Efficacy of vaginal gel with lactic acid in treating bacterial vaginosis and reducing the risk of the disease recurrence
Pokul L.V., Lebedeva M.G., Bebneva T.N., Novginov D.S., Akhmatova A.N.
Objective: To conduct a comparative evaluation of the efficacy of lactic acid and the prebiotic BIOECOLIA in the form of the vaginal gel, Floragel, in combination with the antimicrobial agent metronidazole vaginal gel 5.0 g in the treatment and prevention of recurrence of bacterial vaginosis (BV).
Materials and methods: 81 women from 18 to 45 years old (37.3±7.5 years) were examined. The patients in group I (n=37) were treated with topical metronidazole gel 5.0 g twice a day combined with the vaginal gel, Floragel, twice a day; group II (n=44) received therapy topically only with metronidazole gel 5.0 g twice a day. After three weeks, group III (n=21) was formed from the patients whose treatment did not achieve clinical and laboratory effect. In this group, BV therapy was intensified with Floragel up to three times daily with the addition of a dequalinium chloride antiseptic agent (Septofemin), one vaginal tablet once daily for six days. BV was assessed using the Nugent scoring system, Amsel criteria, real-time polymerase chain reaction (RT-PCR).
Results: In three weeks after the end of treatment there was a 1.5-fold increase in the frequency of normal flora in group I; these patients received combined topical therapy with metronidazole 5.0 g twice a day, as well as gel with lactic acid and prebiotic BIOECOLIA (Floragel). There was also a significant 5.5-fold decrease in residual manifestations of BV (7 scores and higher) according to the Nugent scoring system that proved the efficacy of combined treatment in group I. RT-PCR showed prevalence of resident flora in the form of Lactobacillus spp. in group I (67.5%) as compared to group II (43.2%). Thus, the content of Atopobium vaginae in group II was 5.5 times higher than in group I. The evaluation of BV out-comes also showed the frequency of untreated BV after the first-line therapy. Women from both groups (5 women from group I and 16 women from group II) were included in group III. These patients were offered the second-line therapy for BV with antiseptic agent Septofemin and increased frequency of taking Floragel up to three times a day. As a result, only two patients (9.5%) had persistent signs of disease, which were confirmed by the presence of polyvalent microflora (Gardnerella vaginalis, Atopobium vaginae and Bacteria).
Conclusion: Despite the good efficacy of the vaginal gel with lactic acid and prebiotic BIOECOLIA, this issue should be investigated further in a larger study involving a representative sample of patients.
Authors’ contributions: Pokul L.V., Lebedeva M.G., Bebneva T.N. – planning the study, developing the design of the study, search for new data; Novginov D.S., Akhmatova A.N. – editing the text, translating articles, writing sections of the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was carried out without sponsorship.
Ethical Approval: The study is approved by the local ethics committee (protocol No. 133, dated February 1, 2023).
Patient Consent for Publication: The patients provided an informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Pokul L.V., Lebedeva M.G., Bebneva T.N., Novginov D.S., Akhmatova A.N. Efficacy of vaginal gel
with lactic acid in treating bacterial vaginosis and re-ducing the risk of the disease recurrence.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (5): 137-146 (in Russian)
https://dx.doi.org/10.18565/aig.2025.119
Keywords
bacterial vaginosis
Floragel
metronidazole gel 5.0 g
Septofemin (dequalinium chloride)
recurrence of bacterial vaginosis
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Received 30.04.2025
Accepted 21.05.2025
About the Authors
Liliana V. Pokul, Dr. Med. Sci., Associate Professor at the Department of Obstetrics and Gynecology with a course of perinatology, RUDN University,117198, Russia, Moscow, Miklukho-Maklaya str., 6; oncologist, obstetrician-gynecologist, Ekaterinodar LLC, Russia, Goryachiy Klyuch, Nebrezhnaya str., 3,
https://orcid.org/0000-0002-3877-4883
Marina G. Lebedeva, PhD, Associate Professor at the Department of Obstetrics and Gynecology with a course of perinatology, RUDN University,
117198, Russia, Moscow, Miklukho-Maklaya str., 6, https://orcid.org/0000-0003-3066-9410
Tamara N. Bebneva, Dr. Med. Sci., Associate Professor at the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Continuous Medical Education, Medical Institute, RUDN University, 117198, Russia, Moscow, Miklukho-Maklaya str., 6; obstetrician-gynecologist, National Medical Research Center for Endocrinology, Ministry of Health of Russia, 117292, Russia, Moscow, Dmitry Ulyanov str., 11, https://orcid.org/0000-0003-1095-2008
Dmitrii S. Novginov, PhD, Associate Professor at the Department of Obstetrics and Gynecology with a course of perinatology, RUDN University,
117198, Russia, Moscow, Miklukho-Maklaya str., 6, https://orcid.org/0000-0002-7184-8469
Anastasia N. Akhmatova, PhD, Associate Professor at the Department of Obstetrics and Gynecology with a course of perinatology, RUDN University,
117198, Russia, Moscow, Miklukho-Maklaya str., 6, https://orcid.org/0000-0001-8653-9389
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