DOI: https://doi.org/10.22263/2312-4156.2023.4.57
Yu.I. Shchitenko, N.P. Zhukova
Treatment of chronic recurrent nonspecific vulvovaginitis in prepubertal girls with concomitant extragenital pathology
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2023;22(4):57-65.
Abstract.
Objectives. To evaluate the effectiveness of treatment of chronic recurrent nonspecific vulvovaginitis in girls of prepubertal age with concomitant extragenital pathology.
Material and methods. 67 prepubertal girls with chronic vulvovaginitis relapsing on the background of somatic pathology were treated. These girls were divided into three groups: the 1st group – 25 girls with chronic diseases of the urinary system, the 2nd group – 22 girls with allergic diseases, the 3rd group – 20 girls with chronic diseases of the gastrointestinal tract and enterobiasis. At the first stage the treatment of extragenital diseases was carried out by the doctors of the relevant profile. At the second stage the decontamination of selected biotope was conducted taking into account the sensitivity of isolated microflora to antibiotics. At the same time during this stage the reduction of severity of the clinical manifestations of the inflammatory process, moisturising, softening of the skin and mucous membrane of the vulva and perianal region, increasing the body’s immune ability were carried out. During the third stage the restoration of normal vaginal microflora and stimulation of the reparative processes were conducted. The evaluation of the effectiveness of treatment was made after 14 days, 1 and 6 months, when the full course of therapy was completed. It was based on the results of medical examination, bacterioscopic and bacteriological studies of vaginal discharge of the female patients.
Results. Three-stage therapy of chronic recurrent vulvovaginitis in girls of prepubertal age with concomitant somatic diseases makes it possible to achieve a stable remission of the inflammatory process in 1 month after treatment which is testified by the normalization of clinical (no complaints and no clinical manifestations of vulvovaginitis), microbiological (normocenosis, absence of microbial colonisation of Enterococcus spp., E. coli, Candida albicans, Streptococcus haemolyticus, Gardnerella vaginalis and the reduction of microbial growth of other flora, present in the vaginae of the girls, up to 10*2 FCU/ml) indicators. A positive protective effect was obtained within 6 months.
Conclusions. Persistent remission of chronic vulvovaginitis in girls of prepubertal age helps to prevent disorders in the formation of the reproductive system and long-term reproductive problems.
Keywords: chronic vulvovaginitis, recurrence, prepubertal period, somatic pathology, complex treatment.
References
1. Kazakova AV, Uvarova EV, Limareva LV. Inflammatory diseases of the vulva and vagina in girls: prognosis and prevention. Cheboksary, RF: Sreda; 2020. 184 р. (In Russ.)
2. Brander EPA, McQuillan SK. Prepubertal vulvovaginitis. Canadian Med Assoc J. 2018 Jul;190(26):E800. doi: http://dx.doi.org/10.1503/cmaj.180004
3. Cemek F, Odabaş D, Şenel Ü, Kocaman AT. Personal Hygiene and Vulvovaginitis in Prepubertal Children. J Pediatr Adolesc Gynecol. 2016 Jun;29(3):223-7. doi: http://dx.doi.org/10.1016/j.jpag.2015.07.002
4. Loveless M, Myint O. Vulvovaginitis-presentation of more common problems in pediatricand adolescent gynecology. Best Pract Res Clin Obstet Gynaecol. 2018 Apr;48:14-27. doi: http://dx.doi.org/10.1016/j.bpobgyn.2017.08.014
5. Khuraseva AB. Risk factors for persistence of vulvovaginitis in girls and optimization of therapy. Reproduktiv Zdorov’e Detei Podrostkov. 2014;(3):45-50. (In Russ.)
6. Gurkin YuA, Rukhlyada NN. Pediatric and adolescent gynecology: ruk dlya vrachei. Moscow, RF: MIA; 2019. 392 р. (In Russ.)
7. Kokhreidze NA, Gurkin YuA, Kutusheva GF, Mironova AV. Modern approaches to diagnosis, treatment and prevention of vulvovaginitis in girls in early childhood: ucheb-metod posobie. St. Petersburg, RF: SPbGPMU; 2018. 24 р. (In Russ.)
8. Chebotareva YuYu, Letifov GM, Kostoeva ZA. Some aspects of chronicization of vulvovaginitis in girls with urinary infections. Nefrologiya. 2018;2(5):71-6. doi: http://dx.doi.org/10.24884/1561-6274-2018-22-5-71-76 (In Russ.)
9. Karapetyan-Mitsenko AG, Chebotareva YuYu, Kostoeva ZA, Letifov GM. Some features of vulvar and vaginal pathology in preschool girls with various diseases of urinary system organs. Reproduktiv Zdorov’e Detei Podrostkov. 2016;(3):30-1. (In Russ.)
10. Microbiota disorders as an interdisciplinary problem at the global level. Med Sovet. 2019;(2):53-60. (In Russ.)
11. Kokhreidze NA, Kutusheva GF. Iatrogenic causes of prolonged vulvovaginitis in children. Reproduktiv Zdorov’e Detei Podrostkov. 2015;(5):36-45. (In Russ.)
12. Nesterova IV, Kovaleva SV, Chudilova GA, Lomtatidze LV, Krutova VA, Shuvalov AN, i dr. Efficacy of the program of combined immunotherapy of recurrent chronic nonspecific vulvovaginitis in immunocompromised girls. Vopr Ginekologii Akusherstva Perinatologii. 2018;17(2):35-42. (In Russ.)
13. Lefitov GM, Chebotareva YuYu, Kostoeva ZA. Features of complex treatment of vulvovaginitis in preschool girls with different forms of pyelonephritis. Nefrologiya. 2017;21(5):59-64. doi: http://dx.doi.org/10.24884/1561-6274-2017-21-5-76-85 (In Russ.)
14. Ranđelović G, Mladenović V, Ristić L, Otašević S, Branković S, Mladenović-Antić S, et al. Microbiological aspects of vulvovaginitis in prepubertal girls. Eur J Pediatr. 2012 Aug;171(8):1203-8. doi: http://dx.doi.org/10.1007/s00431-012-1705-9
15. Chebotareva YuYu, Kostoeva ZA, Letifov GM. A multidisciplinary approach to addressing bacterial vulvovaginitis in girls with urinary tract infections. Med Sovet. 2018;(13):124-9. (In Russ.)
Information about authors:
Yu.I. Shchitenko – lecturer of the Chair of Obstetrics and Gynecology, Vitebsk State Order of Peoples’ Friendship Medical University,
e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yuliya I. Shchitenko;
N.P. Zhukova – Doctor of Medical Sciences, professor of the Chair of Obstetrics and Gynecology, Vitebsk State Order of Peoples’ Friendship Medical University.
