We investigated the effects of glycerol monolaurate (GML) on Lactobacillus, Candida, and Gardnerella vaginalis human vaginal microflora. Our previous work demonstrated that 6 months of GML treatment vaginally does not alter lactobacillus counts in monkeys. Candida and G. vaginalis are commonly associated with vaginal infections in women, many becoming chronic or recurrent. In vitro growth inhibition studies determined the effects of GML (0 to 500 g/ml) against multiple Candida species and G. vaginalis. A randomized, double-blind study investigated the effects of GML on vaginal microflora Lactobacillus, Candida, and G. vaginalis in colonized or infected women (n ؍ 36). Women self-administered intravaginal gels containing 0% (n ؍ 14), 0.5% (n ؍ 13), or 5% (n ؍ 9) GML every 12 h for 2 days. Vaginal swabs were collected before and immediately after the first gel administration and 12 h after the final gel administration. Swabs were tested for Lactobacillus, Candida, G. vaginalis, and GML. In vitro GML concentrations of 500 g/ml were candicidal for all species tested, while a concentration of 10 g/ml was bactericidal for G. vaginalis. Control and GML gels applied vaginally in women did not alter vaginal pH or Lactobacillus counts. Control gels reduced G. vaginalis counts but not Candida counts, whereas GML gels reduced both Candida and G. vaginalis. No adverse events were reported by participating women. GML is antimicrobial for Candida and G. vaginalis in vitro. Vaginal GML gels in women do not affect Lactobacillus negatively but significantly reduce Candida and G. vaginalis.The human vagina is colonized by microbes, and infections occur when the balance is disturbed. Under healthy conditions, vaginal flora is dominated by lactobacilli, which maintain acidic pH through production of organic acids at times other than menstruation (1,8,13,30). Disruptions of vaginal pH or lactobacilli may allow potentially pathogenic microorganisms to grow and dominate.Bacterial vaginosis (BV) is a common chronic infection characterized by complex vaginal flora changes, which include elevations of vaginal pH and, when symptomatic, malodorous discharge and inflammation (2,5,11). BV is associated with preterm delivery, increased risk of HIV transmission, and risk of other infections (17). The prevalences of BV range from 4 to 40% of women, with the highest prevalence among patients at sexually transmitted infection clinics (25). During BV infection, there are reductions in lactobacilli and increases in bacterial groups such as the Gram-negative bacterium Gardnerella vaginalis (3,10,18,25). Additional bacterial groups that are associated with BV include Bacteroides fragilis and Peptostreptococcus (12, 28). Current treatment recommendations for BV include metronidazole and clindamycin (4).Vulvovaginal candidiasis (VVC) is also a common infection. VVC is caused by Candida species, most often Candida albicans (7,26). It is estimated that 70 to 75% of women experience VVC at least once during their reproductive years (14), and 5 to 8...
Background. Staphylococcal menstrual toxic shock syndrome depends on vaginal production of exotoxins. Glycerol monolaurate (GML) inhibits Staphylococcus aureus exotoxin production in vitro. The purpose of this study was to determine whether GML, as a tampon fiber finish, inhibits production of exotoxins and the cytokine interleukin 8 (IL-8) during normal tampon use.Methods. On day 2 of menstruation, when vaginal S. aureus counts are high in colonized women, study participants exchanged their own preferred tampons, after wearing them for 2-6 h, for study tampons with or without GML (assigned randomly and blindly), which they then wore for 4-6 h. The women's own tampons and the study tampons with or without GML were assayed for S. aureus, the exotoxins toxic shock syndrome toxin 1 and a-toxin, and IL-8.Results. A total of 225 women completed the study. S. aureus was present in the tampons of 41 women (18%). Lower numbers of S. aureus and the exotoxins were detected in study tampons with or without GML than in women's own tampons; lower amounts of the exotoxins were present in study tampons with GML than study tampons without GML. The IL-8 level was lower in tampons from women without vaginal S. aureus compared with women with S. aureus and was lower in study tampons with GML than in study tampons without GML.Conclusions. Tampons that contain GML reduce S. aureus exotoxin production. S. aureus increases vaginal IL-8 levels, and GML reduces production of this proinflammatory cytokine. These results suggest that GML added to tampons provides additional safety relative to menstrual toxic shock syndrome as well as benefits for vaginal health generally, thus supporting the addition of GML to tampons.
