Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Obstetrics and Gynaecology
  • Obstetrics and Gynaecology Perspective
  • Role of Probiotics in...

Role of Probiotics in recurrent bacterial vaginosis: A review

Written By : Dr Sachin M. Lokhande |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-06-25T12:58:02+05:30  |  Updated On 25 Jun 2022 1:33 PM IST
Role of Probiotics in recurrent bacterial vaginosis: A review
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email
Bacterial vaginosis (BV) has been documented to be the most common urogenital infection in women of reproductive age, with estimates highlighting that it accounts for 90% of all cases in reproductive age women (1,2). Reports show that the vaginal microflora in patients with BV is more diverse than the microbiota of healthy females, with a rise in atypical bacterial species (3). Symptoms may include fishy odor, discharge, and vaginal pH above 4.5, while others may remain completely asymptomatic. BV if left untreated can increase the risk of pelvic inflammatory disease, UTI, and increased susceptibility to sexually transmitted infections, including HIV. Bacterial Vaginosis has further been linked to increased chances of preterm labor and low birth weight during pregnancy. To avoid such unwarranted long-term complications, treating BV efficiently at the earliest, is of utmost importance. (1)

Though antibiotics like metronidazole and clindamycin have been regarded as the conventional drug therapy to manage BV, the recurrence rates remain high (3) owing to the rise of new drug-resistant microbial variants and antibiotic side effects. This has opened the field for use of probiotics, which are now considered to be an efficient alternative strategy to treat BV, by restoring the healthy vaginal microbial ecosystem.

What causes the frequent recurrence of bacterial vaginosis?

Elimination of the commensal organisms in the vagina by antimicrobial therapy, thereby increasing susceptibility to recolonization by pathogens is one of the major causes of high recurrence. Further, antimicrobials fail to eradicate the pathogens, due to biofilm resistance, coupled with the virulent organisms coming back from their source (the person's gut, or partner) and attacking the host whose defenses are suboptimal adds up to the problem. (1)

Role of Probiotics: How do they act?

Probiotics are 'live microorganisms that, when administered in adequate amounts, confer a health benefit on the host' (3). Lactobacillus, Bifidobacterium, Streptococcus, Enterococcus, and Bacillus- are some of the most common beneficial probiotic microorganisms in use today. (4)

BV is characterized by a significant decline in lactic acid-producing lactobacilli, alteration of the optimal vaginal pH, disruption of the vaginal barrier by hydrolytic enzymes, increased release of proinflammatory cytokines and chemokines with increased susceptibility to difficult-to-treat pathogens, and recurrent infection. (4)

In such situations, probiotics act by replenishing the commensal microbes and lowering the risk of reinfection. Ample evidence now suggests that probiotics provide host protection against microbial invasion by blocking the colonization of vaginal pathogens as a result of displacement and exclusion competition and promoting immunomodulation mechanisms by activating the innate immunity system, producing hydrogen peroxide (H2O2), and stimulating anti-inflammatory action. (4)

In post-menopausal women, receding estrogen levels are associated with a decrease in vaginal lactobacilli colonization and adherence, making them more susceptible to urogenital infections, and colonization of the vagina by commensal lactobacilli will serve as a protection against pathogens. (1) Such encouraging results have made lactobacilli species and their various combinations the most studied probiotic to date.

Revealing Study testimonials: Notable studies supporting the use of probiotics in BV

An accumulating body of evidence now supports the eminent role of probiotics in the restoration of vaginal normal flora and in treating bacterial vaginosis.

1. Analyzing the effect of oral probiotics containing Lactobacillus rhamnosus and L. reuteri on women infected with bacterial vaginosis, Anukam et al. (5) noted a remarkable 90% recovery rate in women with BV after probiotic administration to women treated with antibiotics.

2. Another study by Mastromarino et al. (6), highlighted a drastic improvement of the vaginal microbiome among BV infected women, as 83% of the women in the test group were free of BV after therapy with Lactobacillus.

3. In a one of its kind study, Ling et al. (7) showed that probiotic administration has a better effect than the classical antibiotics in treating BV. They found that both 7-day intravaginal metronidazole and 10-day intravaginal probiotics have good efficacy against BV, but probiotics maintained normal vaginal microbiota longer due to effective and steady vaginal microbiota restoration.

