Correction of vaginal microbiota in comorbidity

Karakhalis L.Yu., Ponomareva Yu.S., Petrenko V.S., Petrenko S.I., Bagdasaryan L.Yu.

1) Department of Obstetrics, Gynecology, and Perinatology, Kuban State Medical University, Ministry of Health of the Russian Federation, Krasnodar, Russia; 2) OOO “Center for Colposcopy and Cervical Pathology, Krasnodar, Russia; 3) Territorial Clinical Hospital No 2, Ministry of Health of the Krasnodar Territory, Krasnodar, Russia
Objective. To show the acceptability of using ammonium glycyrrhizinate spray in patients with clinical manifestations of papillomavirus infection (PVI) in the presence of bacterial vaginosis (BV) as a therapy aimed at preventing recurrences.
Materials and methods. Examinations were made in 78 reproductive-aged patients with BV and PVI, who complained of itching and burning in the genital area, vaginal discharge, dyspareunia, and dysuria. Data were collected from the medical records of all the patients; their somatic and gynecological diseases were taken into account; their clinical symptoms were evaluated; weight and height were determined; and the body mass index was calculated. The Colpo-pH test and extended colposcopy were carried out. Human papillomavirus was detected with PCR; bacterial mass and its components were determined by Femoflor-16 real-time PCR. During therapy with ammonium glycyrrhizinate, PCR and mass spectrometry were used to investigate changes in the vaginal microbiota.
Results. 94.9% of the patients had severe/moderate mixed dysbiosis after standard treatment with inosine pranobex for BV and PVI, as indicated in the available recommendations. Complains of itching and burning in the genital area and genital discharge remained in 73.1 and 88.5%, respectively. After the first cycle of therapy with the drug, Panavir intim Normaflore was chosen to correct vaginal dysbiosis and PVI; mass spectrometry showed lactobacilli (Lactobacillus rhamnosus) in moderate amounts, clinical manifestations, such as itching and burning, ceased, the discharge practically disappeared, the clinical picture corresponded to moderate dysbiosis; after the second cycle of therapy, a month later, lactobacilli (Lactobacillus crispatus) were abundantly isolated, which corresponded to the microflora of healthy women and after two cycles, there was microbiota normalization and clinical recovery.
Conclusion. Two consecutive cycles of therapy with Panavir intim Normaflore in the concentration equal to 3 doses 5 times daily for 15 days contributes to the normalization of the clinical picture, the leveling of the existing complaints, and the normalization of the flora due to the growth of lactobacilli.


bacterial vaginosis
papillomavirus infection
restoration of the vaginal microbiota


