Aim — to present the results of the study of the state of vaginal microbiocenosis in women with uterine leiomyoma and inflammatory diseases of the genital organs; to optimize the prevention and treatment of inflammatory changes in the genital organs women of childbearing age with this pathology.
Patients and methods. 150 women of childbearing age were examined, who were divided into three groups:
- I group — 50 women with uterine leiomyoma, who received the treatment and preventive measures proposed by us;
- II group — 50 women with uterine leiomyoma who received traditional therapy;
- III group — 50 healthy women.
Bacteriological studies were conducted in order to assess the species and quantitative composition of the microflora of the vagina in women after course of treatment of vegetative disorders of the nervous system.
Microbiological analyzes and accounting of the results were carried out in accordance with the order of the Ministry of Health of the USSR No. 535 of 1985 and the order of the Ministry of Health of Ukraine dated May 10, 2007 No. 234. For the purpose of prevention and treatment of exacerbations of chronic inflammatory diseases genitals and in complex pre-gravid preparation for safe motherhood of women with uterine leiomyoma vaginal suppositories "Api-Norm" were prescribed.
Results. Study of changes in the microbiocenosis of the genital tract in women with uterine leiomyoma, who complex anti-inflammatory therapy was treated with "Api-Norm" vaginal suppositories, after treatment it shows positive dynamics of indicators of genital insemination by both opportunistic pathogens and others infectious agents compared to women with uterine leiomyoma who received conventional therapy.
After treatment and preventive measures, the biocenosis of the vagina of women with uterine leiomyoma, who are in complex anti-inflammatory therapy received vaginal suppositories "Api-Norm", approached the indicators of vaginal biocenosis of healthy women, and in women with uterine leiomyoma who received traditional therapy, after treatment it changed less actively and some indicators required a repeated course of treatment.
Conclusions. In women of childbearing age with uterine leiomyoma, there is an increase in concentration conditionally pathogenic microflora, which leads to the development of inflammatory processes of the genitals. Increased contamination genitals by representatives of pathogenic and opportunistic microflora in the event of the appearance of inflammatory diseases requires complex treatment. Inclusion of "Api-Norm" vaginal suppositories in complex treatment therapy inflammatory changes of the female genital organs and further prevention of the occurrence or exacerbation of inflammatory diseases indicates the high efficiency of such suppositories.
Introduction
The reproductive health of the population of Ukraine needs close attention.
Issues of health care are a priority, because the health of the people is the greatest social and individual a value that significantly affects the processes and results of the economic, social and cultural development of the country, and therefore are issues of national security and an important criterion for the social development and well-being of the country.
Preserving the health of the country's population is a medical and social problem, the solution of which requires optimal improvement socio-economic situation, preventive measures regarding health care and availability of medical care for all strata of the population.
In modern conditions, the state of reproductive health is affected by various risk factors that lead to negative
changes In particular, in the state of reproductive health, such changes include both somatic and gynecological changes
diseases.
Among the somatic diseases in women, a significant number of diseases draw attention first of all:
- cardiovascular system (in urban and rural residents, respectively) — 35% and 31%;
- digestive organs — 24% and 26%;
- respiratory organs - 28% and 23%;
- blood (anemia and other) — 15% and 18%;
- allergic manifestations — 16% and 11%;
- kidney diseases - 5% and 7%
The most frequent changes in reproductive health are (in urban and rural women):
- chronic inflammatory diseases of genital organs — 82% and 68%;
- disruption of the menstrual cycle — 34% and 21%;
- abortions - 65% and 77.6%;
- sexual health disorders — 31% and 20%;
- precancerous and oncological diseases — 19% and 26% (including benign tumors of the uterus — uterine leiomyoma);
- perinatal disorders — 12% and 18%;
- infertility — 9% and 6%
Therefore, an important parameter characterizing the state of a woman's reproductive health is gynecological morbidity, the frequency of which is increasing every year. Among gynecological diseases, women of childbearing age are more and more common hyperplastic processes occur, among which leiomyoma of the uterus has the greatest impact on reproductive health.
