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THE PROBLEM OF THE LOWER GENITAL TRACT MIXED INFECTIONS IN REPRODUCTIVE AGE WOMEN. CLINICO-PATHOGENETIC TREATMENT IN
MODERN CONDITIONS
Vasyl Benyuk,
MD, Professor,
head of the Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Оlena Shcherba,
PhD, assistant of the Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Victoriya Dronova MD, Professor, Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Tetyana Kovalyuk,
PhD, assistant of the Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Bu Weiwei
Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
ABSTRACT
The frequency of infectious and inflammatory diseases of genitals at the present stage is from 30 to 80% in the structure of gynecological morbidity, with predominance of mixed forms. According to WHO urogenital chlamydiosisis on the first place among the sexually transmitted infections. In Ukraine it frequency is up to 60%. The high frequency of associations of this infection, primarily fungal.
The obtained results indicate a significant positive dynamics of cervico-vaginal infections caused by Chlamydia and Candida clinical course. The frequency of relapses is reducing by almost 2 times. The tendency to restore the anti-infective resistance of the mucous membrane of the lower genital tract by increasing the level of lysozyme in cervical mucus were 2,3 times among reproductive age women treated with proposed complex therapy is shown.
Key words: cervico-vaginal infections, urogenital chlamydiosisis, vulvovaginal candidiasis, treatment.
Sexually transmitted diseases are a key public health priority worldwide due to the influence on the reproductive function and quality of life, accounting for 50-80% of total gynecological morbidity. The frequency of their growing threatening, which is associated with increased sexual activity at a young age, disordered sex life, environmental degradation, uncontrolled
medications, particularly antibiotics and high dose of oral contraceptives [1, 132; 2, 11].
Statistics by the WHO (1995) suggests that sexually transmissible disease every year affects more than 330 million people on the planet. In the USA recorded more than 600 000 new cases every year [3, 44].
It is known that the normal microflora of the genital tract, under certain conditions acquires pathogenic properties, and its representatives become causative agents of several diseases. Recent studies show that 95% of all vaginal discharge that women turn to gynecologist associated with diseases such as candida or Gardnerella vulvovaginitis; cervicitis, caused by Clamidia trachomatis, Herpes simplex or Neisseria gonorrhea. Urogenital infection is almost always polymicrobial, resulting in lose their specificity [4, 92; 5, 57].
According to WHO urogenital chlamydiosisis on the first place among the sexually transmitted infections. In Ukraine it frequency is up to 60% [6, 188; 7, 30]. The high frequency of associations of this infection, primarily fungal [1, 132]. Frequency of vulvovaginal candidiasis is not less than 75% of reproductive age women [2, 11; 8, 37].
The necessity of thorough study and adequate treatment of chlamydial-fungal infection of the lower genital tract in reproductive age women is caused by it widespread, and their affiliation to the risk factors of developing severe infectious process of the female genital organs, fetus and newborn that receives the microflora from the mother during delivery. In addition, recent data show that local drugs have the same efficiency as the system ones [2, 11; 7, 30; 8, 37].
AIM. To reduce the frequency of relapses of cervico-vaginal infections caused by Chlamydia and Candida in reproductive age women by admition of the complex therapy including Lavomax and Hexicon in solution.
THE MATERIALS AND METHODS.We conducted a comprehensive survey of 88 women aged 18 to 35 years. 68 patients with clinical manifestations and microbiologically confirmed diagnosis of cervico-vaginal infections caused by Chlamydia and Candida were divided into two groups of the survey, identical for age, severity and duration of the inflammatory process. The control group included 20 gynecologycally healthy women.
The I group (main) included 36 patients who received the treatment, consisting of macrolide antibiotic - Asimed, antifungal drug Clotrimazol, immunomodulator Lavomax in the standard dosages. As a local treatment the complex therapy
included 0.05% solution of antiseptic Hexicon (chlorhexidine) in bottles of 100 ml for topical application in the form of vaginal irrigations with exposure dose for 2-3 minutes 2 times a day for 10 days. Then, normalization of the vaginal flora was carried out by eubiotics for 10 days. The patients of II group (comparison) - 32 patients underwent traditional two-staged therapy according to the conventional protocol.
Efficacy of treatment was assessed by the dynamics of complaints, clinical symptoms, eradication of pathogens, and according to the immunological studies on 5, 10 and 20 days of treatment and after 3, 6 and 12 months after treatment.
THE RESULTS OF THE STUDY AND THEIR DISCUSSION.
Chlamydia trachomatis (PCR, ELISA) diagnosted in all cases. The main causative agent of candidiasis was Candida albicans - in 93,2% of patients.
All women were observed clinical manifestations cervicovaginitis mixed etiology. During the treatment, the regression of complaints and clinical manifestations of the disease in group I are already observed at 2-3 days(versus patients of group II 4-6 a day). The obtained data of the clinical picture of the disease correlated with parameters of the immune system.
Analysis of specific immunoglobulins (IgM and IgG) content in the serum of patients is demonstrated substantial increasing of the antiChlamydian and antiCandida immunoglobulins level more than 1,5-2 times compared with the control group (p<0,05). On the background of treatment in women both study groups revealed a reduction of the antiChlamydian and antiCandida immunoglobulins, but patients of group I received more promising results [fig. 1, 2].
Study of lysozyme in patients is showed significant decrease of its level in cervical mucus in 2,8 times in comparison with the corresponding indicator in the blood. In the dynamics of treatment, we found a significant increase of the lysozyme level in cervical mucus in patients of I group - by 2,3 times (p<0,05) [Fig. 3].
