Vol 25, No 1 (2023)

Aim. Toassess the prevalence of various types of human papillomavirus (HPV) of high carcinogenic risk (HCR) and the rate of abnormal findings of cytological examination in HPV-positive and HPV-negative women of the Kemerovo region.

Materials and methods. A continuous cross-sectional study was conducted. The study included 675 women aged 21 to 65 (mean age 40.5±10.6 years) residing in the Kemerovo region. Patients were sampled from the cervical canal for semi-quantitative HPV-typing and cytological examination with Papanicolaou staining (PAP-test) using a liquid-based cytology method. For HPV-positive patients, an HPV typing with the quantification of 14 HCR HPV types was performed by polymerase chain reaction with real-time detection. Statistical data processing was performed using the StatSoft Statistica 6.1 software bundle.

Results. The mean rate of HCR HPV detection in women of the Kemerovo region in the age group of 21–65 years is 17.8% and decreases with age. HPV type 16 prevailed and was detected in 31.6% of women. In 19.2% of women, the HPV subtype 31 was diagnosed; in 18.3%, the subtype 35; in 16.7%, the subtype 33. The HPV subtypes 39, 56, and 66 were the rarest. One subtype of HCR HPV was detected in 26.7% of women, two subtypes in 6.7%, and three or more subtypes in 66.6% of women. According to the cytological examination, CIN 1, 2, and 3 rates were 3.3, 0.8, and 0.7%, respectively. HSIL (CIN 2–3) was detected in 1.5% of cases, LSIL (CIN 1) in 3.3%. The rate of CIN 1 in HPV(+) women was higher: 13.3% vs 1.0% in HPV(-) (χ²=43.197; p<0.001). CIN 2 and CIN 3 were reported in HPV(+) patients only. HSIL+ was diagnosed in 7.9% of HPV(+) females (χ²=39.778; p<0.001).

Conclusion. Thus, the study results showed that the mean infection rate of HCR HPV in women of the Kemerovo region at the age of 21–65 years is 17.8% and decreases with age. HPV subtype 16 is predominant; subtypes 31, 35, and 33 were less common. In HPV-positive women, abnormal findings of cytological examination were significantly more common.

Design. A prospective, multicenter, open-label, randomized, comparative clinical study.

Objective. To compare the efficacy and safety of Flucovag (sertaconazole) vaginal suppositories, 300 mg (OTCPharm JSC, Russia; manufactured by Altpharm LLC, Russia) and the brand-name drug Zalain® (sertaconazole), 300 mg (Egis Pharmaceuticals PLC, Hungary) in the treatment of vulvovaginal candidiasis.

Materials and methods. The study included female patients (18–55 years old) with uncomplicated vulvovaginal candidiasis treated in outpatient settings. In total, 220 patients were randomized into two groups: group 1 (n=110) received a single dose of Flucovag vaginal suppositories, and group 2 (n=110) received a single dose of Zalain® vaginal suppositories. Seven days after the treatment, its clinical efficacy was evaluated. In case of incomplete clinical improvement after 7 days, patients received an additional dose of Flucovag (n=4) or Zalain (n=5) suppositories, respectively.

Results. At the end of therapy in the study groups, the clinical cure rates (99.1% vs. 96.3%, p≥0.05), microscopic, and culture results were comparable. No serious adverse events were reported in both groups throughout the study.

Conclusion. The study results demonstrate a favorable safety profile and high antifungal activity of sertaconazole.

Endometriosis remains one of the most topical diseases in current gynecology and is a multifactorial condition with an overgrowth of tissue morphologically and functionally similar to the endometrium outside the uterine cavity. One of the most frequently diagnosed forms of endometriosis is endometrioid ovarian cysts. An important feature of the clinical course of ovarian endometriosis is its negative impact on reproductive function and the recurrent nature of the disease, which may require repeated surgeries with even greater damage to the ovarian tissue. Therefore, the development of a long-term drug treatment strategy for patients with a history of endometrioid cysts aimed at preventing recurrences is urgently needed. According to domestic and foreign clinical guidelines, progestagen hormone therapy is recommended as first-line therapy for such patients. One of the most clinically studied drugs with a favorable efficacy and safety profile proven in numerous studies is dienogest. The paper presents the experience of foreign and domestic authors in conservative therapy in patients with a history of endometrioid cysts using dienogest in terms of recurrence prophylaxis.

