Local antibacterial therapy in the combination treatment of patients with HPV-associated diseases of the cervix uteri
Objective. To investigate the clinical efficacy of Elgyna in the medical treatment of human papillomavirus (HPV)-associated cervical intraepithelial neoplasias (CIN).Kononova I.N., Kareva E.N.
Subject and methods. The results of antibacterial therapy prior to destructive treatment were comparatively analyzed in 53 patients with severe dysbiosis in HPV-associated CIN. A study group included 27 patients who took the combined drug Elgyna as one vaginal tablet twice daily (6 administrations); a comparison group of 27 patients received the combined drug Tergynan as one vaginal tablet twice daily (6 administrations). A control group comprised 20 women with the visually unchanged cervix. All the women underwent standard examinations and vaginal microbiocenosis estimation by RT-PCR assay using the Femoflor test.
Results. The use of the combined drug Elgyna during medical treatment before destruction was found to normalize molecular biological parameters at the local level and contributes to a significant reduction in the time of epithelialization and a decline in the number of recurrences.
Conclusion. HPV-associated cervical neoplasias are accompanied by the development of pronounced dysbiotic processes in the vagina with the predominant involvement of obligate anaerobes. Taking into account the properties of the combined drug Elgyna that provides a normalizing effect on the parameters of biocenosis in accelerating healing and in preventing a recurrence of the process, it is appropriate to prescribe the drug before destructive treatments.
Keywords
cervical intraepithelial neoplasias
papillomavirus infection
combination treatment
References
1. WHO/ICO Information Centre on HPV and Cancer. Russian Federation: Human Papillomavirus and Related Cancers. Fact Sheet. 2016. Available at: http://www.hpvcentre.net
2. Аксель Е.М. Заболеваемость и смертность от злокачественных новообразований органов женской репродуктивной системы в России. Онкогинекология. 2015; 1: 6-15. [Axel E.M. Morbidity and mortality from malignant neoplasms of the female reproductive system in Russia. Onkoginekologiya/Oncogynecology. 2015; 1: 6-15 (in Russian)]
3. Кононова И.Н. Эпидемиология папилломавирусной инфекции в крупном промышленном городе. Охрана материнства и детства. 2015; 1: 9-13. [Kononova I.N. Epidemiology of papillomavirus infection in a large industrial city. Ohrana materinstva i detstva. 2015; 1: 9-13. (in Russian)]
4. Meijer C.J., Berkhof J., Castle P.E., Hesselink A.T., Franco E.L., Ronco G. et al. Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older. Int. J. Cancer. 2009; 124(3): 516-20.
5. Mitra A., Yun L., Macintyre D. et al. Assessment of the vaginal microbiome with bacterial DNA pyrosequencing assording to CIN grade and severity. In: Abstracts 15th Wold congress for cervical pathology and colposcopy. 26-30 May. London; 2014: 123-4.
6. Кононова И.Н., Ворошилина Е.С. Особенности местного иммунитета при цервикальных интраэпителиальных неоплазиях, ассоциированных с папилломавирусной инфекцией. Российский иммунологический журнал. 2014; 8(3): 809-11. [Kononova I.N., Voroshilina E.S. Features of local immunity in cervical intraepithelial neoplasia associated with papillomavirus infection. Russian Immunological Journal. 2014; 8(3): 809-11. (in Russian)]
7. Schafer Z.T., Brugge J.S. IL-6 involvement in epithelial cancers. J. Clin. Invest. 2007; 117(12): 3660-3.
8. Nam K.H., Kim Y.T., Kim S.R., Kim S.W., Kim J.W., Lee M.K. et al. Association between bacterial vaginosis and cervical intraepithelial neoplasia. J. Gynecol. Oncol. 2009; 20(1): 39-43.
9. Zur Hausen H. Red meat consumption and cancer: reasons to suspect involvement of bovine infectious factors in colorectal cancer. Int. J. Cancer. 2012; 130(11): 2475-83.
10. Обоскалова Т.А., Кононова И.Н., Ворошилина Е.С., Кузина Т.В. Эффективность реабилитационных мероприятий после деструктивных методов терапии у пациенток с патологией шейки матки, ассоциированной с папилломавирусной инфекцией. Акушерство и гинекология. 2012; 2: 86-9. [Oboskalova T.A., Kononova I.N., Voroshilina E.S., Kuzina T.V. Efficiency of rehabilitation measures after destructive therapies in patients with uterine cervical pathology associated with papillomavirus infection. Akusherstvo i ginekologiya/Obstetrics and gynecology. 2012; 2: 86-9. (in Russian)]
11. Atashili J., Poole C., Ndumbe P.M., Adimora A.A., Smith J.S. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS. 2008; 22(12): 1493-501.
