VAGINOSE BACTERIANA RECORRENTE: ATUALIDADES NO MANEJO TERAPÊUTICO / RECURRENT BACTERIAL VAGINOSIS: UPDATES IN THERAPEUTIC MANAGEMENT

Introducao : A Vaginose Bacteriana (VB) e uma enfermidade comum e muito prevalente. Decorre do desequilibrio da flora vaginal, com reducao populacional de Lactobacilos e colonizacao por bacterias patogenicas. Apresenta recorrencia significativa com o tratamento convencional monoterapico e necessita de maior compreensao fisiopatogenica para melhor terapeutica. Objetivo : Demonstrar os principais regimes terapeuticos para o tratamento da vaginose bacteriana, enfocando as terapias mais recentes para o controle da recorrencia. Metodos : Estudo bibliografico a partir dos termos: vaginose bacteriana, vaginose bacteriana recorrente e tratamento da Vaginose Bacteriana. Resultados : Apesar dos regimes terapeuticos confiaveis com antibioticos, como Metronidazol® e Clindamicina®, percebe-se falha importante no controle da enfermidade, atribuida ao desenvolvimento de resistencia bacteriana. Outros fatores podem ser incluidos, como predisposicao genetica, habitos sexuais, mas nenhum e suficientemente convincente para explicar a fisiopatogenese da doenca. A maioria das terapias combinadas com os antibioticos tradicionais apresenta bons resultados na diminuicao da recorrencia. Os probioticos, em especial Lactobacillus, mostraram-se eficazes na prevencao da Vaginose Bacteriana recorrente quando em associacao ao antibiotico tradicional. Os prebioticos tambem sao substâncias que podem melhorar o sucesso na terapia de casos recorrentes. Conclusao : Nao obstante a recomendacao de monoterapia para o tratamento a utilizacao de outras substâncias, como os probioticos, e recomendada para adicao ao arsenal terapeutico, considerando a diminuicao significativa da recorrencia de Vaginose Bacteriana em pacientes tratadas com terapia combinada. Palavras-chave : Vaginose bacteriana. Antibioticos. Terapeutica. Probioticos. Abstract Introduction : Bacterial vaginosis (BV) is a common and very prevalent disease. It is an imbalance of the vaginal flora with a reduction of Lactobacilli concentration and colonization by pathogenic bacteria. It presents significant recurrence with conventional monotherapy and that is why its physiopathogenicity needs to be more understood for a better therapy. Objective : To demonstrate the main therapeutic approaches for the treatment of Bacterial vaginosis, focusing on newer therapies for the control of recurrence. Methods : A literature review using the terms: bacterial vaginosis, recurrent bacterial vaginosis and treatment of bacterial vaginosis. Results : Despite the reliable therapeutic approaches with antibiotics such as metronidazole and clindamycin, it is still seen failure in controlling this disease because of bacterial resistance. Other factors may be included, such as genetic predisposition, sexual habits. However, none of these factors is sufficiently convincing to explain the pathophysiology of the disease. The majority of combined therapy with traditional antibiotics presents good results in the reduction of recurrence. The probiotics, especially lactobacillus, were effective in preventing recurrent BV when in combination with traditional antibiotics. The prebiotics are also substances that can improve the success of therapy in recurrent BV. Conclusion : Despite the recommendation of monotherapy for the treatment of Bacterial vaginosis, the use of other substances, such as probiotics, is recommended for addition to the therapeutic arsenal because of the significant reduction in the recurrence of BV in patients treated with combined therapy. Keywords : Bacterial vaginosis. Antibiotics. Therapeutics. Probiotics.