Современные представления о бактериальном вагинозе

Хрянин А.А., Кнорринг Г.Ю. Современные представления о бактериальном вагинозе. Гинекология. 2021; 23 (1): 37–42. DOI: 10.26442/20795696.2021.1.200680

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Khryanin A.A., Knorring G.Yu. Modern understanding of bacterial vaginosis. Gynecology. 2021; 23 (1): 37–42.
DOI: 10.26442/20795696.2021.1.200680

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Аннотация

Бактериальный вагиноз (БВ) – это инфекционный невоспалительный синдром, характеризующийся заменой обычной микрофлоры на полимикробные ассоциации анаэробов и Gardnerella vaginalis. Обзор посвящен актуальным вопросам этого заболевания, включая патогенез, клинические проявления и подходы к лабораторной диагностике. Обсуждаются дискуссионные вопросы, связанные с возможностью передачи возбудителя БВ половым путем. Особое внимание уделяется факторам, обусловливающим развитие БВ. Приводятся классические представления о диагностических критериях диагноза. Наряду с этим авторы обсуждают современные аспекты, касающиеся проблемы формирования биопленок микроорганизмов. БВ не характеризуется наличием определенного микроорганизма, а является результатом образования бактериальной биопленки на эпителии влагалища или крайней плоти. Основным компонентом этой биопленки является G. vaginalis. Причиной БВ является полимикробная гарднереллезная биопленка, все компоненты которой переносятся целиком (например, при помощи ключевых клеток) только во время сексуального контакта. В связи с этим в статье обсуждается возможность использования нового термина – «биопленочный вагиноз», который более точно отражает суть данной проблемы. Представлены современные возможности лечения БВ. Применение комбинированной локальной терапии БВ и неспецифических воспалительных процессов вульвовагинальной зоны становится особенно актуальным на современном этапе. Использование локального комбинированного препарата (Гайномакс) с максимально широким спектром действия позволяет врачам добиваться быстрого купирования симптомов и высокой эффективности терапии.

Ключевые слова: бактериальный вагиноз, вагиниты, биопленки, Gardnerella vaginalis, биоценоз, тинидазол, тиоконазол

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Bacterial vaginosis is an infectious non-inflammatory syndrome characterized by the replacement of the usual microflora by the polymicrobial associations of anaerobes and Gardnerella vaginalis. The review is devoted to current issues of this disease, including pathogenesis, clinical manifestations and approaches to laboratory diagnostics. Discussion issues of this disease related to the possibility of sexual transmission are discussed. Particular attention is paid to the factors causing the development of bacterial vaginosis. The classical concepts of diagnostic criteria for diagnosis are presented. Bacterial vaginosis is not characterized by the presence of a specific microorganism, but is the result of the formation of a bacterial biofilm on the epithelium of the vagina or foreskin. The main component of this biofilm is G. vaginalis. Bacterial vaginosis is caused by polymicrobial gardnerella biofilm, which can only be transferred as a whole (for example, with the help of key cells) only during sexual intercourse. Along with this, the authors discuss modern aspects related to the problem of microbial biofilm formation. In this regard, the authors propose to use a new term – "biofilm vaginosis", which more accurately reflects the essence of this problem. The modern possibilities of treating bacterial vaginosis are presented. The use of combined local therapy of nonspecific inflammatory processes of the vulvovaginal zone is becoming especially relevant at the present stage. The use of a local combination drug (Gainomax) with the widest possible spectrum of action allows doctors to achieve rapid relief of symptoms and high efficiency of therapy.

Keywords: bacterial vaginosis, vaginitis, biofilms, Gardnerella vaginalis, biocenosis, tinidazole, thioconazole

