Effectiveness of the combined drug ternidazole–neomycin sulfate–nystatin–prednisolone in topical therapy of vaginal dysbiosis associated with Atopobium vaginae in nonpregnant and pregnant women with reproductive failure

Background. Atopobium vaginae is an important component of the complex abnormal anaerobic vaginal microflora in vaginal dysbiosis and is believed to be at least partially responsible for known adverse gynecological and obstetric outcomes. Resistance of A. vaginae to traditional therapy (metronidazole and clindamycin) is described.Objective of the study: to evaluate the effectiveness of topical therapy with the combined drug ternidazole–neomycin sulfate–nystatin–prednisoloneof vaginal dysbiosis associated with A. vaginae in diagnostically significant concentrations in non-pregnant and pregnant women of reproductive age with a history of reproductive failure.Materials and methods. 78 women of reproductive age with vaginal dysbiosis associated with A. vaginae in diagnostically significant concentrations were under observation. 37 infertile women had recurrent implantation failures and 41 pregnant women with infertility treated in cycles of assisted reproductive technologies. Control groups consisted of 30 fertile non-pregnant women and 30 pregnant women after natural conception with vaginal normocenosis. Comprehensive quantitative assessment of the vaginal anaerobic microbiota was performed using real-time polymerase chain reaction.Results. A. vaginae in diagnostically significant concentrations in the vaginal microbiota in the vast majority of cases is accompanied by the presence of Gardnerella vaginalis and other co-pathogens, mixed infections. Every second woman has aerobic-anaerobic dysbiosis, which makes it advisable to use combined topical drugs. The use of ternidazole–neomycin sulfate–nystatin–prednisolone vaginal tablets resulted in the absence of facultative and obligate anaerobes, Ureaplasma (urealiticum + parvum) and Candida spp. in the vaginal microbiota in diagnostically significant concentrations in women of treated groups. The average relative content of none of the studied conditionally pathogenic microorganisms after treatment did not exceed -3 CFU.Conclusions. The combined vaginal drug ternidazole–neomycin sulfate–nystatin–prednisolone is a highly effective, safe and compliant remedy for restoring vaginal health in non-pregnant and pregnant women with a history of reproductive failure and vaginal dysbiosis associated with the presence of A. vaginae in diagnostically significant concentrations.