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Сравнительное контролируемое рандомизированное исследование оценки эффективности двухэтапного лечения бактериального вагиноза
Сравнительное контролируемое рандомизированное исследование оценки эффективности двухэтапного лечения бактериального вагиноза
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Аннотация
Проведено сравнительное исследование эффективности лечения бактериального вагиноза (БВ) с применением препарата Гинофлор Э. Гинофлор Э способствует восстановлению физиологического микробиоценоза влагалища после лечения БВ антисептическими препаратами. Терапевтическая и микробиологическая эффективность препарата Гинофлор Э составила 80,8% сразу после окончания терапии и 72,6% через 2–3 нед после окончания лечения. В группе с применением препарата Гинофлор Э раньше восстанавливаются лактобациллы, в основном Lactobacillus crispatus, и их количество не уменьшается после окончания лечения.
Ключевые слова: бактериальный вагиноз, лечение, Гинофлор Э.
Gynoflor E helps to restore physiological vaginal microbiota after antiseptic treatment of bacterial vaginosis. Gynoflor E’s therapeutic and microbiological efficacy reached 80.8% immediately after the end of therapy and remained at 72.6% level in 2-3 weeks after treatment termination. In patients using the Gynoflor E lactobacilli (mainly Lactobacillus crispatus) have restored at a quicker pace, and their number is not reduced after treatment termination.
Key words: Bacterial vaginosis treatment, Gynoflor E.
Ключевые слова: бактериальный вагиноз, лечение, Гинофлор Э.
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Gynoflor E helps to restore physiological vaginal microbiota after antiseptic treatment of bacterial vaginosis. Gynoflor E’s therapeutic and microbiological efficacy reached 80.8% immediately after the end of therapy and remained at 72.6% level in 2-3 weeks after treatment termination. In patients using the Gynoflor E lactobacilli (mainly Lactobacillus crispatus) have restored at a quicker pace, and their number is not reduced after treatment termination.
Key words: Bacterial vaginosis treatment, Gynoflor E.
Полный текст
Список литературы
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2. Wiesenfeld HC, Hillier SL, Krohn MA et al. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 2003; 36: 663–8.
3. Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of sexually transmitted infection. Am J Obstet Gynecol 2011; 205 (2): 113: e1–6.
4. Cherpes TL, Meyn LA, Krohn MA et al. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis 2003; 37: 319–25.
5. Myer L, Kuhn L, Stein ZA et al. Intravaginal practices, bacterial vaginosis, and women’s susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis 2005; 5: 786–94.
6. Sweet RL. Role of bacterial vaginosis in pelvic inflammatory disease. Clin Infect Dis 1995; 20 (Suppl. 2): S271–5.
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8. Wiesenfeld H, Hillier S, Krohn M et al. Lower genital tract infection and endometritis: Insight into subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456–63.
9. Haggerty CL, Hillier SL, Bass DC, Ness RB. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 2004; 39: 990–5.
10. Ralph SG, Rutherford AJ, Wilson JD. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. BMJ 1999; 319: 220–3.
11. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048–59.
12. Hay PE, Lamont RF, Taylor-Robinson D et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994; 308: 295–8.
13. Kurki T, Sivonen A, Renkonen OV et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173–7.
14. Lamont RF, Taylor-Robinson D, Newman M et al. Spontaneous early preterm labour associated with abnormal genital bacterial colonization. Br J Obstet Gynaecol 1986; 93: 804–10.
15. Hillier SL, Nugent RP, Eschenbach DA et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med 1995; 333: 1737–42.
16. Silver HM, Sperling RS, St Clair PJ, Gibbs RS. Evidence relating bacterial vaginosis to intraamniotic infection. Am J Obstet Gynecol 1989: 161: 808–12.
17. Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59: 1–110.
18. Ведение больных инфекциями, передаваемыми половым путем, и урогенитальными инфекциями – клинические рекомендации. Под ред. Экспертного совета Российского общества дерматовенерологов и косметологов. Председатель А.А. Курбанова. М., 2012.
19. Koumans EH, Sternberg M, Bruce C et al. The prevalence of bacterial vaginosis in the United States, 2001–2004: associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007; 34: 864–9.
20. Li J et al. Importance of vaginal microbes in reproductive health. Reprod Sci 2012; 19 (3): 235–42.
21. Antonio MA, Hawes SE, Hillier SL. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis 1999; 180 (6): 1950–6.
22. Jespers V et al. Quantification of bacterial species of the vaginal microbiome in different groups of women, using nucleic acid amplification tests. BMC Microbiol 2012; 12: 83.
23. Lamont R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
24. Vasquez A et al. Vaginal Lactobacillus flora of healthy Swedish women. J Clin Microbiol 2002; 40 (8): 2746–9.
25. Lamont R, Sobel J, Akins R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
26. Larsson PG, Brandsborg E, Hammarström L. Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses. BMC Infect Dis 2011; 11: 22.