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Список литературы

1. Серов В.Н., Сухих Г.Т. Клинические рекомендации. Акушерство и гинекология. 4-е изд. М.: ГЕОТАР-Медиа, 2014 [Serov V.N., Sukhikh G.T. Clinical guidelines. Obstetrics and gynecology. 4th Ed. Moscow: GEOTAR-Media, 2014 (in Russian)].
2. Радзинский В.Е. Акушерская агрессия v.2.0. M.: Медиабюро Статус презенс, 2016 [Radzinsky V.E. Obstetric aggression v.2.0. Moscow: Mediabiuro Status prezens, 2016 (in Russian)].
3. Роговская С.И., Липова Е.В. Шейка матки, влагалище, вульва. Физиология, патология, кольпоскопия, эстетическая коррекция. Руководство для практикующих врачей. М.: Status Praesens, 2014 [Rogovskaia S.I., Lipova E.V. Cervix, vagina, vulva. Physiology, pathology, colposcopy, aesthetic correction.
A guide for medical practitioners. Moscow: Status Praesens, 2014 (in Russian)].
4. Хрянин А.А., Решетников О.В. Бактериальный вагиноз. Новая парадигма. Акушерство и гинекология. 2016; 4: 130–6 [Khrianin A.A., Reshetnikov O.V. Bakterial'nyi vaginoz. Novaia paradigma. Akusherstvo i ginekologiia. 2016; 4: 130–6 (in Russian)].
5. Хрянин А.А., Решетников О.В. Бактериальный вагиноз: новые перспективы в лечении. Клиническая дерматология и венерология. 2011; 2: 76–80 [Khrianin A.A., Reshetnikov O.V. Bakterial'nyi vaginoz: novye perspektivy v lechenii. Klinicheskaia dermatologiia i venerologiia. 2011; 2: 76–80 (in Russian)].
6. Липова Е.В., Радзинский В.Е. Бактериальный вагиноз: всегда дискуссии. Status Praesens. 2012; 7: 27–34 [Lipova E.V., Radzinskii V.E. Bakterial'nyi vaginoz: vsegda diskussii. Status Praesens. 2012; 7: 27–34 (in Russian)].
7. Gillet E, Meys JF, Verstraelen H, et al. Association between bacterial vaginosis and cervical intraepithelial neoplasia: Systematic review and meta-analysis. PLoS One 2012; 7 (10): e45201.
8. Muzny CA, Schwebke JR. Gardnerella vaginalis: still a prime suspect in the pathogenesis of bacterial vaginosis. Curr Infect Dis Rep 2013; 15: 130–5. DOI: 10.1007/s11908-013-0318-4
9. Хрянин А.А., Решетников О.В. Бактериальный вагиноз: новые представления о микробном биосоциуме и возможности лечения. Медицинский совет. 2011; 17: 128–33 [Khrianin A.A., Reshetnikov O.V. Bakterial'nyi vaginoz: novye predstavleniia o mikrobnom biosotsiume i vozmozhnosti lecheniia. Meditsinskii sovet. 2011; 17: 128–33 (in Russian)].
10. Макаров И.О., Гомберг М.А., Боровкова Е.И. и др. Бактериальный вагиноз: состояние изученности проблемы. Акушерство, гинекология, репродукция. 2013; 7 (4): 20–4 [Makarov I.O., Gomberg M.A., Borovkova E.I., et al. Bacterial vaginosis: the state of knowledge of the problem. Akusherstvo, ginekologiya, reproduktsiya. 2013; 7 (4): 20–4 (in Russian)].
11. Липова Е.В. Дискуссионные вопросы бактериального вагиноза: взгляд дерматовенеролога. Доктор.Ру. 2015; 1 (102): 30–4 [Lipova E.V. Diskussionnye voprosy bakterial'nogo vaginoza: vzgliad dermatovenerologa. Doktor.Ru. 2015; 1 (102): 30–4 (in Russian)].
12. Muzny CA, Schwebke JR. Suspected heterosexual transmission of bacterial vaginosis without seminal fluid exposure. Sex Transm Dis 2014; 41: 58–60.
13. Гомберг М.А., Ким Д.Г., Гущин А.Е. Клинические особенности негонококкового уретрита у мужчин, ассоциированного с наличием бактериального вагиноза у их половых партнерш. Клиническая дерматология и венерология. 2020; 19 (6): 836–45 [Gomberg M.A., Kim D.G., Guschin A.E. Clinical features of nongonococcal urethritis in men associated with the presence of bacterial vaginosis in their sexual partners. Rus J Clin Dermatol Venereol. 2020; 19 (6): 836–45 (in Russian)]. DOI: 10.17116/klinderma202019061836
14. Swidsinski А, Doerffel Y, Loening-Baucke V, et al. Gardnerella Biofilm Involves Females and Males and Is Transmitted Sexually. Gynecol Obstet Invest 2010; 70: 256–63. DOI: 10.1159/000314015