Leiomyoma is one of the most common benign tumors of the uterus. The frequency of this benign tumors, according to various authors, is from 15% to 35% in the structure of the total incidence of women over the age of 35 years, and the frequency of surgical interventions in this pathology can be up to 50%.
Uterine leiomyoma is often accompanied by an inflammatory condition of the genitals, and the factor of the presence of infectious factors, which caused the inflammatory process, can be a growth stimulator of this benign tumor.
The purpose of the study is to optimize the prevention and treatment of inflammatory changes of the genital organs in women of childbearing age with uterine leiomyoma.
Research materials and methods
150 women of childbearing age were examined, who were divided into three groups:
- I group — 50 women with uterine leiomyoma, who received the treatment and preventive measures proposed by us;
- II group — 50 women with uterine leiomyoma who received traditional therapy;
- III group — 50 healthy women.
Bacteriological studies were conducted in order to assess the species and quantitative composition of the microflora of the vagina in women after course of treatment of vegetative disorders of the nervous system.
Microbiological analyzes and recording of the results were carried out in accordance with the order of the Ministry of Health of the USSR No. 535 of 1985 and the order of the Ministry of Health of Ukraine dated May 10, 2007 No. 234.
The following differential diagnostic media were used for mucus culture: blood agar, yolk-salt agar, Endo, Saburo medium, MRS medium for lactobacilli.
Sowing was carried out by the method of sector sowing on dense nutrient media, which makes it possible to determine the degree of microbial insemination and reveal the maximum possible range of aerobic and facultatively anaerobic microflora.
The taxonomic position of microorganisms is determined according to "Bergey's Identifier of Bacteria". Identification of microorganisms was carried out according to their cultural and morphological characteristics.
Determination of the number of lactic acid bacteria was carried out after 24–48 hours. incubation at a temperature of 37±1°С. In strokes, which were stained by Gram, lactobacilli had the appearance of gram-positive rods.
To identify staphylococci, yolk-salt agar was used, on which staphylococci grew in the form of yellow or white convex colonies. Pigmentation of the colonies and the presence of lecithinase activity were taken into account during the study.
Identification of detected microorganisms was carried out on the BD BBL Crystal automatic microbiological analyzer (USA).
For the identification of yeast-like fungi, Sabouraud's medium was used. Cups with sieves were incubated in a thermostat for temperature of 37±1°C for 3 days, then the colonies are characterized by their morphology — dense, opaque, milky color microscopically in a 40% caustic soda solution. In smears, yeast-like fungi have the appearance of large oval gram-positive cells located singly, in clusters or chains.
Depending on the obtained results of the state of microbiocenosis of urogenital organs in women of childbearing age (I group) with leiomyoma of the uterus, who had chronic inflammatory diseases of the genital organs, at the first stage, basic treatment that was developed for women with this pathology and the effectiveness of which has already been proven. For the purpose of prevention and treatment of exacerbations of chronic inflammatory diseases of the genital organs and in complex pre-gravid care preparation for safe motherhood of women with uterine leiomyoma in the second stage was prescribed the drug "Api-Norm" for 1 suppositories intravaginally at night 1 time a day for 10 days, and then 2 times a week for a total course of 15 suppositories This drug in the form of rectal suppositories was also prescribed to sexual partners of women with leiomyoma uterus 1 suppository rectally at night 1 time a day for 10 days, and then 2 times a week for a total course of 15 suppositories.
Api-Norm vaginal suppositories contain a balanced multicomponent composition based on beekeeping products and plant components. This drug has a combined anti-inflammatory, antispasmodic, adaptogenic, anti-infective, antioxidant and wound-healing effect; prevents the development of complications and possible relapses in diseases internal organs of the pelvis; activates, modulates and supports the body's own defense mechanisms, including cellular immunity; penetrates deep into tissues, saturates them with natural components, trace elements and vitamins; compatible with many other preventive and therapeutic drugs.
Thanks to the special technology of obtaining constituent components and their activation, the drug "Api-Norm" differs from other drugs of a similar focus with high activity and increased bioavailability of active substances. At the expense of well-chosen components, the properties of the drug components reduce the likelihood of side effects and allergic reactions.
