Prevention Of Bacterial Vaginosis Research Articles

The role of probiotics in maintaining vaginal ecosystem

A disturbed vaginal ecosystem is characterized by reduced or non-existing lactobacillary flora and damaged vaginal epithelium. It may not always be apparent whether alterations of the vaginal epithelium or pathogenic microorganisms are the primary cause of a disturbed vaginal ecosystem. Estriol plays a key role in developing and maintaining a healthy vaginal epithelium, stimulating cell growth and differentiation, increases epithelial thickness, and also promotes glycogen synthesis, which is required to maintain an acidic environment. Estriol deficiency results in the vulvovaginal atrophy and the development of atrophic vaginitis. In turn, Lactobacillus acidophilus maintains a healthy microbiome, protecting against infections and creating an acidic environment unfavourable for the growth of pathogens. In recent years, an increasing interest has been developed in probiotics with the belief that probiotics could be able to restore the vaginal microbiota health. A review of scientific articles on the use of an ultra-low-dose vaginal estriol 0.03 mg in combination with Lactobacillus acidophilus to normalize the vaginal microbiota and treat vaginal infections has been conducted. An analysis of published clinical studies and meta-analyses on the use of probiotics in vaginal infections showed the mechanisms of action of probiotics, their biological role and clinical effects. The integration of probiotics into the treatment and prevention of bacterial vaginosis is growing more urgent. The results of numerous studies and meta-analyses confirmed their high efficacy and safety. The supplementation of standard antibiotic therapy with probiotics improves cure rates, restores normal vaginal microflora and reduces the risk of relapse. Therefore, further studies on the use of probiotics to develop more effective and personalized treatment strategies providing long-term results are needed. The publication of new evidence will make it possible to introduce best practices into clinical practice and ensure a healthier future for patients worldwide.

The Analysis Study of Prevalence, Diagnosis and Management of Bacterial Vaginosis: A Comprehensive Systematic Review

Background: Bacterial vaginosis (BV) is a prevalent condition among women of reproductive age, characterized by a disruption in the normal vaginal microbiota. The systematic review focused on analyzing the prevalence, diagnosis, and management of Bacterial vaginosis based on literature from the past decade. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2014 to 2024. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 630 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: Bacterial vaginosis remains a complex condition influenced by microbial diversity, contraceptive use, and co-infections. Improved diagnostic methods and innovative treatment strategies, including probiotics, are essential for effective management and prevention of BV and its associated complications.

Possibilities of using lactobacilli metabolites for the treatment and prevention of bacterial vaginosis

Bacterial vaginosis is one of the most common reasons for pathological discharge from the genital tract in women of reproductive age, which, among other things, is characterized by a high recurrence rate after standard antibacterial treatment. To date, issues related to the prevention and treatment of bacterial vaginosis have remained relevant and unresolved. This review article discusses the feasibility of using lactobacilli metabolites in the treatment and prevention of bacterial vaginosis, taking into account the data accumulated. The use of lactic acid as an additional second stage of bacterial vaginosis treatment can be considered as a way to improve the effectiveness of therapy and patient adherence to treatment, as well as to reduce the likelihood of recurrences.

Antibiofilm Agents for the Treatment and Prevention of Bacterial Vaginosis: A Systematic Narrative Review.

Bacterial vaginosis (BV) is difficult to eradicate due to BV biofilms protecting BV bacteria (Gardnerella, Prevotella, and other genera). With the growing understanding of biofilms, we systematically reviewed the current knowledge on the efficacy of anti-BV biofilm agents. We searched literature in the Scopus, Medline, and Embase databases for empirical studies investigating substances for the treatment of BV biofilms or prevention of their recurrence and their efficacy and/or safety. Of 201 unique titles, 35 satisfied the inclusion criteria. Most studies (89%) reported on preclinical laboratory research on the efficacy of experimental antibiofilm agents (80%) rather than their safety. Over 50% were published within the past 5 years. Agents were classified into 7 groups: antibiotics, antiseptics, cationic peptides, enzymes, plant extracts, probiotics, and surfactants/surfactant components. Enzymes and probiotics were most commonly investigated. Earlier reports of antibiotics having anti-BV biofilm activity have not been confirmed. Some compounds from other classes demonstrated promising anti-BV biofilm efficacy in early studies. Further research is anticipated on successful antibiofilm agents. If confirmed as effective and safe in human clinical trials, they may offer a breakthrough in BV treatment. With rising antibiotic resistance, antibiofilm agents will significantly improve the current standard of care for BV management.

