Povidone-iodine utilisation in invasive gynecology

Abstract

Background. In the context of increasing antimicrobial resistance, prevention and management of infectious complications in invasive gynecology require a shift away from strategies based predominantly on systemic antibiotic prophylaxis.

Results. This review summarizes the current evidence on the use of povidone-iodine as a broad-spectrum topical antiseptic in obstetric and gynecological practice, with particular emphasis on invasive and minimally invasive procedures. Povidone-iodine is a complex of iodine with polyvinylpyrrolidone that provides controlled release of active iodine and rapid antimicrobial activity. It is effective against Grampositive and Gram-negative bacteria, fungi, viruses (including human papillomavirus), protozoa. Importantly, no microbial resistance to povidone-iodine has been documented despite decades of clinical use. Its mechanism of action involves multi-target oxidative damage to microbial cell membranes, proteins, and nucleic acids, which prevents the development of resistant strains. The article discusses the chemical and biological properties of povidone-iodine, including its pH level close to the physiological one, and its relevance following vaginal procedures involving stabilized hyaluronic acid or poly-L-lactic acid. Special attention is given to safety and tolerability. Evidence indicates that local use in non-pregnant women results in minimal systemic iodine absorption without clinically significant thyroid dysfunction, whereas use during pregnancy should be restricted to strict indications due to potential fetal thyroid effects. Randomized controlled trials and meta-analyses demonstrate that vaginal cleansing with povidone-iodine before cesarean section, hysterectomy, intrauterine device insertion, and other gynecological interventions significantly reduces the incidence of postoperative infections, including endometritis. The use of povidone-iodine allows effective infection prevention without routine systemic antibiotics, which is particularly important in the era of antibiotic resistance. The review concludes that povidone-iodine, including the 7.5% solution, represents a safe and evidencebased component of modern infection control strategies in invasive gynecology.