About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024Reviewers 2026
ISSN 0300-9092 (Print)
ISSN 2412-5679 (Online)
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024Reviewers 2026
Logout
Obstetrics and Gynegology2026№9

Multiplication of therapeutic options using dequalinium chloride for vaginal microbiocenosis disorders

DOI
https://dx.doi.org/10.18565/aig.2026.134

Nazarova N.M., Devyatkina A.R., Isaeva S.G., Prilepskaya V.N., Pavlovich S.V.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Vaginal infections remain one of the most common reasons for women to seek gynecological care and represent a significant clinical issue due to their high prevalence, tendency for recurrence, and negative impact on patients' quality of life. 
The article touches upon current data on the epidemiology, pathogenesis, and treatment of the main forms of vaginal microbiocenosis disorders: bacterial vaginosis, candidal vulvovaginitis, and aerobic vaginitis. Particular attention should be paid to the role of biofilm structures in pathogen persistence, reduced therapeutic efficacy, and the development of antimicrobial resistance. The properties of dequalinium chloride (DQC) – a quaternary ammonium topical antiseptic – are analyzed separately. The action mechanisms of the drug are presented, including anti-biofilm activity against Gardnerella spp., a broad antimicrobial and antifungal spectrum, and minimal systemic absorption. The results of randomized clinical trials, observational studies, and a meta-analysis are summarized, demonstrating that DQC exhibits clinical efficacy comparable to that of traditional antibiotics and antifungal agents in the treatment of bacterial vaginosis and vulvovaginal candidiasis, with a more favorable tolerability profile and a lower risk of secondary candidiasis and drug-induced complications.
Conclusion. Amid rising antimicrobial resistance, DQC represents a promising alternative to systemic treatment, particularly for mixed and recurrent forms of vaginal infections.

Authors’ contributions. Nazarova N.M. – study concept and design, article translation, data processing and analysis, manuscript writing; Devyatkina A.R. – literature search, data processing and analysis, manuscript writing, article translation; Isaeva S.G. – data analysis, article translation, manuscript editing; Prilepskaya V.N. – study concept and design, manuscript editing; Pavlovich S.V. – manuscript editing.
Conflicts of interest. The authors declare no conflicts of interest.
Funding. This study received no external funding.
Generative Artificial Intelligence. Artificial intelligence tools were used in a limited capacity for technical assistance during manuscript preparation, including translation of the abstract. Artificial intelligence was not used for generating scientific content, data analysis, or interpretation of results. All stages of manuscript preparation were performed by the authors, who take full responsibility for its content.
For citation: Nazarova N.M., Devyatkina A.R., Isaeva S.G., Prilepskaya V.N., Pavlovich S.V. Multiplication of therapeutic options using dequalinium chloride for vaginal microbiocenosis disorders.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (9): 162-169 (in Russian)
https://dx.doi.org/10.18565/aig.2026.134

Keywords

vaginal infections
bacterial vaginosis
candidal vulvovaginitis
aerobic vaginitis
dequalinium chloride
antiseptics
biofilms
Full text (in Russian)

