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Возможности лечения оппортунистических инфекций влагалища во время беременности
Возможности лечения оппортунистических инфекций влагалища во время беременности
Карапетян Т.Э., Муравьева В.В., Анкирская А.С. и др. Возможности лечения оппортунистических инфекций влагалища во время беременности. Гинекология. 2017; 19 (6): 11–15. DOI: 10.26442/2079-5696_19.6.11-15
19 (6): 11–15. DOI: 10.26442/2079-5696_19.6.11-15
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19 (6): 11–15. DOI: 10.26442/2079-5696_19.6.11-15
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Аннотация
Цель исследования – оценить эффективность лечения женщин с оппортунистическими инфекциями влагалища во время беременности.
Материалы и методы. Проспективное когортное исследование включало 330 беременных, из которых у 151 диагностирован бактериальный вагиноз (БВ), у 37 – аэробный вагинит (АВ), у 109 – кандидозный вульвовагинит (КВ), у 20 – сочетание КВ+БВ. При проведении антибактериальной терапии в ранние сроки беременности соблюдался принцип местного лечения.
Результаты. Чаще всего (46,0%) вагинальные инфекции выявляли при обращении женщин в ранние сроки беременности. При лечении БВ в ранние сроки беременности антисептиком хлоргексидином положительный результат терапии отмечен у 97,6% женщин. Терапия метронидазолом или клиндамицином БВ у женщин, обратившихся во II и III триместрах, дала положительный результат соответственно в 90,0% и 89,5% случаев. Курс терапии хлоргексидином беременных с АВ был эффективным в 91,7% случаев при обращении в I триместре и 92,0% при обращении во II и III триместрах. При лечении КВ в ранние сроки беременности терапия натамицином была эффективной у 95,0% женщин. Во II и III триместрах лечение эконазолом было успешным соответственно у 88,2 и 88,6% беременных. При лечении сочетания БВ+КВ в ранние сроки гестации комплексный курс хлоргексидин + натамицин был эффективным у 76,5% женщин, во II и III триместрах терапия Нео-Пенотраном Форте оказалась эффективной у 93,8% беременных. Рецидивы вагинальных инфекций наблюдали у 34 беременных (10,3%). Суперинфекция грибами отмечена в 9,3% случаев лечения БВ и у 8,1% беременных с АВ. Среди женщин, наблюдавшихся с ранних сроков беременности, не было случаев преждевременных родов, проявления внутриутробных инфекций отмечены у 5,3% новорожденных. При обращении во II и III триместрах преждевременные роды были у 6,5% и 13,5% женщин, а проявления внутриутробных инфекций – у 15,3% новорожденных. Таким образом, микробиологический мониторинг по своевременному выявлению и лечению оппортунистических инфекций влагалища у беременных групп риска показал целесообразность лечения этих инфекций в ранние сроки гестации.
Ключевые слова: беременность, преждевременные роды, бактериальный вагиноз, аэробный вагинит, кандидозный вульвовагинит, оппортунистические инфекции.
Materials and methods. A prospective cohort study included 330 pregnant women, of whom 151 were diagnosed with bacterial vaginosis (BV), 37 had aerobic vaginitis (AB), 109 had vulvovaginal candidiasis (VC), 20 had a combination of VC + BV. When carrying out antibiotic therapy in the early stages of pregnancy, the principle of local treatment was observed.
Results. Most often (46.0%), vaginal infections were detected when women were treated early in pregnancy. In the treatment of BV in the early stages of pregnancy with antiseptic chlorhexidine, a positive result of therapy was noted in 97.6% of women. Therapy with metronidazole or clindamycin BV in women who applied in the II and III trimesters, gave a positive result, respectively, in 90.0% and 89.5% of cases. The course of therapy with chlorhexidine pregnant women with AB was effective in 91.7% of cases with treatment in the first trimester and 92.0% in treatment in the II and III trimesters. In the treatment of VC in early pregnancy, natamycin was effective in 95.0% of women. In the II and III trimesters, econazole treatment was successful in 88.2% and 88.6%, respectively. In the treatment of combination of BV + VC in early gestation, the complex course of chlorhexidine + natamycin was effective in 76.5% of women, in II and III trimesters Neo-Penotran Forte was effective in 93.8% of pregnant women. Relapses of vaginal infections were observed in 34 pregnant women (10.3%). Superinfection with fungi was noted in 9.3% of cases of BV treatment and in 8.1% of pregnant women with AB. Among women observed from early pregnancy, there were no cases of premature birth, manifestations of intrauterine infections were noted in 5.3% of newborns. At treatment in the II and III trimesters, premature birth was in 6.5% and 13.5% of women, and manifestations of intrauterine infections – in 15.3% of newborns. Thus, microbiological monitoring of timely detection and treatment of opportunistic vaginal infections in pregnant at-risk groups showed the advisability of treating these infections in early gestation.
