Probiotics for bv
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Probiotics for Bacterial Vaginosis (BV): Efficacy and Safety
Introduction to Bacterial Vaginosis and Probiotics
Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance in the vaginal microbiota, characterized by a reduction in lactobacilli and an overgrowth of anaerobic bacteria such as Gardnerella vaginalis and Atopobium vaginae. Probiotics, which are live microorganisms that confer health benefits to the host, have been explored as a potential treatment for BV due to their ability to restore the natural balance of vaginal flora.
Efficacy of Probiotics in Treating BV
Clinical Cure Rates and Nugent Scores
Several studies have demonstrated that probiotics can significantly improve clinical cure rates and Nugent scores in BV patients. A meta-analysis of ten studies involving 2,321 participants found that probiotics-only therapy resulted in a higher clinical cure rate and improved Nugent scores compared to placebo at the 30-day mark, with effects persisting, albeit reduced, after eight weeks1. Another systematic review and meta-analysis of 14 randomized controlled trials (RCTs) involving 1,372 patients also supported the positive impact of probiotics on BV cure rates, particularly when used in combination with antibiotics2.
Prevention of Recurrence
Probiotics have also shown promise in preventing the recurrence of BV. A systematic review and meta-analysis of RCTs found that probiotics reduced the risk of BV recurrences by 45% compared to placebo or metronidazole alone, with the benefits observed after at least one menstrual cycle3. Additionally, a study involving 120 Chinese women with recurrent BV reported that short-term probiotic prophylaxis significantly reduced BV recurrence rates and the incidence of Gardnerella vaginalis over an 11-month follow-up period6.
Safety and Adverse Events
The safety profile of probiotics in the treatment of BV has been consistently positive across multiple studies. No significant adverse events were reported in trials evaluating the efficacy of probiotics, whether used alone or in combination with antibiotics1 2 4. This makes probiotics a safe alternative or adjunctive therapy for managing BV.
Mechanisms of Action
Restoration of Vaginal Microbiota
Probiotics work by restoring the balance of the vaginal microbiota. For instance, the administration of MED-01, a complex of five probiotic strains, significantly increased the presence of beneficial Lactobacillus plantarum while suppressing harmful bacteria such as Mobiluncus spp., Gardnerella vaginalis, and Atopobium vaginae4. Similarly, oral administration of Lactobacillus gasseri and Lactobacillus crispatus was effective in restoring vaginal health post-BV treatment, although the probiotics primarily acted through the gut rather than directly in the vaginal microbiome7.
Enhancement of Antibiotic Efficacy
Probiotics can also enhance the efficacy of antibiotics. A study involving women with Trichomonas vaginalis and BV found that adding probiotics to metronidazole therapy significantly increased the cure rates for both infections and improved the vaginal environment by reducing pH and increasing redox potential5. Another trial demonstrated that a combination of probiotics and lactoferrin with metronidazole improved symptoms, Nugent scores, and reduced recurrence rates over a six-month follow-up period10.
Conclusion
Probiotics have shown significant potential in both the treatment and prevention of bacterial vaginosis. They improve clinical cure rates, reduce recurrence, and restore the natural balance of vaginal microbiota without significant adverse effects. While the current evidence is promising, further high-quality, methodologically standardized RCTs are needed to confirm these findings and optimize probiotic regimens for diverse populations.
Sources and full results
Most relevant research papers on this topic
Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis
Probiotics are safe and may have a short-term and long-term beneficial effect for bacterial vaginosis treatment, with a possible ethnic-specific effect after antibiotics.
Meta-Analysis
Rigorous JournalProbiotics for the treatment of women with bacterial vaginosis: A systematic review and meta-analysis of randomized clinical trials.
Probiotics may have a positive effect on treating bacterial vaginosis, but strong evidence is lacking for their effectiveness.
Meta-AnalysisRigorous JournalProbiotics, a promising therapy to reduce the recurrence of bacterial vaginosis in women? a systematic review and meta-analysis of randomized controlled trials
Probiotics effectively reduce the risk of bacterial vaginosis recurrences by 45% compared to placebo or metronidazole in women aged 18 years and above.
Meta-AnalysisEfficacy and Safety of MED-01 Probiotics on Vaginal Health: A 12-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial
MED-01 probiotics effectively improve vaginal health and reduce bacterial vaginosis in reproductive-aged women, with no adverse events observed.
RCTProbiotics in addition to metronidazole for treatment Trichomonas vaginalis in the presence of BV: a randomized, placebo-controlled, double-blind study
Adding probiotics to metronidazole therapy for Trichomonas vaginalis in the presence of Bacteroides fragilis increases the likelihood of cure and improves vaginal pH and redox potential.
RCTRigorous JournalEfficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study.
Vaginal probiotic capsules effectively reduce bacterial vaginosis recurrence and Gardnerella vaginalis risk in women through 11 months of treatment.
RCT
Highly CitedOrally administrated Lactobacillus gasseri TM13 and Lactobacillus crispatus LG55 can restore the vaginal health of patients recovering from bacterial vaginosis
Orally administered Lactobacillus gasseri TM13 and Lactobacillus crispatus LG55 can restore vaginal health in patients recovering from bacterial vaginosis, but individualized interventions are needed to improve cure rates.
RCTEffects of Pro/Prebiotics Alone over Pro/Prebiotics Combined with Conventional Antibiotic Therapy to Treat Bacterial Vaginosis: A Systematic Review
Pre/probiotic regimens are generally safe and can exhibit long-term and short-term benefits in treating bacterial vaginosis in both pregnant and nonpregnant women.
Systematic ReviewRigorous JournalProbiotics administered intravaginally as a complementary therapy combined with antibiotics for the treatment of bacterial vaginosis: a systematic review protocol
Lactobacilli administered intravaginally in conjunction with antibiotics may improve cure rates and reduce recurrence rates in treating bacterial vaginosis.
Systematic ReviewRigorous JournalEvidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomised clinical trial.
A probiotic mixture containing Lactobacillus acidophilus GLA-14 and Lactobacillus rhamnosus HN001, combined with lactoferrin, significantly improves symptoms, Nugent score, and recurrence rate in women with recurrent bacterial vaginosis.
RCT