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The relevance of the use of povidone-iodine in the practice of obstetrician-gynecologist

Currently, the frequency of relapses of viral diseases, specific and nonspecific vulvovaginitis, and bacterial vaginosis (BV) attracts attention. It is noted that vaginitis refers to diseases that in themselves do not pose a direct threat to a woman’s health, however, in these conditions, opportunistic microorganisms accumulate and are constantly preserved in high concentrations in the lower parts of the genital tract, which are the main causative agents of purulent-inflammatory diseases of the small organs. pelvis [16]. The role of BV as a trigger of inflammatory diseases of the pelvic organs has been proven. The issues of early and adequate diagnosis and prevention of the spread of infectious and inflammatory diseases remain relevant.

The problem of resistance and antibiotic resistance makes it necessary to optimize treatment regimens. It should be recognized that currently there is information about strains of microorganisms resistant to antiseptics, but these reports appear much less frequently than reports about microorganisms resistant to antibiotics. Some researchers demonstrate results in which certain strains of microorganisms, especially hospital ones, become resistant to antiseptics such as an aqueous solution of chlorhexidine, potassium permanganate solution, furatsilin, etc. In this regard, the search for new drugs that reliably prevent the spread of hospital infections is being actively pursued.

Thus, well-known iodine preparations, especially its various complex compounds, are increasingly used.

Iodine as a local antiseptic was first described in 1839. In the process of searching for ways to reduce iodine deficiencies, the ideal solution was found in the development of a polyvinylpyrrolidone complex. Polyvinylpyrrolidone (PVP) is a high molecular weight polymer that was used as a plasma expander during World War II. PVP forms a water-soluble complex with iodine. The first reports of topical use of this complex came from Shelanski and Bogash in 1956.

The biologically active substance povidone-iodine is a free complex of elemental iodine with a neutral, amphipathic organic compound, polyvinylpyrrolidone, which serves as a slow-release iodine reservoir. Povidone-iodine is a broad-spectrum antiseptic with bactericidal, sporicidal and antiviral properties (that is, the spectrum of action extends to gram-positive and gram-negative bacteria, fungi, viruses, protozoa and even prions). Prions are a special class of infectious agents represented by proteins with an abnormal tertiary structure and not containing nucleic acids. Prions are not living organisms, but they can reproduce using the functions of living cells (in this respect, prions are similar to viruses). A prion is a protein with an abnormal three-dimensional (tertiary) structure that can catalyze the conformational transformation of a normal cellular protein homologous to it into a similar one (prion).

Povidone-iodine (Betadine) is an antiseptic and disinfectant whose antimicrobial effect is due to its bactericidal properties. The bactericidal effect of iodine is explained by its strong oxidizing properties. Iodine damages the cell walls of pathogenic microorganisms due to the oxidation of amino acids of bacterial proteins containing SH and OH groups. These are mainly bacterial enzymes and transmembrane proteins that do not have membrane protection. When oxidized, their quaternary structure changes and they lose their catalytic and enzymatic activity. Intracellular iodine blocks the electron transport system in the cytoplasmic membrane of bacteria. The effect develops quickly, usually within 15–60 s. The spectrum of action of Betadine is presented in Table 1.

Average time of antimicrobial effect on microorganisms:

Gram+/gram- – 15–30 s;
viruses – 15 s;
mushrooms – 15–30 s;
trichomonas – 30–60 s.

Betadine is a complex compound of iodine and polyvinylpyrrolidone (PVP), which is an inert synthetic polymer and acts as a carrier that does not have toxic and antigenic properties and is capable of reversibly attaching other substances, such as medicinal toxins, drugs, hormones. All pharmacological properties of the drug are related directly to iodine, while the ability to cause burning of tissues when applied is lost, but high bactericidal activity remains, which has made it possible to expand the scope of its use as an antiseptic. During contact with the skin and mucous membranes, iodine, which is in complex with PVP, is released gradually and evenly, which is manifested by a thin colored layer, which remains until the entire amount of iodine is released, acts more slowly and for a long time [Nikulin V.N., Gerasimenko V.V., Svirskaya E., 2008]. Thanks to the polymer molecule, iodine penetrates deep into the wound, into inflamed tissue and under the scab. Penetration into tissue to a depth of about 1 mm does not interfere with normal regeneration processes.

Compared to other antiseptics, povidone-iodine has a number of significant advantages:

more effective than other antiseptics in suppressing the proliferation of microorganisms even in large dilutions (up to 1/256);
physicochemical conditions at the site of inflammation, determined by pH, protein, blood, enzymes, have little effect on the effect of povidone-iodine;
has the highest specific activity against most infections and a wider antiviral spectrum of action (enteroviruses, polio viruses, herpes, adenoviruses, influenza viruses, and HPV).

