The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections

Abstract

Objective To evaluate the effectiveness of live lactobacilli in combination with low dose oestriol for restoration of the vaginal flora after anti‐infective treatment. Design The study was designed as a single centre, randomised, placebo‐controlled, double‐blind clinical trial. Setting University Hospital. Sample Three hundred and sixty women out of 1750 were randomised. Methods Three hundred and sixty women with the complaints of vaginal infections (bacterial vaginosis, candidiasis, trichomoniasis or fluor vaginalis) were randomly assigned two to seven days after the end of the anti‐infective therapy, to therapy with live lactobacilli in combination with low dose oestriol (study group, n= 240) or placebo (n= 120). The follow up visits occurred three to seven days and four to six weeks after the end of the restoration therapy. Main outcome measures The Normal Flora Index (NFI), which consists of numbers of lactobacilli, pathogenic microorganisms, leucocytes and vaginal pH, was used as the primary outcome of the study. Secondary outcomes included the total symptoms score, the degree of purity of the vaginal flora and the global assessment of the treatment by the investigator and the women. Results During restoration therapy, the NFI increased significantly more in the study group than in the control group in both first and second control visits (P= 0.002 and P= 0.006, respectively). The degree of purity of the vaginal flora also increased significantly more in the study group compared with the control group (P < 0.0001 and P= 0.001, respectively). No serious adverse event was reported during restoration therapy. Conclusion Restoration of the vaginal flora can be significantly enhanced by the administration of live lactobacilli in combination with low dose oestriol.

The Threat of Aerobic Vaginitis to Pregnancy and Neonatal Morbidity

“…The administration of probiotic lactobacilli employed in recent studies restores the disrupted microflora of the vagina and offers a safer alternative to the prolonged prophylactic use of antibiotics which may present with side effects 83,84 . As with most endogenous infections, species prevalence differs among the different geographical regions with some reporting S. aureus as the most prevalent 85,19,9, followed by E. coli 85,86 Enterococcus 85,87 and GBS 86 .…”

Use of lactobacilli and estriol combination in the treatment of disturbed vaginal ecosystem: a review

“…Beneficial vaginal lactobacilli strongly adhere to epithelial cells and thereby prevent colonization of the vagina by pathogens by competitive exclusion. A number of studies have demonstrated the ability of lactobacilli to adhere to human epithelial cells and to diminish the pathogens (19,20). In experiments using cervical HeLa cells and intestinal Caco-2/TC7 cells, it was shown that L. acidophilus KS400 adhered well to these epithelial cells.…”

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

“…Clinical trials in which patients were administered oral capsules, reported a positive effect of the treatment on BV [39, 41-43, 49, 56]. Vaginal probiotic tablets were reported to be effective in alleviating BV symptoms and decreasing its recurrence [1,4,52,53]. Vaginal capsules have also been reported to efficiently ease BV symptoms in some studies [3,42,50,55].…”

“…According to Reid and colleagues [43] different probiotic bacteria have varying capabilities to colonize the vagina of different patients; this indicates the importance of using a combination of strains in probiotic products. Oral administration of L. acidophilus, or intra-vaginal administration of L. acidophilus or L. rhamnosus GR-1 and L. fermentum RC-14, have been documented to most efficiently increase the numbers of vaginal lactobacilli, restore the vaginal microbiota to normal, and cure women of BV [52].…”

“…Various in-vitro studies have shown that specific strains of lactobacilli inhibit the growth of bacteria causing BV by producing H2O2, lactic acid, and/or bacteriocins and/or inhibit the adherence of G. vaginalis to the vaginal epithelium [52]. According to a general theory a probiotic must have two criteria to be selected as an efficient strain in the treatment of urogenital infections: 1] It must be able to colonize the host without any adverse side effects and 2] It must be capable of inhibiting urogenital pathogens [57].…”