Human papillomavirus (HPV) is now considered the most common sexually transmitted infection. Since the discovery by Nobel laureate Harald zur Hausen (2008) of HPV as a virus with a high carcinogenic risk, the strategy for screening and prevention of this disease has changed dramatically. It has significantly increased the relevance of the study of this infection. Although HPV is not life-threatening, its highly oncogenic subtypes can lead to the development of cervical cancer with high mortality.

The sexual activity of patients before and after the treatment of pelvic organ prolapse (POP) largely determines their quality of life and satisfaction with the intervention. This review analyzes current data on the nature of changes in sexual function in various pelvic organ prolapse correction methods. Particular attention is paid to a comparative assessment of the effect of available surgical techniques with abdominal and vaginal access on the risk of de novo dyspareunia. Based on the results of clinical studies and systematic reviews, the most optimal ways of correcting POP have been established; tools for assessing their effectiveness in routine clinical practice have been proposed; the importance of an interdisciplinary approach to the treatment of POP with the involvement of medical psychologists has been noted due to the significant role of emotional and behavioral factors in sexual dysfunction.

Background. Embryo implantation failure remains an urgent issue of assisted reproductive technologies (ART).

Aim. To determine the effect of intrauterine irradiation with a non-ablative erbium laser on the endometrium state using the histological and immunohistochemical examination and to evaluate its effectiveness in ART cryo-protocols.

Materials and methods. The study enrolled 25 women aged 26–45 with 1 to 5 failed implantations who were planning a pregnancy in a cryopreserved embryo transfer protocol. On days 6–10 of the menstrual cycle, all patients underwent a single procedure of intrauterine irradiation of the endometrium and cervical canal mucosa with an erbium laser in a non-ablative mode using Fotona SP Dynamis laser system (Slovenia). The histological and immunohistochemical data of the endometrium before and 1–2 months after the procedure and the pregnancy rate with subsequent transfer of the cryopreserved embryo were assessed.

Results. Intrauterine irradiation with a non-ablative erbium laser increased the proliferative activity of the endometrium (p=0.029), the expression of vascular endothelial growth factor (p=0.029), reduced the sclerosis lesions in the spiral arteries and endometrial stroma, increased the expression of progesterone and estrogen receptors, thus significantly increasing the effectiveness of the ART cryo-protocols (p=0.013).

A historical perspective on the issue of device-based endometrial destruction is presented. The article describes in detail various current methods of thermal coagulation of the uterine mucosa for its destruction. A comparative analysis of hysteroscopic and non-hysteroscopic methods of endometrial destruction in terms of treatment effectiveness, complications, and recurrence prevention is presented. The ways of technological development of instrumental treatment methods of intrauterine disorders are highlighted.

Sexual dysfunction in women is a complex interdisciplinary medical problem that remains beyond the attention of an obstetrician-gynecologist and negatively affects a woman's quality of life and well-being. The article presents data on prospects for using herbal agents based on the chasteberry fruit extract (Vitex agnus-castus, chaste tree) in women with sexual dysfunction.

The use of hormonal contraception is widespread worldwide. Over the years of use, it has been possible to study its contraceptive effectiveness and its effect on carbohydrate metabolism, blood coagulation, lipid profile, liver function tests, and other systems and organs. However, the effect on sexual function has not been sufficiently studied. For a long time, ethinylestradiol remained the main estrogen in combined oral contraceptives; however, the desire to improve safety led to the development of a new drug containing natural, highly selective estrogen estetrol and the well-known progestogen drospirenone. Therefore, it is relevant to study the effect of the new combined oral contraceptive on sexual function.

Endometriosis is the presence of tissue with morphological and functional features similar to endometrium outside the uterine cavity. Endometriosis affects approximately 10% of women worldwide, mostly of reproductive age. The rate of extragenital endometriosis is 0.3–3.5%. Diagnosis of endometriosis of the anterior abdominal wall is complex and includes analysis of clinical and medical history data, ultrasound, magnetic resonance imaging, and histological examination of the removed tissues. The article presents a clinical case of a large lesion of extragenital endometriosis localized in the subcutaneous fat of the anterior abdominal wall in a patient with a history of cesarean section. The main clinical manifestations of this disorder were cyclic pain during menstruation and an enlargement of the existing mass in the subcutaneous fat.