CHARACTERISTICS OF THE VAGINAL MICROBIOTA, CERVICAL AND UTERINE FLORA IN WOMEN WITH THE PAST HISTORY OF SEXUALLY TRANSMITTED INFECTIONS

Abstract

The aim: To identify the characteristics of the vaginal microbiota, cervical and uterine flora in women with the past history of sexually transmitted infections. Materials and methods: A prospective study and the analysis of the vaginal microbiota, cervical and uterine flora were conducted in 96 women of reproductive age with infertility after the past history of STIs, who planned to get pregnant using ART. Together they made up the group I (main group) and the CG included 30 women of reproductive age, who planned pregnancy without a compromised reproductive history. Results: Nonspecific vulvovaginitis (χ2 = 31.6; p <0.001) was diagnosed in 63 (63.6%) patients of the group I, vulvovaginal candidiasis – in 17 (17.7%). Lactobacilli in a vaginal discharge in representatives of the CG and group I – 96.7% and 29.1%, respectively (χ2 = 20.3; p <0.001). Opportunistic pathogens, BV-associated microorganisms and obligate anaerobes in the next titers: 10x5 CFU/ml and higher, CG < 10x3 CFU/ml were found in 68 (70.8%) women of the group I. N. gonorrhoeae was detected in 2 (2.1%) patients of the group I. An intense leukemoid reaction – in 59 (61.5%) women of the group I. The rate of cervical contamination with these pathogens ranged from 10x3 to 10x4 CFU/ml in 35 (36.5%) women of the group I, in 61 (63.5%) – titers of opportunistic pathogens were > 10x4 CFU/ml. Pathogenic bacteria of the cervical canal, represented by obligate anaerobes, was detected in 70 (72.9%) cases, where 11 (11.4%) patients were diagnosed with Chlamydia trachomatis, 2 (2.1%) – N.gonorrhoeae. Chlamydia trachomatis and Mycoplasma genitalium were registered in 11 (11.5%) and 19 (19.8%) cases, respectively, and were not detected in controls. Ureaplasma urealyticum in the cervical canal outnumbered the diagnostic level in women: 17.7% – group I and 6.7% – CG, respectively (χ2 = 7.9; p <0.01). N.gonorrhoeae and Trich. vaginalis were detected in 2.1% and 6.25% of women in the group I, respectively. Persistent urogenital infection – the combination of opportunistic and common pathogens – prevailed in 59 (60.2%). Associations of obligate anaerobes and Chlamydia trachomatis were found in 69 (71.8%) of them, microaerophiles – in 29 (30.2%), the combination of various species of opportunistic pathogens – in 14 (14.6%); the growth of monocultures of opportunistic pathogens, in titers coming to 106-108, was recognized in 19 (19.8%). The growth of monoculture, represented by group B Streptococcus was detected in 8 (8.3%) cases, Enterococcus faecalis – in 12 (12.5%), Mycoplasma genitalium – in 17 (17.7%). The analysis of PCR test results enabled to detect associations of different species of viruses with Myco- and Ureaplasma, Chlamydia in 23 (23.9%) patients of the group I. What should be noted is the predominance of Herpes simplex over CMV infection: 7 (7.3%) and 2 (2.1%), respectively (p <0.05). Conclusions: The predominance of the mixed microbiota, represented by various associations of opportunistic and common pathogens, was identified in infertile women with the past history of STIs as a result of microbial culturing of the samples from the uterine cavity. Chronic inflammation in endometrium is caused by a persistent viral-bacterial infection in the uterine cavity, which differs in the species composition from the microbiota of the lower genital tract.