Alena D. Minakova’s research while affiliated with Sechenov University and other places

BACKGROUND: Bacterial vaginosis is an imbalance of the vaginal microbiome that is characterized by a decrease in lactobacilli and an overgrowth of opportunistic anaerobic bacteria. Given the high prevalence of bacterial vaginosis and the problem of antibiotic resistance, there is a need to develop new treatment methods and optimize the use of existing drugs. AIM: The aim of this study was to evaluate the efficacy and tolerability of the sequential use of lactic acid with clindamycin or dequalinium chloride in the treatment of bacterial vaginosis in women of reproductive age. METHODS: This study involved 127 women aged 18 to 45 years and diagnosed with bacterial vaginosis based on the Amsel criteria. The patients were randomly divided into four groups: Group 1 (34 women) received lactic acid; Group 2 (31 women) received clindamycin and lactic acid; Group 3 (32 women) received dequalinium chloride and lactic acid; and Group 4 (30 women) received clindamycin only. The effectiveness of treatment was assessed after 14 days based on the Amsel criteria. Three months post-treatment, complaints, vaginal discharge pH, amine tests and smears were analyzed if two or more Amsel criteria were present. RESULTS: Two weeks after treatment, bacterial vaginosis symptoms persisted in 14.7% of women in Group 1, 3.2% of women in Group 2, and 13.3% of women in Group 4. Additionally, two weeks after therapy, vulvovaginal candidiasis was diagnosed in one woman (3.2%) in Group 3. Bacterial vaginosis recurrences three months after treatment were recorded in 6.9% of patients in Group 1, 3.3% of patients in Group 2, 6.5% of patients in Group 3, and 11.5% of patients in Group 4. In Group 2, one case of vulvovaginal candidiasis (3.3%) was also documented. The efficacy of lactic acid was 85.3% after 14 days and 93.1% after three months, while clindamycin demonstrated an efficacy of 86.7% after 14 days and 88.5% after three months. Combination therapy with clindamycin and lactic acid demonstrated an efficacy of 96.8% after 14 days and 96.7% after three months. Treatment with dequalinium chloride and lactic acid demonstrated an efficacy of 100% after 14 days and 93.5% after three months. CONCLUSION: The data obtained confirm the high efficacy of the two-stage therapy using clindamycin with lactic acid and dequalinium chloride with lactic acid. This treatment method provides superior outcomes in terms of both cure rates and tolerability compared to traditional treatments. Given the growing resistance of microorganisms to antibiotics, the introduction of safe alternatives is particularly important, while offering new prospects for improving the treatment of bacterial vaginosis and enhancing the quality of life for patients.

BACKGROUND. Bacterial vaginosis is a common infectious non-inflammatory vaginal disease that increases the likelihood of contracting sexually transmitted infections, which has a negative impact on perinatal outcomes and generally reduces the quality of life. Given the low long-term efficacy of antibiotic therapy, as well as the high recurrence rate and side effects associated with antibiotic use, there is a need to find alternative approaches to its treatment. AIM. To evaluate the efficacy and tolerability of a comprehensive two-stage treatment of BV including clindamycin or dequalinium chloride and lactic acid in women of reproductive age. METHODS. An open randomized clinical study was carried out, which involved 54 women aged 18 to 45 years with a diagnosis of bacterial vaginosis confirmed by Amsel's criteria. The participants were randomly assigned into three groups: 17 women from the first group used lactic acid, 20 women from the second group used a combination of clindamycin and lactic acid, and 17 women from the third group used dequalinium chloride with lactic acid. Treatment efficacy was evaluated after 14 days using Amsel's criteria. Three months after the completion of treatment, complaints were assessed and vaginal pH was measured. RESULTS. During the study, it was noted that two weeks after the completion of treatment, whitish-gray vaginal discharge ceased in all women from the second and third groups. In the first group, where only lactic acid was used, discharge continued in three patients. Positive dynamics in the pH change of vaginal secretions were observed in all groups both two weeks and three months after the end of treatment, with the most noticeable effect in women using dequalinium chloride together with lactic acid. Three months after the end of treatment, complaints of vaginal discharge persisted in two women from the first group and two from the second group. CONCLUSION. The conducted study confirmed the high effectiveness of two-stage treatment. However, the combination of dequalinium chloride and lactic acid demonstrated more stable results in both the short and long term, making this method of non-antibacterial therapy the most preferable in the context of the growing problem of antibiotic resistance.

Bacterial vaginosis is one of the most common reasons for pathological discharge from the genital tract in women of reproductive age, which, among other things, is characterized by a high recurrence rate after standard antibacterial treatment. To date, issues related to the prevention and treatment of bacterial vaginosis have remained relevant and unresolved. This review article discusses the feasibility of using lactobacilli metabolites in the treatment and prevention of bacterial vaginosis, taking into account the data accumulated. The use of lactic acid as an additional second stage of bacterial vaginosis treatment can be considered as a way to improve the effectiveness of therapy and patient adherence to treatment, as well as to reduce the likelihood of recurrences.

Background. Currently, the search for the most effective methods to treat bacterial vaginosis remains relevant because of the high recurrence rate and resistance of the associated bacteria to antimicrobial drugs, along with the potential side effects of antibiotic therapy. This study aimed to assess the effectiveness and tolerability of using clindamycin and lactic acid sequentially, in comparison to lactic acid monotherapy, for women with bacterial vaginosis. Materials and methods. An open, randomized, comparative clinical study was conducted with 20 women (aged 18–45 years) who had bacterial vaginosis diagnosed according to R. Amsel criteria. The patients were randomly allocated into two groups, each comprising 10 patients. Group 1 took lactic acid, whereas group 2 employed clindamycin and lactic acid. After 14 days, clinical and laboratory efficacy was assessed based on Amsel criteria. Results. Objective and subjective symptoms such as vaginal discharge of whitish-gray color with unpleasant odor were not observed in both groups 2 weeks after the end of treatment. Positive dynamics of vaginal pH was recorded in both groups; however, a more pronounced effect was observed in women who used clindamycin and lactic acid. Conclusions. Both sequential clindamycin and lactic acid monotherapy demonstrated high clinical efficacy and good tolerability. Posttreatment pH values did not differ significantly between the two groups; however, a greater pH deviation was observed in the clindamycin and lactic acid sequential group. Further evaluations of long-term results are necessary.

Bacterial vaginosis and urinary tract infections are common conditions that lead to a decrease in the quality of life and significant economic costs. The review provides up-to-date information on the role of lactic acid in the microbiota of the vagina and urinary tract, as well as on the use of a lactic acid gel in these conditions. Bacterial vaginosis is associated with an increased risk of urinary tract infections. Antibacterial therapy demonstrates statistically significant results in treating exacerbation, but not preventing further relapses, which is due to the possible high ability of bacteria to form biofilms. Lactic acid, unlike hydrogen peroxide, is involved in maintaining the vaginal microbiota and enhancing its protective function against sexually transmitted infections, and indirectly affects the urinary microbiota. This may allow the use of lactic acid for the treatment and prevention of relapses in both bacterial vaginosis and urinary tract infections.