  1. Соловьев А.М., Чернова Н.И. Фармакотерапия рецидивирующих клинических проявлений генитальной папилломавирусной инфекции. Русский медицинский журнал. 2015; 23(11): 621-5. [Soloviev A.M., Chernova N.I. Pharmacotherapy of recurrent clinical manifestations of the genital papillomavirus infection. Russian Medical Journal. 2015; 23(11): 621-5. (in Russian)].
  2. ВОЗ. Информационный бюллетень «Статистика здоровья». Статистические доклады Всемирной организации здравоохранения. Январь 2017 г. 10с. [WHO. Newsletter "Statistics of Health", 31 Jan 2017. 10p. (in Russian)].
  3. Дидковский Н.А., Малашенкова И.К., Щепеткова И.Н., Танасова А.Н., Зуйков И.А. Герпес-вирусная инфекция: клиническое значение и принципы терапии. Русский медицинский журнал. 2004; 7: 459-64. [Didkovsky N.A., Malashenkova I.K., Schepetkova I.N., Tanasova A.N., Zuikov I.A. Herpes virus infection: the clinical manifestations and therapy principles . Russian Medical Journal, 2004; 7: 459-66. (in Russian)].
  4. Роговская С.И., Теребнева Л.А. Клинические аспекты плоскоклеточных интраэпителиальных поражений низкой степени. Акушерство и гинекология. 2013; 2: 139-43. [Rogovskaya S.I., Terebneva L.A. Clinical aspects of the low-grade squamous cell intraepithelial lesions. Obstetrics and Gynecology. 2013; 2: 139-43. (in Russian)].
  5. Савичева А.М., Рыбина Е.В., Ипастова И.Д. В «дружной» компании. StatusPraesens. Гинекология, акушерство, бесплодный брак. 2014; 6: 39-46. [Savicheva A.M., Rybina E.V. Ipastova I.D. Bacterial vaginosis and mixed vaginal infections: Is one possible without other? StatusPraesens. 2014; 6: 39-46. (in Russian)].
  6. Mongelos P., Mendoza L.P., Rodriguez-Riveros I., Castro A., Gimenez G., Araujo P. et al. Distribution of human papillomavirus (HPV) genotypes and bacterial vaginosis presence in cervical samples from Paraguayan indigenous. Int. J. Infect. Dis. 2015; 39: 44-9.
  7. Гомберг М.А. Использование молочной кислоты для нормализации микрофлоры влагалища. Акушерство и гинекология. 2013; 9: 113-7. [Gomberg M.A. Using of the lactic acid to normalize the vaginal microflora. Obstetrics and Gynecology. 2013; 9: 113-7. (in Russian)].
  8. Карахалис Л.Ю., Зуева Т.П., Петренко С.И. Оптимизация терапии дисплазий шейки матки, ассоциированных с ВПЧ-инфекцией. Проблемы репродукции. 2012; 5: 50-3. [Karakhalis L.Yu., Zueva T.P., Petrenko S.I. Optimization of therapy for cervical dysplasia associated with HPV infection. Reproduction problems. 2012; 5: 50-3. (in Russian).
  9. Amsel R., Totten P.A., Spiegel C.A., Chen K.C., Eschenbach D., Holmes K.K. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am. J. Med. 1983; 74(1): 14-22.
  10. Российское общество акушеров-гинекологов. Клинические рекомендации по диагностике и лечению заболеваний, сопровождающихся патологическими выделениями из половых путей женщин. 2-е изд. М.; 2019. 57с. [Russian Society of Obstetricians and Gynecologists. Clinical recommendations for the diagnosis and treatment of diseases accompanied by abnormal discharge from the genital tract of women. 2nd ed. M,; 2019. 57 p.(in Russian)].
  11. Туякова А.К., Нагызбеккызы Э., Абитаева Г.К., Даулбай С.С., Ахметова Г.Н., Ануарбекова С.С., Алмагамбетов К.Х. Изучение пробиотических свойств новых штаммов лактобактерий. Биотехнология. Теория и практика. 2013; 4: 55-8. [Tuyakova A.K., Nagyzbekkyz E., Abitaeva G.K., Daulbay S.S. et al. Study of probiotic properties of new Lactobacillus strains. Biotechnology. Theory and Practice. 2013; 4: 55-8. (in Russian)].
  12. Будиловская О.В. Современные представления о лактобациллах влагалища женщин репродуктивного возраст. Журнал акушерства и женских болезней. 2016; 65(4): 34-43. [Budilovskaya O.V. Current views on vaginal Lactobacilli in women of reproductive age. Journal of Obstetrics and Women’s Diseases. 2016; 65(4): 34-43. (in Russian)].
  13. Глушанова Н.А., Блинов А.И., Алексеева Н.Б. Масс-спектрометрическая идентификация микроорганизмов. Медицина в Кузбассе. 2015; Специальный выпуск 2: 36-41. [Glushanova N.A., Blinov A.I., Alekseeva N.B. Mass-spectrometric identification of micro-organisms. Medicine in Kuzbass. 2015; Special Issue 2: 36-41. (in Russian)].
  14. Breshears L.M., Edwards V.L., Ravel J., Peterson M.L. Lactobacillus crispatus inhibits growth of Gardnerella vaginalis and Neisseria gonorrhoeae on a porcine vaginal mucosa model. BMC Microbiol. 2015; 15: 276.
  15. Giakoumelou S., Wheelhouse N., Cuschieri K., Entrican G., Howie S.E., Horne A.W. The role of infection in miscarriage. Hum. Reprod. Update. 2016; 22(1): 116-33.

Received 08.12.2020

Accepted 12.12.2020

About the Authors

Lyudmila Yu. Karakhalis, Dr. of Sci.(Med.), Professor, Professor of Chair for Obstetrics, Gynecology and Perinatology, Faculty of Continuing Education and Professional Retraining of Specialists, Kuban State Medical University, Ministry of Health of Russia. E-mail: ORCID: 0000-0003- 1040-6736.
4, Mitrofana Sedina str., Krasnodar, 350063, Russia.
Yuliya S. Ponomareva, a postgraduate student of Chair for Obstetrics, Gynecology and Perinatology, Faculty of Continuing Education and Professional Retraining of Specialists, Kuban State Medical University, Ministry of Health of Russia. E-mail: ORCID: 0000-0002-7183-3531.
4, Mitrofana Sedina str., Krasnodar, 350063, Russia.
Valentina S. Petrenko, resident of Chair of Obstetrics, Gynecology and Perinatology Faculty of Continuing Education and Professional Retraining of Specialists,
Kuban State Medical University, Ministry of Health of Russia. E-mail:; ORCID: 0000-0002-1428-3190.
4, Mitrofana Sedina str., Krasnodar, 350063, Russia.
Sergei I. Petrenko, obstetrician-gynecologist, director of the clinic «Centre for Colposcopy and Cervical Pathology», Krasnodar.
E-mail: ORCID: 42, Chekistov Ave., Krasnodar, Russia.
Liana Yu. Bagdasaryan, a postgraduate student of Chair for Obstetrics, Gynecology and Perinatology, Faculty of Continuing Education and Professional Retraining of Specialists, Kuban State Medical University, Ministry of Health of Russia; gynecologist of the Gynecological Department, Territorial Clinical Hospital No 2.
E-mail: ORCID: 0000-0001-7379-9122. 4, Mitrofana Sedina str., Krasnodar, 350063, Russia.

For citation: Karakhalis L.Yu., Ponomareva Yu.S., Petrenko V.S., Petrenko S.I., Bagdasaryan L.Yu. Correction of vaginal microbiota in comorbidity.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 12: 177-184 (in Russian)

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.