Vaginal discharge syndrome. Problem with many unknowns

Abstract

The main reason for visiting an obstetrician-gynecologist is the vaginal discharge syndrome (VDS) of infectious etiology. The most common causes of infectious vaginitis wich are identifed by European researchers are bacterial vaginosis (BV), aerobic vaginitis, vulvovaginal candidiasis and mixed infections. Treatment of VDS is a serious problem not only because of the pathogens’s resistance and frequent recurrences, but especially due to the COVID-19 pandemic which can complicate further patient`s examination for determination of infectious agent and the choice of individual approach to etiotropic therapy. Purpose of study: to investigate the structure of causes of pathological vaginal discharge in Ukrainian women, as well as assess the compliance and effectiveness of their treatment. Methods: 472 doctors of women's consultation centres, gynecological hospitals and centers of reproductive medicine from 23 regions of Ukraine were enrolled in multi-center study of vulvovaginal infections management. During the study, which lasted from August to December 2019, were examined 45,295 patients aged 18 to 59 years who complained for pathological vaginal discharge. Results: analysis of the structure of nosologies that caused VDS showed that the examined patients were most often diagnosed with BV (41.1%), colpitis of mixed etiology (26.59%) and vulvovaginal candidiasis (19.22%), trichomoniasis was confirmed in 8.44%. The interviewed gynecologists preferred topical therapy in 95,99% cases of BV and colpitis of mixed etiology. Topical combined medications were prescribed in 85,21% of cases, monoforms – in 14.79%. Among the combined vaginal dosage forms the combination of metronidazole 750 mg /miconazole 200 mg was preferred in 48.81% of cases with clinical efficacy 87.1% in patients with BV and 86,9% in women with mixed infection. Normalization of the vaginal biocenosis was observed in 93.50% of the examined patients. The study demonstrated the safety, good tolerability and compliance of patients to therapy with the combined medications metronidazole 750 mg / miconazole 200 mg in vaginal suppositories. Conclusion: BV, colpitis of mixed etiology and vulvovaginal candidiasis are predominated in structure of main causes of VDS in Ukraine. In the treatment of VDS, priority is given to vaginal forms with the most compliant (89.8%) regimen: once a day for a short period (7 days). The obtained high bacteriological (93.50%) and clinical (86,9%) efficacy of therapy of BV and vaginal mixed infections with the combined drug metronidazole 750 mg / miconazole 200 mg allows to recommend it as the drug of choice.

Keywords

• vaginal discharge syndrome
• bacterial vaginosis
• mixed infection
• treatment
• metronidazole
• miconazole