Сучасні аспекти оптимальної терапії цервікальної неоплазії на тлі бактеріального вагінозу

O.A. Taran; V.O. Rud; O.V. Bulavenko; D.G. Konkov

doi:10.18370/2309-4117.2021.60.101-106

Authors

O.A. Taran Vinnytsya National Pirogov Memorial Medical University, Vinnytsia, Ukraine https://orcid.org/0000-0002-8808-7539
V.O. Rud National Pirogov Memorial Medical University, Vinnytsia, Ukraine https://orcid.org/0000-0002-0768-6477
O.V. Bulavenko Vinnytsia National Pirogov Memorial Medical University, Vinnytsia, Ukraine https://orcid.org/0000-0003-1207-9046
D.G. Konkov National Pirogov Memorial Medical University, Vinnytsia, Ukraine https://orcid.org/0000-0002-9375-7509

DOI:

https://doi.org/10.18370/2309-4117.2021.60.101-106

Keywords:

high-grade intracervical neoplasia, high-risk human papilloma virus, bacterial vaginosis, loop excision, vaginal microbiome, epithelialization, decametoxinum

Abstract

Research objective: to evaluate the effectiveness of vaginal decametoxinum in preparation for cervix excision (conization) in women with HSIL (cervical intraepithelial neoplasia (CIN) II) against the background of infection with high-risk human papilloma virus (HPV) in bacterial vaginosis (BV) and effectiveness of vaginal gel with decametoxinum and hyaluronic acid to improve repair in the postoperative period.
Materials and methods. 60 women with HSIL (CIN II) were examined against the background of high-risk oncogenic HPV infection and BV, who underwent loop cervix excision (conization). The main group (n = 30) on the eve of surgery was prescribed BV therapy with decametoxinum solution and oral metronidazole for up to 7 days, after cervical excision used vaginal gel with decametoxinum and hyaluronic acid for 14 days. The control group (30 patients) used oral metronidazole for 7 days for the BV treatment.
Visual cervix inspection was performed by colposcopy. Vaginal biocenosis was assessed by PCR. Elimination of oncogenic HPV strains was assessed by PCR.
Results. Decametoxinum in the combination therapy of HSIL (CIN II) caused faster and complete epithelialization of the wound surface than standard therapy (relative risk (RR) 0.27, 95% CI 0.10 – 0.71, p = 0.008). 3 months after decametoxinum use was determined by a significant increase in cases of vaginal microbiota normalization (RR 0.30, 95% CI 0.09 – 0.98, p = 0.047), an increase in the lactobacilli number in vaginal secretions (RR 0.31, 95% CI 0.11 – 0.84, p = 0.02). There was a statistically significant effect of decametoxinum on the oncogenic HPV elimination (RR 0.22, 95% CI 0.05 – 0.94, p = 0.04) after 6 months of combination therapy. No side effects of decametoxinum were noted either during therapy or at a later date.
Conclusions. Vaginal use of decametoxinum before and after loop cervix excision in women with HSIL (CIN II) on the background of high-risk HPV and BV showed acceleration of cervical reparative processes, pronounced antimicrobial effect, elimination of oncogenic HPV and safety.

Author Biographies

O.A. Taran, Vinnytsya National Pirogov Memorial Medical University, Vinnytsia

MD, associate professor of the Department of Obstetrics and Gynecology No. 1

V.O. Rud, National Pirogov Memorial Medical University, Vinnytsia

MD, professor, Department of Obstetrics and Gynecology No. 2

O.V. Bulavenko, Vinnytsia National Pirogov Memorial Medical University, Vinnytsia

MD, professor, head of Obstetrics and Gynecology Department No. 2

D.G. Konkov, National Pirogov Memorial Medical University, Vinnytsia

MD, professor, Obstetrics and Gynecology Department No. 1

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