18 16
14,2+0,18 15,1+0,13 15,6+0,009
14
12 14,2+0,45 14,2+0,29 14,3+0,16
14,1+0,12
10
8
6 4 2 0
2,2±0,09 2±0,04
2,11±0,08 2,12±0,04 2,1±0,07
1 day 5 day 10 day 20 day
• IgM, 1 group study —■—IgM, 2 group study —A—IgG, 1 group study —X— IgG, 2 group study
Fig. 1 Antillana the content of immunoglobulins igM and igG in the serum of women during treatment, g/l (p<0,05)
Fig. 2 Anticandida the content of immunoglobulins igM and igG in cervical mucus of women patients during treatment, g/l (p<0,05)
0,18 0,16 0,14 0,12 0,1 0,08 0,06 0,04 0,02 0
0,17±0,002
0,14±0,004
4_^ 0,14±0,002
0 11±0 004
0,07±0,006
0,018±0,001 0 019±0 002 0,015±0,005
0,016±0,008 0,018±0,008 0,014±0,009
0,017±0,004
The content of lysozyme in serum, group 1
The content of lysozyme in serum, group 2
The content of lysozyme in serum, the control group
The content of lysozyme in cervical mucus, group 1
The content of lysozyme in cervical mucus, group 2
The content of lysozyme in cervical mucus, the control group
1 day
5 day
10 day
20 day
Fig. 3 The content of lysozyme in serum and cervical mucus in women patients during treatment, g/l (p<0.05)
As a result of proposed treatment there is a reduction in the duration of relapses (almost 2 times), lengthening of interrelapse period (almost 1,5 times, on average 28,4±1,4 days) and reduced titers of specific antibodies to Chlamydia trachomatis according to ELISA (over 2 times), Chlamydia trachomatis according to the PCR it is not revealed, and the
absence of the Candida fungi on the results of bacterioscopic and bacteriological methods of vaginal discharge research during the year of observation, the improvement of the general status and quality of women life [tab.1].
Table.1
The effectiveness of therapy in subjects in women after treatment
Criteria Group research
Group 1, (n=36) Group 2, (n=32)
The recurrence rate during the year, (abs. hours, %) 9 (25%) 15 (46,9%)
Length episodes of exacerbation (days) 4,2 ± 0,6 7,6 ± 0,8
The length of the interval between relapses (days) 85,3 ± 1,6 56,9 ± 1,4
CONCLUSIONS. The obtained results indicate a significant positive dynamics of cervico-vaginal infections caused by Chlamydia and Candidaclinical course.The frequency of relapses is reducing by almost 2 times.The tendency to restore
the anti-infective resistance of the mucous membrane of the lower genital tract by increasing the level of lysozyme in cervical mucus were 2,3 times among reproductive age women treated with proposed complex therapy is shown.
References:
1. Бенюк В.А., Ластовецкая Л.Д., Щерба Е.А., Мельник В.В. Профилактика рецидивов хронического канди-дозного вульвовагинита у женщин в период ранней постменопаузы // Здоровье женщины., 2013, № 6( 80), с. 212-218
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8. Szymankiewicz M. Wrazliwosc in vitro naflukonazolszczerow Candida parapsilosis izolowanych z roznych materialow klinicznych / М. Szymankiewicz // Micologialekarska. - 2007. - Vol.14, №1. - Р.37-40.
MODERN ASPECTS OF CORRECTION OF VAGINAL MICROBIOCENOSIS VIOLATIONS IN WOMEN WITH GENITAL HERPES
Vasyl Benyuk,
MD, Professor,
head of the Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Оlena Shcherba,
PhD, assistant of the Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Lily Lastoveckaya
PhD, associate Professor of the Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Tetyana Kovalyuk,
PhD, assistant of the Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
Bu Weiwei
Obstetrics and gynecology department №3 Bogomolets National Medical University - Kyiv, Ukraine
ABSTRACT
The article presents modern aspects of correction of vaginal microbiocenosis violations in women with genital herpes. Proven clinical and laboratory efficiency of complex anti-inflammatory treatment of patients with recurrent genital herpes. It is established that the inclusion of «Depantol» and «Lavomax» in complex therapy reduces the treatment time and number of recurrences of genital herpes.
Key words: microbiocenosis of the vagina, genital herpes, treatment, Depantol, Lavomax.
Sexually transmitted diseases area key public health priority world wide due to the influence on the reproductive function and quality of life, accounting for 50-80% of total gynaecological morbidity. The frequency of their growing threatening, which is associated with increased sexual activity at a young age, disordered sex life, environmental degradation, a violation of vaginal microecology, intestinal dysbiosis, late referral for medical assistance, uncontrolled medications, particularly antibiotics and high dose of oral contraceptives etc. [1, 158; 2, 133; 3, 193; 4, 26; 5, 140; 10, 698; 11, 139].
It is known that the normal microflora of the genital tract, under certain conditions acquires pathogenic properties, and its representatives become causative agents of several diseases. Recent studies show that 95% of all vaginal discharge that
women turn to gynecologist associated with diseases such as candida or Gardnerella vulvovaginitis; cervicitis, caused by Chlamydia trachomatis, Herpes simplex or Neisseria gonorrhea. [1, 158; 7, 5; 8, 12, 9, 10].In the structure of diseases affecting women's reproductive health, a special role is played by viral infection.
Genital herpes (GH, HSV) is a common human disease that has an epidemic spread in the world. According to WHO, the herpes simplex virus infecting up to 90% of children and adults, and mortality due to herpes infection, takes the second place (15,8 %) after influenza (35,8%) [3, 193]. HSV cause a pathology of pregnancy and childbirth often lead to spontaneous abortions and intrauterine fetal death, or cause generalized infection in newborns. Indicates the link of genital