Key words: pregnancy, premature birth, bacterial vaginosis, aerobic vaginitis, candidal vulvovaginitis, opportunistic infections.
Материалы и методы. Проспективное когортное исследование включало 330 беременных, из которых у 151 диагностирован бактериальный вагиноз (БВ), у 37 – аэробный вагинит (АВ), у 109 – кандидозный вульвовагинит (КВ), у 20 – сочетание КВ+БВ. При проведении антибактериальной терапии в ранние сроки беременности соблюдался принцип местного лечения.
Результаты. Чаще всего (46,0%) вагинальные инфекции выявляли при обращении женщин в ранние сроки беременности. При лечении БВ в ранние сроки беременности антисептиком хлоргексидином положительный результат терапии отмечен у 97,6% женщин. Терапия метронидазолом или клиндамицином БВ у женщин, обратившихся во II и III триместрах, дала положительный результат соответственно в 90,0% и 89,5% случаев. Курс терапии хлоргексидином беременных с АВ был эффективным в 91,7% случаев при обращении в I триместре и 92,0% при обращении во II и III триместрах. При лечении КВ в ранние сроки беременности терапия натамицином была эффективной у 95,0% женщин. Во II и III триместрах лечение эконазолом было успешным соответственно у 88,2 и 88,6% беременных. При лечении сочетания БВ+КВ в ранние сроки гестации комплексный курс хлоргексидин + натамицин был эффективным у 76,5% женщин, во II и III триместрах терапия Нео-Пенотраном Форте оказалась эффективной у 93,8% беременных. Рецидивы вагинальных инфекций наблюдали у 34 беременных (10,3%). Суперинфекция грибами отмечена в 9,3% случаев лечения БВ и у 8,1% беременных с АВ. Среди женщин, наблюдавшихся с ранних сроков беременности, не было случаев преждевременных родов, проявления внутриутробных инфекций отмечены у 5,3% новорожденных. При обращении во II и III триместрах преждевременные роды были у 6,5% и 13,5% женщин, а проявления внутриутробных инфекций – у 15,3% новорожденных. Таким образом, микробиологический мониторинг по своевременному выявлению и лечению оппортунистических инфекций влагалища у беременных групп риска показал целесообразность лечения этих инфекций в ранние сроки гестации.
Ключевые слова: беременность, преждевременные роды, бактериальный вагиноз, аэробный вагинит, кандидозный вульвовагинит, оппортунистические инфекции.
________________________________________________
Materials and methods. A prospective cohort study included 330 pregnant women, of whom 151 were diagnosed with bacterial vaginosis (BV), 37 had aerobic vaginitis (AB), 109 had vulvovaginal candidiasis (VC), 20 had a combination of VC + BV. When carrying out antibiotic therapy in the early stages of pregnancy, the principle of local treatment was observed.
Results. Most often (46.0%), vaginal infections were detected when women were treated early in pregnancy. In the treatment of BV in the early stages of pregnancy with antiseptic chlorhexidine, a positive result of therapy was noted in 97.6% of women. Therapy with metronidazole or clindamycin BV in women who applied in the II and III trimesters, gave a positive result, respectively, in 90.0% and 89.5% of cases. The course of therapy with chlorhexidine pregnant women with AB was effective in 91.7% of cases with treatment in the first trimester and 92.0% in treatment in the II and III trimesters. In the treatment of VC in early pregnancy, natamycin was effective in 95.0% of women. In the II and III trimesters, econazole treatment was successful in 88.2% and 88.6%, respectively. In the treatment of combination of BV + VC in early gestation, the complex course of chlorhexidine + natamycin was effective in 76.5% of women, in II and III trimesters Neo-Penotran Forte was effective in 93.8% of pregnant women. Relapses of vaginal infections were observed in 34 pregnant women (10.3%). Superinfection with fungi was noted in 9.3% of cases of BV treatment and in 8.1% of pregnant women with AB. Among women observed from early pregnancy, there were no cases of premature birth, manifestations of intrauterine infections were noted in 5.3% of newborns. At treatment in the II and III trimesters, premature birth was in 6.5% and 13.5% of women, and manifestations of intrauterine infections – in 15.3% of newborns. Thus, microbiological monitoring of timely detection and treatment of opportunistic vaginal infections in pregnant at-risk groups showed the advisability of treating these infections in early gestation.
