MODERN APPROACHES TO PREDICTION AND TREATMENT OF RECURRENT BACTERIAL VAGINOSIS AND COMBINED DYSBIOSIS OF THE VAGINA AND URINARY TRACT

The prevalence of bacterial vaginosis (BV) is 23–29%. There is a high frequency of recurrent and combined forms of BV with bacterial-viral infections and urinary tract infections that cause difficulties in diagnosis and choice of the treatment. It is necessary to develop new pathogenetic approaches for the prevention of recurrent BV (RBV), treatment of RBV and combined infections. BV-associated and aerobic species of bacteria and fungi trigger an innate immune response in the lower genital tract which is characterized by the activation of pro-inflammatory cytokines. These cytokines remain at high levels if the effect of treatment is not sufficient. A correlation was found between the likelihood of recurrence and a high concentration of the anti-inflammatory cytokine IL-4 in the vaginal discharge after treatment of an episode of the disease. The determination of IL-4 concentration in vaginal swabs after treatment may be used as a predictor for disease recurrence. The comprehensive treatment of patients with RBV and its combined forms using a complex of antimicrobial peptides and cytokines (AMPC), namely Superlymph, has a high clinical efficacy characterized by the elimination of opportunistic microorganisms, cessation of virus secretion, normalization of cytokine balance, and a decrease in the frequency of relapses. According to the concept of two-stage treatment, the use of a medication containing L. acidophilus at least 107 and a complex of proteins, cytokines, vitamins and minerals (cream dosed in suppositories, Acylact DUO) is effective in the prevention of relapses after treatment of an episode of BV. Conclusion: The AMPC complex, when used locally, has an immunomodulatory effect that helps to reduce the frequency of recurrent BV and other infections of the urogenital tract. The medication containing L. acidophilus and a complex of proteins, cytokines, vitamins and minerals, is effective in preventing relapses after an episode of BV. © A group of authors, 2025.