The use of a lactic acid gel in the treatment and prevention of bacterial vaginosis and urinary tract infections as a challenge to antibacterial therapy. A literature review

Bacterial vaginosis and urinary tract infections are common conditions that lead to a decrease in the quality of life and significant economic costs. The review provides up-to-date information on the role of lactic acid in the microbiota of the vagina and urinary tract, as well as on the use of a lactic acid gel in these conditions. Bacterial vaginosis is associated with an increased risk of urinary tract infections. Antibacterial therapy demonstrates statistically significant results in treating exacerbation, but not preventing further relapses, which is due to the possible high ability of bacteria to form biofilms. Lactic acid, unlike hydrogen peroxide, is involved in maintaining the vaginal microbiota and enhancing its protective function against sexually transmitted infections, and indirectly affects the urinary microbiota. This may allow the use of lactic acid for the treatment and prevention of relapses in both bacterial vaginosis and urinary tract infections.

In Vivo Confirmation of the Antimicrobial Effect of Probiotic Candidates against Gardnerella vaginalis.

Bacterial vaginosis (BV) is caused by a microbial imbalance of the vaginal ecosystem, causing genital discomfort and potentially even various complications in women. Moreover, research on the treatment or prevention of BV is increasing. In this study, we evaluated the antimicrobial and anti-inflammation effects of the lactic acid bacteria (LAB) Ligilactobacillus salivarius MG242, Limosilactobacillus fermentum MG901, and Lactiplantibacillus plantarum MG989 in a BV-induced mice model. The oral administration of the LAB significantly inhibited the growth of Gardnerella vaginalis up to 43% (p < 0.05). The LAB downregulated the expression of pro-inflammatory cytokines (IL-1β and TNF-α) and myeloperoxidase (p < 0.05). Upon histological examination, the exfoliation of epithelial cells in the vaginal tissues was found to be reduced in the probiotic administration group compared to the infected group. In addition, the LAB tolerated the gastric and/or intestinal simulated conditions and proliferated, showing potential in promoting health based on hemolysis activity, antibiotic susceptibility, enzyme activity, and lactic acid production. Altogether, our results showed that the investigated LAB may be a good food ingredient candidate for ameliorating BV in women.

A Randomized Controlled Open Label Crossover Trial to Study Vaginal Colonization of Orally Administered Lactobacillus Reuteri RC-14 and Rhamnosus GR-1 in Pregnant Women at High Risk for Preterm Labor.

Lactobacilli administration has been suggested for the treatment and prevention of bacterial vaginosis, which increases the risk for preterm birth. We aimed to evaluate the vaginal colonization of lactobacilli orally administered to pregnant women at risk for preterm birth. We performed a randomized and controlled crossover study between January 2016 and May 2017. Forty pregnant women at high risk for preterm birth with normal vaginal flora (Nugent score ≤ 3) were randomized to either receive two oral capsules/day each containing 5 × 109 Lactobacilli (L.) rhamnosus GR-1 and L. reuteri RC-14 (n = 20) or no treatment (n = 20) for 2 months. Treatments were then crossed over for an additional two months. A vaginal examination and swabbing were performed for assessment of bacterial vaginosis at baseline and every month until study completion. At the same time points, vaginal samples were cultured and subjected to matrix-assisted-laser-desorption/ionization-time-of-flight-mass-spectrometry (MALDI TOF-MS) for the detection of the specific bacterial strains contained in the capsules. The primary endpoint was the presence of the administered lactobacilli strains in the vagina during the first two months of follow-up. Thirty-eight women completed the study. During the first two months of treatment, L. rhamnosus GR-1 was detected in one (5%) woman on the probiotic treatment and 2 (11%) women receiving no treatment (p = 0.6). L. rhamnosus GR-1 was detected in vaginal samples of 4 (11%) women during probiotic treatment (of both groups) and L. reuteri RC-14 was not detected in any samples. The rest of the endpoints were not different between the groups. Altogether, vaginal colonization of lactobacilli following oral administration is low during pregnancy.

Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article.

Bacterial vaginosis (BV) and complicated vulvovaginal candidiasis (VVC) are frequently occurring vaginal infections in postmenopausal women, caused by an imbalance in vaginal microflora. Postmenopausal women suffer from decreased ovarian hormones estrogen and progesterone. A normal, healthy vaginal microflora mainly comprises Lactobacillus species (spp.), which act beneficially as a bacterial barrier in the vagina, interfering with uropathogens. During premenopausal period, estrogen promotes vaginal colonization by lactobacilli that metabolizing glycogen and producing lactic acid, and maintains intravaginal health by lowering the intravaginal pH level. A lower vaginal pH inhibits uropathogen growth, preventing vaginal infections. Decreased estrogen secretion in postmenopausal women depletes lactobacilli and increases intravaginal pH, resulting in increased vaginal colonization by harmful microorganisms (e.g., Enterobacter, Escherichia coli, Candida, and Gardnerella). Probiotics positively effects on vaginal microflora composition by promoting the proliferation of beneficial microorganisms, alters the intravaginal microbiota composition, prevents vaginal infections in postmenopausal. Probiotics also reduce the symptoms of vaginal infections (e.g., vaginal discharge, odor, etc.), and are thus helpful for the treatment and prevention of BV and VVC. In this review article, we provide information on the intravaginal mechanism of postmenopausal vaginal infections, and describes the effectiveness of probiotics in the treatment and prevention of BV and VVC.

Probiotics for treating bacterial vaginosis

Bacterial vaginosis is said to be the most common vaginal syndrome affecting fertile, premenopausal, and pregnant women. Bacterial vaginosis is associated with important adverse health conditions and infectious complications. Therapy with oral or local recommended antibiotics is often associated with failure and high rates of recurrences. The dominance of lactobacilli in healthy vaginal microbiota and its depletion in bacterial vaginosis has given rise to the concept of oral or vaginal use of probiotic Lactobacillus strains for the treatment and prevention of bacterial vaginosis. This review investigated the evidence for the use of a single strain or cocktail of probiotics, administered orally or intravaginally, either alone or in conjunction with antibiotics for the treatment of bacterial vaginosis.

Probiotics for Treatment and Prevention of Urogenital Infections in Women: A Systematic Review.

Probiotics are a complementary and integrative therapy useful in the treatment and prevention of urogenital infections in women. This study extends the work of researchers who systematically investigated the scientific literature on probiotics to prevent or treat urogenital infections. A systematic review was conducted to determine the efficacy of probiotics for prevention and/or treatment of urogenital infections in adult women from January 1, 2008, through June 30, 2015. We searched in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Dissertations and Theses, and Alt-HealthWatch. After removing duplicates and studies that did not meet inclusion criteria, 20 studies were reviewed. All included at least one species of Lactobacillus probiotic as an intervention for treatment or prevention of urogenital infections. Data extracted included samples, settings, study designs, intervention types, reported outcomes, follow-up periods, and results. We evaluated all randomized controlled trials for risk of bias and made quality appraisals on all studies. Fourteen of the studies focused on bacterial vaginosis (BV), 3 on urinary tract infections (UTIs), 2 on vulvovaginal candidiasis, and one on human papillomavirus (HPV) as identified on Papanicolaou test. Studies were heterogeneous in terms of design, intervention, and outcomes. Four studies were of good quality, 9 of fair, and 7 poor. Probiotic interventions were effective for treatment and prevention of BV, prevention of recurrences of candidiasis and UTIs, and clearing HPV lesions. No study reported significant adverse events related to the probiotic intervention. The quality of the studies in this systematic review varied. Although clinical practice recommendations were limited by the strength of evidence, probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co-treatments. More good quality research is needed to strengthen the body of evidence needed for application by clinicians.