Healthy women with normal menstrual cycles were randomly assigned to use either a test tampon during cycle 1 and a reference tampon during cycle 2 or a reference tampon during cycle 1 and a test tampon during cycle 2. Tampons were identical except for their cover materials: apertured film for the test tampon and nonwoven fleece for the reference tampon. Product use was doubly blinded. Qualitative and quantitative analyses of vaginal cultures were done pre-, mid-, and postmenstrually for a broad panel of microorganisms, colposcopy was performed, and diary reports were collected; 101 of 105 enrolled subjects completed the study. Midmenstrual findings for a variety of organisms differed from pre-and postmenstrual observations whether subjects were using test or reference tampons. No statistically significant differences were noted in prevalence or colony counts at premenstrual versus mid-and postmenstrual visits for most microorganisms. Prevalences of Gardnerella and anaerobic gram-negative rods were significantly different between tampons at the premenstrual visit, when unusually low values were observed for the test and reference tampons, respectively. None of the changes or differences in microflora were considered to be clinically significant. It is noteworthy, however, that declines in the prevalence and abundance of Lactobacillus during the menstrual periods were less pronounced during the use of both test and reference tampons than those reported from previous studies. Colposcopy showed no abnormal findings with either tampon and no changes in vaginal or cervical epithelial integrity. Thus, all evidence from both microbiological and colposcopic evaluations indicates that the apertured film cover of the test tampon is as safe as the nonwoven cover of the reference tampon.
Yearling rams actively immunized against GnRH were used as a hypogonadotropic model for studies of the significance of the pulsatility of LH secretion in determining the trophic actions of the hormone on testicular steroidogenesis. GnRH-immunized rams, in which testicular regression was complete, were infused iv for 12-20 days with ovine LH (NIDDK oLH 24) in three different regimens, delivering a total daily dose of 60 micrograms/100 kg: 1) 1-min pulses of 5 micrograms/100 kg every 2 h (low amplitude, high frequency), 2) 1-min pulses of 30 micrograms/100 kg every 12 h (high amplitude, low frequency), or 3) continuous infusion of 2.5 micrograms/100 kg.h. Serum testosterone levels and acute responses to LH challenges were monitored at intervals throughout the infusion periods. Acute responses to LH were evaluated in terms of the area under the curve for serum testosterone vs. time after LH and the lag time between the infusion of LH and attainment of maximum serum testosterone levels. At the beginning of the experiments, serum testosterone was at castrate values, and testosterone responses to LH were of low magnitude with a long lag time. LH infusion in the low amplitude, high frequency regimen consistently increased the magnitude and decreased the lag time of acute responses to LH; these effects were significant by the sixth day of treatment and persisted for the duration of the experiments. This regimen also had positive effects on morphological features of testes and Leydig cells. Infusion of the high amplitude, low frequency regimen, however, had neither of the positive effects on responsiveness to LH, but did seem to improve testicular and Leydig cell morphology. Continuous infusion of LH also increased the magnitude and decreased the lag time of responses to low amplitude pulses of LH, at least as well as the high frequency infusion regimen did. These results suggest that the high frequency, low amplitude pattern of LH secretion characteristic of reproductively active animals has trophic actions on the testes, increasing their responsiveness to acute gonadotropic stimulation, but the pulsatility of that pattern of LH secretion is not necessary for its trophic actions. The efficacy of high frequency LH secretion may depend only on the elevation of basal or mean LH concentrations, rather than on the low amplitude peaks or the dynamic changes in LH concentrations to which the testes are exposed.
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