RU2703708C1 - Method for prediction of a risk of vaginal microbiota failure - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to gynecology, and can be used for examination for early detection of vaginal microbiota. That is ensured by collection and analysis of clinical-laboratory data. Anamnestic, clinical and laboratory signs are evaluated. Anamnestic signs are used to assess the presence of complaints of pathological copious homogenous discharge from genital tracts with an unpleasant odor, in the presence of which one assigns 1 point. If observing infectious-inflammatory diseases of the genital tract, and/or urinary tract infections, and/or gastrointestinal diseases, the signs are evaluated by 2 points. If the number of sexual partners 1 is 1 point, more than 2 is assigned 2 points. If using antibacterial drugs and/or if accompanying extragenital diseases are assigned to each feature 1 point. Presence of: menstrual disturbance is evaluated as 1 point, change of vaginal discharge is evaluated as 2 points, positive amine test with KOH is evaluated in 2 points, while pH level>4.5 is assigned 5 points. Determining the laboratory signs: in the presence of key cells in the smears, and/or bacteria in the general urine analysis, and/or detection of pathogenic microflora in the bacteriological urine examination, each attribute is assigned 3 points, in case of biocoenosis change by type of anaerobic, aerobic or mixed dysbiosis in analysis of Femoflor 16 and/or prevalence of pathogenic microflora in bacteriological examination, 7 points are assigned from a cervical channel. Obtained points are summed up and total score of 1–15 shows low degree of risk of vaginal microbiota abnormality, total score of 16–30 shows moderate risk, and total score of 31–45 shows high risk of vaginal microbiota.

EFFECT: method provides effective and early prediction of vaginal microbiota abnormality by taking into account certain anamnestic, clinical and laboratory signs.

1 cl, 1 tbl, 2 ex

Description

The invention relates to medicine and may find application in gynecological practice.

The relevance of the proposed method for predicting the degree of risk is that one of the main tasks of the obstetrician-gynecologist is the active and timely identification of predictors of vaginal microbiota disorders. Violations of the biocenosis of the vaginal environment are diverse and complex, both internal and environmental factors influence their appearance. Initial changes in the vaginal microflora often occur latently. Given the fact that the reproductive system is very sensitive to the effects of various adverse factors, leading gradually to imbalance in the biocenosis, maintaining a favorable balance of microorganisms in the vaginal environment is of no small importance. Often, the diagnosis of a violation of the vaginal microbiota is made by the doctor intuitively, based on the complaints of the patients themselves, the data of an objective examination and the results of a smear on the flora. Treatment is also prescribed without taking into account changes in microbiocenosis. So for the diagnosis of bacterial vaginosis, three criteria out of four Amsel’s criteria are sufficient:

• Detection of pathological abundant homogeneous discharge from the genital tract.

• Increase in pH more than 4.5.

• Positive amine test (determination of volatile amines) - when a 10% KOH solution is added to the secretions, an unpleasant “fishy” smell appears.

• The presence of key cells (cluecells) during microscopic examination of wet unpainted smears and smears stained by Gram.

There is a method (prototype) for assessing the vaginal biocenosis, which consists in determining the lysozyme activity of the vagina, determining the pH of the vaginal secretion, assessing microflora with the calculation of the total microbial number (patent RU 2179849).

The disadvantage of the prototype is that it takes into account only obvious pathological changes in the vaginal secretion, based on a small part of the clinical and laboratory data, and this volume of research is currently insufficient. The method we have proposed is more objective, demonstrates an integrated approach and allows you to most accurately predict the risk of disturbance of the vaginal microbiota.

The technical result of the invention is improving the efficiency of complex and early prediction of vaginal microbiota disturbances.

The technical result is achieved by the fact that in the prognosis of disorders of the vaginal microbiocenosis, indicators are used:

1. Anamnestic signs

• complaints of abnormal abnormal abnormal discharge from the genital tract with an unpleasant odor: the diagnostic coefficient is 1 point;

• infectious and inflammatory diseases of the genital tract: the diagnostic coefficient is 2 points;

• urinary tract infections: the diagnostic coefficient is 2 points;

• diseases of the gastrointestinal tract: the diagnostic coefficient is 2 points;

• number of sexual partners: 1 - the diagnostic coefficient is 1 point; > 2 diagnostic coefficient is 2 points;

• use of antibacterial drugs: the diagnostic coefficient is 1 point;

• the presence of concomitant extragenital diseases: the diagnostic coefficient is 1 point.

2. Clinical signs

• change in vaginal discharge: the diagnostic coefficient is 2 points;

• menstrual irregularities: the diagnostic coefficient is 1 point;

• positive amine test with KOH (potassium hydroxide): the diagnostic coefficient is 2 points;

• increase in pH> 4.5: the diagnostic coefficient is 5 points.

3. Laboratory signs

• the presence of key cells in smears on the flora: the diagnostic coefficient is 3 points;

• results of the analysis of Femoflor 16 with a change in biocenosis by the type of anaerobic dysbiosis, aerobic dysbiosis, mixed dysbiosis: the diagnostic coefficient is 7 points;

• the results of bacteriological studies from the cervical canal with the identification of the prevailing pathological microflora: the diagnostic coefficient is 7 points;

• the presence of bacteria in the general analysis of urine: the diagnostic coefficient is 3 points;

• detection of pathogenic microflora in bacteriological examination of urine: the diagnostic coefficient is 3 points.

