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Immune-mediated mechanisms of the inflammatory response in women with combined infections of the lower genital tract

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.209

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Abstract

Aim: to increase the effectiveness of combination therapy and reduce frequency of recurrences of inflammatory diseases in the lower genital tract of combined etiology.

Materials and Мethods. There was conducted a prospective, randomized, blind, comparative clinical study. 80 women with vaginal microbiota disorders were examined randomized into 2 groups: group I (n = 40) – antibiotic therapy was carried out in combination with the preparation Superlimph, group II (n = 40) – a standalone antibacterial therapy; group III consisted of 20 patients lacking gynecological diseases considered to provide with control laboratory parameters. Clinical and laboratory methods were used: microscopy of vaginal smears, detection of viruses and sexually transmitted infections, measurement of serum cytokine levels – interleukins (IL-1â, IL-2, IL-4, IL-6, IL-8, IL-10), tumor necrosis factor alpha, (TNF-á), interferon gamma (IFN-ã).

Results. It was found that clinical recovery occurred in 90.0 and 70.0 % of patients in group I and group II (р = 0.02), respectively. Microbiological recovery was observed in 100.0 and 67.5 % of patients, respectively (р = 0.003). In group I, the isolation of herpes simplex virus type 2 was found in 80.0 and 45.2 % of patients before and after treatment (p < 0.001), respectively, whereas in group II – in 82.5 and 77.5 %, respectively (p = 0.58), between groups – p < 0.001. Before treatment the level of all cytokines, excepting IFN-ã, was higher than the reference values in both groups: in group I, their magnitude decreased after treatment (p < 0.001) and corresponded to the reference values; in group II no changes occurred. Three months after treatment, no relapses were observed in group I, whereas frequency of relapses in group II was 22.5 %, within 1 year – 0 and 35.1 %, respectively. Predictors of recurrent dysbiosis (IL-2, IL-6 and TNF-á in increased concentrations after a course of treatment) were identified.

Conclusion. Treatment with a combined broad-spectrum antimicrobial drug along with topical immunomodulatory agent containing exogenous cytokines is an effective strategy for treating concomitant dysbiosis and preventing relapse.

About the Authors

G. B. Dikke
Academy of Medical Education named after F. I. Inozemtsev
Russian Federation

Galina B. Dikke – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology with a Course of Reproductive Medicine

22 Liter M, Moskovskiy Avenue, Saint Petersburg 190013



A. A. Sukhanov
Tyumen State Medical University, Health Ministry of Russian Federation
Russian Federation

Anton A. Sukhanov – MD, PhD, Head of Polyclinic

10 Permyakov Str., Tyumen 625013



I. I. Kukarskaya
Tyumen State Medical University, Health Ministry of Russian Federation; Tyumen Region Perinatal Center
Russian Federation

Irina I. Kukarskaya – MD, Dr Sci Med, Professor of the Department of Obstetrics, Gynecology and Reanimatology with a Course of Clinical Laboratory Diagnostics, Tyumen State Medical University; Chief Physician, Tyumen Region Perinatal Center; Chief Specialist in Obstetrics and Gynecology, Department of Health of the Tyumen Region

10 Permyakov Str., Tyumen 625013

1 Daudelnaya Str., Tyumen 625002



V. V. Ostromenskii
Academy of Medical Education named after F. I. Inozemtsev
Russian Federation

Vladimir V. Ostromenskii – MD, PhD, Head of the Department of Obstetrics and Gynecology with a Course of Reproductive Medicine

22 Liter M, Moskovskiy Avenue, Saint Petersburg 190013



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For citation:


Dikke G.B., Sukhanov A.A., Kukarskaya I.I., Ostromenskii V.V. Immune-mediated mechanisms of the inflammatory response in women with combined infections of the lower genital tract. Obstetrics, Gynecology and Reproduction. 2021;15(3):245-257. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.209

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