15. Landlinger C, Tisakova L, Oberbauer V, et al. Engineered Phage Endolysin Eliminates Gardnerella Biofilm Without Damaging Beneficial Bacteria in Bacterial Vaginosis Ex Vivo. Pathogens 2021; 10: 54. DOI: 10.3390/pathogens10010054
16. Patterson JL, Stull-Lane A, Giererd PH, Jefferson KK. Analysis of adherence, biofilm formation and cytotoxicity suggests a greater virulence potential of Gardnerella vaginalis relative to other bacterial-vaginosis – associated anaerobes. Microbiology 2010; 156: 392–9.
17. Paul M, Leibovici L. Combination antimicrobial treatment versus monotherapy: the contribution of meta-analyses. Infect Dis Clin North Am 2009; 23 (2): 277–93.
DOI: org/10.1016/j.idc.2009.01.004
18. Хрянин А.А., Кнорринг Г.Ю. Современные представления о биопленках микроорганизмов. Фарматека. 2020; 6: 34–42 [Khryanin A.A., Knorring G.Yu. Modern concepts of microbial biofilms. Pharmateca. 2020; 6: 34–42 (in Russian)].
19. Савичева А.М., Тапильская Н.И., Шипицына Е.В., Воробьева Н.Е. Бактериальный вагиноз и аэробный вагинит как
основные нарушения баланса вагинальной микрофлоры. Особенности диагностики и терапии. Акушерство и гинекология. 2017; 5: 24–31 [Savicheva A.M., Tapil'skaia N.I., Shipitsyna E.V., Vorob'eva N.E. Bakterial'nyi vaginoz i aerobnyi vaginit kak osnovnye narusheniia balansa vaginal'noi mikroflory. Osobennosti diagnostiki i terapii. Akusherstvo i ginekologiia. 2017; 5: 24–31 (in Russian)].
20. Sexually Transmitted Diseases Treatment Guidelines. 2015. Available at: www.cdc.gov. Accessed: 25.01.2021.
21. 2018 European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge. Available at: http://www.iusti.org/regions/europe/pdf/2018/IUSTIvaginalDischargeGuidelines2018.pdf. Accessed: 25.01.2021.
22. Клинические рекомендации по диагностике и лечению заболеваний, сопровождающихся патологическими выделениями из половых путей женщин. М.: РОАГ, 2015 [Clinical guidelines for the diagnosis and treatment of diseases accompanied by pathological discharge from the genital tract of women. Moscow: ROAG, 2015 (in Russian)].
23. Phillips NA. Recurrent Bacterial Vaginosis: A Recurrent Clinical Dilemma. J Womens Health (Larchmt) 2019; 28 (9): 1179. DOI: 10.1089/jwh.2019.7969
24. Tomás M, Palmeira-de-Oliveira A, Simões S, et al. Bacterial vaginosis: Standard treatments and alternative strategies. Int J Pharm 2020; 587: 119659. DOI: 10.1016/j.ijpharm.2020.119659
25. Schwebke JR, Desmond RA. Tinidazole versus Metronidazole for the Treatment of Bacterial Vaginosis. Am J Obstet Gynecol 2011; 204 (3): 211.e1–6. DOI: 10.1016/j.ajog.2010.10.898
26. Духанин А.С., Семиошина О.Е. Рациональный выбор вагинального препарата: роль лекарственной формы. РМЖ. Мать и дитя. 2019; 2 (4): 314–20 [Dukhanin A.S., Semioshina O.E. Rational choice of vaginal drug formulation. Rus J Wom Child Health. 2019; 2 (4): 314–20 (in Russian)]. DOI: 10.32364/2618-8430-2019-2-4-314-32036
27. Paul M, Leibovici L. Combination antimicrobial treatment versus monotherapy: the contribution of meta-analyses. Infect Dis Clin North Am 2009; 23 (2): 277–93. DOI: org/10.1016/j.idc.2009.01.004
28. Вагинальные инфекции вне и во время беременности. Взгляд гинеколога, дерматовенеролога и акушера. III конгресс «Дискуссионные вопросы современного акушерства», 2015 [Vaginal infections outside and during pregnancy. View of a gynecologist, dermatovenerologist and obstetrician. III Congress “Discussion issues of modern obstetrics”, 2015 (in Russian)].
29. Федеральные клинические рекомендации. Диагностика и лечение заболеваний, сопровождающихся патологическими выделениями из половых путей женщин. М.: РОАГ, 2019 [Federal clinical guidelines. Diagnosis and treatment of diseases accompanied by pathological discharge from the genital tract of women. Moscow: ROAG, 2019 (in Russian)].
30. Farah CH, D’Elia E, Trabulsi LR. Use of tinidazole/tioconazole combination in the treatment of vaginal infections caused by Trichomonas, Gardnerella vaginalis or Candida albicans. J Bras Ginecol. 1987; 97 (1–2): 43–7.