References

  1. Chen J., Tse J., Shi L., Cheng M.M., Lillis R., Near A.M. Real-world clinical burden of patients presenting with vaginitis symptoms in the United States. AJOG Glob. Rep. 2025; 5(2):100504. https://dx.doi.org/10.1016/j.xagr.2025.100504
  2. Muzny C.A., Schwebke J.R. Biofilms: An underappreciated mechanism of treatment failure and recurrence in vaginal infections. Clin. Infect. Dis. 2015; 61(4): 601-6. https://dx.doi.org/10.1093/cid/civ353
  3. Pelling H., Nzakizwanayo J., Milo S., Denham E.L., MacFarlane W.M., Bock L.J. et al. Bacterial biofilm formation on indwelling urethral catheters. Lett. Appl. Microbiol. 2019; 68(4): 277-93. https://dx.doi.org/10.1111/lam.13144
  4. Miquel S., Lagrafeuille R., Souweine B., Forestier C. Anti-biofilm activity as a health issue. Front. Microbiol. 2016; 7: 592. https://dx.doi.org/10.3389/fmicb.2016.00592
  5. Mendling W., Weissenbacher E.R., Gerber S., Prasauskas V., Grob P. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch. Gynecol. Obstet. 2016; 293(3): 469-84. https://dx.doi.org/10.1007/s00404-015-3914-8
  6. Michaleas S.N., Laios K., Charalabopoulos A., Samonis G., Karamanou M. Joseph Lister (1827-1912): A pioneer of antiseptic surgery. Cureus. 2022; 14(12): e32777. https://dx.doi.org/10.7759/cureus.32777
  7. Gaspar C., Rolo J., Cerca N., Palmeira-de-Oliveira R., Martinez-de-Oliveira J., Palmeira-de-Oliveira A. Dequalinium chloride effectively disrupts bacterial vaginosis (BV) Gardnerella spp. biofilms. Pathogens. 2021; 10(3): 261. https://dx.doi.org/10.3390/pathogens10030261
  8. Bailly C. Medicinal applications and molecular targets of dequalinium chloride. Biochem. Pharmacol. 2021; 186: 114467. https://dx.doi.org/10.1016/j.bcp.2021.114467
  9. Eckel F., Farr A., Deinsberger J., Kernmayer-Farr K., Foessleitner P. Dequalinium chloride for the treatment of vulvovaginal infections: a systematic review and meta-analysis. J. Low Genit. Tract Dis. 2024; 28(1): 76-83. https://dx.doi.org/10.1097/LGT.0000000000000790
  10. Vieira-Baptista P., Stockdale C.K., Sobel J., eds. International Society for the Study of Vulvovaginal Disease Recommendations for the Diagnosis and Treatment of Vaginitis [Internet]. Ad Médic, Lda.; 2023. https://dx.doi.org/10.59153/adm.rdtv.001
  11. Thamkhantho M., Chayachinda C. Vaginal tablets of dequalinium chloride 10 mg versus clotrimazole 100 mg for vaginal candidiasis: a double-blind, randomized study. Arch. Gynecol. Obstet. 2021; 303(1): 151-60. https://dx.doi.org/10.1007/s00404-020-05784-z
  12. Nguyen A.T.C., Le Nguyen N.T., Hoang T.T.A., Nguyen T.T., Tran T.T.Q., Tran D.N.T. et al. Aerobic vaginitis in the third trimester and its impact on pregnancy outcomes. BMC Pregnancy Childbirth. 2022; 22(1): 432. https://dx.doi.org/10.1186/s12884-022-04761-5
  13. Donders G., Bellen G., Donders F., Pinget J., Vandevelde I., Michiels T. et al. Improvement of abnormal vaginal flora in Ugandan women by self-testing and short use of intravaginal antimicrobials. Eur. J. Clin. Microbiol. Infect. Dis. 2017; 36(4): 731-8. https://dx.doi.org/10.1007/s10096-016-2856-9
  14. Donders G., Bellen G., Grinceviciene S., Ruban K., Vieira-Baptista P. Aerobic vaginitis: no longer a stranger. Res. Microbiol. 2017; 168(9-10): 845-58. https://dx.doi.org/10.1016/j.resmic.2017.04.004
  15. Paladine H.L., Desai U.A. Vaginitis: diagnosis and treatment. Am. Fam. Physician. 2018; 97(5): 321-9.
  16. Huang S.H., Hsu H.C., Lee T.F., Fan H.M., Tseng C.W., Chen I.H. et al. Prevalence, associated factors, and appropriateness of empirical treatment of trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis among women with vaginitis. Microbiol. Spectr. 2023; 11(3): e0016123. https://dx.doi.org/10.1128/spectrum.00161-23
  17. Миханошина Н.В., Припутневич Т.В., Григорян И.Э. Вагиниты и вагиноз: подходы к диагностике и лечению в свете действующих клинических рекомендаций. Акушерство и гинекология. 2022; 11: 172-8. https://dx.doi.org/10.18565/aig.2022.11.172-178 [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. Obstetrics and Gynecology. 2022; (11): 172-8 (in Russian). https://dx.doi.org/10.18565/aig.2022.11.172-178].
  18. Пустотина О.А. Бактериальный вагиноз: патогенез, диагностика, лечение и профилактика. Акушерство и гинекология. 2018; 3: 150-6. https://dx.doi.org/10.18565/aig.2018.3.150-156 [Pustotina O.A. Bacterial vaginosis: pathogenesis, diagnosis, treatment, and prevention. Obstetrics and Gynecology. 2018; (3): 150-6. (in Russian). https://dx.doi.org/10.18565/aig.2018.3.150-156].
  19. Савичева А.М., Тапильская Н.И., Шипицына Е.В., Воробьева Н.Е. Бактериальный вагиноз и аэробный вагинит как основные нарушения баланса вагинальной микрофлоры. Особенности диагностики и терапии. Акушерство и гинекология. 2017; 5: 24-31. https://dx.doi.org/10.18565/aig.2017.5.24-31 [Savicheva A.M., Tapilskaya N.I., Shipitsyna E.V., Vorobyeva N.E. Bacterial vaginosis and aerobic vaginitis as major vaginal microflora balance disorders: Diagnostic and therapeutic characteristics. Obstetrics and Gynecology. 2017; (5): 24-31. (in Russian). https://dx.doi.org/10.18565/aig.2017.5.24-31].
