At present, vaginal infection occupies one of the first places in the structure of inflammatory diseases of the female genital organs. According to the literature data, bacterial vaginosis (BV) is most common in women of reproductive age (30–57.6%) [1–5]. It is known that BV is a risk factor, and the presence of a mixed infection – one of the reasons for the development of severe pathology of the genitals, complications of pregnancy and childbirth [6–12].

BV – violation of the biocenosis of the vagina (dysbiosis), due to the growth of microaerophilic and obligate anaerobic bacteria. Unlike vaginitis in BV, there are almost no leukocytes in the vaginal discharge, and the characteristic features are: a large number of "key cells"; in a Gram-stained smear, a sharp decrease in the concentration of lactobacilli.

Given the absence of signs of an inflammatory process, obstetrician-gynecologists often ask themselves the question: is treatment for BV necessary? We are deeply convinced that BV requires active treatment, and not only because it causes constant discomfort in patients, including sexual discomfort, but also in order to prevent the diseases and complications listed above.

There are many regimens for the treatment of bacterial infections [13–16], which necessarily include various topical preparations, one of them is the drug Betadine (CJSC "Egis Pharmaceutical Plant" (Hungary)), which has a wide spectrum of antimicrobial activity. Betadine is available as a vaginal suppository and contains 200 mg of povidone-iodine.

Betadine is a complex compound of iodine and a synthetic polymer. Pharmacologically, the polymer is absolutely inactive, and therefore the therapeutic effects of the drug are associated only with iodine. Iodine belongs to the group of halogen antiseptics, the spectrum of action of which extends to gram-positive and gram-negative bacteria, fungi, viruses and protozoa. The bactericidal effect of iodine is due to its pronounced oxidizing properties, it actively interacts with amino acids, as a result of which the structure of proteins changes. Basically, iodine disrupts the structures of bacterial transmembrane proteins and enzyme proteins that do not have membrane protection. It is the content of iodine in the composition of the drug Betadine that provides its bactericidal effect, however, hypersensitivity reactions to the drug may occur.

Survey methods

To select the optimal tactics for treating women, it is necessary to clarify the etiology of the disease of the vagina. Examination of women involves a generally accepted gynecological examination and special research methods, which are conventionally divided into:

  • microscopic (bacterioscopic);
  • Amines test;
  • pH of vaginal discharge;
  • serological (ELISA, RIF);
  • cultural or bacteriological;
  • molecular biological (PCR).

Microscopic (bacterioscopic) diagnosis is carried out by examining smears stained with methylene blue or Gram. The main advantage of the – in simplicity, accessibility and speed of obtaining the result (30 & ndash; 60 min). However, its sensitivity is low. The value of the technique increases when preparations (smears) are treated with specific mono- or polyclonal antibodies labeled with fluorescein (RIF, PIF, ELISA).

A positive amine test is the appearance or increase in the smell of "rotten fish"; when added to 1–2 drops of vaginal secretion 1–2 drops of 10% potassium hydroxide solution.

Normally, the pH of vaginal contents in women of the reproductive period is in the range of 3.8-4.5. An increase in pH over 4.5 is assessed as a diagnostic sign of a violation of the vaginal biocenosis.

Serological studies of RIF and ELISA are indirect (indirect) tests based on the antigen-antibody reaction. In practical healthcare, RIF is most often used – detection of pathogen antigens to HSV, CMV, ureaplasma, mycoplasma, chlamydia and gardnerella.

The advantage of enzyme immunoassay (ELISA) is the ability to quantify highly specific antibodies of the IgM, IgG and IgA classes to various microbial antigens, which makes it possible to assess the stage of the infectious process. Thus, the determination of IgM antibodies to HSV, CMV and chlamydia indicates a primary infection or reactivation of the process. Determination of IgG antibodies to HSV, CMV, urea-, mycoplasmas and chlamydia makes it possible to judge the latent or persistent course of the infectious process. The ELISA method also determines the concentration of total immunoglobulin E (IgE) in the blood serum. A persistent increase in the level of IgE usually occurs in conditions of prolonged intake of relatively small amounts of antigen, and sensitization can then persist for a long time even in the absence of antigen.

