Vulvovaginal candidiasis in women of reproductive age: immunological aspects of modern algorithms for examination and treatment
https://doi.org/10.21518/2079-701X-2022-16-16-57-61
Abstract
immunological defense complex is involved: the role of complement, T-lymphocytes, NK-cells is noted. Of particular importance among immune factors is interferon-γ, which is able to limit the reproduction of Candida fungi in the early stages of infection by stimulating the immune response. This is due to the fact that interferon-γ is the strongest stimulator of effector functions of macrophages (microbicidal activity, cytokine production), increases the expression of histocompatibility molecules MHCI and MHCII, as well as adhesion molecules on endothelial cells, increasing endothelial permeability. Thus, the rate of development and severity of the pathological process depend on the state of the body’s defenses. The use of antibiotics, glucocorticoids and cytostatics, as well as radiation therapy can enhance the adhesive properties of yeast fungi. The choice of treatment for VVC should be based on the results of a comprehensive diagnosis, taking into account the form and risk factors of the disease. Local immunity impairment due to the innate quality of the vaginal epitheliocytes is currently one of the most significant risk factors for the development of VVC. This also explains the availability of sufficient drugs for etiotropic therapy, which does not affect its recurrence rate. The use of topical immunomodulators is a very promising method of overcoming the therapeutic failures in the complex treatment of genital candidiasis.
About the Authors
Yu. E. Dobrochotova
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Yulia E. Dobrochotova, Dr. Sci. (Med.), Professor, Head of the Department
Faculty of Medicine
Department of Obstetrics and Gynecology
117997
1, Ostrovityanov St.
Moscow
A. Kh. Karanasheva
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Albina Kh. Karanasheva, Cand. Sci. (Med.), Assistant
Faculty of Medicine
Department of Obstetrics and Gynecology
117997
1, Ostrovityanov St.
Moscow
References
1. Доброхотова Ю. Э. Лечение инфекционных заболеваний влагалища / Ю. Э. Доброхотова, И. Ю. Ильина // РМЖ. Мать и дитя. – 2017. – 25 (15): 1108–1110. Режим доступа: https://www.rmj.ru/articles/ginekologiya/Lechenie_infekcionnyh_zabolevaniy_vlagalischa. – Dobrokhotova Yu. E., Ilyina I. Yu. Treatment of vaginal infectious diseases. Russian Journal of Woman and Child Health. 2017; 25 (15): 1108–1110. (In Russ.) Available at: https://www.rmj.ru/articles/ginekologiya/Lechenie_infekcionnyh_zabolevaniy_vlagalischa.
2. Веселов А. В. Системные антимикотики: состояние и перспективы / А. В. Веселов // Клиническая микробиология и антимикробная химиотерапия. – 2007. – 9 (1): 73–80. Режим доступа: https://cmac-journal.ru/publication/2007/1/cmac-2007-t09-n1-p073. – Veselov A. V. Systemic antimycotics: status and prospects. Klinicheskaia Mikrobiologiia i Antimikrobnaia Khimioterapiia. 2007; 9 (1): 73–80. (In Russ.) Available at: https://cmac-journal.ru/publication/2007/1/cmac-2007-t09-n1-p073/.
3. Ma D., Chen Y., Chen T. Vaginal microbiota transplantation for the treatment of bacterial vaginosis: a conceptual analysis. FEMS Microbiol Lett. 2019; 366 (4): fnz025. https://doi.org/10.1093/femsle/fnz025.
4. Chen X., Li T., Wang F. J., Shang C. G., Zhang X., Bai H. H., Liu Z. H. Changes of local vaginal immune regulation in rats infected with vulvovaginal candidiasis. Zhonghua Fu Chan Ke Za Zhi. 2019; 54 (5): 330–337. (In Chinese) https://doi.org/10.3760/cma.j.issn.0529-567x.2019.05.008.
5. Soper D. E. Bacterial vaginosis and surgical site infections. Am J Obstet Gynecol. 2020; 222 (3): 219–223. https://doi.org/10.1016/j.ajog.2019.09.002.
6. Swidsinski A., Guschin A., Tang Q., Dörffel Y., Verstraelen H., Tertychnyy A. et al. Vulvovaginal candidiasis: histologic lesions are primarily polymicrobial and invasive and do not contain biofilms. Am J Obstet Gynecol. 2019; 220 (1): 91.e1–91.e8. https://doi.org/10.1016/j.ajog.2018.10.023.
7. 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): 104–108. https://doi.org/10.1007/s11908-013-0325-5.
8. Пустотина О. А. Бактериальный вагиноз: патогенез, диагностика, лечение и профилактика / О. А. Пустотина // Акушерство и гинекология. – 2018. – (3): 150–156. https://doi.org/10.18565/aig.2018.3.150-156. – Pustotina O. A. Bacterial vaginosis: pathogenesis, diagnosis, treatment and prevention. Akusherstvo i Ginekologiya (Russian Federation). 2018; (3): 150–156. (In Russ.) https://doi.org/10.18565/aig.2018.3.150-156.