  20. Agrawal M., Nigam N., Goel R., Goel J.K., Shukla M. Etiopathogenesis of vaginal discharge among married women in reproductive age group residing in rural area of Bhojipura District, Western Uttar Pradesh. Int. J. Reprod. Contracept. Obstet. Gynecol. 2019; 8(7): 2598. https://dx.doi.org/10.18203/2320-1770.ijrcog20192638
  21. Konschuh S., Jayaprakash T., Dolatabadi A., Dayo E., Ramay H., Sycuro L. O02.3 Reclassification of Atopobium vaginae as three novel Fannyhessea species: implications for understanding their role in bacterial vaginosis. Sex. Transm. Infect. 2021; 97(Suppl 1): A18.2-A18. https://dx.doi.org/10.1136/sextrans-2021-sti.58
  22. Vaneechoutte M., Guschin A., Van Simaey L., Gansemans Y., Van Nieuwerburgh F., Cools P. Emended description of Gardnerella vaginalis and description of Gardnerella leopoldii sp. nov., Gardnerella piotii sp. nov. and Gardnerella swidsinskii sp. nov., with delineation of 13 genomic species within the genus Gardnerella. Int. J. Syst. Evol. Microbiol. 2019; 69(3): 679-87. https://dx.doi.org/10.1099/ijsem.0.003200
  23. Machado D., Castro J., Palmeira-de-Oliveira A., Martinez-de-Oliveira J., Cerca N. Bacterial vaginosis biofilms: challenges to current therapies and emerging solutions. Front. Microbiol. 2016; 6: 1528. https://dx.doi.org/10.3389/fmicb.2015.01528
  24. Singh H., Gahane A., Singh V., Ghosh S., Thakur A. Antibiofilm activity of Fmoc-phenylalanine against Gram-positive and Gram-negative bacterial biofilms. J. Antibiot. 2021; 74(6): 407-16. https://dx.doi.org/10.1038/s41429-021-00409-2
  25. Vives J.A., Cancelo M.J., Losada M.Á., Doménech A. Dequalinium chloride use in adult Spanish women with bacterial vaginosis: an observational study. J. Obstet. Gynaecol. 2022; 42(1): 103-9. https://dx.doi.org/10.1080/01443615.2020.1867966
  26. Larsson P.G., Breding K., Vikström I., Larsson J., Farnebäck M., Hermelin A. A test of cure using a new molecular diagnostic approach for bacterial vaginosis in infected women treated with dequalinium chloride vaginal tablets. J. Womens Health Gyn. 2020; 7: 1-12.
  27. Raba G., Ďurkech A., Malík T., Bassfeld D., Grob P., Hurtado-Chong A. et al. Efficacy of dequalinium chloride vs metronidazole for the treatment of bacterial vaginosis: a randomized clinical trial. JAMA Netw. Open. 2024; 7(5): e248661. https://dx.doi.org/10.1001/jamanetworkopen.2024.8661
  28. Gonçalves B., Ferreira C., Alves C.T., Henriques M., Azeredo J., Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit. Rev. Microbiol. 2016; 42(6): 905-27. https://dx.doi.org/10.3109/1040841X.2015.1091805
  29. Blostein F., Levin-Sparenberg E., Wagner J., Foxman B. Recurrent vulvovaginal candidiasis. Ann. Epidemiol. 2017; 27(9): 575-582.e3. https://dx.doi.org/10.1016/j.annepidem.2017.08.010
  30. Sobel J.D., Sobel R. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Exp. Opin. Pharmacother. 2018; 19(9): 971-7. https://dx.doi.org/10.1080/14656566.2018.1476490
  31. Подзолкова Н.М., Никитина Т.И. Сравнительная оценка различных схем лечения больных с бактериальным вагинозом и неспецифическим вульвовагинитом. Российский вестник акушера-гинеколога. 2012; 12(5): 72-8. [Podzolkova N.M., Nikitina T.I. Comparative assessment of different treatment regimens for patients with bacterial vaginosis and nonspecific vulvovaginitis. Russian Bulletin of Obstetrician-Gynecologist. 2012; 12(5): 72-8. (in Russian)].
  32. Du L., Dong X., Song J., Lei T., Liu X., Lan Y. et al. Temporal and spatial differences in the vaginal microbiome of Chinese healthy women. PeerJ. 2023; 11: e16438. https://dx.doi.org/10.7717/peerj.16438
  33. Donders 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
  34. Paavonen J., Brunham R.C. Bacterial vaginosis and desquamative inflammatory vaginitis. N Engl. J. Med. 2018; 379(23): 2246-54. https://dx.doi.org/10.1056/NEJMra1808418
  35. Радзинский В.Е., Хамошина М.Б., Шеленина Л.А., Климова О.И., Лебедева М.Г., Замотина И.В. Терапия вагинальных инфекций: грани проблемы (международные реалии и российский опыт). Доктор.Ру. 2013; 7(85): 13-7. [Radzinsky V.E., Khamoshina M.B., Shelenina L.A., Klimova O.I., Lebedeva M.G., Zamotina I.V. Vaginal infection treatment: different aspects of the problem (international reality and local experience). Doctor.Ru. 2013; 7(85): 13-7 (in Russian)].
  36. Савичева А.М., Тапильская Н.И., Крысанова А.А., Будиловская О.В., Хуснутдинова Т.А., Шалепо К.В. Отдаленные результаты двухэтапного лечения бактериального вагиноза с применением антисептиков и пробиотиков. Акушерство и гинекология: новости, мнения, обучение. 2021; 9(4): 19-28. https://dx.doi.org/10.33029/2303-9698-2021-9-4-19-28 [Savicheva A.M., Tapilskaya N.I., Krysanova A.A., Budilovskaya O.V., Khusnutdinova T.A., Shalepo K.V. Long term results of two stage treatment of bacterial vaginosis using antiseptics and probiotics. Obstetrics and Gynecology: News, Opinions, Training. 2021; 9(4): 19-28. https://dx.doi.org/10.33029/2303-9698-2021-9-4-19-28 (in Russian)].
  37. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Воспалительные болезни шейки матки, влагалища и вульвы. 2025. Доступно по: https://cr.minzdrav.gov.ru/preview-cr/989_1 [Ministry of Health of the Russian Federation. Clinical guidelines. Inflammatory diseases of the cervix, vagina and vulva. 2025. Available at: https://cr.minzdrav.gov.ru/preview-cr/989_1 (in Russian)].