Plant components and beekeeping products included in "Api-Norm" have a high level of efficiency and safety from the point of view of evidence-based medicine.
Our choice stopped on this drug, because the components of multicomponent vaginal suppositories have a positive effect on the condition of women's reproductive organs. Candles include:
- buckthorn oil, which has anti-inflammatory, pain-relieving, antibacterial (especially in relation to staphylococci and Proteus) effect. Promotes epithelization and granulation of tissues, accelerates wound healing. Normalizes degenerative changes of mucous membranes. Contains a complex of vitamins;
- marigold extract (calendula) has regenerating, antibacterial, antiviral, analgesic, anti-inflammatory, bacteriostatic (especially against streptococci and staphylococci) effect. Suppresses the migration of leukocytes places of inflammation. It is used for disorders of the menstrual cycle, ulcers, erosions, white hair;
- propolis extract has antioxidant, antiviral, antibacterial, anti-inflammatory, wound-healing, antispasmodic and antiseptic effect. It includes more than 50 biologically active substances, a significant amount of vitamins and trace elements. Increases the number of immunoglobulins (increases specific immunity). Enhances the effect of natural and synthetic antibiotics and antimycotics. Stabilizes cell membranes. Delays growth cancerous and pathological cells;
- St. John's wort extract has an antibacterial, antiseptic, pain-relieving effect, as well as strengthens the regenerative capacity of tissues. Reduces spasm and fragility of blood vessels. Important active substances of St. John's wort are essential oils, flavonoids (rutin, quercetin, hyperoside) and hypericin;
- natural beeswax has an anti-inflammatory, antiseptic and softening effect, is a source of vitamin A and trace elements important for cellular immunity. Increases the biological activity of plant components extracts.
Rectal suppositories "Api-Norm", prescribed to sexual partners of women with uterine leiomyoma, have a combined anti-inflammatory, antispasmodic, adaptogenic, anti-infective, antioxidant and wound-healing effect; own antitumor effect, delay the development of hyperplasia, reduce the risk of cancer; prevent the development of complications and possible relapses in diseases of the prostate gland and other internal diseases pelvic organs; activate, modulate and support the body's own protective mechanisms, including cellular ones immunity; penetrate deep into tissues, saturate them with trace elements and vitamins; compatible with many others prophylactic and therapeutic drugs. Treatment and preventive measures for sexual partners of women who suffer from uterine leiomyoma, are important because they ensure the effectiveness of treatment and preventive measures for these women.
Thanks to the special technology of obtaining constituent components and their activation, the drug "Api-Norm" differs from drugs of similar orientation with high activity and increased bioavailability of active substances. At the expense of success selected components, the properties of the components of the drug reduce the likelihood of side effects and allergic reactions reactions.
Plant components and beekeeping products included in "Api-Norm" have a high level of efficiency and safety from the point of view of evidence-based medicine.
The composition of rectal suppositories is slightly different from those prescribed for women and contains:
- black poplar extract, which has antioxidant, anti-inflammatory, antimycotic, antimicrobial effects; promotes epithelization and granulation of tissues. The content of glycoside and populin causes pain-relieving properties. The antihistamine properties of the extract reduce the risk of allergic reactions from other components;
- extract of comfrey (comfrey) has regenerating, analgesic, anti-inflammatory, hemostatic and enveloping effect, shows antitumor activity. Among its main active substances: allantoin, zinc, vitamin B12, tripertene. Antioxidant properties prevent the development of malignant neoplasms;
- propolis extract has antioxidant, antiviral, antibacterial, anti-inflammatory, wound-healing, antispasmodic and antiseptic effects. It includes more than 50 biologically active substances, a significant amount of vitamins and trace elements. Increases the number of immunoglobulins (increases specific immunity). Enhances the effect of natural and synthetic antibiotics and antimycotics. Stabilizes cell membranes. Delays growth cancerous and pathological cells;
- St. John's wort extract has an antibacterial, antiseptic, pain-relieving effect, as well as strengthens the regenerative capacity of tissues. Reduces spasm and fragility of blood vessels. Important active substances of St. John's wort are essential oils, flavonoids (rutin, quercetin, hyperoside) and hypericin;
- natural beeswax has an anti-inflammatory, antiseptic and softening effect, is a source of vitamin A and trace elements important for cellular immunity. Increases the biological activity of plant components extracts.
