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.
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
- 27 women completely recovered, 5 showed a good improvement and only 2 women were still suffering from vulvovaginitis at the end of treatment.
- 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.
- **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)