Dentro do espectro de desordens ginecológicas, a vaginose citolítica (VC) representa um desafio diagnóstico e terapêutico singular, frequentemente subestimado na prática clínica. Caracterizada por um desequilíbrio na flora vaginal, onde há uma proliferação excessiva de lactobacilos, essa condição conduz à citólise das células epiteliais vaginais, manifestando-se por sintomas que mimetizam infecções por Candida spp. Conhecer as características da vaginose citolítica, sua patogênese e como fazer o diagnóstico e abordá-la é fundamental para otimizar o tratamento das pacientes afetadas.
Patogênese
A vaginose citolítica é decorrente de um supercrescimento de lactobacilos na vagina, que, paradoxalmente, são bactérias comumente benéficas, responsáveis pela manutenção do pH vaginal ácido. Em condições normais, este ambiente ácido protege contra a proliferação de patógenos. No entanto, quando há um crescimento excessivo, os lactobacilos podem causar a lise de células epiteliais, levando a sintomas irritativos locais.
Apresentação Clínica
Pacientes com vaginose citolítica frequentemente apresentam-se com queixas de prurido vaginal, ardor, dispareunia e corrimento branco semelhante à candidíase. Os sintomas, muitas vezes, pioram no período pré-menstrual. A confusão com candidíase vulvovaginal é comum, o que pode levar a tratamentos antifúngicos desnecessários e repetitivos, exacerbando o desequilíbrio da flora vaginal.
Diagnóstico
O diagnóstico de vaginose citolítica é essencialmente clínico, complementado por exames de microscopia. A observação de células guia ou a presença de “clue cells” não é característica, diferenciando-a da vaginose bacteriana. Ao exame microscópico, identifica-se um número elevado de lactobacilos juntamente com células epiteliais vaginais em processo de citólise. Testes de pH vaginal podem mostrar um pH inferior a 4,5, consistente com a superpopulação de lactobacilos.
Manejo
A abordagem terapêutica para a vaginose citolítica foca na restauração do equilíbrio da flora vaginal. O manejo pode incluir a suspensão de agentes desencadeantes, como antibióticos ou duchas vaginais, e a utilização de medidas que promovam a recolonização por uma flora vaginal diversificada e saudável. Em alguns casos, pode-se considerar a infusão vaginal de solução de bicarbonato de sódio para alcalinização do meio. É crucial evitar o tratamento empírico para candidíase sem uma avaliação diagnóstica adequada, para prevenir a perpetuação do desequilíbrio microbiano.
A vaginose citolítica destaca a complexidade da microbiota vaginal e a importância de um diagnóstico preciso na presença de sintomas vulvovaginais. O reconhecimento desta condição pelo ginecologista é fundamental para evitar terapias inapropriadas e promover estratégias eficazes que restabeleçam a harmonia microbiana vaginal.
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