Diagnosis and treatment of recurrent vaginal discharge of non-Candida origin in women
Objective. To carry out a systems analysis of the data available in the current literature on the diagnosis and therapy of recurrent vaginal discharge of non-candidiasis origin.Gomberg M.A.
Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. The guidelines of the US Center for Disease Control and Prevention (CDC), the European International Union Against Sexually Transmitted Infections (IUSTI), and the Russian Society of Dermatovenereologists and Cosmetologists (RSDC) were analyzed.
Results. The paper describes standard and alternative therapy regimens and notes the importance of therapy tolerability as one of the components of adherence to treatment.
Conclusion. The standard therapy for uncomplicated trichomoniasis or bacterial vaginosis yields a good effect in most cases. However, the international guidelines contain no clear indication for the algorithm of a physician’s actions in the recurrent course of these diseases. 5-nitroimidazole remains the drug of choice for the treatment of trichomoniasis and this drug and clindamycin for bacterial vaginosis. Due to its better tolerability and lower frequency of adverse reactions, Ornidazole is recommended by the RSDC as an alternative agent for better compliance with 5-nitroimidazoles.
Keywords
bacterial vaginosis
trichomoniasis
clinical guidelines
5-nitroimidazole tolerability
ornidazole
References
1. 2018 European (IUSTI/WHO) guideline on the management of vaginal discharge. http://www.iusti.org/regions/europe/euroguidelines.htm#Current
2. Прилепская В.Н., Мирзабалаева А.К., Кира Е.Ф., Гомберг М.А., Аполихина И.А., Байрамова Г.Р. Федеральные клинические рекомендации. Диагностика и лечение заболеваний, сопровождающихся патологическими выделениями и половых путей женщин. М.: Российское общество акушеров-гинекологов; 2013. [Prilepskaya V.N., Mirzabalaeva A.K., Kira E.F., Gomberg M.A., Apolikhina I.A., Bayramova G.R. Federal clinical guidelines. Diagnosis and treatment of diseases accompanied by pathological secretions and the genital tract of women. Moscow: Russian Society of Obstetricians and Gynecologists; 2013. (in Russian)]
3. Клинические рекомендации по ведению больных инфекциями, передаваемыми половым путем, и урогенитальными инфекциями. М.: Деловой экспресс; 2012.112с. [Clinical recommendations for management of patients with sexually transmitted infections and urogenital infections. Moscow: Business express; 2012.112p. (in Russian)]
4. Приказ Минздрава РФ от 13.10.2017 N 804н «Об утверждении номенклатуры медицинских услуг». [Order of the Ministry of Health of the Russian Federation of 13.10.2017 N 804n “On the approval of the nomenclature of medical services.” (in Russian)]
5. Workowski K.A., Bolan G.A.; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm. Rep. 2015; 64(RR-03): 1-137.
6. Kirkcaldy R.D., Augostini P., Asbel L.E., Bernstein K.T., Kerani R.P., Mettenbrink C.J. et al. Trichomonas vaginalis antimicrobial drug resistance in 6 US cities, STD Surveillance Network, 2009-2010. Emerg. Infect. Dis. 2012; 18(6): 939-43.
7. Кира Е.Ф. Бактериальный вагиноз. М.: МИА; 2012. 471с. [Kira E.F. Bacterial vaginosis. Moscow: MIA; 2012. 471p. (in Russian)]
8. Hanson L., VandeVusse L., Jerme M., Abad C.L., Safdar N. Probiotics for treatment and prevention of urogenital infections in women: a systematic review. J. Midwifery Womens Health. 2016; 61(3): 339-55.
9. Verstraelen H., Swidsinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment. Curr. Opin. Infect. Dis. 2013; 26(1): 86-9.
Received 12.04.2018
Accepted 28.04.2018
About the Authors
Gomberg Mikhail Aleksandrovich, MD, professor, leading researcher of the Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology.119071, Russia, Moscow, Leninsky Prospekt 17. Tel.: +74959523422. E-mail: centr@mosderm.ru
For citations: Gomberg M.A. Diagnosis and treatment of recurrent vaginal discharge of non-Candida origin in women. Akusherstvo i Ginekologiya/
Obstetrics and Gynecology. 2018; (5): 138-42. (in Russian)
https://dx.doi.org/10.18565/aig.2018.5.138-42
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