Key words: pregnancy, premature birth, bacterial vaginosis, aerobic vaginitis, candidal vulvovaginitis, opportunistic infections.
Полный текст
Список литературы
1. Анкирская А.С., Муравьева В.В. Интегральная оценка состояния микробиоты влагалища. Диагностика оппортунистических вагинитов (Медицинская технология). М., 2011. / Ankirskaya A.S., Murav'eva V.V. Integral'naia otsenka sostoianiia mikrobioty vlagalishcha. Diagnostika opportunisticheskikh vaginitov (Meditsinskaia tekhnologiia). M., 2011. [in Russian]
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3. Подгорная А.В., Махмутходжаев А.Ш., Михеенко Г.А., Кох Л.И. Ведение беременных женщин с рецидивирующим бактериальным вагинозом. Соврем. проблемы науки и образования. 2016 (6): 172. / Podgornaya A.V., Makhmutkhodzhaev A.Sh., Mikheenko G.A., Kokh L.I. Vedenie beremennykh zhenshchin s retsidiviruiushchim bakterial'nym vaginozom. Sovrem. problemy nauki i obrazovaniia. 2016 (6): 172. [in Russian]
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5. Aguin T, Akins RA, Sobel JD. High-dose vaginal maintenance metronidazole for recurrent bacterial vaginosis: a pilot study. Sex Transm Dis 2014; 41 (5): 290–1.
6. Amaya-Guio J, Viveros-Carreño DA, Sierra-Barrios EM et al. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2016; 10: CD011701.
7. Beghini J, Giraldo PC, Linhares IM et al. Neutrophil Gelatinase-Associated Lipocalin Concentration in Vaginal Fluid: Relation to Bacterial Vaginosis and Vulvovaginal Candidiasis. Reprod Sci 2015; 22 (8): 964–8.
8. Catallozzi M, Fraiz L, Hargreaves KM et al. Pregnant women's attitudes about topical microbicides for the prevention and treatment of bacterial vaginosis during pregnancy. Int J STD AIDS 2016.
9. Chavoustie SE, Jacobs M, Reisman HA et al. Metronidazole vaginal gel 1.3% in the treatment of bacterial vaginosis: a dose-ranging study. J Low Genit Tract Dis 2015; 19 (2): 129–34.
10. Foxman B, Wen A, Srinivasan U et al. Mycoplasma, bacterial vaginosis-associated bacteria BVAB3, race, and risk of preterm birth in a high-risk cohort. Am J Obstet Gynecol 2014; 210 (3): 226.
11. Haahr T, Ersbøll AS, Karlsen MA et al. Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery – a clinical recommendation. Acta Obstet Gynecol Scand 2016; 95 (8): 850–60.
12. Heczko PB, Tomusiak A, Adamski P et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health 2015; 15: 115.
13. Hilbert DW, Smith WL, Chadwick SG et al. Development and Validation of a Highly Accurate Quantitative Real-Time PCR Assay for Diagnosis of Bacterial Vaginosis. J Clin Microbiol 2016; 54 (4): 1017–24.
14. Liang Q, Li N, Song S et al. High-dose nifuratel for simple and mixed aerobic vaginitis: A single-center prospective open-label cohort stud. J Obstet Gynaecol Res 2016; 42 (10): 1354–60.
15. Liu MB, Xu SR, He Y et al. Diverse vaginal microbiomes in reproductive-age women with vulvovaginal candidiasis. PLoS One 2013; 8(11).
16. Mengistie Z, Woldeamanuel Y, Asrat D, Yigeremu M. Comparison of clinical and gram stain diagnosis methods of bacterial vaginosis among pregnant women in Ethiopia. J Clin Diagn Res 2013; 7 (12): 2701–3.
