Obstetrics and GynecologyObstetrics and GynecologyАкушерство и гинекология0300-90922412-5679Bionika Media24824210.18565/aig.2018.3.150-156ArticlesСтатьиResearch ArticleBacterial vaginosis: pathogenesis, diagnosis, treatment, and preventionБактериальный вагиноз: патогенез, диагностика, лечение и профилактикаPustotinaOlga AnatolievnaПустотинаОльга Анатольевна

Doctor of Medicine, Professor of the department of Obstetrics, Gynecology and Reproductive Health

д.м.н., профессор кафедры акушерства, гинекологии и репродуктивной медицины факультета повышения квалификации медицинских работников

rudn@rudn.ruPeoples' Friendship University of RussiaРоссийского университета дружбы народов150320183NO3 (2018)№3 (2018)15015618022023Copyright ©; 2018, Bionika MediaCopyright ©; 2018, ООО «Бионика Медиа»2018Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/0300-9092/article/view/248242

Objective. To carry out a systematic analysis of scientific researches, international and Russian clinical practice guidelines on bacterial vaginosis (BV). Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on vaginal microbiocenosis in healthy women and in patients with BV, as well as the clinical practice guidelines by the Centers for Disease Control and Prevention (CDC) (2015), the International Union against Sexually Transmitted Infections (IUSTI) (2011), and the Russian Society of Obstetricians and Gynecologists (2016) for the management of BV. Results. BV is characterized by complex vaginal microbiocenotic changes, the basis for which is the replacement of hydrogen peroxide-producing lactobacilli by a large number of predominantly anaerobic bacteria, which is accompanied by watery, cream gray discharge with an amine odor. BV can be diagnosed using Amsel’s criteria. The derivatives of nitroimidazole and lincosamide are drugs of choice for the treatment of BV. There are no universal recommendations for the prevention of its recurrences today, which is due to the multifactorial pattern of causes and to the polymorphism of BV pathogens, therefore alternative agents and methods are being sought for. But despite the large number of scientific publications and constantly updated foreign and Russian clinical practice guidelines, practitioners are often guided by outdated approaches when managing women with complaints of vaginal discharge. Conclusion. The paper analyzes main myths about BV in practitioners and presents an update on its diagnosis, pathogenesis, treatment and prevention.

Цель исследования. Провести систематический анализ научных исследований, международных и отечественных клинических рекомендаций, посвященных бактериальному вагинозу (БВ). Материал и методы. В обзор включены данные зарубежных и отечественных статей, найденных в Pubmed, опубликованных за последние 10 лет, посвященных вагинальному микробиоценозу у здоровых женщин и при БВ, а также клинических рекомендаций CDC (2015), IUSTI (2011) и РОАГ (2016) по ведению женщин с БВ. Результаты. БВ характеризуется комплексными изменениями вагинального микробиоценоза, в основе которых лежит замещение лактобактерий, продуцирующих перекись водорода, большим количеством преимущественно анаэробной микрофлоры, что сопровождается жидкими молочно-серыми выделениями с аминным запахом. Диагноз БВ устанавливается с помощью критериев Амселя. Препаратами выбора для лечения БВ являются производные нитроимидазола и линкозамиды. Универсальных рекомендаций для профилактики рецидивов на сегодняшний день не существует, что связано с мультифакторностью причин и полиморфизмом возбудителей БВ, поэтому проводится поиск альтернативных средств и методов. Но несмотря на большое количество научных публикаций и постоянно обновляемые зарубежные и отечественные клинические рекомендации, практические врачи нередко руководствуются устаревшими подходами при ведении женщин с жалобами на вагинальные выделения. Заключение. В статье проведен анализ основных мифов у практикующих врачей, касающихся БВ, и представлены современные данные о диагностике, патогенезе, лечении и профилактике БВ.

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