Ascorbic acid, which is part of "Api-Norm" (17 mg per 1 suppository), is an antioxidant, plays an active role in the regulation of redox processes, carbohydrate metabolism, blood coagulation, tissue regeneration; raises resistance of the body to infections, reduces vascular permeability, reduces the need for other vitamins such as: B1, B2, A, E, folic acid, pantothenic acid. Strengthens the activity and increases the bioavailability of flavonoids.
The study was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local by the ethics committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research.
Statistical processing of the research results was carried out using standard computer packages "Analysis data" Microsoft Excel for Windows 2007. The value of the arithmetic mean was calculated - the value (M), the average error average value (m), level of probability of discrepancies (p). An assessment of the reliability of the obtained data was carried out by the generally accepted method using the Student's criterion. Reliability was considered established if its probability was equal to at least 95% (0.05).
Research results and their discussion
A bacteriological study of vaginal secretions of examined women of childbearing age proved that in women with leiomyoma of the uterus in combination with inflammatory changes of the genitals, there were changes in the state of the microbiocenosis.
Examination of women with uterine leiomyoma showed that before treatment (I and II groups) gram-positive cocci with hemolytic properties were distinguished with a higher frequency than in healthy women (III group). Thus, S. aureus was detected in 13%, S. epidermidis (hem.) — in 17%, S. agalactiae — in 12%; among enterobacteria: E. coli — in 18%, hemolytic E. coli — in 12% women, Klebsiella — in 20%.
The frequency of sowing Candida fungi was 25%. Representatives of normal microflora — lactobacilli were detected in 72% examined women. Deficiency of lactobacilli was observed in 51%, and their absence in 28% of patients. Concentration of lactic acid bacteria did not reach the indicators of healthy women and was lg3.6 CFU/ml.
Gardnerellosis in women with uterine leiomyoma before treatment (I and II groups) was diagnosed in 38%, chlamydia — in 15%, ureaplasmosis — in 17%, herpes virus — in 28% of the examined.
Associative forms of bacterial insemination of the vagina were detected before treatment in 35% of patients of the I and II groups. Of the associations most often included gram-positive cocci and enterobacteria (Klebsiella) or enterococcus and Candida fungi, and also gardnerella and herpes virus.
Quantitative indicators of seeding of gram-positive cocci in women with uterine leiomyoma were lg3.8–lg4.2 CFU/ml. Representatives of enterobacteria were found in concentrations of lg4.0–lg4.5 CFU/ml, fungi of the genus Candida — lg4.7 CFU/ml. These indicators exceeded the diagnostic value and were higher than in women of the III group.
Thus, the obtained data indicate that in women with uterine leiomyoma, opportunistic bacteria and pathogens of the "new generations" were detected with a higher frequency and in lower concentrations than in healthy women.
The study of changes in the microbiocenosis of the genital tract in women of the 1st group after treatment indicated positive dynamics indicators of genital insemination by both opportunistic pathogens and other infectious agents compared to women of the II group.
In women of the 1st group, quantitative indicators of seeding of various types of staphylococci, which had pathogenic properties, after treatment were in the range of lg2.0–lg3.5 CFU/ml. The level of enterobacteria seeding in patients of the 1st group decreased after treatment and did not exceeded normal values (lg2.0–lg2.8 CFU/ml). Sexual contamination corresponded to the norm in women of the I group pathways by Candida fungi (lg3.2 CFU/ml), as well as protective microflora (lg5.2 CFU/ml).
The frequency of diagnosis of chlamydia, ureaplasmosis and gardnerellosis in women of the 1st group significantly decreased after treatment (table). Also, with a lower frequency than before treatment, and compared to women of the II group, the frequency was recorded contamination of the genital tract by associations of bacterial flora, viruses, infectious agents of the "new generation" and Gardnerel (15%).