31. Leitzke G, Focchi J, Reitzfeld G, et al. Open non-comparative study of Tioconazole/Tinidazole vaginal cream in the treatment of vaginal infections due to Trichomonas vaginalis, Candida albicans and or Gardnerella vaginalis. J Bras Ginecol 1989; 99 (7): 303–7.
32. Cagayan S, Bravo SL, Fallarme A. Randomized, single-blind, one-centre trial comparing the efficacy, safety and acceptability of 3-day versus 7-day treatment of Gynomax (150 mg tinidazole/100 mg tioconazole) vaginal ovules in vaginitis treatment. In: The 3rd Asia Pacific Congress on Controversies in Obstetrics Gynecology & Infertility. Beijing, China. November 12–15, 2009.
33. Каткова Н.Ю., Гусева О.И., Качалина О.В. и др. Лечение вагинитов при беременности. Акушерство и гинекология. 2020; 4: 190–4 [Katkova N.Yu., Guseva O.I., Kachalina O.V., et al. Treatment of vaginitis during pregnancy. Obstetrics and gynecology. 2020; 4: 190–4 (in Russian)]. DOI: 10.18565/aig.2020.4
34. Волков В.Г., Захарова Т.В. Оптимизация предоперационной подготовки женщин с цервикальными неоплазиями высокой степени. РМЖ. Мать и дитя. 2019; 2 (3): 243–6 [Volkov V.G., Zakharova T.V. Improving preoperative management of women with high-grade cervical intraepithelial neoplasia. Rus J Wom Child Health. 2019; 2 (3): 243–6 (in Russian)].
35. Beggs WH. Fungicidal activity of tioconazole in relation to growth phase of Candida abicans and Candida parapsilosis. Antimicrob Agents Chemother 1984; 26: 699–701.
36. Lefler E, Stevens DA. Inhibition and killing of Candida albicans in vitro by five imidazoles in clinical use. Antimicrob Agents Chemother 1984; 25: 450–4.
37. Sud IJ, Feingold DS. Heterogeneity of action of mechanisms among antimycotic imidazoles. Antimicrob Agents Chemother 1981; 20 (1): 71–4.
38. Marriot MS, Brammer KW, Faccini J, et al. Tioconazole, a new broad-spectrum antifungal agent: Preclinical studies related to vaginal candidiasis. Gynak Rdsch 1983; 23 (1): 1–11.
39. Jevons S, Gymer GE, Brammer KW, et al. Antifungal activity of tioconazole (UK-20,349), a new imidazole derivative. Antimicrob Agents Chemother 1979; 15: 597–602.
40. Henderson JT, Neilson W, Wilson AB, et al. Tioconazole in the treatment of vaginal candidiasis. Gynäkologisch-geburtshilfliche Rundschau 1983; 23 (1): 42–60.
41. Raja IM, Basavareddy A, Mukherjee D, et al. Randomized, double-blind, comparative study of oral metronidazole and tinidazole in treatment of bacterial vaginosis. Indian J Pharmacol 2016; 48 (6): 654–8.
42. Donders GGG, Zodzika J, Rezeberga D. Treatment of bacterial vaginosis: what we have and what we miss. Exp Opin Pharmacother 2014; 15 (5): 645–57.
43. Nailor MD, Sobel JD. Tinidazole for bacterial vaginosis. Expert Rev Anti Infect Ther 2007; 5: 343–8.
44. Macklaim JM, Clemente JC, Knight R, et al. Changes in vaginal microbiota following antimicrobial and probiotic therapy. Microb Ecol Health Dis 2015; 26: 27799. DOI: 10.3402/mehd.v26.27799
45. Kovachev S, Vatcheva-Dobrevski R. Efficacy of combined 5-nitroimidazole and probiotic therapy of bacterial vaginosis: randomized open trial. Akush Ginekol (Sofiia) 2013; 52 (3): 19–26.
46. Торшин И.Ю., Аполихина И.А., Баранов И.И. и др. Эффективность и безопасность комбинации тинидазола и тиоконазола в лечении вагинальных инфекций. Акушерство и гинекология. 2020; 4: 214–22 [Torshin I.Yu., Apolikhina I.A., Baranov I.I., et al. The efficacy and safety of a combination of tinidazole and thioconazole in the treatment of vaginal infections. Akusherstvo i ginekologiya. 2020; 4: 214–22 (In Russian)]. DOI: 10.18565/aig.2020.4.214-222
47. Исследование «Оценка приверженности терапии гинекологических инфекций». М.: Romir, 2020 [Study “Evaluation of adherence to therapy for gynecological infections”. Moscow: Romir, 2020 (in Russian)].