4. The efficacy of combining probiotics or placebo with oral metronidazole was assessed in 125 women aged 18 to 44 with BV. Researchers noted a cure rate of 40% in placebo and 88% in probiotic subjects, affirming that probiotics can augment the effects of antibiotics in managing BV. (8)

5. A study by Bastani et al confirmed the potential efficacy of lactobacilli in restoring and maintaining the normal urogenital flora and showed that probiotic bacteria when supplemented for 2 months can most appropriately normalize vaginal flora, help cure the existing infection and prevent recurrence of BV. They also elaborated that longer periods of probiotic administration may be useful for long-term control of BV relapses after conventional antibiotic therapy. (4)

6. Yet another recent study aimed at investigating the efficiency of long-term Lactobacillus administration in restoring vaginal microbiota among 250 nonpregnant women with BV over 9 months, has confirmed the pivotal role of Lactobacillus as prophylactic therapy in suppressing BV recurrence, even after antibiotic treatment. (4)

7. Evaluating the antimicrobial effect of two Lactobacillus strains (Lactobacillus rhamnosus and Lactobacillus acidophilus) alone or in combination, the results from a study have revealed that the combination of the strains exerts a synergic activity against Escherichia coli, thus augmenting recovery from BV. (9)

8. A study by Rukshana Shamshu et al reported that in the treatment of bacterial vaginosis, the addition of probiotics (Lactobacillus rhamnosus and Lactobacillus reuteri) to the conventional antibiotics can improve the cure rate of bacterial vaginosis and reduce the rate of recurrences. (10)

Backed by such positive results, it is not surprising that probiotics as adjunctive and alternative medicine is already being widely used particularly in those with chronic vaginitis.

Highlights-

1. Maintaining a harmonious balance of vaginal microbiota is crucial to preventing recurrent BV.

2. Probiotics are being considered the latest armamentarium to ward off BV by replenishing the vaginal microbiome, restoring physiological homeostasis and host function, including reducing hostile bacteria, regulating the immune system, preventing infection, and promoting overall reproductive health.

3. As evidence continues to support the benefits of probiotics not only treating, but also preventing bacterial vaginosis, practitioners should be optimistic about recommending them to their full potential as and when needed.

Conclusion-Accounting for a global prevalence of between 23% to 29% (4) across different regions, BV is emerging to be a grave and costly health burden. Though drug therapy is effective in the relief of symptoms typically associated with acute infections, they are generally unable to offer long-term protection against possible recurrences. Given the unique mechanism of action of probiotics, along with its good safety and tolerability profile, the future direction of managing BV lies in considering this therapy as an effective and viable strategy against recurrent cases of BV.

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

References

1. Cribby, Sarah; Taylor, Michelle; Reid, Gregor (2008). Vaginal Microbiota and the Use of Probiotics. Interdisciplinary Perspectives on Infectious Diseases, 2008(), 1–9. doi:10.1155/2008/256490

2. Dr. Anshu Mishra. Analysis of vaginal infections in pregnant women: A clinical study. Int J Clin Obstet Gynaecol 2018;2(1):10-12.

3. Superti, F., & De Seta, F. (2020). Warding Off Recurrent Yeast and Bacterial Vaginal Infections: Lactoferrin and Lactobacilli. Microorganisms, 8(1), 130. https://doi.org/10.3390/microorganisms8010130

4. Yue Han, Qing-ling Ren, Does probiotics work for bacterial vaginosis and vulvovaginal candidiasis, Current Opinion in Pharmacology, Volume 61,2021, Pages 83-90, ISSN 1471-4892,https://doi.org/10.1016/j.coph.2021.09.004

5. Anukam KC, Osazuwa E, Osemene GI, Ehigiagbe F, Bruce AW, Reid G: Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect 2006, 8: 2772–2776.

6. Mastromarino P, Macchia S, Meggiorini L, et al.: Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect 2009, 15:67–74.

7. Ling Z, Liu X, Chen W, et al.: The restoration of the vaginal microbiota after treatment for bacterial vaginosis with metronidazole or probiotics. Microbiol 2013, 65:773–780

8. K. Anukam, E. Osazuwa, I. Ahonkhai, et al., "Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo-controlled trial," Microbes and Infection, vol. 8, no. 6, pp. 1450–1454, 2006.

9. Bertuccini, L.; Russo, R.; Iosi, F.; Superti, F. Effects of Lactobacillus rhamnosus and Lactobacillus acidophilus on bacterial vaginal pathogens. Int. J. Immunopathol. Pharmacol. 2017, 30, 163–167.

10. International Journal of Reproduction, Contraception, Obstetrics and Gynecology Shamshu R et al. Int J ReprodContraceptObstet Gynecol. 2017 Feb;6(2):671-681 www.ijrcog.org

bacterial vaginosisProbioticsLactobacillus probioticsstreptococcus probioticsprobiotics in vaginosisvibact dslactobacillus acidophilus probioticsprophylactic therapy in vaginosisvibact in vaginosis
Dr Sachin M. Lokhande
Dr Sachin M. Lokhande

    Dr. Sachin M. Lokhande is an MBBS, DGO, DNB, FMAS. Dr. Lokhande has 12 years of clinical experience as a Gynaecologist. He is a former Assistant Professor at CMC Vellore and RJH AIROLI at Navi Mumbai.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story

    Editorial

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

    Aspirin in Primary Prevention- When to Consider?

    Aspirin in Primary Prevention- When to Consider?

    Featured image representing medico legal

    What's the Role of Expert Opinion in Medical Negligence?

    7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

    7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

    Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

    Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

    View All

    Journal Club Today

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

    View All

    Health News Today

    Health Bulletin 09/ May/ 2025

    Health Bulletin 09/ May/ 2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok