Gyneco

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Vaginal yeast infection

Vaginal yeast infection, a common fungal infection of the vulva and vagina, seems to be more likely to occur if the balance of the vaginal microbiota is disrupted. Treatment is increasingly directed towards the use of probiotics.

Vaginal yeast infection (or vulvovaginal candidiasis) affects 70 to 75% of women at least once in their life.1 It is characterized by pruritus associated with burning sensation, erythema, and leukorrhea. 

Dysbiosis, a favorable environment for Candida to thrive

In the majority of cases (85 to 90%), vaginal yeast infection is caused by Candida albicans that is naturally present in the vaginal and intestinal microbiota. Following a dysbiosis, the balance of the vaginal flora is disrupted, and C. albicans proliferates abnormally, thus leading to the development of this disease.
This imbalance in the vaginal microbiota may arise from different sources; it can appear with antibiotic treatment or corticosteroids, pregnancy, immunosuppression, and even uncontrolled diabetes,2 although the mechanisms are not totally understood. 

Classic treatment and the potential use of probiotics 

The standard treatment for candidal vulvovagnitis is anti-fungal3,4,5 (azole and polyene derivatives), with a success rate of 80%. However, reoccurrences can happen and new therapeutic options are currently being evaluated including, promisingly, probiotics.6 Taken orally or topically (capsules or vaginal suppositories), probiotics may be able to rebalance the vaginal microbiota and reduce the frequency of recurrent Candida infections.7,8
 

Sources:
1. Sherrard J et al. 2011 European (IUSTI/WHO) guidelines on the management of vaginal discharge. Int J STD AIDS. 2011 Aug;22(8):421 https://www.ncbi.nlm.nih.gov/pubmed/21795415
2 – Mendling W. Guideline: vulvo-vaginal condidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candisosis).  Mycosis 2015; 58:1-15. http://onlinelibrary.wiley.com/doi/10.1111/myc.12292/abstract;jsessionid=069DDE60257C865FFF881D08496D0F19.f04t04 
3 - ACOG Practice Bulletin Number 72: Clinical Management Guidelines For Obstetricians & Gynecologists. Vaginitis. Obst Gyn 2006; 107(5):1195-1206. https://www.ncbi.nlm.nih.gov/pubmed/16648432
4 - Sherrard J et al. 2011 European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge. http://www.iusti.org/regions/europe/pdf/2011/Euro_Guidelines_Vaginal_Discharge_2011.Intl_Jrev.pdf
5 - Van Schalkwyk J et al. Vulvovaginitis: Screening for and Management of Trichomoniasis, Vulvovaginal Candidiasis, and Bacterial Vaginosis. J Obstet Gynaecol Can 2015;37(3):266–274. http://sogc.org/wp-content/uploads/2015/03/gui320CPG1504E.pdf
6 - Reid G et al. Microbiota restoration: natural and supplemented recovery of human microbial communities. Nat Rev Microbiol. 2011 Jan;9(1):27-38. doi: 10.1038/nrmicro2473. Epub 2010 Nov 29. https://www.ncbi.nlm.nih.gov/pubmed/21113182
7. Strus M et al.  Studies on the effects of probiotic Lactobacillus mixture given orally on vaginal and rectal colonization and on parameters of vaginal health in women with intermediate vaginal flora. Eur J Obstet Gynecol Reprod Biol 2012; 163: 210-15. http://www.ejog.org/article/S0301-2115(12)00194-7/abstract
8.  Vujic G et al. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections:  a double-blind, randomized,  placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 2013; 168: 75-9. http://www.ejog.org/article/S0301-2115(13)00013-4/abstract

Vaginosis

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
 

Sources:
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

Pathologies

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  • Allergics

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  • Psychiatric and Neurodegenerative

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