17. Nasioudis D, Linhares IM, Ledger WJ, Witkin SS. Bacterial vaginosis: a critical analysis of current knowledge. BJOG 2017; 124 (1): 61–9.
18. Nelson DB, Komaroff E, Nachamkin I et al. Relationship of selected bacterial vaginosis-associated bacteria to Nugent score bacterial vaginosis among urban women early in pregnancy. Sex Transm Dis 2013; 40 (9): 721–3.
19. Nelson DB, Hanlon AL, Wu G et al. First Trimester Levels of BV-Associated Bacteria and Risk of Miscarriage Among Women Early in Pregnancy. Matern Child Health J 2015; 19 (12): 2682–7.
20. Singh RH, Zenilman JM, Brown KM et al. The role of physical examination in diagnosing common causes of vaginitis: a prospective study. Sex Transm Infect 2013; 89 (3): 185–90.
21. Sioutas A, Sandström A, Fiala C et al. Effect of bacterial vaginosis on the pharmacokinetics of misoprostol in early pregnancy. Hum Reprod 2012; 27 (2): 388–93.
22. Subramaniam A, Kumar R, Cliver SP et al. Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race. Am J Perinatol 2016; 33 (4): 401–8.
23. Sungkar A, Purwosunu Y, Aziz MF et al. Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate. Int J Gynaecol Obstet 2012; 117 (3): 264–7.
24. Sobel R, Sobel JD. Metronidazole for the treatment of vaginal infections. Expert Opin Pharmacother 2015; 16 (7): 1109–15.
25. Tellapragada C, Eshwara VK, Bhat P et al. Screening of vulvovaginal infections during pregnancy in resource constrained settings: Implications on preterm delivery. J Infect Public Health 2016; 16: 1876.
26. Vieira-Baptista P, Lima-Silva J, Pinto C et al. Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities. Eur J Clin Microbiol Infect Dis 2016; 35 (4): 657–64.
27. Vitali B, Cruciani F, Picone G et al. Vaginal microbiome and metabolome highlight specific signatures of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2015; 34 (12): 2367–76.
28. Wang ZL, Fu LY, Xiong ZA et al. Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes. Taiwan J Obstet Gynecol 2016; 55 (1): 40–4.
29. Xiao B, Niu X, Han N et al. Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora. Sci Rep 2016; 6: 26674.
30. Yang S, Reid G, Challis JR et al. Is there a role for probiotics in the prevention of preterm birth? Front Immunol 2015; 6: 62.
2. Vasil'chenko O.N., Baev O.R. Effektivnost' lecheniia bakterial'nogo vaginoza u beremennykh antiseptikom oktenidina digidrokhlorid. Med. sovet. 2016; 12: 21–23. [in Russian]
3. Podgornaya A.V., Makhmutkhodzhaev A.Sh., Mikheenko G.A., Kokh L.I. Vedenie beremennykh zhenshchin s retsidiviruiushchim bakterial'nym vaginozom. Sovrem. problemy nauki i obrazovaniia. 2016 (6): 172. [in Russian]
4. Uitkin Stiven S. Vaginal'nyi mikrobiom, mekhanizmy antimikrobnoi zashchity vlagalishcha i klinicheskaia problema snizheniia riska prezhdevremennykh rodov, sviazannykh s infitsirovaniem. Akusherstvo i ginekologiia: novosti, mneniia, obuchenie. 2016; 1 (11): 20–6. [in Russian]
5. Aguin T, Akins RA, Sobel JD. High-dose vaginal maintenance metronidazole for recurrent bacterial vaginosis: a pilot study. Sex Transm Dis 2014; 41 (5): 290–1.
6. Amaya-Guio J, Viveros-Carreño DA, Sierra-Barrios EM et al. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2016; 10: CD011701.
7. Beghini J, Giraldo PC, Linhares IM et al. Neutrophil Gelatinase-Associated Lipocalin Concentration in Vaginal Fluid: Relation to Bacterial Vaginosis and Vulvovaginal Candidiasis. Reprod Sci 2015; 22 (8): 964–8.
8. Catallozzi M, Fraiz L, Hargreaves KM et al. Pregnant women's attitudes about topical microbicides for the prevention and treatment of bacterial vaginosis during pregnancy. Int J STD AIDS 2016.