Povidone-iodine has been proven to be highly effective in the local treatment of herpetic lesions of the mucous membranes [15] and is highly active in the prevention of transmission of human papillomavirus infection to a sexual partner [14]. It was noted that papillomavirus is not sensitive to other antiseptics. In some studies, povidone-iodine has been shown to be more effective in the treatment and prevention of viral infections compared to specific antiviral agents.

According to S. Tsutomu, S. Junko (1996–1998), R. Kawana et al. (1998), E. Shanbrom (1996):

anti-infectives containing povidone-iodine can be used to combat diseases caused by HIV, chlamydia, gonococci, treponema and herpes simplex virus (Table 2);
not a single fact of the development of resistance of microorganisms to povidone-iodine has been described, despite a long period of use in surgical practice;
lack of systemic effect due to the large size of the povidone-iodine complex (400–4000 kDa);
povidone-iodine, unlike other antiseptics, normalizes the acidity of the vaginal environment, which creates conditions for the rapid restoration of normal vaginal microflora, which is an important factor in the absence of relapses of vaginal infection after treatment.

For 10 years, we have used Betadine suppositories:

for the treatment of common vaginitis;
for prevention in everyday life (unprotected sexual intercourse during a casual relationship, visiting a dubious pool in a sauna, rape, etc.);
before inserting an intrauterine device (IUD);
before planned gynecological surgical interventions and then together with taking antibiotics throughout the entire course of antibiotic therapy;
before treatment of uterine fibroids using uterine artery embolization;
before transvaginal microcatheter balloon radiopaque recanalization of the fallopian tubes in the treatment of infertility;
in the complex treatment of cervical lesions.

One of our studies is indicative of the prevention of postoperative complications. Before an abortion or diagnostic curettage, 80 women were prescribed Betadine for 7 days, 1 suppository at night, and immediately before the procedure, ultrasound resonance instillation of the cervical canal was performed with a 10% Betadine solution for 2 minutes. As a result, we did not record a single case of inflammatory changes either on the day of discharge or 10 days later. Of the 80 women who did not receive preventive therapy with Betadine, 45% had to be prescribed modern antibiotics in the postoperative period. Our study indicates that about 45% of patients in surgical gynecology have disorders of the vaginal microcenosis, which can cause the development of infectious complications after surgical interventions on the pelvic organs. In this case, the administration of antibiotics long before surgery is not justified (they do not provide preoperative decontamination of the patient, and the risk of the emergence of antibiotic-resistant microorganisms significantly increases).

A large number of studies have been devoted to the effectiveness of Betadine, however, they do not pay due attention to the individual tolerability of this drug in women. For this purpose, we conducted another study. 60 women took part in the study. In 20 of them, Betadine suppositories were prescribed before invasive procedures (abortion, separate diagnostic curettage, installation of an IUD), in 20 - in parallel with antibiotics, 10 women used Betadine for prophylactic purposes, and 10 patients were treated with Betadine for vaginitis.

The regimens for using Betadine, depending on the reason for which it was prescribed, were as follows: before planned invasive interventions - 7 days before the procedure, 1 suppository at night; parallel to taking antibiotics - 1 suppository at night during the entire course of antibiotic therapy; for preventive purposes - 1 suppository at once, then 1 suppository at night for 6 days; for the treatment of colpitis - 1 suppository at night for 14 days. All women who used Betadine were asked to complete a questionnaire that included questions regarding its tolerability. In addition, the study assessed the effectiveness of Betadine in the situations in which it was prescribed. As a result of the study, it was found that the main inconvenience when using Betadine, which was noted by 52 (86.6%) women, is staining of linen, while 50 women rated the severity of this discomfort as insignificant. Vaginal burning and itching were noted by 8 (13.3%) women. To the question “how do you assess the effectiveness of Betadine,” 98% of women answered “effective,” and only 2% of patients did not find any particular effect from the use of Betadine. All women who took part in the study found it acceptable to use Betadine for preventive purposes in everyday life; 98%, after talking with a doctor, expressed a desire to always have Betadine with them. At the same time, the results of microbiological studies showed that in all observations, when the patient was prescribed Betadine before invasive interventions, inflammatory complications did not develop. In women who used Betadine in parallel with taking antibacterial drugs, the development of vulvovaginal candidiasis was not observed (in this case, the action of Betadine is aimed not only at sanitizing the lesion, but also at preventing the development of candidal infection). In the group of women who were prescribed Betadine for the treatment of colpitis, at the end of the course of therapy, all noted normalization of the flora in the vagina and the disappearance of signs of inflammation. Local use of antiseptic drugs that effectively decontaminate mucous membranes is also necessary if it is impossible to quickly verify the causative agent of the inflammatory process.