Современный подход к этиологии, патогенезу, лечению и профилактике бактериального вагиноза и вагинального кандидоза

The article outlines modern points of etiology, pathogenesis, diagnosis, treatment and prevention of bacterial vaginosis and vaginal candidiasis - the most common causes of vaginal discharge. Place of the combined drugs and the importance of an integrated campaign in the treatment and prevention of vaginal disorders microbiocenosis are also discussed.

Lactobacillus for Vaginal Microflora Correction.

IntroductionDespite the significant progress made in prevention, diagnosis, and treatment, there is still a high rate of vaginal dysbiosis in Kazakh women. The use of antibiotics in the treatment of vaginal dysbiosis contributes to the elimination of pathogens as well as microflora, which can lead to a decrease in local immunity and more favorable conditions for infection spread. The most physiologically safe and promising method for the restoration of vaginal biocenosis is the use of probiotics administered by a vaginal route.MethodsWe have allocated 64 of cultures of Lactobacillus from the vaginal epithelium of healthy women of reproductive age and women with diagnosed bacterial vaginosis (BV). Identification of cultures was performed by PCR analysis of 16S ribosomal RNA. Evaluation of biological significance was determined by the following criteria: high antagonistic activity against Candida albicans, Escherichia coli, Serratia marcescens, Proteus mirabilis, Klebsiella ozaenae, and Staphylococcus aureus; and production of hydrogen peroxide, resistance to antibiotics, adhesive activity. We studied the symbiotic relationship of selected biologically active of cultures to each other and received options for consortiums with properties of probiotics through co-cultivation.ResultsResults of genotyping showed that the isolated lactobacilli belong to the seven species: L. fermentum, L. salivarius, L. gasseri, L. crispatus, L. jensenii, L. plantarum, and L. delbrueskii. L. fermentum, L. salivarius, L. gasseri, and L. jensenii occur in women with suspected BV. The highest percentage of occurrence in the vagina of healthy women was L. fermentum (28%). Most strains of lactobacilli possess high inhibitory activity for all test-strains, except Candida albicans (37.5%). 56% of studied cultures revealed high adhesion to human erythrocytes. All lactobacillus strains were resistant to metronidazole, 80% to kanamycin, 57% to vancomycin, and sensitivity to roxithromycin, amoxiclav, ampicillin was diagnosed in all strains. 50% of cultures showed a moderate sensitivity to gentamicin and cefazolin. In a study of peroxide-producing activity, 80% of the cultures exhibited peroxide-producing activity. As a result of screening, the 7 most active strains of lactobacilli were selected for development of 10 variants of probiotic consortia. Also, there was increase of adhesive activity in the consortia compared to other components. These consortia can be used for the treatment of BV in addition to metronidazole.ConclusionThe probiotic consortia identified in this study had high antagonistic, adhesive properties, and resistance to metronidazole. These probiotics can potentially be used for the development of biological products for the treatment and prevention of bacterial vaginosis.

Evaluation of polycaprolactone matrices for the intravaginal delivery of metronidazole in the treatment of bacterial vaginosis

Microporous, poly (ɛ-caprolactone) (PCL) matrices loaded with the antibacterial, metronidazole were produced by rapidly cooling suspensions of drug powder in PCL solutions in acetone. Drug incorporation in the matrices increased from 2.0% to 10.6% w/w on raising the drug loading of the PCL solution from 5% to 20% w/w measured with respect to the PCL content. Drug loading efficiencies of 40-53% were obtained. Rapid 'burst release' of 35-55% of the metronidazole content was recorded over 24 h when matrices were immersed in simulated vaginal fluid (SVF), due to the presence of large amounts of drug on matrix surface as revealed by Raman microscopy. Gradual release of around 80% of the drug content occurred over the following 12 days. Metronidazole released from PCL matrices in SVF retained antimicrobial activity against Gardnerella vaginalis in vitro at levels up to 97% compared to the free drug. Basic modelling predicted that the concentrations of metronidazole released into vaginal fluid in vivo from a PCL matrix in the form of an intravaginal ring would exceed the minimum inhibitory concentration of metronidazole against G. vaginalis. These findings recommend further investigation of PCL matrices as intravaginal devices for controlled delivery of metronidazole in the treatment and prevention of bacterial vaginosis.

