Abstract
BackgroundOver recent years, a growing interest has developed in microbiota and in the concept of maintaining a special balance between Lactobacillus and other bacteria species in order to promote women’s well-being. The aim of our study was to confirm that vaginal Lactobacilli long-lasting implementation in women with HPV-infections and concomitant bacterial vaginosis or vaginitis might be able to help in solving the viral infection, by re-establishing the original eubiosis.MethodsA total of 117 women affected by bacterial vaginosis or vaginitis with concomitant HPV-infections were enrolled at Department of Gynecological Obstetrics and Urological Sciences, La Sapienza University, Rome, Italy between February 2015 and March 2016. Women were randomized in two groups, standard treatment (metronidazole 500 mg twice a day for 7 days or fluconazole 150 mg orally once a day for 2 consecutive days) plus short-term (3 months) vaginal Lactobacillus implementation (group 1, short probiotics treatment protocol group, n = 60) versus the same standard treatment plus long-lasting (6 months) vaginal Lactobacillus rhamnosus BMX 54 administration (group 2, treatment group, n = 57).ResultsAfter a median follow up of 14 months (range 9–30 months) the chance to solve HPV-related cytological anomalies was twice higher in probiotic long-term users (group 2) versus short probiotics implementation group (group 1) (79.4% vs 37.5%, p = 0.041). Moreover, a total HPV-clearance was shown in 11.6% of short schedule probiotics implementation patients compared to a percentage of 31.2% in vaginal Lactobacilli long term users (p = 0.044), assessed as negative HPV-DNA test documented at the end of the study period.ConclusionsThe consistent percentage of clearance of PAP-smear abnormalities and HPV-clearance obtained in long-term treatment group has been interestingly high and encouraging. Obviously, larger and randomized studies are warranted to confirm these encouraging results, but we believe that eubiosis re-establishment is the key to tackle effectively even HPV-infection.Trial registrationRetrospectively registered on PRS NCT03372395 (12/12/2017).
Highlights
Over recent years, a growing interest has developed in microbiota and in the concept of maintaining a special balance between Lactobacillus and other bacteria species in order to promote women’s well-being
The aim of our study was to investigate if Lactobacillus rhamnosus BMX 54 (NORMOGIN ®) long-lasting vaginal application in women with dysbiosis and concomitant human papillomavirus (HPV)-infections, might be able to have an advantageous effect on viral infection control, by restoring a stable microbiota to eubiosis
Inclusion criteria were: age > 18 years, documented BV or yeast vaginitis associated with HPVinfection documented as PAP-smear abnormalities (ASCUS, Low Grade Intraepithelial Lesion (L-SIL) or High Grade Intraepithelial Lesion (H-SIL) histologically demonstrated as CIN1) and/or positive for HPV-DNA
Summary
A growing interest has developed in microbiota and in the concept of maintaining a special balance between Lactobacillus and other bacteria species in order to promote women’s well-being. Lactobacilli are the most widespread and prevailing subpopulation In some conditions, this balance can be compromised (dysbiosis) and other microorganisms may grow reducing anti-bacterial defence mechanisms. This balance can be compromised (dysbiosis) and other microorganisms may grow reducing anti-bacterial defence mechanisms The loss of this delicate steadiness can move in numerous directions (pathobiosis), depending on different of factors (hormone levels, douching, sexual practices, bacterial interactions, host defences, and so on), promoting disorders such as bacterial vaginosis and yeast vaginitis, and endorsing the occurrence of sexually transmitted diseases. The mechanisms by which Lactobacilli are able to stabilize the vaginal microbiota consist of the production of antimicrobial compounds (hydrogen peroxide, lactic acid, bacteriocinlike substances) and in the capability to adhere and compete for adhesion sites in the vagina with other pathogens [1,2,3]
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