Patients were randomized between a placebo and either of two regiments of double strain Bifilact( ®) probiotics. Ma, D., Chen, Y. & Chen, T. Vaginal microbiota transplantation for the treatment of bacterial vaginosis: a conceptual analysis. FEMS Microbiol Lett. 366, fnz025 (2019).

This is bad: they really sting! Insert as efficiciently as you can to avoid the stinging on the outside. Also, they are really messy! Insert at night and use a sanitary pad. Anukam, K. C. et al. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect. 8, 2772–2776 (2006). Within the Ada symptom assessment tool, you will be asked a series of questions about your health and symptoms to help Ada generate a symptom assessment report. A total of 147 postmenopausal women were randomized (86 to the intervention arm and 61 to the control arm), and 124 (87.9%) presented for a 3-month follow-up. There was no difference between the arms in age, race, body mass index, and Charlson Comorbidity Index. A majority of participants had the pessary managed by the health care professional (intervention arm vs control arm, 46 [76.7%] vs 55 [68.8%]; P = 0.30). Composition of the vaginal microenvironment did not differ with or without probiotic treatment at 3 months. Bother from vaginal symptoms, including discharge, itching, and discomfort, did not differ between arms. Adverse effects from the intervention were minor, resolved with discontinuation, and occurred at 39.1%. yoghurt containing L. acidophilus at > 1.0 × 10 8 colony-forming units ( n = 23). Yoghurt was consumedStoyancheva, G., Marzotto, M., Dellaglio, F. & Torriani, S. Bacteriocin production and gene sequencing analysis from vaginal lactobacillus strains. Arch. Microbiol. 196, 645–653 (2014). Cs, B. & Rm, B. Making inroads into improving treatment of bacterial vaginosis—striving for long-term cure. BMC Infect. Dis. 15, 292 (2015). Finally, the vaginal microenvironment is altered by BV-related bacteria, which could increase the difficulty for probiotic strains to compete with BV-related bacteria and hinder the colonization of probiotic strains 52. Thus, it may be necessary to open a niche for probiotic strains to minimize colonization resistance from resident bacteria, especially overgrown biofilm-forming bacteria. Combinations of antibiotics and probiotic treatments have been previously attempted. A study indicated that the combination of probiotics and metronidazole is more effective than antibiotics alone in maintaining a healthy vaginal ecosystem 67. There is also an overall higher remission rate with clinical trials with combined probiotic and antibiotic treatment (42–83%) compared to those using probiotics alone (20–48%) in long-term studies (≥4 months) (Table 4 vs. Table 2). For instance, short-term studies (<4 months) on L. rhamnosus GR-1 and L. reuteri RC-14 showed an 88% cure rate with antibiotic pretreatment compared to 51–88% in L. rhamnosus GR-1 and L. reuteri RC-14 only without antibiotic pretreatment (Tables 1 and 3) 55, 56, 58. Moreover, long-term studies (≥4 months) on L. rhamnosus GR-1 and L. reuteri RC-14 showed a 42% cure rate with antibiotic pretreatment compared to 20% on L. rhamnosus GR-1 and L. reuteri RC-14 only without antibiotic pretreatment 59, 60 (Tables 2 and 4). Given that orally administered antibiotics influence the whole gut microbiome 36, 37, we propose larger randomized cohort studies with L. crispatus delivered directly to the vagina after pretreatment with antibiotics administered vaginally that reduce the influence of BV-related bacteria (Fig. 1). VMT Kenyon, C., Colebunders, R. & Crucitti, T. The global epidemiology of bacterial vaginosis: a systematic review. Am. J. Obstet. Gynecol. 209, 505–523 (2013). seven days: 5 mL of fermented milk containing between 5.0 × 10 8 and 2.0 × 10 9 colony-forming units/mL of L.

Gao W., Weng J., Gao Y., Chen X. (2013). Comparison of the vaginal microbiota diversity of women with and without human papillomavirus infection: a cross-sectional study. BMC Infect. Dis. 13, 271. doi: 10.1186/1471-2334-13-271 Martinez, R. C. R. et al. Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial. Can. J. Microbiol. 55, 133–138 (2009). Did you know that just like our gut, which is populated by beneficial bacteria, so too the urogenital tract of women contains valuable microbiota? 1 These are mostly of the Lactobacillus species (spp. or group) of bacteria, and are responsible for maintaining the health of the vaginal tract. 2 Probiotics containing these beneficial bacteria can be taken orally, but may also be applied locally in a ‘pessary’ form, and can be helpful in maintaining the balance of good bacteria in the vaginal tract. 1-3 After completing metronidazole treatment, patients received probiotics and placebo, respectively (n=166).

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BV prevalence varies geographically and ethnically, and can affect >50% of women in some countries 6. BV is diagnosed using Amsel’s criteria or Nugent score, with Amsel’s criteria more commonly used in the clinic 5. Amsel’s criteria combines inspection of vaginal secretions, pH measurement, visual inspection under microscopy, and the Whiff test, whereas the Nugent score focuses exclusively on scoring Gram-stained microscopy images. The BV definition based on DNA sequencing of vaginal secretions is referred to as molecular BV 7, 8. Gambrell R. D., Jr. (1986). The menopause. Invest. Radiol. 21 ( 4), 369–378. doi: 10.1097/00004424-198604000-00017

the vaginal epithelium, and these are associated with increased resistance to lactobacilli-producedwomen, 37% of the patients in the L. rhamnosus GR-1 and L. reuteri RC-14 probiotic group had a lactobacilli-dominated Chen T., Xia C., Hu H., Wang H., Tan B., Tian P., et al.. (2021). Dysbiosis of the rat vagina is efficiently rescued by vaginal microbiota transplantation or probiotic combination. Int. J. Antimicrob. Agents 57 ( 3), 106277. doi: 10.1016/j.ijantimicag.2021.106277 Bacterial vaginosis (BV) is one of the most common diseases in women of reproductive age [ 1]. In China, the prevalence of BV ranged from 5.9% to 15.4% [ 2]. However, this number was 16.3%–29.2% in the United States [ 3], and reached up to 50% in southern and eastern Africa [ 4]. Despite this being a mild disease, patients with BV may suffer from a higher risk of reproductive tract infections and adverse pregnancy outcomes [ 5, 6, 7]. Anukam, K. 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 Infect. 8, 1450–1454 (2006).