Bacterial vaginosis. Modern view of the problem and its status in Ukraine
Keywords:bacterial vaginosis, patient survey, abnormal discharge, Gardnerella vaginalis, diagnosis, treatment
Research objective: to examine the incidence of asymptomatic and recurrent bacterial vaginosis (BV) in Ukrainian women and to evaluate diagnostic and treatment strategies for the disease control.
Materials and methods. This study lasted from January to March 2021 and included 277 doctors of women's clinics, gynecological hospitals and oncology centers from all regions of Ukraine. Information was provided on 12 896 patients between of 18 and 59 ages with BV.
Results. Analysis of data from 12 896 questionnaires allowed us to determine that women from 18 to 35 years of age (62.6%) were the most frequently consulted about BV. Only 58.72% patients with BV reported about abnormal vaginal discharge as the reason for visit, while 41.24% of the respondents reported other reasons. Questionnaire analysis of patients with vaginal discharge revealed scant symptoms of the disease: only 62.67% complained about the change of discharge character; 38.49% and 36.35% of examinees pointed to the vaginal itching and unpleasant odor, respectively; 19.89% of patients were troubled by dysuric symptoms and 15.10% of patients mentioned dyspareunia.
In the list of submitted questionnaires, 59.92% of patients indicated an additional examination to identify the causes of vaginitis by the PCR method (urogenital scraping). According to its results, Gardnerella vaginalis was detected in diagnostically significant concentrations in 71.49% of patients, Atopobium vaginae was found in 11.32% of cases, Mobiluncus spp. was detected in 19.96% of patients and
Trichomonas vaginalis was found in 13.12% of patients. Candida colonization was diagnosed in 62.07%, with Candida albicans in 48,52% cases and non-albicans forms in 13,55% of patients.
In the treatment of BV priority was given to the vaginal forms of the most compliant therapy regimens: 2 times a day for 3 days or once a day for 7 days, depending on the clinical situation. Some patients opted for a long course of treatment for recurrent infections, choosing the combination metronidazole 750 mg / miconazole 200 mg 1 suppository once a day for 5 days for 12 months.
Conclusion. Diagnosis of BV in Ukraine continues to be based on clinical conditions and requires a unified algorithm that will be based on current clinical guidelines and dictated by national protocols for management. High mycotic colonization (62,07%) in BV makes it expedient to use combined agents (metronidazole 750 mg / miconazole 200 mg tioconazole/tinidazole) both as etiotropic and empirical therapy and especially if there are clinical conditions that may can cause BV (before surgical interventions, after antibiotic therapy, in endocrine pathology, etc.).
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