9. Chavoustie SE, Jacobs M, Reisman HA et al. Metronidazole vaginal gel 1.3% in the treatment of bacterial vaginosis: a dose-ranging study. J Low Genit Tract Dis 2015; 19 (2): 129–34.
10. Foxman B, Wen A, Srinivasan U et al. Mycoplasma, bacterial vaginosis-associated bacteria BVAB3, race, and risk of preterm birth in a high-risk cohort. Am J Obstet Gynecol 2014; 210 (3): 226.
11. Haahr T, Ersbøll AS, Karlsen MA et al. Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery – a clinical recommendation. Acta Obstet Gynecol Scand 2016; 95 (8): 850–60.
12. Heczko PB, Tomusiak A, Adamski P et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health 2015; 15: 115.
13. Hilbert DW, Smith WL, Chadwick SG et al. Development and Validation of a Highly Accurate Quantitative Real-Time PCR Assay for Diagnosis of Bacterial Vaginosis. J Clin Microbiol 2016; 54 (4): 1017–24.
14. Liang Q, Li N, Song S et al. High-dose nifuratel for simple and mixed aerobic vaginitis: A single-center prospective open-label cohort stud. J Obstet Gynaecol Res 2016; 42 (10): 1354–60.
15. Liu MB, Xu SR, He Y et al. Diverse vaginal microbiomes in reproductive-age women with vulvovaginal candidiasis. PLoS One 2013; 8(11).
16. Mengistie Z, Woldeamanuel Y, Asrat D, Yigeremu M. Comparison of clinical and gram stain diagnosis methods of bacterial vaginosis among pregnant women in Ethiopia. J Clin Diagn Res 2013; 7 (12): 2701–3.
17. Nasioudis D, Linhares IM, Ledger WJ, Witkin SS. Bacterial vaginosis: a critical analysis of current knowledge. BJOG 2017; 124 (1): 61–9.
18. Nelson DB, Komaroff E, Nachamkin I et al. Relationship of selected bacterial vaginosis-associated bacteria to Nugent score bacterial vaginosis among urban women early in pregnancy. Sex Transm Dis 2013; 40 (9): 721–3.
19. Nelson DB, Hanlon AL, Wu G et al. First Trimester Levels of BV-Associated Bacteria and Risk of Miscarriage Among Women Early in Pregnancy. Matern Child Health J 2015; 19 (12): 2682–7.
20. Singh RH, Zenilman JM, Brown KM et al. The role of physical examination in diagnosing common causes of vaginitis: a prospective study. Sex Transm Infect 2013; 89 (3): 185–90.
21. Sioutas A, Sandström A, Fiala C et al. Effect of bacterial vaginosis on the pharmacokinetics of misoprostol in early pregnancy. Hum Reprod 2012; 27 (2): 388–93.
22. Subramaniam A, Kumar R, Cliver SP et al. Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race. Am J Perinatol 2016; 33 (4): 401–8.
23. Sungkar A, Purwosunu Y, Aziz MF et al. Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate. Int J Gynaecol Obstet 2012; 117 (3): 264–7.
24. Sobel R, Sobel JD. Metronidazole for the treatment of vaginal infections. Expert Opin Pharmacother 2015; 16 (7): 1109–15.
25. Tellapragada C, Eshwara VK, Bhat P et al. Screening of vulvovaginal infections during pregnancy in resource constrained settings: Implications on preterm delivery. J Infect Public Health 2016; 16: 1876.
26. Vieira-Baptista P, Lima-Silva J, Pinto C et al. Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities. Eur J Clin Microbiol Infect Dis 2016; 35 (4): 657–64.
27. Vitali B, Cruciani F, Picone G et al. Vaginal microbiome and metabolome highlight specific signatures of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2015; 34 (12): 2367–76.
28. Wang ZL, Fu LY, Xiong ZA et al. Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes. Taiwan J Obstet Gynecol 2016; 55 (1): 40–4.
29. Xiao B, Niu X, Han N et al. Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora. Sci Rep 2016; 6: 26674.
30. Yang S, Reid G, Challis JR et al. Is there a role for probiotics in the prevention of preterm birth? Front Immunol 2015; 6: 62.
