A breakthrough in the treatment of bacterial vaginosis: adjuvant treatment reduces the risk of recurrence

At the end of September, new Clinical and Methodological Guidelines for the Diagnosis and Treatment of Conditions Associated with Abnormal Vaginal Discharge in Women were published, developed by Russian key opinion leaders^[1]. The Guidelines define approaches to the diagnosis and treatment of common conditions such as bacterial vaginosis, vulvovaginal candidiasis, and other infectious and inflammatory diseases of the female genital tract. Patients with bacterial vaginosis (BV) often experience disease recurrence after treatment^[2]. This makes it critically important to introduce new approaches that increase treatment efficacy, accelerate recovery, and help prevent relapse.

Bacterial vaginosis is the most common cause of abnormal vaginal discharge in women of reproductive age^[3], accounting for 40–60% of inflammatory diseases of the female genital tract^[4]. In BV, the vaginal microbiome is disrupted due to suppression of lactobacilli by anaerobic microorganisms. The diversity of pathogens, as well as the biofilm-associated nature of the process, reduces the effectiveness of therapy and contributes to disease recurrence^[5]. The disruption of vaginal biofilms and improvement of BV treatment outcomes are therefore critically important for preserving women’s reproductive health.

The foundation of BV therapy is the use of antibacterial agents, whose effectiveness is compromised by biofilm formation. This year, updated Clinical and Methodological Guidelines for the Diagnosis and Treatment of Conditions Associated with Abnormal Vaginal Discharge in Women were released, prepared by leading medical organizations in this field*, including Russian Society of Obstetricians and Gynecologists, Russian Association for Genital Infections and Neoplasia, IUSTI Russia — Russian Branch of the International Union against Sexually Transmitted Infections, and others. According to the "Adjuvant treatment" section of the Guidelines, antibacterial treatment should be complemented with agents capable of disrupting biofilms. In particular, the Guidelines recommend the use of bovhyaluronidase azoximer, which destroys the matrix of bacterial and mixed fungal—bacterial biofilms by hydrolyzing hyaluronic acid, one of their key structural components.

According to the Clinical and Methodological Guidelines, adding bovhyaluronidase azoximer to antibacterial treatment for BV increases treatment effectiveness by 97.3%, enhances the efficacy and bioavailability of antibiotics, and contributes to the reduction of abnormal discharge and inflammatory processes in the pelvis.

Background information

The Clinical and Methodological Guidelines for the Diagnosis and Treatment of Conditions Associated with Abnormal Vaginal Discharge in Women were developed by Russian key opinion leaders who are members of non-governmental, non-profit organizations (Interdisciplinary Council of the Russian Society of Obstetricians and Gynecologists, Russian Association for Genital Infections and Neoplasia, Association of Medical Microbiologists, Russian Branch of the International Union against Sexually Transmitted Infections (IUSTI)), with the participation of Association of Specialists in Evidence-Based Gynecology, Society for Pharmacogenetics, Pharmacokinetics and Personalized Therapy, key opinion leaders in the fields of obstetrics/gynecology and sexually transmitted infections across the federal districts of Russia, as well as from state university, academic and research institutions and professional medical organizations.