Clinical and laboratory evaluation of the effectiveness of a personified approach to treating bacterial vaginosis and its concurrence with vulvovaginal candidiasis

Objective. To evaluate the effectiveness of a personified approach to treating bacterial vaginosis and its concurrence with vulvovaginal candidiasis, by using the results of clinical and laboratory studies. Subjects and methods. The investigation enrolled 259 female patients aged 18-35 years who were divided into two groups. Group 1 included 174 (67.18+2.92%) patients with verified bacterial vaginosis. Group 2 consisted of 85 (32.82+2.92%) patients with bacterial vaginosis concurrent with vulvovaginal candidiasis. The diagnosis was verified on the basis of clinical (the type of complaints; gynecological examination) and laboratory (bacterioscopy; femoflor-16 real-time polymerase chain reaction, and vaginalpH-metry using a colposcopic test) studies. Results. The authors’findings suggest that the presence of bacterial vaginosis requires a mandatory test for fungal pathogens (C. albicans et non albicans). The concurrence of bacterial vaginosis and vulvovaginal candidiasis requires careful study of the vaginal microbial landscape and subsequent use of combination antibiotic therapy for both nosological entities. Personalized treatment can act upon aerobic and anaerobic bacteria found in higher titers and upon the fungal representatives of the genus Candida. In the authors’ opinion, combined antimicrobial therapy in conjunction with antimycotics eliminates a vaginal inflammatory process and normalizes the ratio of the anaerobic, aerobic, and mycotic spectrum, including the disappearance of A. vaginae, G. vaginalis, and C. albicans. The next stage of therapeutic measures in this study was the correction of vaginal biocenosis. The normalized pH values in the vagina were an indicator for its ecosystem restoration. Conclusion. In addition to routine examinations, the diagnosis of bacterial vaginosis or the latter concurrent with vulvovaginal candidiasis requires that a study of the vaginal microbial spectrum by Femoflor-16 polymerase chain reaction should be included into a package of diagnostic measures. In addition to its diagnostic value, real-time polymerase chain reaction allows for objectively monitoring the results of therapeutic measures that are advisable to be implemented in several steps, including a combined scheme of antimicrobial therapy and vaginal biotope-restoring drugs.

bacterial vaginosis, vulvovaginal candidiasis, vaginal microbiocenosis