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1. Serov V.N., Sukhikh G.T. Clinical guidelines. Obstetrics and gynecology. 4th Ed. Moscow: GEOTAR-Media, 2014 (in Russian)].
2. Radzinsky V.E. Obstetric aggression v.2.0. Moscow: Mediabiuro Status prezens, 2016 (in Russian)
3. Rogovskaia S.I., Lipova E.V. Cervix, vagina, vulva. Physiology, pathology, colposcopy, aesthetic correction. A guide for medical practitioners. Moscow: Status Praesens, 2014 (in Russian)
4. Khrianin A.A., Reshetnikov O.V. Bakterial'nyi vaginoz. Novaia paradigma. Akusherstvo i ginekologiia. 2016; 4: 130–6 (in Russian)
5. Khrianin A.A., Reshetnikov O.V. Bakterial'nyi vaginoz: novye perspektivy v lechenii. Klinicheskaia dermatologiia i venerologiia. 2011; 2: 76–80 (in Russian)].
6. Lipova E.V., Radzinskii V.E. Bakterial'nyi vaginoz: vsegda diskussii. Status Praesens. 2012; 7: 27–34 (in Russian)
7. Gillet E, Meys JF, Verstraelen H, et al. Association between bacterial vaginosis and cervical intraepithelial neoplasia: Systematic review and meta-analysis. PLoS One 2012; 7 (10): e45201.
8. Muzny CA, Schwebke JR. Gardnerella vaginalis: still a prime suspect in the pathogenesis of bacterial vaginosis. Curr Infect Dis Rep 2013; 15: 130–5. DOI: 10.1007/s11908-013-0318-4
9. Khrianin A.A., Reshetnikov O.V. Bakterial'nyi vaginoz: novye predstavleniia o mikrobnom biosotsiume i vozmozhnosti lecheniia. Meditsinskii sovet. 2011; 17: 128–33 (in Russian)
10. Makarov I.O., Gomberg M.A., Borovkova E.I., et al. Bacterial vaginosis: the state of knowledge of the problem. Akusherstvo, ginekologiya, reproduktsiya. 2013; 7 (4): 20–4 (in Russian)
11. Lipova E.V. Diskussionnye voprosy bakterial'nogo vaginoza: vzgliad dermatovenerologa. Doktor.Ru. 2015; 1 (102): 30–4 (in Russian)
12. Muzny CA, Schwebke JR. Suspected heterosexual transmission of bacterial vaginosis without seminal fluid exposure. Sex Transm Dis 2014; 41: 58–60.
13. Gomberg M.A., Kim D.G., Guschin A.E. Clinical features of nongonococcal urethritis in men associated with the presence of bacterial vaginosis in their sexual partners. Rus J Clin Dermatol Venereol. 2020; 19 (6): 836–45 (in Russian) DOI: 10.17116/klinderma202019061836
14. Swidsinski А, Doerffel Y, Loening-Baucke V, et al. Gardnerella Biofilm Involves Females and Males and Is Transmitted Sexually. Gynecol Obstet Invest 2010; 70: 256–63. DOI: 10.1159/000314015
15. Landlinger C, Tisakova L, Oberbauer V, et al. Engineered Phage Endolysin Eliminates Gardnerella Biofilm Without Damaging Beneficial Bacteria in Bacterial Vaginosis Ex Vivo. Pathogens 2021; 10: 54. DOI: 10.3390/pathogens10010054
16. Patterson JL, Stull-Lane A, Giererd PH, Jefferson KK. Analysis of adherence, biofilm formation and cytotoxicity suggests a greater virulence potential of Gardnerella vaginalis relative to other bacterial-vaginosis – associated anaerobes. Microbiology 2010; 156: 392–9.
17. Paul M, Leibovici L. Combination antimicrobial treatment versus monotherapy: the contribution of meta-analyses. Infect Dis Clin North Am 2009; 23 (2): 277–93.
DOI: org/10.1016/j.idc.2009.01.004