27. http://www2a.cdc.gov/stdtraining/ready-to-use/Manuals/Vaginitis/ vaginitis-slides-2013.pdf
2. Wiesenfeld HC, Hillier SL, Krohn MA et al. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 2003; 36: 663–8.
3. Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of sexually transmitted infection. Am J Obstet Gynecol 2011; 205 (2): 113: e1–6.
4. Cherpes TL, Meyn LA, Krohn MA et al. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis 2003; 37: 319–25.
5. Myer L, Kuhn L, Stein ZA et al. Intravaginal practices, bacterial vaginosis, and women’s susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis 2005; 5: 786–94.
6. Sweet RL. Role of bacterial vaginosis in pelvic inflammatory disease. Clin Infect Dis 1995; 20 (Suppl. 2): S271–5.
7. Hillier SL, Kiviat NB, Hawes SE et al. Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 1996; 175: 435–41.
8. Wiesenfeld H, Hillier S, Krohn M et al. Lower genital tract infection and endometritis: Insight into subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456–63.
9. Haggerty CL, Hillier SL, Bass DC, Ness RB. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 2004; 39: 990–5.
10. Ralph SG, Rutherford AJ, Wilson JD. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. BMJ 1999; 319: 220–3.
11. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048–59.
12. Hay PE, Lamont RF, Taylor-Robinson D et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994; 308: 295–8.
13. Kurki T, Sivonen A, Renkonen OV et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173–7.
14. Lamont RF, Taylor-Robinson D, Newman M et al. Spontaneous early preterm labour associated with abnormal genital bacterial colonization. Br J Obstet Gynaecol 1986; 93: 804–10.
15. Hillier SL, Nugent RP, Eschenbach DA et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med 1995; 333: 1737–42.
16. Silver HM, Sperling RS, St Clair PJ, Gibbs RS. Evidence relating bacterial vaginosis to intraamniotic infection. Am J Obstet Gynecol 1989: 161: 808–12.
17. Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59: 1–110.
18. Ведение больных инфекциями, передаваемыми половым путем, и урогенитальными инфекциями – клинические рекомендации. Под ред. Экспертного совета Российского общества дерматовенерологов и косметологов. Председатель А.А. Курбанова. М., 2012.
19. Koumans EH, Sternberg M, Bruce C et al. The prevalence of bacterial vaginosis in the United States, 2001–2004: associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007; 34: 864–9.
20. Li J et al. Importance of vaginal microbes in reproductive health. Reprod Sci 2012; 19 (3): 235–42.
21. Antonio MA, Hawes SE, Hillier SL. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis 1999; 180 (6): 1950–6.
22. Jespers V et al. Quantification of bacterial species of the vaginal microbiome in different groups of women, using nucleic acid amplification tests. BMC Microbiol 2012; 12: 83.
23. Lamont R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
24. Vasquez A et al. Vaginal Lactobacillus flora of healthy Swedish women. J Clin Microbiol 2002; 40 (8): 2746–9.
25. Lamont R, Sobel J, Akins R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
26. Larsson PG, Brandsborg E, Hammarström L. Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses. BMC Infect Dis 2011; 11: 22.
27. http://www2a.cdc.gov/stdtraining/ready-to-use/Manuals/Vaginitis/ vaginitis-slides-2013.pdf
2. Wiesenfeld HC, Hillier SL, Krohn MA et al. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 2003; 36: 663–8.
3. Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of sexually transmitted infection. Am J Obstet Gynecol 2011; 205 (2): 113: e1–6.
4. Cherpes TL, Meyn LA, Krohn MA et al. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis 2003; 37: 319–25.
5. Myer L, Kuhn L, Stein ZA et al. Intravaginal practices, bacterial vaginosis, and women’s susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis 2005; 5: 786–94.
6. Sweet RL. Role of bacterial vaginosis in pelvic inflammatory disease. Clin Infect Dis 1995; 20 (Suppl. 2): S271–5.
7. Hillier SL, Kiviat NB, Hawes SE et al. Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 1996; 175: 435–41.
8. Wiesenfeld H, Hillier S, Krohn M et al. Lower genital tract infection and endometritis: Insight into subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456–63.
9. Haggerty CL, Hillier SL, Bass DC, Ness RB. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 2004; 39: 990–5.
10. Ralph SG, Rutherford AJ, Wilson JD. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. BMJ 1999; 319: 220–3.
11. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048–59.
12. Hay PE, Lamont RF, Taylor-Robinson D et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994; 308: 295–8.
13. Kurki T, Sivonen A, Renkonen OV et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173–7.
14. Lamont RF, Taylor-Robinson D, Newman M et al. Spontaneous early preterm labour associated with abnormal genital bacterial colonization. Br J Obstet Gynaecol 1986; 93: 804–10.
15. Hillier SL, Nugent RP, Eschenbach DA et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med 1995; 333: 1737–42.
16. Silver HM, Sperling RS, St Clair PJ, Gibbs RS. Evidence relating bacterial vaginosis to intraamniotic infection. Am J Obstet Gynecol 1989: 161: 808–12.
17. Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59: 1–110.
18. Ведение больных инфекциями, передаваемыми половым путем, и урогенитальными инфекциями – клинические рекомендации. Под ред. Экспертного совета Российского общества дерматовенерологов и косметологов. Председатель А.А. Курбанова. М., 2012.
