The method of local treatment of bacterial vaginosis

 

(57) Abstract:

The invention relates to medicine, in particular to obstetrics and gynecology, and for the treatment of bacterial vaginosis. To do this, carry out a preliminary vaginal cleansing with an antiseptic solution, and then injected 3.5% gel chitosan-ascorbate, containing metronidazole at a dose of 2 mg in 1 ml, in a volume of 20 ml of 1 times in 2 days. The method provides suppression of anaerobic microflora, the normalization of functional epithelium of the mucous membrane of the vagina and has no significant impact on the viability of Lactobacillus and, consequently, provides long-lasting therapeutic effect. table 2.

The invention relates to medicine, namely to obstetrics and gynecology, and can also be used in the treatment of complications in proctology, urology, surgery and dermatology.

Among the most common gynecological diseases include vaginal infections, among which one of the leading bacterial vaginosis (BV). It should be noted that when disturbed BV the microbiocenosis of the vagina and the role of conditionally pathogenic endogenous microflora. When this occurs, the replacement of the normal microflora of the vagina (laktobaktery mycoplasmas. Bacterial vaginosis as a monoinfection occurs without signs of inflammatory reaction and the absence of leukocytes in vaginal discharge, which sometimes confuses doctors and leads to an incorrect diagnosis and tactics of the patient.

It is known that BV is a risk factor, and sometimes a cause of severe pathology of the female genital organs and complications of pregnancy and childbirth. Research a number of authors suggest that BV may lead to the development of chorioamnionitis, postpartum endometritis, premature birth and birth of children with low body weight, the occurrence of inflammatory processes in the genital organs, purulent-septic complications in the mother and child in the postpartum period, and so on, thus affecting the frequency of obstetric and neonatal pathology.

Despite numerous experimental and clinical studies, treatment of BV remains one of the most serious and intractable problems of practical medicine. Widely used for this purpose, the antibiotics along with the obvious positive impact on the disease usually cause a number of side effects: allergic reactions like itching, swelling and hyperamylasemia and other (G. R. Bayramov. Clinical features and the effectiveness of various methods of treatment of bacterial vaginosis: author. dis... Kida. the honey. Sciences. - M., 1996). It should be noted that such methods of treatment of BV as irrigation, irrigation of the vagina disinfectants are routine and inefficient, leading to the withdrawal of the normal microflora and contribute little to recovery (E. F. Kira, Bacterial vaginosis, LLC “Neva-Suite”, 2001, S. 251).

The purpose of the invention is to improve the effectiveness of treatment of bacterial vaginosis in women of reproductive age.

The purpose is due to the fact that after the preliminary reorganization of the vagina with an antiseptic solution is introduced into the vagina of 3.5% gel CHITOSAN-ASCORBATE, containing METRONIDAZOLE at a dose of 2 mg in 1 ml, in a volume of 20 ml of 1 times in 2 days. Treatment leads to signs of recovery: inhibition of anaerobic microflora, transformation Hypo - or atrophic mucosa of the vagina in a functional epithelium, increase in the concentration of glycogen; reducing the pH of vaginal secretions, normalization of the capillary permeability, decreased extravasation of fluid into the vagina (VP Smetnik, L., Tumilovich. Non-operative gynecology, MIA, 2002, S. 327).

Examined and treated 51 patient aged 19 to 42 years. All patients on the basis of typical clinical signs and laboratory tests diagnosed with BV. The disease duration ranged from 2 months to 2 years. Patients complained of abundant homogeneous discharge from the genital tract with an unpleasant odor, and itching and burning in the vulva. During the inspection of the vaginal walls with mirrors in almost all patients registered no obvious signs of inflammation, colposcopic picture was characterized by degenerative changes in the mucous membrane of the vagina. Informative laboratory method of diagnosis was detected in smears, Gram-stained, key cells (slomannyh epithelial cells of the vagina, covered with small gram-negative rods). The emergence of key cells in the s and enhanced adhesion of gram-negative microorganisms to these cells. Positive amine test (determination of volatile amines) with 10% solution of potassium hydroxide is the presence of a specific smell “rotten fish” and pH-metry vaginal discharge more than 4.5 confirmed BV. The control treatment was assessed by the rate of erythrocyte deformability (PDE), to assess the condition of the membrane structures of cells with infectious-inflammatory processes. The test used for prognostic purposes in women of childbearing age with BV. The rate of erythrocyte deformability was assessed by the conventional method and Dormandy modification Y. I. Greenstein (Grinstein Y. M., Kalinin, I. A., Whitman, P. C. Deformability of erythrocytes from patients with acute and chronic renal failure // therapist. Arch. - 1986. No. 12, S. 91-93).

