Vaginitis and vaginosis: diagnostic and treatment approaches in the light of the current clinical practice guidelines

Vaginal inflammatory diseases of microbial etiology (vaginitis) are one of the most common reasons for women to visit a gynecologist. It is important to know the etiology, pathogenesis, clinical course types, diagnosis, and treatment of aerobic (nonspecific) vaginitis and bacterial vaginosis. Making the correct diagnosis is a key to choose effective treatment means and methods. Bacterial vaginosis (BV) is a polymicrobial dysbiotic disease, in which the numbers of Lactobacillus spp. dramatically decrease, whereas those of facultative and obligate anaerobes and microaerophiles, such as Gardnerella vaginalis, Peptostreptococcus, Clostridium spp., Prevotella spp., Bacteroides, Fusobacterium, Veillonella, Eubacterium, Atopobium vaginae, Mobiluncus spp., and others, increase. At our present level of knowledge, G. vaginalis and A. vaginae are recognized to play a leading role. The Russian Society of Obstetricians and Gynecologists recommendations (2019) state that aerobic vaginitis (AV) is a vaginal mucosal inflammatory disease that occurs when the opportunistic aerobic microorganisms activate and affect the epithelial cells. Since 2011, the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, has been using the medical technology “Integral assessment of the vaginal microbiota. Diagnosis of opportunistic vaginitis”, permitted by FS No. 2011/072 dated April 18, 2011, which was designed by A.S. Ankirskaya and V.V. Muravieva. The diagnosis is based on a combination of gram-stained smear microscopy and vaginal discharge culture. This makes it possible to obtain reliable information on the vaginal microbiota, to diagnose infections caused by opportunistic microorganisms, and to prescribe goal-directed treatment at the lowest economic costs. Conclusion: The main goal of treatment for mixed vaginitis is to affect aerobic microorganisms by topical application of broad-spectrum bactericidal antibiotics, including those in combination with antifungal agents to eliminate yeast fungi, and to prevent the development of resistance in opportunistic pathogens.

aerobic vaginitis, bacterial vaginosis, mixed vaginitis