19. Koumans EH, Sternberg M, Bruce C et al. The prevalence of bacterial vaginosis in the United States, 2001–2004: associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007; 34: 864–9.
20. Li J et al. Importance of vaginal microbes in reproductive health. Reprod Sci 2012; 19 (3): 235–42.
21. Antonio MA, Hawes SE, Hillier SL. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis 1999; 180 (6): 1950–6.
22. Jespers V et al. Quantification of bacterial species of the vaginal microbiome in different groups of women, using nucleic acid amplification tests. BMC Microbiol 2012; 12: 83.
23. Lamont R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
24. Vasquez A et al. Vaginal Lactobacillus flora of healthy Swedish women. J Clin Microbiol 2002; 40 (8): 2746–9.
25. Lamont R, Sobel J, Akins R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
26. Larsson PG, Brandsborg E, Hammarström L. Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses. BMC Infect Dis 2011; 11: 22.
27. http://www2a.cdc.gov/stdtraining/ready-to-use/Manuals/Vaginitis/ vaginitis-slides-2013.pdf
________________________________________________
2. Wiesenfeld HC, Hillier SL, Krohn MA et al. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 2003; 36: 663–8.
3. Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of sexually transmitted infection. Am J Obstet Gynecol 2011; 205 (2): 113: e1–6.
4. Cherpes TL, Meyn LA, Krohn MA et al. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis 2003; 37: 319–25.
5. Myer L, Kuhn L, Stein ZA et al. Intravaginal practices, bacterial vaginosis, and women’s susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis 2005; 5: 786–94.
6. Sweet RL. Role of bacterial vaginosis in pelvic inflammatory disease. Clin Infect Dis 1995; 20 (Suppl. 2): S271–5.
7. Hillier SL, Kiviat NB, Hawes SE et al. Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 1996; 175: 435–41.
8. Wiesenfeld H, Hillier S, Krohn M et al. Lower genital tract infection and endometritis: Insight into subclinical pelvic inflammatory disease. Obstet Gynecol 2002; 100: 456–63.
9. Haggerty CL, Hillier SL, Bass DC, Ness RB. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 2004; 39: 990–5.
10. Ralph SG, Rutherford AJ, Wilson JD. Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. BMJ 1999; 319: 220–3.
11. McGregor JA, French JI, Jones W et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol 1994; 170: 1048–59.
12. Hay PE, Lamont RF, Taylor-Robinson D et al. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994; 308: 295–8.
13. Kurki T, Sivonen A, Renkonen OV et al. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol 1992; 80: 173–7.
14. Lamont RF, Taylor-Robinson D, Newman M et al. Spontaneous early preterm labour associated with abnormal genital bacterial colonization. Br J Obstet Gynaecol 1986; 93: 804–10.
15. Hillier SL, Nugent RP, Eschenbach DA et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med 1995; 333: 1737–42.
16. Silver HM, Sperling RS, St Clair PJ, Gibbs RS. Evidence relating bacterial vaginosis to intraamniotic infection. Am J Obstet Gynecol 1989: 161: 808–12.
17. Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59: 1–110.
18. Ведение больных инфекциями, передаваемыми половым путем, и урогенитальными инфекциями – клинические рекомендации. Под ред. Экспертного совета Российского общества дерматовенерологов и косметологов. Председатель А.А. Курбанова. М., 2012.
19. Koumans EH, Sternberg M, Bruce C et al. The prevalence of bacterial vaginosis in the United States, 2001–2004: associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007; 34: 864–9.
20. Li J et al. Importance of vaginal microbes in reproductive health. Reprod Sci 2012; 19 (3): 235–42.
21. Antonio MA, Hawes SE, Hillier SL. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis 1999; 180 (6): 1950–6.
22. Jespers V et al. Quantification of bacterial species of the vaginal microbiome in different groups of women, using nucleic acid amplification tests. BMC Microbiol 2012; 12: 83.
23. Lamont R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
24. Vasquez A et al. Vaginal Lactobacillus flora of healthy Swedish women. J Clin Microbiol 2002; 40 (8): 2746–9.
25. Lamont R, Sobel J, Akins R et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011; 118: 533–49.
26. Larsson PG, Brandsborg E, Hammarström L. Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses. BMC Infect Dis 2011; 11: 22.
27. http://www2a.cdc.gov/stdtraining/ready-to-use/Manuals/Vaginitis/ vaginitis-slides-2013.pdf
Авторы
А.М.Савичева1, К.В.Шалепо1, В.В.Назарова1, Ю.Н.Менухова2
1. ФГБУ Научно-исследовательский институт акушерства и гинекологии им. Д.О.Отта СЗО РАМН, Санкт-Петербург;
2. Женская консультация №34 СПб ГУЗ Городская поликлиника №34
1. ФГБУ Научно-исследовательский институт акушерства и гинекологии им. Д.О.Отта СЗО РАМН, Санкт-Петербург;
2. Женская консультация №34 СПб ГУЗ Городская поликлиника №34
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