With the bacteriological, or cultural, method of research, bacterial cultures are made from the cervical canal on the flora (isolation of a pure culture, identification of microorganisms, and determination of sensitivity to antibiotics). This method has high sensitivity, specificity, reliably establishes the etiology of the pathological process. In addition, this method can be used as a method for evaluating the effectiveness of antimicrobial therapy.

PCR is a more effective, sensitive and highly specific diagnostic method, it makes it possible to determine a wide range of pathogens in one clinical sample (the so-called "microbiological passport" of the patient). The advantages of this method include the speed of execution compared to cultural methods. However, the high sensitivity of PCR is also its disadvantage: the presence of a diagnostically insignificant number of microorganisms can give a positive answer.

Under our supervision there were 61 patients with bacterial infection of the vagina. Conducting a comprehensive clinical and laboratory examination made it possible to distinguish 2 groups: 33 women with BV and 28 – with bacterial vulvovaginitis.

The vast majority of women had a latent form of HSV and CMV infection (in our studies, 91% and 83%, respectively), which, as a rule, was confirmed by the absence of IgM antibodies to HSV and CMV.

Clinically, the course of vulvovaginitis was always accompanied by complaints of abundant discharge from the genital tract, and BV proceeded in 2 variants: asymptomatic or with complaints of vaginal discharge with an unpleasant odor. According to the literature, BV is diagnosed by chance in every fifth woman who considers herself healthy. According to our data, asymptomatic course of BV occurred only in 8% of women, the diagnosis was made during the examination for preconception preparation. Based on the clinical data and the results of the examination, the question of treatment is decided.

Treatment

Treatment was carried out depending on the nosological form of the disease. When diagnosing BV, all women were prescribed:

    Betadine 1 suppository 1 rub./day in the vagina for 14 days.
For bacterial vulvovaginitis, the following treatment regimen was used:

    ofloxacin 200 mg 2 times a day for 5 days (if sensitivity to this antibiotic is detected);
    • ornidazole 500 mg also 2 times a day for 5 days;
    • Betadine intravaginally, 1 suppository 2 rubles/day for 7 days.
Control studies were carried out after 1 and 4 weeks. after treatment.

Evaluation of the effectiveness of the therapy

Before treatment, microscopy of a vaginal smear in the BV group ranged from 2 to 15 leukocytes per field of view. Gardnerella were the main cause of BV (in 67% of cases), opportunistic strains of ureaplasma (18%) and mycoplasma (15%) were detected almost equally often.

Against this background, Staphylococcus epidermidis 103 CFU and Staphylococcus saprophiticus 103 CFU were sown in bacterial cultures in half of the patients.

Lactobacilli were absent in 15%, at a concentration of 103 CFU they were in 22%, 104 CFU – in 36%, 105 CFU – in 21% of patients. Only in 6% of cases the titer of lactobacilli was within the normal range.

A week after the therapy, no woman complained. With repeated microscopy of the vaginal smear and examination by the RIF method after 1 and 4 weeks. after treatment, we did not detect opportunistic pathogens in our patients.

Analysis of bacteriological studies showed that after 1 week. after the therapy, only 7% of the patients had Staphylococcus epidermidis inoculated, and at the second control visit, all women had no opportunistic flora, and an increase in the titer of lactobacilli was noted.

To normalize the vaginal biocenosis after a course of treatment with Betadine, 50% of the patients were blindly treated with eubiotics: suppositories with acilact were prescribed intravaginally for 7 days. Initially, 25% of women had no lactobacilli, 33% – their concentration was 103 CFU, in 42% – 104 CFU. The analysis showed that, regardless of the treatment regimen (with and without the use of eubiotics), after 4 weeks. after therapy, in 93% of women, the vaginal biocenosis returned to normal, the titer of lactobacilli was within the normal range during the second study. Only in 7% of patients the concentration of lactobacilli was equal to 104 CFU, and half of them received suppositories with acylact, and the other half – did not receive.

