Abstract
Objectives: The objectives of the study were to ascertain the efficacy of probiotics along with antimicrobials in the treatment of vulvovaginitis and to evaluate the rate of recurrence. Methods: The study was done on 60 patients who were randomly selected and divided into two groups of 30 each. Prior permission from the Institutional Ethics Committee and higher authorities was obtained before conducting the study. One group received standard treatment including antibacterial, antiviral, and antifungal as per the gynecologist discretion and in other group along with standard treatment, probiotic capsules containing combination of Saccharomyces boulardii, Lactobacillus sporogenes (50 million), Streptococcus faecalis (30 million), Clostridium butyricum (2 million), and Bacillus mesentericus (1 million) given orally twice daily and followed up for a period of 3 months. The drugs were started on the 5th day after menstruation taking starting of the bleeding as day 1. Results: The parameters compared were symptoms and signs (significantly reduced – p-value), clue cells (significantly reduced in number), and recurrence rates (significantly reduced), in 80% of patients smears which were not consistent with BV. Maximum number of patients showed negative KOH mount (71.5%), saline wet mount was negative in 80% of patients in antimicrobial agents + probiotics group. Conclusion: From the present interventional study, probiotics along with antimicrobial agents showed better improvement than antimicrobial agents alone. Hence, supplementation of probiotics along with antimicrobial agents provides better efficacy than antimicrobial agents alone in treating vulvovaginal infections.
Highlights
Female lower genital tract, consisting of vagina and ectocervix, is biological niche where numerous aerobic and anaerobic microorganisms coexist in a dynamic balance
Lactobacilli are implicated in regulating the normal vaginal microbiota by preventing overgrowth of pathogenic bacteria and opportunistic organisms [1]
The prevalence of bacterial vaginosis varies in different parts of the world and it is higher in developing countries [5]
Summary
Female lower genital tract, consisting of vagina and ectocervix, is biological niche where numerous aerobic and anaerobic microorganisms coexist in a dynamic balance. The common forms of infectious vulvovaginitis are bacterial vaginosis (40–50%), candidiasis (20–25%), and trichomoniasis (15–20%) all with high rates of recurrence [2,3]. Up to 10–15% of patients fail to respond to initial antimicrobial therapy and recurrence rates are significant (up to 80%) and requiring repeated administration of antimicrobial agents. Such repeated exposure increases the risk of emergence of resistant strains, alteration of microbiota, and possible persistence of bacterial vaginosis associated pathogens [4]. Vulvovaginal candidiasis (VVC) is estimated to be the second most common form of vaginitis after bacterial vaginosis [8]. Drugs may reduce the normal protective vaginal flora to increase the risk of recurrent infections and can cause many adverse effects [9,10]
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