A New Sustainable Symbiotic Association of Lactic Acid Cocci and Bacilli for Colonization/Recolonization of Vagina and Prevention of Bacterial Vaginosis

Various factors; nutrition, hygiene, stress, infections, low immunity, menses, frequent sexual intercourses, pregnancy etc., destroyed vaginal microbial balance, which reflected in the number of lactobacilli decrease and increase the number of pathogenic microorganisms, as well as the pH-value. All this in turn causes vaginosis. The aim of this study is creation of symbiotic association of probiotic bacteria (SAPB) with high colonization/recolonization properties for rapid response to vaginal acute and chronic challenges. It is expected that LABs symbiotic association will be more beneficial for vaginal colonization/recoclonization, because the lactococci are growth well at elevate pH 9.0-5.0 and by reducing of vaginal pH promote the growth of lactobacilli, adapted to low pH 6.5-3.5. In this study used lactobacilli biocompatible with cocci possessing high antimicrobial activity from laboratory LABs collection, isolated earlier from 20-45 years old healthy Ar-menian woman volunteers (n=40). And it is the first time that lactococci were used as probiotic in vaginal coloniza-tion/recolonization practice. The symbiotic association of Lactobacillus plantarum (L. plantarum) GH 202 and Lactococcus lactis (L. lactis) GH 204 strains shows higher inhibitory activities against bacterial pathogens and Candida albicans (C. albicans). The SAPB growth rate is more intensive and biomass accumulation is higher, than the mono cultures. It is sustainable at different pH conditions of growth and during multiple subculturing imitating up and down changes of vaginal pH. The SAPB strains have high hydrophobicity evaluated by MATS test and high coaggregation properties essential for increasing their colonization potential, when they used in mixed culture.

P3.362 Microbicide Use During Pregnancy: Acceptability For Prevention/Treatment and the Role of Partners

ObjectivesTo explore pregnant women’s acceptance of microbicides for reproductive tract infections (RTIs).MethodsTo date, we have analysed interview transcripts of 15 women in their third trimester who participated in a qualitative...

Benzoyl Peroxide Formulated Polycarbophil/Carbopol 934P Hydrogel with Selective Antimicrobial Activity, Potentially Beneficial for Treatment and Prevention of Bacterial Vaginosis

The human vagina is colonized by a variety of indigenous microflora; in healthy individuals the predominant bacterial genus is Lactobacillus while those with bacterial vaginosis (BV) carry a variety of anaerobic representatives of the phylum Actinobacteria. In this study, we evaluated the antimicrobial activity of benzoyl peroxide (BPO) encapsulated in a hydrogel against Gardnerella vaginalis, one of the causative agents of BV, as well as indicating its safety for healthy human lactobacilli. Herein, it is shown that in well diffusion assays G. vaginalis is inhibited at 0.01% hydrogel-encapsulated BPO and that the tested Lactobacillus spp. can tolerate concentrations of BPO up to 2.5%. In direct contact assays (cells grown in a liquid culture containing hydrogel with 1% BPO or BPO particles), we demonstrated that hydrogels loaded with 1% BPO caused 6-log reduction of G. vaginalis. Conversely, three of the tested Lactobacillus spp. were not inhibited while L. acidophilus growth was slightly delayed. The rheological properties of the hydrogel formulation were probed using oscillation frequency sweep, oscillation shear stress sweep, and shear rate sweep. This shows the gel to be suitable for vaginal application and that the encapsulation of BPO did not alter rheological properties.

