Vaginitis and vaginosis: diagnostic and treatment approaches in the light of the current clinical practice guidelines
Vaginal inflammatory diseases of microbial etiology (vaginitis) are one of the most common reasons for women to visit a gynecologist. It is important to know the etiology, pathogenesis, clinical course types, diagnosis, and treatment of aerobic (nonspecific) vaginitis and bacterial vaginosis. Making the correct diagnosis is a key to choose effective treatment means and methods. Bacterial vaginosis (BV) is a polymicrobial dysbiotic disease, in which the numbers of Lactobacillus spp. dramatically decrease, whereas those of facultative and obligate anaerobes and microaerophiles, such as Gardnerella vaginalis, Peptostreptococcus, Clostridium spp., Prevotella spp., Bacteroides, Fusobacterium, Veillonella, Eubacterium, Atopobium vaginaе, Mobiluncus spp., and others, increase. At our present level of knowledge, G. vaginalis and A. vaginae are recognized to play a leading role.Mikhanoshina N.V., Priputnevich T.V., Grigorian I.E.
The Russian Society of Obstetricians and Gynecologists recommendations (2019) state that aerobic vaginitis (AV) is a vaginal mucosal inflammatory disease that occurs when the opportunistic aerobic microorganisms activate and affect the epithelial cells.
Since 2011, the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, has been using the medical technology “Integral assessment of the vaginal microbiota. Diagnosis of opportunistic vaginitis”, permitted by FS No. 2011/072 dated April 18, 2011, which was designed by A.S. Ankirskaya and V.V. Muravieva. The diagnosis is based on a combination of gram-stained smear microscopy and vaginal discharge culture. This makes it possible to obtain reliable information on the vaginal microbiota, to diagnose infections caused by opportunistic microorganisms, and to prescribe goal-directed treatment at the lowest economic costs.
Conclusion: The main goal of treatment for mixed vaginitis is to affect aerobic microorganisms by topical application of broad-spectrum bactericidal antibiotics, including those in combination with antifungal agents to eliminate yeast fungi, and to prevent the development of resistance in opportunistic pathogens.
Keywords
aerobic vaginitis
bacterial vaginosis
mixed vaginitis
References
- Greenbaum S., Greenbaum G., Moran-Gilad J., Weintruab A.Y. Ecological dynamics of the vaginal microbiome in relation to health and disease. Am. J. Obstet. Gynecol. 2019; 220(4): 324-35. https://dx.doi.org/10.1016/j.ajog.2018.11.1089.
- Li T., Liu Z.H., Li K., Bai H.H. Evaluation of the vaginal microbiome in clinical diagnosis and management of vaginal infectious diseases. Chin. Med. J. (Engl.). 2019; 132(9): 1100-3. https://dx.doi.org/10.1097/CM9.0000000000000211.
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Бактериальный вагиноз. М.: Российское общество дерматовенерологов и косметологов; 2022. [Ministry of Health of the Russian Federation. Clinical guidelines. Bacterial vaginosis. M.: Russian Society of Dermatovenerologists and Cosmetologists; 2022. (in Russian)].
- Анкирская А.С., Муравьева В.В. Интегральная оценка состояния микробиоты влагалища. Диагностика оппортунистических вагинитов. Акушерство и гинекология: новости, мнения, обучение. 2020; 8(1): 69-76. https://dx.doi.org/10.24411/2303-9698-2020-11009. [Ankirskaya A.S., Muravieva V.V. Integral assessment of the condition of the vaginal microbiota. Diagnosis of opportunistic vaginitis. Obstetrics and Gynecology: News, Opinions, Training. 0; 8(1): 69-76. (in Russian)]. https://dx.doi.org/10.24411/2303-9698-2020-11009.
- Neal C.M., Kus L.H., Eckert L.O., Peipert J.F. Noncandidal vaginitis: a comprehensive approach to diagnosis and management. Am. J. Obstet. Gynecol. 2020; 222(2): 114-22. https://dx.doi.org/10.1016/j.ajog.2019.09.001.
- Paavonen J.A., Brunham R.C. Vaginitis in nonpregnant patients: ACOG Practice Bulletin Number 215. Obstet. Gynecol. 2020; 135(5): 1229-30.https://dx.doi.org/10.1097/AOG.0000000000003857.
- Wi T.E., Ndowa F.J., Ferreyra C., Kelly-Cirino C., Taylor M.M., Toskin I. et al. Diagnosing sexually transmitted infections in resource-constrained settings: challenges and ways forward. J. Int. AIDS Soc. 2019; 22(Suppl. 6): e25343. https://dx.doi.org/10.1002/jia2.25343.
- Sherrard J., Wilson J., Donders G., Mendling W., Jensen J.S. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int. J. STD AIDS. 2018; 29(13): 1258-72. https://dx.doi.org/10.1177/0956462418785451.
- Sobel J.D., Subramanian C., Foxman B., Fairfax M., Gygax S.E. Mixed vaginitis-more than coinfection and with therapeutic implications. Curr. Infect. Dis. Rep. 2013; 15(2): 104-8. https://dx.doi.org/10.1007/s11908-013-0325-5.
- Qi W., Li H., Wang C., Li H., Zhang B., Dong M. et al. Recent advances in presentation, diagnosis and treatment for mixed vaginitis. Front.Cell. Infect. Microbiol. 2021; 11: 759795. https://dx.doi.org/10.3389/fcimb.2021.759795.
