Prevention and treatment of urogenital infections and complications: lactobacilli's multi-pronged effects

Abstract

The association between depletion of vaginal lactobacilli and increased risk of various urogenital infections and complications such as preterm labor, has been known for some time. Restoration of depleted lactobacilli by administration of probiotic strains has been demonstrated in humans using Lactobacillus rhamnosus GR-1 and L. reuteri RC-14. These organisms also augment antibiotic efficacy, lessen the side effects of these drugs, and alleviate diarrhea in AIDS patients. The mechanisms appear to be multi-factorial, and include production of: (i) anti-microbial factors such as lactic acid, bacteriocins, hydrogen peroxide, (ii) biosurfactants or other components that affect pathogen colonization and biofilm formation, (iii) signalling compounds that influence pathogen virulence expression, and (iv) signalling compounds that modulate immunity. Recombinant strains have been produced that inhibit or kill HIV, offering hope for microbicide applications that can be self-used by women. As more information becomes available about the ‘normal’ versus ‘disease prone’ vaginal microbiota and strains that confer the most benefits, current and new probiotic remedies will potentially provide improved restorative and therapeutic options to lower the one billion urogenital infections currently afflicting women around the world.