18. Khryanin A.A., Knorring G.Yu. Modern concepts of microbial biofilms. Pharmateca. 2020; 6: 34–42 (in Russian)
19. Savicheva A.M., Tapil'skaia N.I., Shipitsyna E.V., Vorob'eva N.E. Bakterial'nyi vaginoz i aerobnyi vaginit kak osnovnye narusheniia balansa vaginal'noi mikroflory. Osobennosti diagnostiki i terapii. Akusherstvo i ginekologiia. 2017; 5: 24–31 (in Russian)
20. Sexually Transmitted Diseases Treatment Guidelines. 2015. Available at: www.cdc.gov. Accessed: 25.01.2021.
21. 2018 European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge. Available at: http://www.iusti.org/regions/europe/pdf/2018/IUSTIvaginalDischargeGuidelines2018.pdf. Accessed: 25.01.2021.
22. Clinical guidelines for the diagnosis and treatment of diseases accompanied by pathological discharge from the genital tract of women. Moscow: ROAG, 2015 (in Russian)
23. Phillips NA. Recurrent Bacterial Vaginosis: A Recurrent Clinical Dilemma. J Womens Health (Larchmt) 2019; 28 (9): 1179. DOI: 10.1089/jwh.2019.7969
24. Tomás M, Palmeira-de-Oliveira A, Simões S, et al. Bacterial vaginosis: Standard treatments and alternative strategies. Int J Pharm 2020; 587: 119659. DOI: 10.1016/j.ijpharm.2020.119659
25. Schwebke JR, Desmond RA. Tinidazole versus Metronidazole for the Treatment of Bacterial Vaginosis. Am J Obstet Gynecol 2011; 204 (3): 211.e1–6. DOI: 10.1016/j.ajog.2010.10.898
26. Dukhanin A.S., Semioshina O.E. Rational choice of vaginal drug formulation. Rus J Wom Child Health. 2019; 2 (4): 314–20 (in Russian)
DOI: 10.32364/2618-8430-2019-2-4-314-32036
27. Paul M, Leibovici L. Combination antimicrobial treatment versus monotherapy: the contribution of meta-analyses. Infect Dis Clin North Am 2009; 23 (2): 277–93. DOI: org/10.1016/j.idc.2009.01.004
28. Vaginal infections outside and during pregnancy. View of a gynecologist, dermatovenerologist and obstetrician. III Congress “Discussion issues of modern obstetrics”, 2015 (in Russian)
29. Federal clinical guidelines. Diagnosis and treatment of diseases accompanied by pathological discharge from the genital tract of women. Moscow: ROAG, 2019 (in Russian)
30. Farah CH, D’Elia E, Trabulsi LR. Use of tinidazole/tioconazole combination in the treatment of vaginal infections caused by Trichomonas, Gardnerella vaginalis or Candida albicans. J Bras Ginecol. 1987; 97 (1–2): 43–7.
31. Leitzke G, Focchi J, Reitzfeld G, et al. Open non-comparative study of Tioconazole/Tinidazole vaginal cream in the treatment of vaginal infections due to Trichomonas vaginalis, Candida albicans and or Gardnerella vaginalis. J Bras Ginecol 1989; 99 (7): 303–7.
32. Cagayan S, Bravo SL, Fallarme A. Randomized, single-blind, one-centre trial comparing the efficacy, safety and acceptability of 3-day versus 7-day treatment of Gynomax (150 mg tinidazole/100 mg tioconazole) vaginal ovules in vaginitis treatment. In: The 3rd Asia Pacific Congress on Controversies in Obstetrics Gynecology & Infertility. Beijing, China. November 12–15, 2009.
33. Katkova N.Yu., Guseva O.I., Kachalina O.V., et al. Treatment of vaginitis during pregnancy. Obstetrics and gynecology. 2020; 4: 190–4 (in Russian) DOI: 10.18565/aig.2020.4
