Bacterial vaginosis, the most common gynecological disease, has a considerable effect on women’s quality of life. It is the result of an imbalance in the vaginal flora that can be regulated through the use of probiotics.
Vaginosis is a bacterial vaginal disorder that is estimated to affect about a third of sexually active women.1 Although the disease can go unnoticed by some women, its symptoms most often include local irritation and foul-smelling discharge. It is not a sexually transmitted disease (STD), but it can increase the risk of contracting STDs such as herpes or HIV.2
A disease caused by dysbiosis
Bacterial vaginosis is a dysbiosis of the vaginal microbiota characterized by a modified ratio of Lactobacillus to other bacteria and a massive proliferation of mixed anaerobic flora. There is a predominance of Bacteroides spp., Mobiluncus spp., Mycoplasma hominis, or Gardnerella vaginalis. The latter secretes polyamines that cause an inflammatory reaction and increase the pH,5 thus causing vaginosis.
Probiotics as a backup
Vaginosis is generally treated with local or oral antibiotics.6 Nevertheless, this therapy can cause in turn a dysbiosis and increase the risk of reoccurrence.7,8 To restore a balanced equilibrium in the vaginal microbiota and make the pH more acidic, strains of probiotics belonging to the genus Lactobacillus may be used, such as the species L. rhamnosus, L. acidophilus, L. crispatus and L. reuteri. These probiotics stimulate the immune system, restore the vaginal ecosystem, competitively exclude pathogenic bacteria, lower pH levels, and produce antimicrobial substances like H2O2.9
1. Allsworth JE et al. Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data [archive], Obstet Gynecol. 2007 ; 109 : 114-20. https://www.ncbi.nlm.nih.gov/pubmed/17197596
2. Martin DH et al. The microbiota of the human genitourinary tract: trying to see the forest through the trees. Trans Am Clin Climatol Assoc. 2012; 123 : 242-56. https://www.ncbi.nlm.nih.gov/pubmed/23303991
3. Tomusiak A et al. Efficacy and safety of a vaginal medicinal product containing three strains of probiotic bacteria: a multicenter, randomized, double-blind, and placebo-controlled trial. Drug Des Devel Ther. 2015 Sep 25;9:5345-54. doi: 10.2147/DDDT.S89214. eCollection 2015. https://www.ncbi.nlm.nih.gov/pubmed/26451088
4. Romero R et al. The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women Microbiome. 2014; 2: 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916806/
5. Nunn KL et al. Enhanced Trapping of HIV-1 by Human Cervicovaginal Mucus Is Associated with Lactobacillus crispatus-Dominant Microbiota. MBio. 2015 Oct 6;6(5):e01084-15. doi: 10.1128/mBio.01084-15. https://www.ncbi.nlm.nih.gov/pubmed/26443453
6. Dovnik A et al. Treatment of vulvovaginal candidiasis: a review of the literature. Acta Dermatovenerol Alp Pannonica Adriat. 2015;24(1):5-7. https://www.ncbi.nlm.nih.gov/pubmed/25770305
7. Sobel JD et al. Suppressive antibacterial therapy with 0,75 % metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol 2006; 194 (5):1283-9.
8. Senok AC et al.. Probiotics for the treatment of bacterial vaginosis (review) Cochrane Database Syst Rev. 2009 Oct 7; (4): CD006289.
9. Mastromariano P et al. Bacterial vaginosis : a review on clinical trials with probiotics. New Microbiol. 2013 Jul;36(3):229-38. Epub 2013 Jun 30. https://www.ncbi.nlm.nih.gov/pubmed/23912864