): 71–92. DOI: 10.1146/annurev-micro-091014-104330

15.          Ramage, G., Rajendran, R., Sherry, L., Williams, C. “Fungal biofilm resistance.” Int J Microbiol 2012 (2012): 528521. DOI: 10.1155/2012/528521

16.          Sherry, L., Kean, R., McKloud, E., et al. “Biofilms formed by isolates from recurrent vulvovaginal candidiasis patients are heterogeneous and insensitive to fluconazole.” Antimicrob Agents Chemother 61.9 (2017): e01065–17. DOI: 10.1128/AAC.01065-17

17.          Blostein, F., Levin-Sparenberg, E., Wagner, J., Foxman, B. “Recurrent vulvovaginal candidiasis.” Annals of Epidemiology 27.9 (2017): 575–82. DOI: 10.1016/j. annepidem.2017.08.010

18.          Roberts, C.L., Rickard, K., Kotsiou, G., Morris, J.M. “Treatment of asymptomatic vaginal candidiasis in pregnancy to prevent preterm birth: an open label pilot randomized controlled trial.” BMC Pregnancy Childbirth 11 (2011): ID 18.

19.          Roberts, C., Algert, C., Morris, J., Rickard, K. “Treating vaginal candidiasis for the prevention of preterm birth: protocol for a systematic review and meta-analysis.” Systematic Review 4 (2015): 31. DOI: 10.1186/s13643-015-0018-2

20.          Workowski, K.A., Bolan, G.A. “Sexually transmitted diseases treatment guidelines, 2015.” The MMWR Recommendations and Reports 64.RR3 (2015): 1–137.

21.          Sherrard, J., Wilson, J., Donders, G., et al. European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge (2018).

22.          Бебнева Т.Н. Современные особенности кандидозного вульвовагинита и выбора рациональной терапии вне и во время беременности / Т.Н. Бебнева, Г.Б. Дикке // РМЖ. Мать и дитя. – 2018. – № 1. – С. 49–56.

23.          Czeiel, А.E., Toth, M., Rockenbauer, M. “No teratogenik effect after clotrimazole therapy during pregnancy.” Epidemiology 10 (1999): 437–40.

24.          World Health Organization. Model List of Essential Medicines. 20th List (March 2017). Available from: [http://www.who.int/].

25.          World Health Organization. Antimicrobial resistance: global report on surveillance. Available from: [https://apps.who.int/iris/bitstream/han dle/10665/112642/9789241564748_eng.pdf], last accessed Feb 11, 2020





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

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