2. Васильченко О.Н., Баев О.Р. Эффективность лечения бактериального вагиноза у беременных антисептиком октенидина дигидрохлорид. Мед. совет. 2016; 12: 21–23. / Vasil'chenko O.N., Baev O.R. Effektivnost' lecheniia bakterial'nogo vaginoza u beremennykh antiseptikom oktenidina digidrokhlorid. Med. sovet. 2016; 12: 21–23. [in Russian]
3. Подгорная А.В., Махмутходжаев А.Ш., Михеенко Г.А., Кох Л.И. Ведение беременных женщин с рецидивирующим бактериальным вагинозом. Соврем. проблемы науки и образования. 2016 (6): 172. / Podgornaya A.V., Makhmutkhodzhaev A.Sh., Mikheenko G.A., Kokh L.I. Vedenie beremennykh zhenshchin s retsidiviruiushchim bakterial'nym vaginozom. Sovrem. problemy nauki i obrazovaniia. 2016 (6): 172. [in Russian]
4. Уиткин Стивен С. Вагинальный микробиом, механизмы антимикробной защиты влагалища и клиническая проблема снижения риска преждевременных родов, связанных с инфицированием. Акушерство и гинекология: новости, мнения, обучение. 2016; 1 (11): 20–6. / Uitkin Stiven S. Vaginal'nyi mikrobiom, mekhanizmy antimikrobnoi zashchity vlagalishcha i klinicheskaia problema snizheniia riska prezhdevremennykh rodov, sviazannykh s infitsirovaniem. Akusherstvo i ginekologiia: novosti, mneniia, obuchenie. 2016; 1 (11): 20–6. [in Russian]
5. Aguin T, Akins RA, Sobel JD. High-dose vaginal maintenance metronidazole for recurrent bacterial vaginosis: a pilot study. Sex Transm Dis 2014; 41 (5): 290–1.
6. Amaya-Guio J, Viveros-Carreño DA, Sierra-Barrios EM et al. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2016; 10: CD011701.
7. Beghini J, Giraldo PC, Linhares IM et al. Neutrophil Gelatinase-Associated Lipocalin Concentration in Vaginal Fluid: Relation to Bacterial Vaginosis and Vulvovaginal Candidiasis. Reprod Sci 2015; 22 (8): 964–8.
8. Catallozzi M, Fraiz L, Hargreaves KM et al. Pregnant women's attitudes about topical microbicides for the prevention and treatment of bacterial vaginosis during pregnancy. Int J STD AIDS 2016.
9. Chavoustie SE, Jacobs M, Reisman HA et al. Metronidazole vaginal gel 1.3% in the treatment of bacterial vaginosis: a dose-ranging study. J Low Genit Tract Dis 2015; 19 (2): 129–34.
10. Foxman B, Wen A, Srinivasan U et al. Mycoplasma, bacterial vaginosis-associated bacteria BVAB3, race, and risk of preterm birth in a high-risk cohort. Am J Obstet Gynecol 2014; 210 (3): 226.
11. Haahr T, Ersbøll AS, Karlsen MA et al. Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery – a clinical recommendation. Acta Obstet Gynecol Scand 2016; 95 (8): 850–60.
12. Heczko PB, Tomusiak A, Adamski P et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health 2015; 15: 115.
13. Hilbert DW, Smith WL, Chadwick SG et al. Development and Validation of a Highly Accurate Quantitative Real-Time PCR Assay for Diagnosis of Bacterial Vaginosis. J Clin Microbiol 2016; 54 (4): 1017–24.
14. Liang Q, Li N, Song S et al. High-dose nifuratel for simple and mixed aerobic vaginitis: A single-center prospective open-label cohort stud. J Obstet Gynaecol Res 2016; 42 (10): 1354–60.
15. Liu MB, Xu SR, He Y et al. Diverse vaginal microbiomes in reproductive-age women with vulvovaginal candidiasis. PLoS One 2013; 8(11).
16. Mengistie Z, Woldeamanuel Y, Asrat D, Yigeremu M. Comparison of clinical and gram stain diagnosis methods of bacterial vaginosis among pregnant women in Ethiopia. J Clin Diagn Res 2013; 7 (12): 2701–3.
17. Nasioudis D, Linhares IM, Ledger WJ, Witkin SS. Bacterial vaginosis: a critical analysis of current knowledge. BJOG 2017; 124 (1): 61–9.
18. Nelson DB, Komaroff E, Nachamkin I et al. Relationship of selected bacterial vaginosis-associated bacteria to Nugent score bacterial vaginosis among urban women early in pregnancy. Sex Transm Dis 2013; 40 (9): 721–3.
