Vaginitis and cervicitis: choice of an effective therapy method (literature review)
https://doi.org/10.21518/2079-701X-2020-3-17-23
Abstract
Among gynaecological diseases in women of reproductive age the leading place is occupied by inflammatory diseases of the lower part of the genital tract (70%), a significant proportion of which are inflammatory processes of the vagina and cervix uteri. In ⅔ of women, cervicitis is most often asymptomatic, so they do not seek medical treatment, and 65–77.6% have a transition to a chronic form. Thus, chronic cervicitis is diagnosed in almost one in three women who seek assistance from a gynaecologist due to leukorrhea, and there is no tendency for a decrease in frequency. The article presents an actual view on the problem of inflammatory diseases of the lower genital tract. The analysis of some researches devoted to the influence of local immunity and the state of vaginal microflora on the development of chronic inflammatory diseases is carried out. The results of proteomic researches of cervicovaginal fluid in early diagnostics of inflammatory diseases of the lower genital tract and the possibility of using cytokine biomarkers in clinical practice with the aim of prediction of pathological state and choice of further treatment tactics of the patient are presented. Efficiency of use of the combined medication on the basis of chlorhexidine and dexpantenol possessing pronounced antimicrobial, regenerating and metabolic action and applied in therapy of acute and chronic vaginitis; bacterial vaginosis; endo-, exocervicitis that is topical in therapy of inflammatory diseases of the lower genital tract is considered.
About the Authors
N. M. NazarovaRussian Federation
Niso M. Nazarova, Dr. of Sci. (Med), Leading Researcher of the Research Outpatient Department
4, Academician Oparin St., Moscow, 117997
M. E. Nekrasova
Russian Federation
Mariya E. Nekrasova, Cand. of Sci. (Med), Junior Researcher of the Research Outpatient Department
4, Academician Oparin St., Moscow, 117997
E. R. Dovletkhanova
Russian Federation
El’mira R. Dovletkhanova, Cand. of Sci. (Med Senior Researcher of the Research Outpatient Department
4, Academician Oparin St., Moscow, 117997
P. R. Abakarova
Russian Federation
Patimat R. Abakarova, Cand. of Sci. (Med), Researcher of the Research Outpatient Department
4, Academician Oparin St., Moscow, 117997
References
1. Serov V.N., Sukhikh G.T., Prilepskaya V.N., Radzinskiy V.E.(ed.). Manual on Outpatient Care in Obstetrics and Gynecology. 3rd ed., rev. and supp. M.: GEOTAR-Media; 2016. 1136 p. Available at: https://www.rosmedlib.ru/book/ISBN9785970440049.html.
2. Bayramova G.R., Kostava M.N. Assessment of efficacy and acceptability of combined therapy of nonspecific vaginitis and cervicitis. Ginekologiya = Gynecology. 2011;13(1):4–7. Available at: https://con-med.ru/magazines/gynecology/gynecology-01-2011/otsenka_effektivnosti_i_priemlemosti_kombinirovannoy_terapii_nespetsificheskogo_vaginita_i_tservitsi/.
3. Ollendorff A.T., Karjane N.W. Cervicitis. Medscape. 2017;(2):09. Available at: https://emedicine.medscape.com/article/253402-overview.
4. Agostinis C., Mangogna A., Bossi F., Ricci G., Kishore U., Bulla R. Uterine Immunity and Microbiota: A Shifting Paradigm. Frontiers Immunol. 2019;(10):23–87. doi: 10.3389/fimmu.2019.02387.
5. Iijima N., Thompson J.M., Iwasaki A. Dendritic cells and macrophages in the genitourinary tract. Mucosal Immunol. 2008;1(6):451–459. doi: 10.1038/mi.2008.57.
6. Ochiel D.O., Fahey J.V., Ghosh M., Haddad S.N., Wira C.R. Innate Immunity inthe Female Reproductive Tract: Role of Sex Hormones in Regulating Uterine Epithelial Cell Protection Against Pathogens. Curr Womens Health Rev. 2008;4(2):102–117. doi: 10.2174/157340408784246395.
7. Eschenbach D.A., Thwin S.S., Patton D.L., Hooton T.M., Stapleton A.E., Agnew K., Winter C., Meier A., Stamm W.E. Influence of the normal menstrual cycleon vaginal tissue, discharge, and microflora. Clin Infect Dis. 2000;30(6):901–907. doi: 10.1086/313818.
8. Valore E.V., Park C.H., Igreti S.L., Ganz T. Antimicrobial components of vaginal fluid. Am J Obstet Gynecol. 2002;187(3):561–568. doi: 10.1067/mob.2002.125280.
9. Rohan L.C., Sassi A.B. Vaginal drug delivery systems for HIV prevention. AAPS J. 2009;11(1):78–87. doi: 10.1208/s12248-009-9082-7.
10. Wira C.R., Grant-Tschudy K.S., Crane-Godreau M.A. Epithelial cells in the female reproductive tract: a central role as sentinels of immune protection. Am J Reprod Immunol. 2005;53(2):65–76. doi: 10.1111/j.1600-0897.2004.00248.x.
11. Klein L.L., Jonscher K.R., Heerwagen M.J., Gibbs R.S., McManaman J.L. Shotgun proteomic analysis of vaginal fluid from women in late pregnancy. Reprod Sci. 2008;15(3):263–273. doi: 10.1177/1933719107311189.
12. Ferrero-Miliani L., Nielsen O.H., Andersen P.S., Girardin S.E. Chronic inflammation: importance of NOD2 and NALP3 in interleukin-1β generation. Clin Exp Immunol. 2007;147(2):227–235. doi: 10.1111/j.1365-2249.2006.03261.x.