Probiotic strategies for the treatment and prevention of bacterial vaginosis

Importance of the field: Urogenital infections are on average the number-one reason for women to visit the doctor. Yet, treatment and preventive strategies have gone unchanged for close to 50 years. With prevalence rates for bacterial vaginosis at more than 29%, depending on the population, and similarly high incidences of vulvo-vaginal candidiasis and urinary tract infections, plus HIV, new therapies are urgently needed to improve the health of women around the world.Areas covered in the review: This review discusses the vaginal microbiota, our improved understanding of its composition, and its role in health and disease. It also discusses the progress made in the past 10 years or so, with the development and testing of probiotic lactobacilli to improve vaginal health and better manage urogenital infection recurrences.What the reader will gain: The reader will have an understanding of the clinical data obtained so far, and the potential mechanisms of action of probiotics. Despite the need for more clinical studies, the review illustrates a case for inclusion of probiotics as part of the approach to disease prevention, and as an adjunct to antimicrobial treatment. Challenges remain in optimizing clinical benefits, selecting new strains, preparing new products and having them tested in humans then approved with informative claims, and making products readily accessible to women in the developed and developing world.Take home message: The vaginal microbiota is a complex structure that can change quickly and dramatically, and significantly impact a woman's health. New health-maintenance and disease-treatment approaches are badly needed, and probiotics should be considered.

Estimation of the incidence of bacterial vaginosis and other vaginal infections and its consequences on maternal/fetal outcome in pregnant women attending an antenatal clinic in a tertiary care hospital in North India

Aims:This study was undertaken to estimate the incidence of bacterial vaginosis (BV) and other vaginal infections during pregnancy and its association with urinary tract infections (UTI) and its consequences on pregnancy outcome, maternal and fetal morbidity and mortality.Settings and Design:Prospective cohort study.Materials and Methods:The present prospective cohort study was conducted on 200 women attending the antenatal clinic (ANC) of a tertiary hospital. All pertinent obstetric and neonatal data covering antenatal events during the course of pregnancy, delivery, puerperium and condition of each newborn at the time of birth were collected. BV was detected by both Gram stain and gold standard clinical criteria (Amsel’s composite criteria).Statistical analysis used:Data were analyzed using SPSS version 9. Fischer’s exact test, chi square tests and Student’s’ test has been used for analysis. The probability of 5% was considered as significant for continuous variables such as age, period of gestation and birth weight. Odds ratio (OR) and confidence interval (CI) with 95% probability were determined.Results:The incidence of bacterial vaginosis was 41 in 200 patients. Adverse outcomes such as preterm labor, PROM and fetal complications were found more in pregnant women who had bacterial vaginosis (N=41), bacterial vaginosis with UTI (N=14) as compared to those without bacterial vaginosis (N=118).Conclusions:The incidence of poor pregnancy outcome was higher in bacterial vaginosis with UTI. Prevention of BV and UTI is cost effective to minimize the pregnancy-related complications and preterm labor to decrease in perinatal and maternal mortality and morbidity. We recommend all antenatal patients should be screened for the presence of bacterial vaginosis, other infections and UTI.

Bacterial vaginosis

Bacterial vaginosis is a common cause of abnormal discharge in women of child-bearing age. It is present in 10–20% women in the UK, and may recur or regress spontaneously. It is not regarded as an STI because it can occur in virgin women, but it is more common in sexually active women. Other associations include smoking, partner change, having a female partner with bacterial vaginosis, black ethnicity and IUD use. It is characterized by an offensive, fishy-smelling discharge and a high vaginal pH (> 4.5). The usual Lactobacillus-dominated vaginal flora is replaced by an overgrowth of anaerobic/facultative anaerobic organsims including Gardnerella vaginalis, Mycoplasma hominis and Bacteroides spp. Diagnosis is based on the composite Amsel criteria, incorporating clinical features and microscopy of vaginal fluid, or interpretation of Gram-stained vaginal smears using the Nugent or Hay-Ison criteria. Bacterial vaginosis usually clears with treatment with topical or oral metronidazole or clindamycin, but relapses within 1 month in about 30% of women. Women with frequent recurrences of symptomatic bacterial vaginosis experience embarrassment and frustration. Better means of preventing relapses are needed, preferably not involving repeated courses of antibiotics. Bacterial vaginosis is also a risk factor for acquisition of STIs, including Chlamydia and HIV. Prevention of bacterial vaginosis might aid HIV prevention and control of other STIs.