Efficiency and acceptability of two-stage therapy for recurrent bacterial vaginosis

Objective: To evaluate the clinical and laboratory efficiency, acceptability, and safety of anti-relapse therapy with a cream containing acidophilic bacteria (Lactobacillus acidophilus), vitamin-mineral protein-peptide complex (Superlimflife) in patients with bacterial vaginosis (BV) Materials and methods: One hundred and sixteen women aged 18 to 49 years with recurrent BV were examined. The diagnosis was based on Amsel’s criteria. After assessing the inclusion and exclusion criteria, 100 women were included in the study. The patients were divided into 2 groups: 1) 50 patients with recurrent BV who were prescribed one-stage therapy; 2) 50patients with recurrent BV who were prescribed two-stage therapy using Acylact DUO cream. The urogenital tract microflora was comprehensively studied using real-time PCR. The expression profiling method was used to evaluate the state of local (mucosal) immunity by the mRNA expression levels of the key immune response genes. The expression level of 8 genes, such as IL-1fi, IL-10, IL-18, TNFa, TLR4, GATA3, CD68, and B2M, was taken into account in the epithelial cell sample, by using the ImmunoQuantex kit. Results: The findings suggest that the number of complaints in the patients who received two-stage therapy at Visit 4, while their recurrence occurred after one-stage therapy. Microscopic examination of vaginal smears by Visit 4 revealed that the predominance of the Lactobacillus spp. morphotype and the absence of key cells were more common in the patients receiving anti-relapse therapy than in those having one-stage therapy (p<0.05). In Group 2 women who received two-stage therapy by Visit 4, the number of lactobacilli in 45 (90%) women corresponded to the normal value, moderate and significant decreases in lactobacilli were found in 2 (4%) and 3 (6%) patients, respectively; while in Group 1 by Visit 4, the normal number of lactobacilli was observed in 22 (44%) women; moderate or significant decrease were seen in 16 (32%) and 12 (24%) patients, respectively. Analyzing the time course of changes in the expression level of proinflammatory and anti-inflammatory cytokines in each of the groups during 4 visits revealed that the women in the two-stage group had a tendency to decrease proinflammatory markers and to increase anti-inflammatory ones (p<0.05). On the contrary, the women having one-stage therapy showed a decrease in the expression level of anti-inflammatory markers and an increase in that of TLR4 and TNFA compared to the screening stage; while the expression level of IL8, IL10, and TLR2decreased (p < 0.05). Conclusion: Two-stage therapy using the Acylact DUO cream enhances the efficiency of antibacterial therapy in combined use due to the normalization of a local immune response, contributes to a more stable restoration of the normal representative ratio for the vaginal microbiota and to a decrease in the rate of the recurrent process.

vaginal microflora, bacterial vaginosis, recurrent BV, probiotics, acidophilic bacteria, Acylact DUO