The wide spectrum of action of Betadine provides great opportunities for its use in diseases such as:

vaginitis of any etiology (bacterial, fungal, viral, trichomoniasis);
bacterial vaginosis;
chlamydial, ureaplasma and mycoplasma infection (in combination with etiotropic therapy);
genital herpes and genital warts (as a local etiotropic drug and for the prevention of superinfection);
vaginitis of mixed etiology (up to 30% of all vaginitis is mixed!) is the drug of choice.

When using Betadine, it is important to remember that you can start treatment with it immediately after taking a smear. The earlier the drug is used, the less often the need for antibiotics arises. Long-term antibacterial treatment of chronic nonspecific vulvovaginitis changes the endogenous microflora, causing an increase in the number of strains resistant to antibacterial drugs. That is why most researchers assign the main role to local treatment of vulvovaginitis. The advantages of local treatment are the minimal risk of adverse reactions, simplicity and ease of use, the absence of contraindications (except for individual intolerance to the drug) and the possibility of use for extragenital pathology [2].

Considering the certain sensitivity of human papillomavirus infection and the ability of povidone-iodine to penetrate under the scab, we used Betadine in surgical treatment of cervical pathology in the amount of excision/conization. In the first group (20 people) after surgical treatment of the cervix, Betadine was prescribed 1 suppository at night for 10 days, in the second (20 people) - before destructive treatment for 3 days and after treatment of the cervix for 7 days Betadine 1 suppository at night, in the third (20 people) - after surgical treatment of the cervix, suppositories containing dexpanthenol + chlorhexidine bigluconate were prescribed. In the first and second groups, faster epidermization of the cervix by 5±3 days was noted, and no significant difference in the epidermization of the cervix in the 1st and 2nd groups (using Betadine) was noted.

Betadine is of great importance in preconception decontamination of women; it can be used for the treatment of BV and mixed vaginitis in the first trimester of pregnancy, when it is undesirable to use antibacterial drugs. Betadine is used for disinfection in the stages of preparation for childbirth or cesarean section, during childbirth, for treating the skin, umbilical cord and palpebral fissure in newborns. Clinical experience has shown that treating the skin of newborns with a 0.1% Betadine solution completely eliminates the possibility of developing a nosocomial infection. It is also important to note that Betadine solution is more effective and less toxic than traditional means for the prevention of conjunctivitis in newborns. Belarusian researchers [Safina M.R., Soloshkina D.A., 2006] report convincing results of using Betadine for the treatment of mixed vaginal infections in pregnant women in the first trimester. The effectiveness of therapy was assessed after 7–8 days. The criteria for cure were a subjective assessment of the patient, a decrease in vaginal discharge and normalization of the bacterioscopic picture during a control smear examination. In the group of pregnant women treated with Betadine, the clinical cure rate for mixed infections reached 91%, which coincides with literature data. Use this drug for 7 days at 37–40 weeks. pregnancy is an effective way to prevent septic complications after vaginal delivery, as well as after surgical delivery. Prenatal prevention reduces the incidence of traumatic damage to the tissues of the birth canal during childbirth and improves the results of healing of postpartum injuries [12].

In addition to the prevention of inflammatory diseases during invasive procedures, Betadine is indispensable in situations of unprotected sexual intercourse, rape or condom rupture, when there is a possibility of infection from a sexual partner. In these cases, the prompt administration of Betadine followed by its use of 1 suppository at night for 7 days helps to avoid the development of the inflammatory process.

Betadine can replace frequent vaginal douches and douching in women prone to mysophobia (fear of infection). In addition, for prophylactic purposes, Betadine can be used in the premenstrual period in women with frequent relapses of BV, since it is in this phase that the vaginal pH increases, which can help activate the growth of anaerobes.

Thus, it is necessary to clearly identify the main areas of application of the drug Betadine. Firstly, Betadine is an antiseptic, its task is not treatment, but prevention, although in relation to BV, Betadine can be considered from a therapeutic point of view. Betadine is used for the prevention of inflammatory diseases of the pelvic organs during invasive interventions and infectious complications in obstetrics. The use of Betadine in combination with antibiotics can reduce the incidence of vulvovaginal candidiasis. In a woman’s daily life, Betadine is a means of preventing BV and sexually transmitted infections.

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