Treating vaginitis with probiotics in non‑pregnant females: A systematic review and meta‑analysis

Abstract

Vaginitis, also known as vulvovaginitis, is an inflammation of the vagina and vulva and a common disease in females. It is thought to be caused by vaginal dysbiosis and improved by probiotics. Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are the major types of vaginal infections. The present systematic review and meta-analysis aimed to clarify the efficacy of probiotics in the treatment of common vaginal infections in non-pregnant females. Literature on randomized controlled trials and two-armed prospective studies on any intervention with probiotics published until December 24th, 2018 was searched in the PubMed, Cochrane and EMBASE databases. The outcomes of interest were recurrence rate, cure rate, remission rate and normal vaginal flora restoration. Finally, a total of 30 studies on bacterial vaginosis (BV) and/or VVC were included and stratified into 3 study types based on treatment design as follows: Type I, antibiotic/probiotics vs. antibiotics/antifungals (22 studies); Type II, probiotics vs. placebo (5 studies); Type III, probiotics vs. antibiotics (3 studies). The type I studies comprised 1,788 non-pregnant females and had the highest inter-study comparability in post-treatment follow-up design and meta-analysis outcome data. Probiotics interventions were significantly associated with a lower recurrence rate of vaginitis [pooled odds ratio (OR)=0.27, 95% CI: 0.18-0.41, P<0.001] and higher cure/remission rate (pooled OR=2.28, 95% CI: 1.20-4.32, P= 0.011). However, a significant increase in normal vaginal flora after probiotic treatment was observed only in BV (pooled OR=4.55, 95% CI: 1.44-14.35, P=0.01). In addition, supportive but heterogeneous results were obtained from the 6-month follow-up data of Type-I studies, different infection types and supplementary analysis of Type-II studies. In conclusion, probiotics have a significant short-term effect in the treatment of common vaginal infections in non-pregnant females. In order to evaluate the long-term effects of probiotics in common vaginal infections, it is worthwhile to perform higher-quality clinical trials in the future.

A clinical pilot study on the effect of the probiotic Lacticaseibacillus rhamnosus TOM 22.8 strain in women with vaginal dysbiosis

“…salicinius , L. delbrueckii subsp. lactis , L. reuteri , L. casei , L. reuteri , L. crispatus , and L. rhamnosus GG , either alone or in various combinations, had a significant effect in the treatment of common vaginal infections in non-pregnant females 9 . However, the majority of the studies evaluated the vaginally applied probiotics and, given the current evidence, a strain-dependent effect was demonstrated 7 , 12 .…”

“…In this context, probiotic lactobacilli have been used as adjuvant or maintenance therapy preventing incidence or recurrence of BV and VVC or as a stand-alone dysbiosis treatment. As recently reviewed by Jeng et al 9 the administration of lactobacilli, such as L. rhamnosus BMX54 , L. fermentum , L. plantarum , L. gasseri , L. plantarum , L. acidophilus , L. brevis CD2 , L. salivarius subsp. salicinius , L. delbrueckii subsp.…”

“…For these reasons, there is a growing interest in the in vitro selection of promising probiotic strains as well as in the in vivo evaluation of their ability to treat and/or prevent vaginal imbalance. Although the usefulness of probiotics administration has long been considered, recently their efficacy has been demonstrated, and, unlike antibiotic treatment, no adverse effects have been reported [7][8][9] .To date, several clinical trials have shown that both oral and vaginal probiotic administration hold promise to cure and prevent bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) 10,11 . Indeed, being the vaginal dysbiosis is caused by several bacterial species, both aerobic and anaerobic, and different Candida species, antibiotic treatment is often ineffective.…”

“…In this context, probiotic lactobacilli have been used as adjuvant or maintenance therapy preventing incidence or recurrence of BV and VVC or as a stand-alone dysbiosis treatment. As recently reviewed by Jeng et al 9 the administration of lactobacilli, such as L.…”

“…For these reasons, there is a growing interest in the in vitro selection of promising probiotic strains as well as in the in vivo evaluation of their ability to treat and/or prevent vaginal imbalance. Although the usefulness of probiotics administration has long been considered, recently their efficacy has been demonstrated, and, unlike antibiotic treatment, no adverse effects have been reported [7][8][9] .…”