13. Prilepskaya V.N. Pathology of the cervix uteri. Moscow: Medpress-Inform; 2008. 384 p. Available at: https://www.03book.ru/upload/iblock/867/286_Patologija_shejki_matkigPrilepskajar.pdf.
14. Radzinsky V.E., Petrova V.D., Khamoshina M.B., Salimova L.Ya., Rudneva O.D., Arkhipova M.P., Stroni R. Optimization of wound healing after plastic surgery. Akusherstvo i ginekologiya = Obstetrics and Gynecology. 2011;(1):89–94. (In Russ.) Available at: https://aig-journal.ru/articles/Optimizaciya-zajivleniya-rany-posle-plasticheskih-hirurgicheskihoperacii.html.
15. Ohlsson A.I., Shah V.S., Stade B.C. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database Syst Rev. 2014;(12):CD003520. doi: 10.1002/14651858.CD003520.pub3.
16. Radzinskiy V.E., Khamoshina M.B., Orazov M.R., Tulupova M.S., Pestrikova T. Yu., Yarmolinskaya M.I., Rymashevsky A.N. Results of a multicenter observational study: therapy for acute non-specific and mixed vaginitis in reproductive-aged patients. Akusherstvo i Ginekologiya = Obstetrics and Gynecology. 2019;(8):150–158 (In Russ.) doi: 10.18565/aig.2019.8.150-158.
17. Trifonova R.T., Bajpai M., Pasicznyk J.M., Chandra N., Doncel G.F. et al. Biomarkers of leukocyte traffic and activation in the vaginal mucosa. Biomarkers. 2007;12(6):608–622. doi: 10.1080/13547500701600670.
18. Ning Y.M., Wang Y., Lu L., Li R.L., Liu C.J., Jiang Y.J., Zhu X.Z. Pathogenesis and clinical significance of interleukin-8 and tumor necrosis factor-alpha in cervicitis. Zhonghua Yi Xue Za Zhi. 2009;89(24):1684–1686. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19957526.
19. Zhang D., Liu Z.H., Liao Q.P., Ma J.M., Sun Y.F., Fan S.R., Hu L.N., Jia H.J., Di W., Wang W. Zhonghua Fu Chan Ke Za Zhi. 2009;44(1):13–15. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19563055.
20. Savicheva A.M., Spasibova E.V., Shalepo K.V. Investigation of the susceptibility of clinical microbial isolates from the female urogenital tract to the active ingredients contained in Depanthol. Rossiyskiy vestnik akushera-ginekologa = Russian Bulletin of Obstetrician-Gynecologist. 2019;19(1):86-91. (In Russ.) doi: 10.17116/rosakush20191901192.
21. Afonso E., Blot K., Blot S. Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials. Euro Surveill. 2016;21(46). doi: 10.2807/1560-7917.ES.2016.21.46.30400.
22. Climo M.W., Yokoe D.S., Warren D.K., Perl T.M., Bolon M., Herwaldt L.A. et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med. 2013;368(6):533–542. doi: 10.1056/NEJMoa1113849.
23. Bleasdale S.C., Trick W.E., Gonzalez I.M., Lyles R.D., Hayden M.K., Weinstein R.A. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med. 2007;167(19):2073–2079. doi: 10.1001/archinte.167.19.2073.
24. Milstone A.M., Elward A., Song X., Zerr D.M., Orscheln R., Speck K. et al. Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial. Lancet. 2013;381(9872):1099–1106. doi: 10.1016/S0140-6736(12)61687-0.
25. Selikhova M.S., Vdovin S.V., Ababekyan N.V. Possibilities for reducing birth trauma in women at high risk for maternal passage soft tissue injuries. Akusherstvo i Ginekologiya = Obstetrics and Gynecology. 2016;(11):124–130. (In Russ.) doi: 10.18565/aig.2016.11.124-30.
26. Kalendgyan A.S., Khamoshina M.B., Shelenina L.I., Petrova V.D., Soyunov M.A. Treating Imbalance in Vaginal Microbiota Following Destruction of Cervix. Doctor.Ru. 2015;(14):12–20. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=25301681.
27. Oboskalova T.A., Kononova I.N., Voroshilina E.S., Kuzina T.V. Efficiency of rehabilitation measures after destructive therapies in patients with uterine cervical pathology associated with papillomavirus infection. Akusherstvo i Ginekologiya = Obstetrics and Gynecology. 2012;(2):86–89. (In Russ.) Available at: https://aig-journal.ru/articles/Effektivnost-reabilitacionnyh-mero-priyatiiposledestruktivnyh-metodov-terapii-u-pacientok-s-patologiei-sheiki-matkiassociirovannois-papillomavirus.html.
28. Aulendorf C.V. Effect of Topically Applied Dexpanthenol on Epidermal Barrier Function and Stratum Corneum Hydration. Arzneimittelforschung. 2000;50(7):659–663. doi: 10.1055/s-0031-130.
29. Radtke M.A., Lee-Seifert C., Rustenbach S.J., et al. Patientennutzen und anwendungsmerkmale der behandlung irritierter haut mit dexpanthenolhaltiger salbe. Hautarzt. 2009;60(5):414-419. doi: 10.1007/s00105-009-1729-x.
Review
For citations:
Nazarova NM, Nekrasova ME, Dovletkhanova ER, Abakarova PR. Vaginitis and cervicitis: choice of an effective therapy method (literature review). Meditsinskiy sovet = Medical Council. 2020;(3):17-23. (In Russ.) https://doi.org/10.21518/2079-701X-2020-3-17-23