Probiotics' Treatment Among Women with Symptomatic White Discharge: An Indian Experience

Antimicrobial therapy is frequently used to treat vaginal infections. While this approach has been largely successful in treating bacterial infections of the vagina, rising antibiotic resistance and the inability of antibiotics to alter host susceptibility to recurrent infections, as well as a detrimental effects on patient quality of life, make it essential to consider therapeutic options beyond antibiotics. (2)

Probiotics for Symptomatic White Discharge per Vagina- Reviewing an Indian Study:

Loss of vaginal lactobacilli appears to be the major factor in the cascade of changes leading to bacterial vaginosis, which is further characterized by symptomatic white discharge. (2)

Kusuma Naik et al. conducted a prospective randomized clinical study on 50 Indian women with a history of white discharge per vagina to assess probiotics' efficacy in restoring the vaginal flora and providing symptomatic relief. (2)

The patients received a combination of antibiotics and antifungal (Ofloxacin + Ornidazole + Fluconazole) along with probiotics containing 2,500 million spores of Lactobacillus for 1 week. The results of the study demonstrated that 82% of patients reported symptomatic relief within 1 week. Additionally, 50% patients showed improvement in the Lactobacilli count which was interpreted using improvement in Nugent's score. The Nugent score is an accepted method for identifying bacterial vaginosis by microscopic examination of a Gram-stained smear of vaginal discharge.

These findings suggested that intestinal passage of probiotic strains leads to a beneficial impact on the vaginal microbiome. It is possible that the treatment with probiotics altered the host's mucosal immunity (through the vagina and gut), which contributed to the pathogen count reduction. (2)

According to the study's findings, using probiotic Lactobacillus is safe and can also help prevent harmful bacteria and yeast from colonizing the vagina. (2)

FOGSI Recommendations on the Use of Probiotics: Infection Practice Points-Vaginitis Evaluation and Management published by The Federation of Obstetric and Gynaecological Societies of India (FOGSI) recommends administering probiotics containing Lactobacillus strains to prevent bacterial vaginosis and reduce vaginal discharge. (3)

Probiotics and Vaginal Health: The symbiotic relationship between reproductive-age women and their vaginal Lactobacillus species is well established. Lactobacilli dominate the vaginal ecosystem and safeguard vaginal health by inhibiting the growth of pathogenic microbes. (4) The vaginal flora is considered abnormal when the vault is colonized primarily or solely by pathogenic bacteria, such as Escherichia coli or Gardnerella vaginalis. (2)

Bacteria, protozoan parasites, fungi, and viruses are the pathogens associated with vaginal discharge. Gardnerella vaginalis and Neisseria gonorrhoeae are examples of common bacterial culprit pathogens. (2) One-third of vulvovaginal infections are caused by bacterial vaginosis. (1)

The mode of action of probiotics in maintaining vaginal health can be summarised through the following activity sequels:(2)

• Increase in probiotics and the native Lactobacilli from the rectal surface to the vagina.
• A healthy vaginal microflora leads to fewer pathogens migrating into the vagina from the rectal skin.
• Enhancement of intestinal mucosal immunity which impacts vaginal immunity and makes the systemic environment less susceptible to bacteria that cause bacterial vaginosis.

Practical Pointers:

• The common clinical complaint in women of the reproductive age group is abnormal vaginal discharge.
• Bacterial vaginosis is the most common cause of symptomatic vaginal discharge.
• Injudicious treatment with multiple antimicrobial agents alone leads to the development of drug-resistant strains and an economic burden on the patient, with a  persistent recurrence risk.
• Evidence from an Indian clinical study substantiated that treatment with probiotics increases Lactobacillus, improves vaginal flora, and prevents bacterial vaginosis.
• Probiotics could be considered a reasonably effective treatment for the management of abnormal vaginal discharge.

The above article has been published by Medical Dialogues under the MD Brand Connect Initiative. For more details on Probiotics, click here

References:

1. Gopal V, Gopal R, Rupavani, Mangaiyarkarasi T. Clinico-etiological study of vaginal discharge in adult women – A hospital-based study. Indian J Microbiol Res. 2018;5(4):535-537

2. Kumar R, Krishna L, A, Naik K, Nusrat H. An RCT for Efficacy of Oral Probiotics in Treatment of Cases with Symptomatic White Discharge per Vagina in Rural Population. J South Asian Feder Obs Gynae 2012; 4 (3):126-129.

3. Infection Practice Points Vaginitis-Evaluation and Management. Federation of Obstetric and Gynaecological Societies of India (FOGSI). 2019.Retrieved on 11^th March 2023 from https://www.fogsi.org/wp-content/uploads/tog/TOG_IPP_VAGINITIS_Final.pdf

4. Pendharkar S, Skafte-Holm A, Simsek G, Haahr T. Lactobacilli and Their Probiotic Effects in the Vagina of Reproductive Age Women. Microorganisms. 2023; 11(3):636. https://doi.org/10.3390/microorganisms11030636