34. Volkov V.G., Zakharova T.V. Improving preoperative management of women with high-grade cervical intraepithelial neoplasia. Rus J Wom Child Health. 2019; 2 (3): 243–6 (in Russian)
35. Beggs WH. Fungicidal activity of tioconazole in relation to growth phase of Candida abicans and Candida parapsilosis. Antimicrob Agents Chemother 1984; 26: 699–701.
36. Lefler E, Stevens DA. Inhibition and killing of Candida albicans in vitro by five imidazoles in clinical use. Antimicrob Agents Chemother 1984; 25: 450–4.
37. Sud IJ, Feingold DS. Heterogeneity of action of mechanisms among antimycotic imidazoles. Antimicrob Agents Chemother 1981; 20 (1): 71–4.
38. Marriot MS, Brammer KW, Faccini J, et al. Tioconazole, a new broad-spectrum antifungal agent: Preclinical studies related to vaginal candidiasis. Gynak Rdsch 1983; 23 (1): 1–11.
39. Jevons S, Gymer GE, Brammer KW, et al. Antifungal activity of tioconazole (UK-20,349), a new imidazole derivative. Antimicrob Agents Chemother 1979; 15: 597–602.
40. Henderson JT, Neilson W, Wilson AB, et al. Tioconazole in the treatment of vaginal candidiasis. Gynäkologisch-geburtshilfliche Rundschau 1983; 23 (1): 42–60.
41. Raja IM, Basavareddy A, Mukherjee D, et al. Randomized, double-blind, comparative study of oral metronidazole and tinidazole in treatment of bacterial vaginosis. Indian J Pharmacol 2016; 48 (6): 654–8.
42. Donders GGG, Zodzika J, Rezeberga D. Treatment of bacterial vaginosis: what we have and what we miss. Exp Opin Pharmacother 2014; 15 (5): 645–57.
43. Nailor MD, Sobel JD. Tinidazole for bacterial vaginosis. Expert Rev Anti Infect Ther 2007; 5: 343–8.
44. Macklaim JM, Clemente JC, Knight R, et al. Changes in vaginal microbiota following antimicrobial and probiotic therapy. Microb Ecol Health Dis 2015; 26: 27799. DOI: 10.3402/mehd.v26.27799
45. Kovachev S, Vatcheva-Dobrevski R. Efficacy of combined 5-nitroimidazole and probiotic therapy of bacterial vaginosis: randomized open trial. Akush Ginekol (Sofiia) 2013; 52 (3): 19–26.
46. Torshin I.Yu., Apolikhina I.A., Baranov I.I., et al. The efficacy and safety of a combination of tinidazole and thioconazole in the treatment of vaginal infections. Akusherstvo i ginekologiya. 2020; 4: 214–22 (In Russian) DOI: 10.18565/aig.2020.4.214-222
47. Study “Evaluation of adherence to therapy for gynecological infections”. Moscow: Romir, 2020 (in Russian)

Авторы

А.А. Хрянин*1,2, Г.Ю. Кнорринг3

1 ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России, Новосибирск, Россия;
2 РОО «Ассоциация акушеров-гинекологов и дерматовенерологов», Новосибирск, Россия;
3 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*khryanin@mail.ru

________________________________________________

Aleksey A. Khryanin*1,2, German Yu. Knorring3

1 Novosibirsk State Medical University, Novosibirsk, Russia;
2 Association of Obstetrician-Gynecologists and Dermatologists, Novosibirsk, Russia;
3 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*khryanin@mail.ru

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