Oral use of probiotics as an adjunctive therapy to fluconazole in the treatment of yeast vaginitis: A study of Nigerian women in an outdoor clinic

Abstract

Background: Vulvovaginal candidiasis (VVC) is one of the major urogenital infections for which women seek medical treatment or use self-prescribed antifungals. The objective of this study was to investigate whether probiotic lactobacilli can be used as an adjunctive treatment in the management of VVC in Nigerian women. Patients and methods: Fifty-nine premenopausal women attending health clinics were diagnosed with vaginal yeast infection by both clinical assessment and standard laboratory culture techniques. After informed consent, they were randomized blindly to receive a conventional single oral dose of fluconazole (150 mg) and a daily probiotic capsule containing Lactobacillus rhamnosus GR-1 and Lactobacillusreuteri RC-14 or placebo for 3 months (90 days). Results: At day 7, 47 of the 59 patients attended for follow-up. Seven of the 33 on probiotics (23%) and 2 of 14 on placebo (14%) had evidence of yeast infection by culture on day 7 (p>0.1), indicating a cure rate of approximately 80% with single dose fluconazole. However, of the 26 subjects who reported at day 90, 79% who received probiotics were free of yeast infection compared with 43% on placebo (p =0.1490). PCR confirmed this finding, as 75% in the probiotics group were negative for heat shock protein specific for Candida albicans at day 90. A PCR primer set specific for L. rhamnosus GR-1 and L. reuteri RC-14 revealed the presence of the Lactobacillus strains on day 90 in 25% of the subjects who took probiotics. All the patients in the placebo group (100%) had two or three recurrences during the 90 day follow-up, while 53% of the probiotics group had one to two recurrences (p =0.05). Conclusion: The study shows that adjunctive treatment of VVC with probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not impact the cure rate at day 7, but did lead to fewer vulvovaginitis recurrences. Problems with patients returning for follow-up appointments suggest the need for a more active education programme in Nigeria on clinical trials per se and probiotics in particular.Clinical Trial Registration Number: NCT00479947.