9. Fong I. W. The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin Med. 1992; 68 (3): 174–176. https://doi.org/10.1136/sti.68.3.174.
10. Sherrard J., Donders G., White D., Jensen J. S. European (IUSTI/WHO) guideline on the management of vaginal discharge, 2011. Int J STD AIDS. 2011; 22 (8): 421–429. https://doi.org/10.1258/ijsa.2011.011012.
11. Прилепская В. Н. Клинические рекомендации по диагностике и лечению заболеваний, сопровождающихся патологическими выделениями из половых путей женщин / В. Н. Прилепская [и др.] – М., 2019. – 59 с. Режим доступа: http://zdrav.spb.ru/media/filebrowser/клинические_рекомендации_по_диагностике_и_лечению_заболеваний%2C_сопровождающихся_патологическими_выделениями_из_половых_путей_женщин.pdf. – Prilepskaya V. N., Kira E. F., Apolikhina I. A., Bairamova G. R., Gomberg M. A., Minkina G. N. et al. Clinical recommendations for the diagnosis and treatment of diseases accompanied by pathological discharge from the genital tract of women. Moscow; 2019. 59 p. (In Russ.) Available at: http://zdrav.spb.ru/media/filebrowser/клинические_рекомендации_по_диагностике_и_лечению_заболеваний%2C_сопровождающихся_патологическими_выделениями_из_половых_путей_женщин.pdf.
12. Савельева Г. М. Гинекология / Г. М. Савельева [и др.] – М.: ГЭОТАР-Медиа? 2017. – 1008 с. – Savelyeva G. M., Sukhikh G. T., Serov V. N., Radzinsky V. E., Manukhin I. B. (eds.). Gynecology. Moscow: GEOTAR-Media; 2017. 1008 p. (In Russ.)
13. Workowski K. A., Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010; 59 (RR-12):1–110. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm.
14. Доброхотова Ю. Э. Использование комбинации метронидазола и миконазола в коррекции дисбиоза влагалища / Ю. Э. Доброхотова, И. И. Иванова // РМЖ. Мать и дитя. – 2018. – 1 (1): 82–87. https://doi.org/10.32364/2618-8430-2018-1-1-82-87. – Dobrokhotova Yu. E., Ivanova I. I. Using a combination of metronidazole and miconazole in correcting vaginal dysbiosis. Russian Journal of Woman and Child Health. 2018; 1 (1): 82–87. (In Russ.) https://doi.org/10.32364/2618-8430-2018-1-1-82-87.
15. Шульженко А. Е. Рецидивирующие смешанные инфекции урогенитального тракта у женщин: стратегия коррекции мукозального иммунитета / А. Е. Шульженко, Р. В. Щубелко, И. Н. Зуйкова // Consilium Medicum. – 2016. – 18 (6): 87–93. Режим доступа: https://consilium.orscience.ru/2075-1753/article/view/94521. – Shulzhenko A. E., Shchubelko R. V., Zuykova I. N. Recurrent mixed urogenital infections in women: correction strategy of mucosal immunity. Consilium Medicum. 2016; 18 (6): 87–93. (In Russ.) Available at: https://consilium.orscience.ru/2075-1753/article/view/94521.
16. Handisurya A., Lázár S., Papay P., Primas C., Haitel A., Horvat R. et al. Anogenital Human Papillomavirus Prevalence is Unaffected by Therapeutic Tumour Necrosis Factor-alpha Inhibition. Acta Derm Venereol. 2016; 96 (4): 494–498. https://doi.org/10.2340/00015555-2298.
17. Летяева О. И. Патогенетические аспекты терапии воспалительных заболеваний урогенитального тракта у женщин репродуктивного возраста / О. И. Летяева, О. Р. Зиганшин // РМЖ. Мать и дитя. – 2021. – 4 (1): 59–64. https://doi.org/10.32364/2618-8430-2021-4-1-59-64. – Letyaeva O. I., Ziganshin O. R. Pathogenic treatment of the inflammatory diseases of the urogenital tract in women of reproductive age. Russian Journal of Woman and Child Health. 2021; 4 (1): 59–64. (In Russ.) https://doi.org/10.32364/2618-8430-2021-4-1-59-64.
18. Роговская С. И. Регрессия генитальных кондилом и цервикальной интраэпителиальной неоплазии легкой степени на фоне иммунотерапии (клиническое наблюдение) / С. И. Роговская, Т. Н. Бебнева // РМЖ. Мать и дитя. 2020. – 3 (2): 100–104. https://doi.org/10.32364/2618-8430-2020-3-2-100-104. – Rogovskaya S. I., Bebneva T. N. Regression of genital warts and mild cervical intraepithelial neoplasia on the background of immunotherapy (clinical observation). Russian Journal of Woman and Child Health. 2020; 3 (2): 100–104. (In Russ.) https://doi.org/10.32364/2618-8430-2020-3-2-100-104.
Review
For citations:
Dobrochotova YE, Karanasheva AK. Vulvovaginal candidiasis in women of reproductive age: immunological aspects of modern algorithms for examination and treatment. Meditsinskiy sovet = Medical Council. 2022;(16):57-61. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-16-57-61
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