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Home Uncategorized Episode 206: Women’s Health, etc with guest Dr. Abigail Aiyepola
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Episode 206: Women’s Health, etc with guest Dr. Abigail Aiyepola

Published on July 18, 2013, by in Uncategorized.
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We have a special guest this week.  Dr. Abigail Aiyepola joins us to discuss various topics on women’s health including bacterial vaginosis/vaginitis.  Enjoy this week’s podcast and we hope to have more guests soon to talk about all the hot topics.

 

 

 

 

 

 

 

 

 

References:

Strains of Lactobacillus strains with clinical potential for urogenital health

  • **All of these are found in the vagina and has anti-pathogenic properties. Problem is that all of these are not commercially available
  • L. Ruteri: inhibiting property of GBS, candida, gardnerella,
  • L crispatus CT VO5
  • L rhamnosus GR-1 (resistant to spermicide)
  • L. fermentum RC-14
  • Additional species:
    • L. salivarius
    • L plantarum
    • L acidophilus
    • L gasseri
    • L jensenii
    • L iners
  • OTC Products with these strains:
    • Integrative Therapeutics: rhamnosus GR-1, ruteri RC-14 (ProFlora)
    • Vitania: plantarum, salivarius, rhamnosus & acidophilus (FemEcology)
    • Jarrow: rhamnosus and ruteri (they have a product containing these two)

 

Use of Lactobacillus for tx of vaginitis

–        Looked at all of the research over 10 years

  • plenty of evidence that oral probiotic supplementation colonizes the vagina

–        Must supplement for 2-6 months to MAINTAIN continued colonization

–        Controlled trials are encouraging, but few

–        Review of Studies (VVC & Lactobacillus)

  • First two (positive)
  • Next 3 (positive–rhamnosus)
  • Yogurt positive
  • Last two negative
    • yogurt for two months
    • no effect of prevention p-abx use (but what species did they use)
  • Hilton: L GG bid/7 days; > sx/signs for VVC; 4/5 cultures neg after tx
  • Williams: L acid weekly vs Rx vs P; VVC culture (15.5% vs 14% vs 32%
  • Reid: L rhamnosus GR-1+> fermentum RC-14 oral for 60 days vs P; 30% improvement vs 12%
  • Reid: L rhamnosus GR-1 + L fermentum RC -14 oral bid x 14 days; no sx of VVC
  • Reid: 3 groups had different amounts of Gr-1/RC-14 Vs GG only; N flora 12/13 groups 1,2,3 vs ¼ in group 4
  • Hilton: 8 oz  L. Acid yogurt x 6 mo then none x 6 mo; decreased ave # of VVC during 6 mo of yogurt
  • Shalev: L acid yoghurt x 2 mo then none x 2 mo then pasteurized x 2 mo. vs pasteurized then none then yoghurt; no significant differences
  • Pirotta: no effect of oral or vaginal prevention of post-antibiotic use

–        Study of azole drug + vag specific probiotic

  • Randomized DBPC trial, n = 55 women with VVC
  • Tx: single dose of fluconazole plus 2 oral caps/d x 28d of
    • L. rhamnosus GR-1 and L. reuteri RC-14
    • or placebo
  • At 4 weeks, probiotic group cured compared to the placebo group (p < 0.05).
  • Probiotic group showed
    • less vaginal discharge (10.3% vs. 34.6%)
    • lower presence of yeast (10.3% vs. 38.5%)

Letters Applied Microbiol 2009;48:269-74.

  • **Note: If not responding do both
    • also start to suspect C. glabrata instead of C. albicans!!
    • C. glabrata: boric acid helps!!

 

 

Yeast Vaginitis (VVC—Vulvovaginal Candidiasis)

–        Lactoferrin and VVC

  • 34 patients aged 25-45 years and presenting signs and symptoms of acute vulvovaginal candidiasis. The patients have been treated with a cream containing lactoferrin 4%, 5 g of cream in vagina and 2 gm applied on the vulva twice a day for 7 days
    • RESULTS
      • 27 women completely recovered, 5 showed a good improvement and only 2 women were still suffering from vulvovaginitis at the end of treatment.
    • CONCLUSION
      • a cream containing lactoferrin seems to be clinically effective in the treatment of acute vulvovaginal candidiasis, with a good response on all the characteristic symptoms of this infection

                                                                                          Minerva Ginecol. 2008 Apr;60(2):121-5

 

 

–        Yogurt and VVC

  • **one positive study, one negative study
  • Small crossover trial with women with recurrent VVC found that daily ingestion of yogurt with L. acidophilus for 6 months reduced the mean number of infections and C. albicans colonization of the vagina an rectum  when compared to 6 months with no yogurt consumption (0.38 vs. 2.54 [p = 0.001] and 0.84 vs. 3.23 [p = 0.001], respectively).1
  • A RDBPCT in women (18-50 years) who were prescribed antibiotics for non-GU infections received an oral combination of L. rhamnosus and B. longum or oral placebo and/or a intravaginal pessary containing L. rhamnosus, L. delbrueckii, L. acidophilus, S. thermophilus or a placebo pessary (potencies or strain designators are not given) for 6 days during antibiotics and for 4 days after. The results fail to show a preventive effect for probiotics.2

1. Ann Intern Med 1992;116:353-7

2. BMJ 2004;329:548-52

 

 

Bacterial Vaginosis (BVV)

–        Compounded Lactobacillus plus estriol

  • L. acidophilus tablets and 0.03 mg estriol or placebo tablet every night for 6 days.
  • 2 weeks: 75% cure rate in L. acidophilus and estriol group vs 25% in placebo
  • 4 weeks: 88% were cured in tx group and only 22% in placebo group.

                                                        Arzneimittelforschung 1996;46

  • **An important compounded med: lactobacilli and estrogen
  • **Gynoflore vaginal suppositories (available in canada, not in us)
    • This combination is very exciting!
    • this compounded formula is great use of a compounding pharmacy—put in some rhamnosus as well as lactobacillus

–        L. gasseri and L. rhamnosus

  • •Randomized DBPC of 100 women (mean age 34 years) with BV
  • •Tx: 2% vaginal clindamycin cream x 7d and then randomized to receive vaginal capsules for 10 days containing either
    • –placebo or
    • –combination of L. gasseri and L. rhamnosus (10 bn CFU/capsule)
  • Repeated for 3 cycles
  • Probiotics did not improve efficacy of BV treatment during the first month of treatment.
  • However, women initially “cured” were followed for 6 menstrual cycles or until relapse within that time. At the end of 6 months:
    • 64.9% of the probiotic-treated group were still BV-free
    • compared to 46.2% in the placebo group

BMC Women’s Health 2008;8:3.

–        L. rhamnosus & L. ruteri for BV in Black women

  • DBPC Trial, n= 125 premenopausal African women (18-44 years old) with diagnosed BV
  • 1 week oral metronidazole, then one month of
    • one capsule of L. rhamnosus GR-1 and L. reuteri RC-14
    • or placebo
  • In the probiotic group, 88% cured compared to 40% in the placebo group.
  • Of the remaining subjects12% in probiotic group, none had BV, but had mild sx, compared to remaining 30% in placebo group, of which half had BV.

Microbes Infect 2006;8:1450-4.

  • **Note: Oral metronidazole is a common rx given by physicians (a vaginal metronidazole would have been MUCH better! No need to expose them to the SEs of oral)

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