Lactobacilli‐containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs

Abstract

Background Vaginal probiotics claiming to cure and/or prevent bacterial and/or fungal vaginal dysbiosis are available on the market but, until recently, did not have to be approved as drugs for human use. Objectives We evaluated the impact of vaginal probiotics on bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) cure and/or recurrence, as well as vaginal microbiota (VMB) composition and vaginal detection of probiotic strains. Search strategy We performed a systematic literature search in MEDLINE and Embase up to 15 January 2019. Selection criteria There were no restrictions in probiotic strains/formulations, study populations, and designs. BV had to be diagnosed by Nugent or Ison‐Hay Gram stain scoring, VVC by culture, wet mount or PCR, and VMB composition/detection by molecular techniques. Data collection and analysis The authors independently extracted data. Main results All 22 vaginal probiotics evaluated in the 34 eligible studies contained Lactobacillus strains, and some contained additional active ingredients. The probiotics hold promise for BV cure and prevention, but much less so for VVC cure and prevention. No major safety concerns were reported in any of the studies. Vaginal detection of probiotic strains never lasted long beyond the dosing period, suggesting that they did not colonise the vagina. However, findings are not definitive because heterogeneity was high and the quality of most studies suboptimal. Conclusions Availability of vaginal probiotics for vaginal health indications will likely decline in 2020 because of regulatory changes. We urge the field to invest in clinical evidence‐based product development and to conduct future trials more rigorously. Tweetable abstract Lactobacilli‐containing vaginal probiotics hold promise for bacterial vaginosis cure and prevention, but not for vulvovaginal candidiasis.

Diverse Expression of Antimicrobial Activities Against Bacterial Vaginosis and Urinary Tract Infection Pathogens by Cervicovaginal Microbiota Strains of Lactobacillus gasseri and Lactobacillus crispatus

“…urogenital isolates have been well documented (Servin, 2004;Spurbeck and Arvidson, 2011;Petrova et al, 2013;Smith and Ravel, 2017). Clinical trials have confirmed the therapeutic interest of some of these strains to treat dysbiosis, BV and UTIs (MacPhee et al, 2010;Hanson et al, 2016;De Vrese et al, 2019;van de Wijgert and Verwijs, 2019). Here, we aimed to evaluate the distribution of a range of in vitro antimicrobial activities against BVassociated P. bivia and G. vaginalis, UPEC, and recurrent cystitis and infection-related preterm labor-associated E. coli in cervicovaginal strains of L. gasseri and L. crispatus.…”

Re: Lactobacilli‐containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs

“…In their excellent systematic review, van de Wijgert and Verwijs suggest that lactobacilli‐containing vaginal probiotics hold promise for cure and prevention of bacterial vaginosis (BV), but not for vulvovaginal candidiasis. They call for more rigorous trials.…”

Vaginal probiotic adherence and acceptability in Rwandan women with high sexual risk participating in a pilot randomised controlled trial: a mixed-methods approach

“…We have since conducted a systematic review, which showed that long-term safety of vaginal probiotics has not yet been evaluated. 28 Our survey with women at recruitment sessions and enrolment visits showed that high-risk Rwandan women had heard of several STIs, but were generally unaware of BV, its causes and potential consequences, and what they can do to prevent it. Experiences with HIV show that public health interventions can only succeed if healthcare professionals and the public have sufficient knowledge of causes and consequences of disease.…”