After the medical and preventive measures, the biocenosis of the vagina of women of the 1st group approached the indicators of biocenosis vaginas of the III group; in women of the II group, after treatment, it changed less actively and, according to some indicators, required repeated course of treatment.
| Type of microorganisms | |||||
|---|---|---|---|---|---|
| Group of women | |||||
| Group I | Group II | Group III | |||
| before treatment | after treatment | before treatment | after treatment | ||
| S. epidermidis with hemolysis | (17) 4,2 ±0,04 | (5) 2,0 ±0,04* | (17) 4,2 ±0,04 | (16) 4,0 ±0,0 | (6,6) 2,3 ±0,02 |
| S. aureus | (13) 4,0 ±0,02 | (3) 2,1 ±0,03** | (13) 4,0 ±0,02 | (10) 3,8 ±0,02 | (3,3) 2,8 ±0,06 |
| S. viridans | (10) 3,8 ±0,05 | (5) 3,0 ±0,02 | (10) 3,8 ±0,05 | (15) 3,2 ±0,03 | (10) 3,1 ±0,06 |
| S. agalactiae | (12) 4,1 ±0,04 | (3) 2,5 ±0,03** | (12) 4,1 ±0,04 | (10) 4,0 ±0,04 | (6,6) 2,8 ±0,06 |
| S. faecalis | (22) 4,2 ±0,03 | (8) 3,5 ±0,03 | (22) 4,2 ±0,03 | (20) 4,1 ±0,06 | (13,3) 3,6 ±0,03 |
| E. coli | (18) 4,2 ±0,04 | (5) 2,8 ±0,02** | (18) 4,2 ±0,04 | (16) 4,0 ±0,07 | (10) 3,1 ±0,06 |
| E. coli with hemolysis | (12) 4,5 ±0,02 | — | (12) 4,5 ±0,02 | (15) 4,3 ±0,06 | — |
| Klebsiella spp. | (20) 4,3 ±0,04 | (3) 2,7 ±0,03** | (20) 4,3 ±0,04 | (18) 4,1 ±0,04 | (3,3) 3,1 ±0,03 |
| Enterobacter spp. | (16) 4,0 ±0,02 | (3) 2,0 ±0,02** | (16) 4,0 ±0,02 | (16) 4,0 ±0,04 | (6,6) 2,3 ±0,02 |
| Candida fungi | (25) 4,7 ±0,02 | (5) 3,2 ±0,03** | (25) 4,7 ±0,02 | (22) 4,3 ±0,06 | (10) 3,4 ±0,03 |
| Lactobacillus spp. | (72) 3,6 ±0,04 | (97) 5,2 ±0,06** | (72) 3,6 ±0,04 | (78) 3,8 ±0,07 | (100) 5,2 ±0,07 |
| Gardnerella vaginalis | 38 | 8 | 38 | 35 | 10 |
| Chlamidya trahomatis | 15 | 5 | 15 | 12 | 6,6 |
| Ureaplasma urealiticum | 17 | 10 | 17 | 15 | 16,6 |
| HSV | 28 | 3 | 28 | 20 | 6 |
* — statistically significant difference between the indicators of women with uterine fibroids (group I) before and after treatment (p>0.05);
** — the statistically significant difference between the indicators of women with uterine leiomyoma of group I and women with uterine leiomyoma (II group) (p>0.05);
*** — a statistically significant difference between the indicators of women with uterine leiomyoma of group I after treatment and healthy women women (III group) (p>0.05)
Conclusions
In women of childbearing age with uterine leiomyoma, there is an increase in the concentration of conditionally pathogenic microflora, which leads to the development of inflammatory processes of the genital organs.
Increased contamination of genitals by representatives of pathogenic and conditionally pathogenic microflora in case of appearance inflammatory diseases require complex treatment.
Inclusion in complex therapy of treatment of inflammatory changes of female genital organs and further prevention occurrence or exacerbation of inflammatory diseases of vaginal suppositories "Api-Norm" indicates high effectiveness such suppositories.
Prospects for further research
Prospective research into the mechanisms of development of inflammatory diseases of the genital organs in women of childbearing age with uterine leiomyoma is the study of the further state of their reproductive health and the catamnesis of occurrence or exacerbation inflammatory diseases.
The authors declare no conflict of interest
