The changes in the landscape of the vaginal microbiome in patients undergoing complex treatment for mixed recurrent vaginal infections

DOI

https://dx.doi.org/10.18565/aig.2024.67

Kutsenko I.I., Borovikov I.O., Kravtsova E.I., Avakimyan A.A., Borovikova O.I., Andreeva A.A.
Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia,

Recurrent mixed vaginal infections (RMVI) have not only become an epidemiological and clinical problem, but they can also lead to serious social and psychological consequences. In order to develop effective strategies for their diagnosis and treatment, it is necessary to understand the mechanisms of both commensalism and pathogenesis. Despite numerous treatment patterns, patients with mixed vaginal infections experience relapses with high frequency, and repeated prescriptions of antibacterial drugs (both systemic and local) only increase microbial resistance. The paper describes the experience of clinical application of complex therapy, including decontamination with a broad-spectrum antiseptic drug (dequalinium chloride), followed by prolonged use of replacement therapy with a probiotic containing lyophilisate of Lactobacillus acidophilus with low doses of estrogens.
Objective: To analyze the clinical and microbiological effectiveness of complex local decontamination (dequalinium chloride) and contamination (Lactobacillus acidophilus in combination with ultra-low-dose estriol) therapy in the treatment of recurrent mixed vaginal infections.
Materials and methods: The study included 124 patients with mixed recurrent vaginal infections (at least two episodes of clinical manifestations per year). Vaginal microbial communities were assessed using microscopic examination (Hay/Ison criteria) and real-time PCR (Femoflor 16). The identification of Lactobacilli species was carried out using the method of mass spectrometry. The vaginal microbiota was assessed in 14 days, 6 and 12 months after the end of the treatment.
Results: Complex local therapy with a prolonged stage of contamination with estriol-containing vaginal probiotics during clinical and microbiological monitoring for 12 months showed a decrease in the number of recurrent mixed vaginal infections by 2.4 times compared with the standard treatment pattern. The patients undergoing prolonged contamination with lactobacillus microflora with donation of microdoses of estriol showed more effective stabilization of the vaginal secretion pH, vaginal microbiocenosis (Hay/Ison criteria) and normalization of the ratio of competitive and weakly competitive lactobacilli, which prevented the development of dysbiotic disorders in the vagina.
Conclusion: The long-term course of contamination therapy with a combination of lactobacilli with ultra-low-dose estriol that promotes the adhesion of lactobacilli to the vaginal epithelium together with local empirical treatment with dequalinium chloride (Fluomizin) is preferable for patients with recurrent vaginal infections.

Authors’ contributions: Kutsenko I.I. – developing the concept of the study, analysis and interpretation of the data obtained, preparing and editing the text, approval of the final version of the article; Borovikov I.O. – developing the concept of the study, collection, analysis and interpretation of the data obtained, providing literary sources for analysis, preparing and editing the text, approval of the final version of the article; Kravtsova E.I., Avakimyan A.A., Andreeva A.A. – developing the concept of the study, analysis and interpretation of the data obtained, providing literary sources for analysis, preparing and editing the text, approval the final version of the article, preparing the work in terms of visualization of the data; Borovikova O.I. – developing the concept of the study, analysis of the data obtained, conducting statistical analysis, preparing and editing of the text, approval of the final version of the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Kuban State Medical University, Ministry of Health of Russia, Krasnodar.
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: Kutsenko I.I., Borovikov I.O., Kravtsova E.I., Avakimyan A.A., Borovikova O.I., Andreeva A.A. The changes in the landscape of the vaginal microbiome in patients undergoing complex treatment for mixed recurrent vaginal infections.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (3): 153-162 (in Russian)
https://dx.doi.org/10.18565/aig.2024.67

mixed recurrent vaginal infections

Lactobacillus acidophilus

estriol

dequalinium chloride

Full text (in Russian)

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Received 21.03.2024

Accepted 25.03.2024

Irina I. Kutsenko, Dr. Sci. (Med.), Professor, Department of Obstetrics, Gynecology and Perinatology, Kuban State Medical University, Ministry of Health of Russia,
350063, Russia, Krasnodar, М. Sedina str., 4, luzum69@mail.ru, https://orcid.org/0000-0003-0938-8286
Igor O. Borovikov, Dr. Sci. (Med.), Associate Professor, Department of Obstetrics, Gynecology and Perinatology, Kuban State Medical University, Ministry of Health of Russia, 350063, Russia, Krasnodar, М. Sedina str., 4, bio2302@mail.ru, https://orcid.org/0000-0001-8576-1359
Elena I. Kravtsova, PhD (Med.), Associate Professor, Department of Obstetrics, Gynecology and Perinatology, Kuban State Medical University, Ministry of Health of Russia, 350063, Russia, Krasnodar, М. Sedina str., 4, luzum69@mail.ru, https://orcid.org/0000-0001-8987-7375
Artem A. Avakimyan, Associate Professor, Department of Obstetrics, Gynecology and Perinatology, Kuban State Medical University, Ministry of Health of Russia,
350063, Russia, Krasnodar, М. Sedina str., 4, 43434340@mail.ru, https://orcid.org/0000-0003-0068-3385
Olga I. Borovikova, Postgraduate Student, Department of Obstetrics, Gynecology and Perinatology, Kuban State Medical University, Ministry of Health of Russia,
350063, Russia, Krasnodar, М. Sedina str., 4, borovikovaoi@oxy-center.ru, https://orcid.org/0000-0002-7275-9388
Anastasia A. Andreeva, Postgraduate Student, Department of Obstetrics, Gynecology and Perinatology, Kuban State Medical University, Ministry of Health of Russia,
350063, Russia, Krasnodar, М. Sedina str., 4, oks707@rambler.ru, https://orcid.org/0000-0001-5749-4193

The changes in the landscape of the vaginal microbiome in patients undergoing complex treatment for mixed recurrent vaginal infections

Kutsenko I.I., Borovikov I.O., Kravtsova E.I., Avakimyan A.A., Borovikova O.I., Andreeva A.A.

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