When developing the proposed method, women of reproductive age were examined who applied for a doctor’s visit to the gynecologist of the NIH Road Clinical Hospital at the station Voronezh-1 of the Russian Railways of Voronezh. Women from 18 to 35 years old with complaints of copious homogeneous discharge from the genital tract are included in the examination.

The inventive forecasting method is as follows.

With a thorough history and examination of patients, the presence of the previously listed signs is assessed, which are assigned scores from 0 to 7 depending on the degree of significance of the sign and the total score is calculated. The maximum number of points is 45 points, which indicates a 100% violation of the vaginal microbiota.

The total score of 1-15 indicates a low risk of forming a violation of the vaginal microbiota.

The sum of points 16-30 - indicates the average risk of violation of the vaginal microbiota.

The total score of 31-45 - indicates a high degree of risk of violation of the microbiota of the vagina.

The invention is illustrated by the following examples from practice:

Clinical example No. 1

A woman, K., 26 years old, went to an appointment with a doctor obstetrician-gynecologist of the NIH Road Clinical Hospital at Voronezh Station 1 of the Russian Railways of Voronezh. In accordance with the prognostic table, a point assessment of the risk of disturbance of the vaginal microbiota was carried out.

1. Anamnestic signs:

- abnormal abundant homogeneous discharge from the genital tract with an unpleasant odor: 1 point;

- infectious and inflammatory diseases of the genital tract: 2 points;

- urinary tract infections: 2 points;

- diseases of the gastrointestinal tract: 2 points;

- the number of sexual partners - 1: 1 point;

- the use of antibacterial drugs: 1 point;

- the presence of concomitant extragenital diseases: 1 point.

2. Clinical signs:

- change in vaginal discharge: 2 points;

- positive amine test with KOH: 2 points;

- increase in pH> 4.5: 5 points.

3. Laboratory signs:

- the presence of key cells in a smear on the flora: 3 points;

- the results of the analysis of Femoflor 16 with a change in biocenosis as anaerobic dysbiosis: 7 points;

- the results of bacteriological studies with the identification of the prevailing pathological microflora: 7 points;

- detection of pathogenic microflora in bacteriological examination of urine: 3 points.

The total score of 39, which corresponds to a high degree of risk of violation of the microbiota of the vagina. This patient is recommended for the treatment of anaerobic vaginal dysbiosis.

Clinical example No. 2

Woman X. 32 years old, went to the doctor’s obstetrician-gynecologist NUZ Road Clinical Hospital at Voronezh-1 station of Russian Railways OJSC with complaints of excessive discharge from the genital tract for several days. In accordance with the prognostic table, a point assessment of the risk of disturbance of the vaginal microbiota was carried out.

1. Anamnestic signs:

- abnormal abundant homogeneous discharge from the genital tract with an unpleasant odor: 1 point;

- infectious and inflammatory diseases of the genital tract: 2 points;

- the number of sexual partners - one: 1 point;

2. Clinical signs:

- change in vaginal discharge: 2 points;

- positive amine test with KOH: 2 points;

- increase in pH> 4.5: 5 points.

3. Laboratory signs:

- the presence of key cells in a smear on the flora: 3 points;

- results of the analysis of Femoflor 16 with a change in biocenosis as a mixed dysbiosis: 7 points;

The total score is 23, which corresponds to an average risk of disturbance of the microbiota of the vagina. The patient is recommended treatment of mixed dysbiosis.

Thus, this method is economically affordable, simple, allows for the prediction of violations of the microbiota of the vagina.

Claims (1)

A method for predicting the degree of risk of violation of the vaginal microbiota, including the collection and analysis of clinical and laboratory data, characterized in that the anamnestic, clinical, laboratory signs are evaluated in a complex; as anamnestic signs, the presence is assessed: complaints of abnormal abnormal abnormal discharge from the genital tract with an unpleasant odor, in the presence of which they assign 1 point, infectious and inflammatory diseases of the genital tract, and / or urinary tract infections, and / or diseases of the gastrointestinal tract, in the presence of which signs are evaluated at 2 points, with the number of sexual partners 1 assigned 1 point, more than 2 assigned 2 points, when using antibacterial drugs and / or if there are any vuyuschih extragenital diseases assigned to each feature 1 point; among the clinical signs, the presence is assessed: menstrual irregularities are estimated at 1 point, the change in vaginal discharge is estimated at 2 points, a positive amine test with KOH is estimated at 2 points, with an increase in pH> 4.5, 5 points are assigned; laboratory signs are determined: in the presence of key cells in smears and / or bacteria in the general analysis of urine, and / or the detection of pathogenic microflora during bacteriological examination of urine, 3 points are assigned to each symptom, in case of a change in biocenosis as anaerobic, aerobic or mixed dysbiosis with analysis of Femoflor 16 and / or with the prevalence of pathogenic microflora in a bacteriological study from the cervical canal assign 7 points; the points obtained are summarized and, with a score of 1-15, a low risk of vaginal microbiota disturbance is determined, with a score of 16-30, an average risk, and with a score of 31-45, a high risk of vaginal microbiota disturbance.