A Double-blind Treatment Study of Bacterial Vaginosis with Normal Vaginal Lactobacilli after an Open Treatment with Vaginal Clindamycin Ovules

Abstract

The expected 4-week cure rate after conventional treatment of bacterial vaginosis are only 65-70%. In an attempt to improve the cure rate by adding probiotic lactobacilli we performed a double-blind placebo-controlled study of adjuvant lactobacilli treatment after an open treatment with vaginal clindamycin ovules. Women with bacterial vaginosis as defined by Amsel's criteria were treated with clindamycin ovules. Vaginal smears were collected and analysed according to Nugent's criteria. During the following menstruation period the women used, as an adjuvant treatment, either lactobacilli-prepared tampons or placebo tampons. The lactobacilli tampons were loaded with a mixture of freeze-dried L. fermentum, L. casei var. rhamnosus and L. gasseri. The cure rate was recorded after the second menstruation period. There was no improvement in the cure rate after treatment with lactobacilli-containing tampons compared to placebo tampons; the cure rates as defined by Amsel's criteria were 56% and 62%, respectively, and 55% and 63%, as defined by Nugent's criteria. This is the first study to report cure rates for women with 'intermediate' wet smear ratings according to Nugent's classification and this group had an overall cure rate of 44%. The cure rate of treatment of bacterial vaginosis was not improved by using lactobacilli-prepared tampons for one menstruation.

Dairy Probiotic Foods and Bacterial Vaginosis: A Review on Mechanism of Action

“…Probiotics are believed to protect the host against infections by means of several mechanisms including: [1] occupation of specific adhesion sites at the epithelial surface of the urinary tract; [2] maintenance of a low pH and production of antimicrobial substances like acids, hydrogen peroxide, and bacteriocins; [3] degradation of polyamines; and [4] the production of surfactants with antiadhesive properties [21,42].…”

“…Current data indicate that the overall prevalence of BV is much higher among STD clinic attendees and commercial sex workers [1]. BV is believed to occur as a result of an imbalance in the normal vaginal microbiota [2] when the normal Lactobacillus bacteria in the vagina are disrupted and subsequently replaced by predominantly anaerobic bacteria including Gardnerella vaginalis, Mycoplasma hominis, Prevotella, and Peptostreptococcus [3]. Other bacteria such as Escherichia coli from the rectum have also been shown to cause the disease.…”

“…Oral administration introduces the beneficial bacteria directly into the vagina; probiotics consumed orally are believed to ascend to the vaginal tract after they are excreted from the rectum. Mechanism through which probiotics play a role in BV treatment include: [1] occupation of specific adhesion sites at the epithelial surface of the urinary tract; [2] maintenance of a low pH and production of antimicrobial substances like acids, hydrogen peroxide and bacteriocins; [3] degradation of polyamines; and [4] the production of surfactants with antiadhesive properties [21]. Probiotics have been shown to exert the beneficial effects both in foods such as yoghurt [22], ice cream [23,24], and supplements [25].…”

Sustained Delivery of Commensal Bacteria from Pod-Intravaginal Rings

“…The intravaginal administration of probiotics traditionally has been achieved using a variety of dosage forms, including tablets (21), capsules (7,8), suppositories (9), and tampons (22). Collectively, these approaches have led to detectable, but not optimally sustainable, levels of the delivered bacteria.…”

Efeito da utilização de culturas láticas probióticas na microbiota vaginal de pacientes acometidas por infecções bacterianas e fúngicas

“…A detecção da produção de H 2 O 2 de lactobacilos isolados da microbiota vaginal é comumente realizada por método qualitativo em placa, com a utilização de peroxidase incorporada em meio contendo ágar e o reagente tetrametilbenzidina (ESCHENBACH et al, 1989;HAWES et al, 1996;MARTIN et al, 1999;MIJAC et al, 2006). Somente alguns estudos determinaram quantitativamente a produção de H 2 O 2 por lactobacilos vaginais (FONTAINE;TAYLOR-ROBINSON, 1990;BERTHIER, 1993;BRU;NADER-MACÍAS, 2003).…”