12. Кононова И.Н., Обоскалова Т.А., Ворошилина Е.С., Кузина Т.В. Коррекция анаэробных дисбиозов влагалища у пациенток с цервикальными интраэпителиальными неоплазиями. Акушерство и гинекология. 2014; 3: 87-90. [Kononova I.N., Oboskalova T.A., Voroshilina E.S., Kuzina T.V. Correction of anaerobic vaginal dysbiosis in patients with cervical intraepithelial neoplasias. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2014; 3: 87-90. (in Russian)]
13. Радзинский В.Е., Ордиянц И.М., Лебедева М.А. Эффективность препарата локального действия для эпителизации шейки матки после радиоволновой эксцизии. Акушерство и гинекология. 2010; 3: 58-60. [Radzinsky V.E., Ordiyants I.M., Lebedeva M.A. Efficacy of a local action drug for cervical epithelization after radio wave excision. Akusherstvo i ginekologiya/Obstetrics and gynecology. 2010; 3: 58-60. (in Russian)]
14. Watts D.H., Fazzari M., Minkoff H., Hillier S.L., Sha B., Glesby M. et al. Effects of bacterial vaginosis and other genital infections on the natural history of human papillomavirus infection in HIV-1-infected and high-risk HIV-1-uninfected women. J. Infect. Dis. 2005; 191(17): 1129-39.
15. Карева Е.Н. Скрининг новых лекарственных средств на основе анализа специфического связывания химических соединений с рецепторами биологически активных веществ. В кн.: Шимановский Н.Л., ред. Практикум по молекулярной и клеточной фармакологии. Учебное пособие. М.; 2017: 54-80. [Kareva E.N. Screening of new drugs based on the analysis of specific binding of chemical compounds to receptors of biologically active substances. In: Shimanovsky N.L., ed. Workshop on molecular and cellular pharmacology. Moscow; 2017: 54-80. (in Russian)]
16. Шипицына Е.В., Мартикайнен З.М., Воробьева Н.Е., Ермошкина М.С., Степанова О.С., Донников А.Е., Скоркина Ю.А., Тумбинская Л.В. Применение теста Фемофлор для оценки микробиоценоза влагалища. Журнал акушерства и женских болезней. 2009; 58(3): 44-50. [Shipitsyna E.V., Martikainen Z.M., Vorobyeva N.E., Ermoshkina M.S., Stepanova O.S., Donnikov A.E., Skorkina Yu.A., Tumbinskaya L.V. The use of the test of Femoflor for the evaluation of the vaginal microbiocenosis. Journal of Obstetrics and Women’s Diseases. 2009; 58(3): 44-50. (in Russian)]
17. Баранова Е.Е., Батенева Е.И., Галкина И.С., Донников А.Е., Зорина В.В., Тумбинская Л.В., Шигорина Г.Г. ПЦР в реальном времени: новые возможности технологии в решении репродуктивных проблем. М.; 2013. Available at: http://www.dna-technology.ru/files/images/broshura/Reshenie_reprod_problem_A5_082-4.pdf [Baranova E.E., Bateneva E.I., Galkina I.S., Donnikov A.E., Zorina V.V., Tumbinskaya L.V., Shigorina G.G. Real-time PCR: new technologies in solving reproductive problems. Moscow; 2013. Available at: http://www.dna-technology.ru/files/images/broshura/Reshenie_reprod_problem_A5_082-4.pdf]
18. Klomp J.M., Boon M.E., Van Haaften M., Heintz A.P. Cytologically diagnosed Gardnerella vaginalis infection and cervial (pre)neoplasia as established in population-based cervical screening. Am. J. Obstet. Gynecol. 2008; 199: 480. e1-5.
Received 08.06.2018
Accepted 22.06.2018
About the Authors
Kononova lrina Nikolaevna, MD, PhD, Chief Scientific Researcher, Research Institute of Maternal and Infant Care, Ministry of Health of Russia.620028, Russia, Yekaterinburg, Repina str. 1. Tel.: +73433718911. E-mail: irkonmed@mail.ru
Kareva Elena Nikolaevna, MD, PhD Professor of Academician P.V. Sergeev Department of Molecular Pharmacology and Radiobiology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; Professor of Department of Pharmacology of the Faculty of General Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia. 119991, Russiа, Moscow, Bolshaya Pirogovskaya str. 2-4
For citations: Kononova I.N., Kareva E.N. Local antibacterial therapy in the combination treatment of patients with HPV-associated diseases of the cervix uteri. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (7): 103-7. (in Russian)
https://dx.doi.org/10.18565/aig.2018.7.103-107
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