When examining patients with bacterial vulvovaginitis, vaginal swabs revealed up to 75 leukocytes per field of view. The following were found in bacterial cultures:

    Enterococcus faecalis (36% women);
    • Staphylococcus epidermidis 103 CFU (39%);
    • Staphylococcus saprophiticus 103 CFU (18%).
When examining the RIF and PCR methods, it was revealed that in 50% of the patients the cause of inflammation was a mixed infection, in the rest – either chlamydia, or ureaplasma or mycoplasma were sown.

After treatment, at the first follow-up visit, 24% of women continued to complain of discharge from the genital tract and discomfort in the vagina. When examining these women by the RIF method, mycoplasma was detected in 8% (initially – 50%), in 16% – ureaplasma (before treatment - 67.8%). At the re-control examination after 1 month. no pathogens were found after treatment.

After 4 weeks. after the therapy, in 88% of patients, the landscape of the vaginal smear returned to normal: the number of leukocytes was 2-10 in the field of view. Only in 8% of women, smear microscopy revealed a small amount of mycelium of the fungus. In bacterial crops after treatment, opportunistic flora was not detected.

Before treatment, none of the cultures from the cervical canal had a normal titer of lactobacilli:

    lactobacilli were absent in 57% of women;
    • concentration of 103 CFU was in 18%;
    • concentration 104 CFU – 18%;
    • concentration 105 CFU – only in 7% of patients.
Additionally, 50% of women received eubiotic therapy, of which lactobacilli were not found in 64% of patients, in the rest – the concentration of lactobacilli was 103 CFU. Regardless of the treatment regimen (with or without the use of eubiotics), at the follow-up examination in 64% of women who completed treatment, the titer of lactobacilli was within the normal range, of which half of the patients received suppositories with acylact, and the rest – conducted a course of therapy without eubiotics.

After 1 month after treatment, clinical symptoms stopped in 80% of patients, complaints of moderate discharge from the genital tract and itching of the external genital organs remained in 20% of women.

To evaluate the influence of the main component Betadine – yoda – on the level of allergization of the examined women, a comparative analysis of the content of immunoglobulin E in the blood serum was carried out before and after 4 weeks. after treatment, the results of which are presented in table 1.

The results obtained were evaluated as follows: IgE concentration is less than or equal to 25 IU/ml – low level of allergization, within 25–100 IU/ml – average level of allergization and above 100 IU/ml – high level of allergization.

In the group with BV before treatment, 51.5% of patients had a low level of allergization, in 30.3% – average and 18.2% – high. After 4 weeks after a course of therapy, 56.6% had a low level of allergization, the average – 33.3%, high – in 10.1% of women.

In the group of women with bacterial vulvovaginitis, at the first examination, 82.2% of patients had a low level of IgE, 17.8% – average. After treatment, all patients had a serum IgE concentration below 25 IU/ml. Therefore, the level of IgE after treatment in both groups tended to decrease.

A retrospective analysis showed that 96.4% of patients had no adverse allergic reactions to taking drugs, including Betadine. In 3.6% of women, individual intolerance to the drug was noted, manifested in the form of swelling and itching of the external genitalia.

Conclusions

    Betadine is an effective treatment for BV and complex treatment of bacterial vulvovaginitis;
    • Betadine normalizes the vaginal biocenosis in 93.4% of cases in BV and in 64% of cases – with bacterial vulvovaginitis;
    • when using Betadine, no additional prescription of eubiotics is required;
    • The proposed treatment regimens with intravaginal use of Betadine do not cause allergization of the patient's body;
    • Betadine is well tolerated by patients, the frequency of side effects does not exceed 3.6%.
According to rmj.ru

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