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Obstetrics and Gynegology2021№5
Role of abnormal vaginal microbiota...

Role of abnormal vaginal microbiota in the pathogenesis of recurrent lower urinary tract infection: a modern view of the problem

DOI
https://dx.doi.org/10.18565/aig.2021.5.40-46

Zaitsev A.V., Apolikhina I.A., Khodyreva L.A., Bernikov A.N., Kupriyanov Yu.A., Stroganov R.V., Arefyeva O.A., Teterina T.A.

1) A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia; 2) Research Institute of Health Organization and Medical Management, Moscow Healthcare Department, Moscow, Russia; 3) S.I. Spasokukotsky City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia; 4) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia; 5) Department of Obstetrics, Gynecology, and Perinatology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia
The review is devoted to the problem of recurrent urinary tract infections (RUTIs) in women. It considers risk factors for RUTIs and the role of abnormal vaginal microbiota in this disease. E. coli have special virulence factors that cause urinary tract infection and colonization by adhesion to urothelial cells: the pronounced virulence of Type 1 factor (or Type 1 pili), which triggers an inflammatory response by attracting neutrophils to the bladder. Despite the fact that RUTIs are not considered a life threatening disease, they have a significant impact on quality of life, disabling effects on women's health, intimate and social relationships, self-rating and work ability, and also lead to irritability, fatigue, and inability to concentrate until depression develops. There are modern views on bacterial vaginosis and the associated new pathogenesis of RUTIs. The existing relationship between the factors of RUTIs, sexual practice, and the composition of the vaginal microbiome requires correction of the composition of the vaginal flora and the implementation of preventive measures and non-antimicrobial treatment. The major mechanisms of RUTI development are reinfection and bacterial persistence. Female RUTIs are associated with a steady upward entrance of the microflora from the periurethral region. Antibiotics are the most common treatment regimen for urinary tract infections (UTIs), at the same time they are becoming increasingly ineffective due to the emergence of antibiotic-resistant microorganisms. The global emergence of multidrug-resistant UPEC strains over the past decade highlights the need for alternative therapeutic and preventive strategies to combat UTIs.
Conclusion. Thus, a vicious circle is formed: the patient takes antibiotics often or even continuously for the treatment of cystitis, which leads to the development of vaginal dysbiosis, bacterial vaginosis, candidiasis, and vulvar and urethral discomfort. The presented results of clinical trials have confirmed the rationale, efficiency, and safety of taking vitamin D3, D-mannose, and proanthocyanidins in the treatment, prevention, and rehabilitation of patients with UTIs.

Keywords

urinary tract infection
cystitis
vaginal microbiota
bacterial vaginosis
proanthocyanidins
D-mannose
vitamin D3
Full text (in Russian)

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Received 28.04.2021

Accepted 17.05.2021

About the Authors

Andrew V. Zaitcev, Dr. Med. Sci., Professor at the Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia. Tel.: +7(926)104-65-56. E-mail: zaitcevandrew@mail.ru. ORCID: 0000-0003-3044-1424. 127473, Russia, Moscow, Delegatskaya str., 20/1.
Inna A. Apolikhina, MD, PhD, professor, Head of the Department of Aesthetic gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; President of Association of Aesthetic Gynecology Specialists (AAGS),
President of European Association for Genital Aesthetic Medicine and Plastic Surgery (EAGAMPS). Tel.: +7(495)735-10-55. ORCHID: 0000-0002-4581-6295.
117997, Russia, Moscow, Akademika Oparina str., 4.
Luybov A. Khodyreva, Ph.D, Head of the Department of organizational and methodical support for the urology, Research Institute for the Organization of Healthcare and Medical Management, Moscow Department of Healthcare. ORCID: 0000-0002-0751-4982. 115088, Russia, Moscow, Sharikopodshipnikovskaya str., 9.
Alexander N. Bernikov, PhD, Associate professor at the Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health
of Russia. ORCID: 0000-0001-8361-585Х. 127473, Russia, Moscow, Delegatskaya str., 20/1.
Yuriy A. Kupriyanov, PhD, MD, assistant at the Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia. ORCID: 0000-0002-5807-7591. 127473, Russia, Moscow, Delegatskaya str., 20/1.
Roman V. Stroganov, PhD, assistant at the Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia.
ORCID: 0000-0002-5529-1787. 127473, Russia, Moscow, Delegatskaya str., 20/1.
Oksana A. Arefyeva, PhD, assistant at the Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia.
ORCID: 0000-0003-2309-2094. 127473, Russia, Moscow, Delegatskaya str., 20/1.
Tatiana A. Teterina, MD, PhD, gynecologist of the Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(495)735-10-55. E-mail: t_teterina@oparina4.ru. ORCHID: 0000-0003-0990-2302.
117997, Russia, Moscow, Akademika Oparina str., 4.

For citation: Zaitsev A.V., Apolikhina I.A., Khodyreva L.A., Bernikov A.N., Kupriyanov Yu.A., Stroganov R.V., Arefyeva O.A., Teterina T.A. Role of abnormal vaginal microbiota in the pathogenesis of recurrent lower urinary tract infection: a modern view of the problem.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 5: 40-46 (in Russian)
https://dx.doi.org/10.18565/aig.2021.5.40-46

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