The proposed method was treated with 27 women, formed the first group, within 7 days of applying to the mucous membrane of the vagina is 3.5% gel CHITOSAN-ASCORBATE with METRONIDAZOLE in 20 ml of 1 times in 2 days with prior vaginal cleansing water furatsilina 1:5000.

The second group consisted of 24 women, intrawaginalno using the “Polygynax” 1 capsule at night for 12 days (1 vaginal capsule contains antimycotic is Russia, 2002, vol. 5, OOO radar - 20002”, S. 682). The results were evaluated on several criteria: complaints and clinical picture; bacteriological examination of the vaginal flora (smear and culture diagnosis) and PDE (see tab.1).

During the treatment in the first group of patients with complaints of itching and burning in the vagina disappeared by the end of the second day. When the control gynecological examination on the fifth day (table.1) 24 (88%) of the 27 women were no complaints of itching and burning of the mucous membrane. On day 7 of treatment 25 (94%) patients complaints were not filed, the number of vaginal secretions were significantly reduced. When viewed in the mirror was no inflammatory changes in the mucous membrane of the vagina, the allocation was consistent with physiological norm. The measure of the deformability of red blood cells before treatment was 10% (at a rate of 1-6%), on day 7 - 8%, after treatment is 4-6%, which indicates a decrease in the inflammatory process and the effectiveness of treatment. 3 women (11%) during therapy proposed by way gone are the symptoms of endocervicitis, which confirms the high reparative capabilities of CHITOSAN gel-ASCORBATE-METRONIDAZOLE restoration of the mucous membrane of the lower division shall not affect the viability of lactobacilli (table.2) and does not reduce their functional activity. Within 3 months regarding the development of relapses addressed only 3 (12%) women, which indicates the effectiveness of the treatment of BV.

During the treatment in the second group of women at every 4th patient treatment was complicated vulvovaginal candidiasis (25%) (table.2), which indicates low effectiveness of antibiotics in chronic recurrent processes. It was also noted increased itching, allergic reactions to treatment in 2 women. Signs of inflammation when viewed in the mirrors was observed on the 7th day of treatment, the treatment was continued until the period of 12 days. The measure of the deformability of red blood cells before treatment 10%, during 8-9% and after treatment of 6-7%, which indicates the presence of infectious-inflammatory process in membrane structures. In the dynamics of observations (within 3 months) relapse after treatment polygynax were detected in 11 of 24 (45%) women, (the results of the study of literature - from 25 to 60%) and sought additional therapeutic measures (E. F. Kira, Bacterial vaginosis, LLC “Neva-Suite”, 2001, S. 275).

Clinical example 2. Patient B., 25 years old, came to the antenatal clinic on the location of the act, rich homogeneous discharge from the genital tract with an unpleasant odor. When surveyed in the mirror: - mucosa hyperemic smears discharge from the vagina is the key cells more than 40%, the reaction with NaOH solution positive leukocytes 2-4 in the field of view, in the bacterial content - Cardnerella vaginalis, metric PDE - 9%. After treatment by the proposed method on the 7th day - no complaints; when viewed in the mirrors-the vaginal mucosa pale pink; smears discharge from the vagina is the key cells are not detected, the reaction with NaOH-negative leukocytes 1-2 in sight, bacterial content, the Lactobacillus sp, metric PDE - 6%. Examination of the patient 3 months after treatment of recurrent bacterial vaginosis no.

Thus, the proposed method of local treatment of bacterial vaginosis in women of reproductive age allows on average 2 times (5-7 days versus 12 days in the control group) to shorten the time of treatment gel CHITOSAN-ASCORBATE-METRONIDAZOLE, prevents the development of complications in the form of candidal vulvovaginitis and reduces the number of relapses 3.7 times (45% vs. 12%), provides long-lasting therapeutic effect.

The method of local treatment of bacterial is audica fact, after preliminary rehabilitation antiseptic solution is introduced into the vagina of 3.5% gel chitosan-ascorbate, containing metronidazole at a dose of 2 mg in 1 ml, in a volume of 20 ml of 1 times in 2 days.

 

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