Received 23.04.2026

Accepted 19.06.2026

About the Authors

Niso M. Nazarova, Dr. Med. Sci., Professor, Leading Researcher, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, 4, Oparina str., Moscow, 117997, Russia, n_nazarova@oparina4.ru, https://orcid.org/0000-0001-9499-7654
Anastasia R. Devyatkina, obstetrician-gynecologist, PhD student, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, 4, Oparina str., Moscow, 117997, Russia, grinasta26@mail.ru, https://orcid.org/0009-0006-1742-7555
Sapiiat G. Isaeva, resident, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4, Oparina str.,
Moscow, 117997, Russia, isaevasapiat79@inbox.ru, https://orcid.org/0000-0002-8560-0181
Vera N. Prilepskaya, Dr. Med. Sci., Professor, Honored Scientist of the Russian Federation, Head of the Scientific and Polyclinic Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4, Oparina str., Moscow, 117997, Russia, v_prilepskaya@oparina4.ru,
https://orcid.org/0000-0003-3993-7629
Stanislav V. Pavlovich, PhD, Scientific Secretary, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4, Oparina str., Moscow, 117997, Russia, s_pavlovich@oparina4.ru, https://orcid.org/0000-0002-1313-7079

Similar Articles

№8 / 2025
Dikke G.B., Voroshilina E.S.
The role of lactoferrin and tyndallized Lactobacilli in the eradication of opportunistic pathogens and the restoration of vaginal eubiosis
№7 / 2025
Uruymagova A.T., Mezhevitinova E.A., Donnikov A.E.
Immunogenetic mechanisms of recurrent pathological vaginal discharge in women of reproductive age
№3 / 2026
Virivskaya E.V., Tarasova L.P., Kapyrina T.D., Kolomeets E.V., Podsekaeva S.A.
Gentle treatment: the role of emollients in vulvovaginitis
№2 / 2026
Apolikhina I.A., Rakhmatulina M.R., Olina A.A., Artymuk N.V., Tarnaeva L.A., Marochko T.Yu.
Use of vaginal ornidazole in women of reproductive age with bacterial vaginosis: results of a multicenter observational study
№12 / 2024
Teterina T.A., Apolikhina I.A., Suleimanova Zh.Zh.
The role and place of proper female intimate hygiene in preventing vulvovaginitis and bacterial vaginosis

Site is using cookie

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