Vaginal dysbiosis: The species composition of lactobacilli and the potentialities of non-drug correction

Objective. To evaluate the clinical and microbiological efficiency of a two-stage vaginal dysbiosis correction regimen using a low-frequency ultrasound (LFU)-treated processed 0.05% aqueous chlorhexidine solution and the probiotic drug ecofemin floravag (EF). Subjects and methods. The investigation enrolled 88 women aged 18 to 49 years with vaginal dysbiosis. According to the magnitude of dysbiotic disorders, the examinees were divided into 2 groups: 1) 33 women with moderate anaerobic dysbiosis and 2) 55 women with severe one. A two-stage correction regimen for vaginal dysbiosis was applied. At Stage 1, the vagina was treated with a LFU-processed 0.05% aqueous chlorhexidine solution. At Stage 2, all the patients took 2 EF capsules orally once daily for 10 days. The lower genitalia were clinically evaluated before and after treatment. Vaginal microbiocenosis and lactobacillus species composition were examined by a real-time polymerase chain reaction assay (a Femoflor16 test system, DNA-Technology, Moscow) thrice: before treatment (at the stage of primary counselling (Point 1)); immediately after the third vaginal treatment with LFU-processed 0.05% aqueous chlorhexidine solution (Point 2); a month after completion of EF intake (Point 3). Results. The potentialities of vaginal dysbiosis correction depend on the baseline status of microbiocenosis. Normocenosis was restored without antibiotics twice more frequently in moderate dysbiosis than in severe one. Overall, the proportion of lactobacilli was increased in 75.79% of the patients with moderate anaerobic dysbiosis and in 69.1% of those with severe anaerobic dysbiosis. This investigation recorded no case of Lactobacillus crispatus detected after an EF therapy cycle in the absence of this species among the lactobacilli at the start of follow-up. The species composition of the normal flora in each specific woman is stable and little influenced by physicochemical and biological factors. The administration of a probiotic drug containing L. crispatus does not lead to that the latter is supplanted by other dominant Lactobacillus species, but it favors the restoration of an intrinsic lactobacillus population. Conclusion. The two-stage regimen for non-drug correction of vaginal dysbiosis, which involves triple vaginal treatment with LFU-processed 0.05% aqueous chlorhexidine solution and the probiotic drug EF, demonstrates high efficiency: every two patients have achieved clinical recovery and restoration of normocenosis.

vaginal microbiocenosis, lactobacilli, processed chlorhexidine solution, probiotics, real-time polymerase chain reaction