Experience with two-stage therapy in the treatment of patients with bacterial vaginosis: long-term results of treatment

Background. Modern principles of treatment of bacterial vaginosis (BV) include the use of complex two-stage treatment: the first stage of treatment is the eradication of opportunistic microorganisms and anaerobes; the second stage is the restoration of vaginal pH and normal microflora.

Objective. Determination of the effectiveness of different treatments for BV by assessing the composition of the vaginal microbiota.

Methods. A clinical and laboratory examination of 110 women with BV was carried out, a gynecologic history was analyzed, and the features of extragenital pathology were studied. The patients were divided into 3 groups: group I (38 patients) with severe anaerobic dysbiosis (with predominance of Gardnerella vaginalis) received metronidazole 500 mg orally 2 times a day for 7 days; group II (40 patients) with severe anaerobic dysbiosis (with predominance of obligate anaerobes) – clindamycin for 7 days; group III (32 patients) with severe aerobic-anaerobic dysbiosis – chlorhexidine for 7 days. At the 2nd stage of treatment, prebiotics or probiotics were prescribed depending on the initial number of lactobacilli. The effectiveness was evaluated 1, 3 and 6 months after the treatment, as well as upon presentation of complaints.

Results. The present study proved the importance of determining the composition and quantitative ratio of the vaginal microbiota in BV for the selection of differentiated therapy. Two-stage therapy for BV, selected taking into account the molecular biological variants of vaginal dysbiosis, had a stable treatment effect in 87.3% of cases.

Conclusion. The additional use of prebiotics of the oligosaccharide group as an anti-relapse therapy enhances the colonization of lactobacilli and ensures the stability of the vaginal biotope in 95.4% of cases.