19. Nelson DB, Hanlon AL, Wu G et al. First Trimester Levels of BV-Associated Bacteria and Risk of Miscarriage Among Women Early in Pregnancy. Matern Child Health J 2015; 19 (12): 2682–7.
20. Singh RH, Zenilman JM, Brown KM et al. The role of physical examination in diagnosing common causes of vaginitis: a prospective study. Sex Transm Infect 2013; 89 (3): 185–90.
21. Sioutas A, Sandström A, Fiala C et al. Effect of bacterial vaginosis on the pharmacokinetics of misoprostol in early pregnancy. Hum Reprod 2012; 27 (2): 388–93.
22. Subramaniam A, Kumar R, Cliver SP et al. Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race. Am J Perinatol 2016; 33 (4): 401–8.
23. Sungkar A, Purwosunu Y, Aziz MF et al. Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate. Int J Gynaecol Obstet 2012; 117 (3): 264–7.
24. Sobel R, Sobel JD. Metronidazole for the treatment of vaginal infections. Expert Opin Pharmacother 2015; 16 (7): 1109–15.
25. Tellapragada C, Eshwara VK, Bhat P et al. Screening of vulvovaginal infections during pregnancy in resource constrained settings: Implications on preterm delivery. J Infect Public Health 2016; 16: 1876.
26. Vieira-Baptista P, Lima-Silva J, Pinto C et al. Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities. Eur J Clin Microbiol Infect Dis 2016; 35 (4): 657–64.
27. Vitali B, Cruciani F, Picone G et al. Vaginal microbiome and metabolome highlight specific signatures of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2015; 34 (12): 2367–76.
28. Wang ZL, Fu LY, Xiong ZA et al. Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes. Taiwan J Obstet Gynecol 2016; 55 (1): 40–4.
29. Xiao B, Niu X, Han N et al. Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora. Sci Rep 2016; 6: 26674.
30. Yang S, Reid G, Challis JR et al. Is there a role for probiotics in the prevention of preterm birth? Front Immunol 2015; 6: 62.
________________________________________________
2. Vasil'chenko O.N., Baev O.R. Effektivnost' lecheniia bakterial'nogo vaginoza u beremennykh antiseptikom oktenidina digidrokhlorid. Med. sovet. 2016; 12: 21–23. [in Russian]
3. Podgornaya A.V., Makhmutkhodzhaev A.Sh., Mikheenko G.A., Kokh L.I. Vedenie beremennykh zhenshchin s retsidiviruiushchim bakterial'nym vaginozom. Sovrem. problemy nauki i obrazovaniia. 2016 (6): 172. [in Russian]
4. Uitkin Stiven S. Vaginal'nyi mikrobiom, mekhanizmy antimikrobnoi zashchity vlagalishcha i klinicheskaia problema snizheniia riska prezhdevremennykh rodov, sviazannykh s infitsirovaniem. Akusherstvo i ginekologiia: novosti, mneniia, obuchenie. 2016; 1 (11): 20–6. [in Russian]
5. Aguin T, Akins RA, Sobel JD. High-dose vaginal maintenance metronidazole for recurrent bacterial vaginosis: a pilot study. Sex Transm Dis 2014; 41 (5): 290–1.
6. Amaya-Guio J, Viveros-Carreño DA, Sierra-Barrios EM et al. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2016; 10: CD011701.
7. Beghini J, Giraldo PC, Linhares IM et al. Neutrophil Gelatinase-Associated Lipocalin Concentration in Vaginal Fluid: Relation to Bacterial Vaginosis and Vulvovaginal Candidiasis. Reprod Sci 2015; 22 (8): 964–8.
8. Catallozzi M, Fraiz L, Hargreaves KM et al. Pregnant women's attitudes about topical microbicides for the prevention and treatment of bacterial vaginosis during pregnancy. Int J STD AIDS 2016.
9. Chavoustie SE, Jacobs M, Reisman HA et al. Metronidazole vaginal gel 1.3% in the treatment of bacterial vaginosis: a dose-ranging study. J Low Genit Tract Dis 2015; 19 (2): 129–34.
