Diagnosis and therapy of mixed and recurrent vulvovaginal infections

Abstract

Infections of the vulva and vagina remain one of the most pressing problems of modern gynecology due to the high prevalence, frequent relapses, and negative effects on the functions of the reproductive system, which increases the risks of gynecological diseases and obstetric complications. The most common forms of vulvovaginal infection are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AB) and trichomoniasis. Features of the biocenosis and immune status in infections caused by conditionally pathogenic microorganisms predispose to relapses of BV, AB, and VVK, against the background of which a mixed infection develops. Its occurrence is also the result of repeated courses of treatment for recurrent monoinfection. Therapy of BV consists in the use of metronidazole and clindamycin, the benefits of clindamycin are in a wider spectrum of action, covering difficult to identify anaerobic microorganisms, as well as aerobes. The treatment of mixed infection and the prevention of the development of IHC in patients with BV involves the use of azole antimycotics, which remain the first line treatment option for the infection caused by Candida albicans. Thus, the combination therapy with clindamycin and azole antimycotics can be considered the optimal treatment option for mixed and recurrent vulvovaginal infections.