- Российское общество акушеров-гинекологов. Клинические рекомендации. Воспалительные болезни шейки матки, влагалища и вульвы. 2021. [Russian Society of Obstetricians and Gynecologists. Clinical guidelines. Inflammatory diseases of the cervix, vagina and vulva. 2021.(in Russian)].
- Хашукоева А.З., Маркова Э.А., Дугиева М.З., Хлынова С.А., Каранашева А.Х. Алгоритм диагностики и лечения бактериального вагиноза. Акушерство и гинекология. 2021; 9(Приложение): 4-10. [Khashukoeva A.Z., Khlynova S.A.,Karanasheva A.Kh., Markova E.A. Abnormal uterine bleeding of reproductive and premenopausal periods. Obstetrics and Gynecology. 2021; 9(Suppl): 4-10. (in Russian)].
- Российское общество акушеров-гинекологов. Клинические рекомендации по диагностике и лечению заболеваний, сопровождающихся патологическими выделениями из половых путей женщин. М.; 2019. 57с. [Russian Society of Obstetricians and Gynecologists. Clinical guidelines for the diagnosis and treatment of diseases accompanied by pathological discharge from the female genital tract. М.; 2019. 57 p.(in Russian)].
- Donders G.G.G., Vereecken A., Bosmans E., Dekeersmaecker A., Salembier G., Spitz B. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG. 2002; 109(1): 34-43. https://dx.doi.org/10.1111/j.1471-0528.2002.00432.x.
- Аполихина И.А., Горбунова Е.А. Аэробный вагинит. Акушерство и гинекология. 2022; 3(Приложение): 32-6. [Apolikhina I.A., Gorbunova E.A. Aerobic vaginitis. Obstetrics and Gynecology. 2021; 3 (Suppl): 32-6.(in Russian)].
- Sonthalia S., Aggarwal P., Das S., Sharma P., Sharma R., Singh S. Aerobic vaginitis - an underdiagnosed cause of vaginal discharge - narrative review. Int. J. STD AIDS. 2020; 31(11): 1018-27. https://dx.doi.org/10.1177/0956462420913435.
- Mason M.J., Winter A.J. How to diagnose and treat aerobic and desquamative inflammatory vaginitis. Sex. Transm. Infect. 2017; 93(1): 8-10. https://dx.doi.org/10.1136/sextrans-2015-052406.
- Wang H., Huang Z., Wu Z., Qi X., Lin D. An epidemiological study on vaginitis in 6,150 women of reproductive age in Shanghai. New Microbiol. 2017; 40(2): 113-8.
- Bohbot J.M., Goubard A., Aubin F., Goubard A., Aubin F., Mas Y. et al. PRISM Study: Comparison of a nystatin-neomycin-polymyxin B combination with miconazole for the empirical treatment of infectious vaginitis. Med. Mal. Infect. 2019; 49(3): 194-201. https://dx.doi.org/10.1016/j.medmal.2019.01.011.
- Neut C., Verriere F., Nelis H.J., Coenye T. Topical treatment of infectious vaginitis: effects of antibiotic, antifungal and antiseptic drugs on the growth of normal vaginal lactobacillus strains. Open J. Obstet. Gynecol. 2015; 5: 173-80. https://dx.doi.org/10.4236/ojog.2015.53024.
- Радзинский В.Е., Ордиянц И.М., Побединская О.С., Зыков Е.В. Опыт применения препарата Полижинакс в лечении вульвовагинитов, вызванных аэробной и смешанной микрофлорой. Российский вестник акушера-гинеколога. 2016; 16(1): 84-8. https://dx.doi.org/10.17116/rosakush201616184-8. [Radzinskiĭ V.E., Ordiiants I.M., Pobedinskaia O.S., Zykov E.V. Experience with Polygynax used in the treatment of vulvovaginitis caused by the aerobic and mixed microflora. Russian Bulletin of Obstetrician-Gynecologist. 2016; 16(1): 84-8. (in Russian)]. https://dx.doi.org/10.17116/rosakush201616184-88.
Received 23.10.2022
Accepted 14.11.2022
About the Authors
Natalya V. Mikhanoshina, bacteriologist, Head of Biomaterials Collection and Storage Laboratory, Institute of Microbiology, Antimicrobial Therapy and Epidemiology,V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(916)546-47-80, mikhanoshina.natalya@yandex.ru, https://orcid.org/0000-0002-2868-0867,
117997, Russia, Moscow, Akademika Oparina str., 4.
Tatiana V. Priputnevich, Corresponding Member of the RAS, Dr. Med. Sci., Director of the Institute of Microbiology, Antimicrobial Therapy and Epidemiology, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(910)414-56-16, priput1@gmail.com, https://orcid.org/0000-0002-4126-9730,
117997, Russia, Moscow, Akademika Oparina str., 4.
Iren E. Grigorian, Junior Researcher, Institute of Microbiology, Antimicrobial Therapy and Epidemiology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, +7(909)912-59-66, irengrigorian96@yandex.ru, https://orcid.org/0000-0003-4675-9568, 117997, Russia, Moscow, Akademika Oparina str., 4.
Authors’ contributions: Mikhanoshina N.V., Priputnevich T.V., Grigorian I.E. – material collection and processing, writing the article, editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
For citation: Mikhanoshina N.V., Priputnevich T.V., Grigorian I.E. Vaginitis and vaginosis: diagnostic and treatment approaches in the light of the current clinical practice guidelines.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 11: 172-178 (in Russian)
http://dx.doi.org/10.18565/aig.2022.11.172-178
Similar Articles