10. Foxman B, Wen A, Srinivasan U et al. Mycoplasma, bacterial vaginosis-associated bacteria BVAB3, race, and risk of preterm birth in a high-risk cohort. Am J Obstet Gynecol 2014; 210 (3): 226.
11. Haahr T, Ersbøll AS, Karlsen MA et al. Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery – a clinical recommendation. Acta Obstet Gynecol Scand 2016; 95 (8): 850–60.
12. Heczko PB, Tomusiak A, Adamski P et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health 2015; 15: 115.
13. Hilbert DW, Smith WL, Chadwick SG et al. Development and Validation of a Highly Accurate Quantitative Real-Time PCR Assay for Diagnosis of Bacterial Vaginosis. J Clin Microbiol 2016; 54 (4): 1017–24.
14. Liang Q, Li N, Song S et al. High-dose nifuratel for simple and mixed aerobic vaginitis: A single-center prospective open-label cohort stud. J Obstet Gynaecol Res 2016; 42 (10): 1354–60.
15. Liu MB, Xu SR, He Y et al. Diverse vaginal microbiomes in reproductive-age women with vulvovaginal candidiasis. PLoS One 2013; 8(11).
16. Mengistie Z, Woldeamanuel Y, Asrat D, Yigeremu M. Comparison of clinical and gram stain diagnosis methods of bacterial vaginosis among pregnant women in Ethiopia. J Clin Diagn Res 2013; 7 (12): 2701–3.
17. Nasioudis D, Linhares IM, Ledger WJ, Witkin SS. Bacterial vaginosis: a critical analysis of current knowledge. BJOG 2017; 124 (1): 61–9.
18. Nelson DB, Komaroff E, Nachamkin I et al. Relationship of selected bacterial vaginosis-associated bacteria to Nugent score bacterial vaginosis among urban women early in pregnancy. Sex Transm Dis 2013; 40 (9): 721–3.
19. Nelson DB, Hanlon AL, Wu G et al. First Trimester Levels of BV-Associated Bacteria and Risk of Miscarriage Among Women Early in Pregnancy. Matern Child Health J 2015; 19 (12): 2682–7.
20. Singh RH, Zenilman JM, Brown KM et al. The role of physical examination in diagnosing common causes of vaginitis: a prospective study. Sex Transm Infect 2013; 89 (3): 185–90.
21. Sioutas A, Sandström A, Fiala C et al. Effect of bacterial vaginosis on the pharmacokinetics of misoprostol in early pregnancy. Hum Reprod 2012; 27 (2): 388–93.
22. Subramaniam A, Kumar R, Cliver SP et al. Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race. Am J Perinatol 2016; 33 (4): 401–8.
23. Sungkar A, Purwosunu Y, Aziz MF et al. Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate. Int J Gynaecol Obstet 2012; 117 (3): 264–7.
24. Sobel R, Sobel JD. Metronidazole for the treatment of vaginal infections. Expert Opin Pharmacother 2015; 16 (7): 1109–15.
25. Tellapragada C, Eshwara VK, Bhat P et al. Screening of vulvovaginal infections during pregnancy in resource constrained settings: Implications on preterm delivery. J Infect Public Health 2016; 16: 1876.
26. Vieira-Baptista P, Lima-Silva J, Pinto C et al. Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities. Eur J Clin Microbiol Infect Dis 2016; 35 (4): 657–64.
27. Vitali B, Cruciani F, Picone G et al. Vaginal microbiome and metabolome highlight specific signatures of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2015; 34 (12): 2367–76.
28. Wang ZL, Fu LY, Xiong ZA et al. Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes. Taiwan J Obstet Gynecol 2016; 55 (1): 40–4.
29. Xiao B, Niu X, Han N et al. Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora. Sci Rep 2016; 6: 26674.
30. Yang S, Reid G, Challis JR et al. Is there a role for probiotics in the prevention of preterm birth? Front Immunol 2015; 6: 62.
Авторы
Т.Э.Карапетян*, В.В.Муравьева, А.С.Анкирская, Л.А.Любасовская, Т.В.Припутневич
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова» Минздрава России. 117997, Россия, Москва, ул. Академика Опарина, д. 4
*tomamed02@mail.ru
V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4
*tomamed02@mail.ru
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова» Минздрава России. 117997, Россия, Москва, ул. Академика Опарина, д. 4
*tomamed02@mail.ru
________________________________________________
V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4
*tomamed02@mail.ru
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