Image by Lqbal Osman[/caption]By Case Adams, Naturopath
Recent research has found that the application of probiotics for vaginosis and vaginitis produces definite clinical effectiveness, with or without additional treatment with antibiotics.
Two 2013 studies have illustrated this.
Vaginosis is the alteration of the normal microbiological ecology. Vaginitis is an overgrowth of pathogenic bacteria, and their resulting infection. They typically occur together.
In the most recent, Bulgarian hospital researchers treated 60 women with bacterial vaginosis with antibiotic treatment alone or antibiotic treatment followed by probiotic treatment.
The first group was given metronidazole orally with two local applications over a five day period. The second group was given the same treatment for the first five days and then given local application of Lactobacillus casei var rhamnosus – also called Lactobacillus rhamnosus.
After the two treatments, the researchers found that 60% of the patients in the first group had resolution of their infections, while the group receiving the probiotic treatment experienced an 88.5% resolution.
The researchers also noted that the restoration of the vagina probiotics in the second group would help prevent future infections, stating that the probiotic treatment...
“for bacterial vaginosis increased the clinical and microbiological efficacy of the therapy by 25% - 30%. The microbial balance in the vaginal ecosystem was restored in the majority of patients (88%), which is a prerequisite for low percentage of bacterial vaginosis relapses.”
As to whether probiotic treatment alone will outperform antibiotic treatment, this latter issue is important. Antibiotic treatment has two consequences: One that it does also knock out the healthy flora of the vagina, leaving the vagina open to new opportunistic infections.
Secondly, the infective bacteria and yeasts can also become resistant to the antibiotic. This of course has been the evolving case among many bacteria that are increasingly becoming resistant to our antibiotic arsenal.
Probiotics versus antibiotic therapy for vaginosis
As to whether a probiotic treatment will beat the conventional antibiotic treatment for vaginosis, another 2013 study from Bulgaria hospital researchers studied 381 women with bacterial vaginosis.
They split the patients into three groups. They gave 143 patients 10 applications (twice a day for five days) of Lactobacillus acidophilus and Lactobacillus rhamnosus. The second group of 126 patients were given the oral antibiotic Clindamycin with two treatments of local antibiotic Metronidazole treatment. A third group of 112 women was given the same antibiotic treatment for first days followed by the probiotic treatment, again with local application of Lactobacillus acidophilus and Lactobacillus rhamnosus.
The researchers then followed up with the patients between 46 and 40 days after the probiotic treatment ended. They found that the patients given the probiotic-only treatment was 41% microbiologically effective and was 43% clinically effective – meaning their symptoms were resolved.
Meanwhile the effectiveness of the antibiotic treatment was 47% and 52% effective, respectively. The best results were obtained from the combined therapy, which resulted in 80% effectiveness in the micro analysis and 87% clinically effective.
This of course means that like the first study mentioned, the infection was knocked out by the antibiotics and then the flora environment was restored by the probiotics.
Shortcomings of both studies
Both studies illustrate that probiotics is a bonafide treatment for vaginosis - just not as effective as antibiotics. But wait...
The two obvious short-comings of both of these studies are that the probiotic treatment in each was ridiculously short. The researchers were practically testing the probiotics side by side as if the probiotic treatment should only take a week to complete.
In practical application, natural practitioners will typically suggest the probiotic application continues for at least a few weeks to get full resolution. During this time the probiotics will increasingly colonize the vagina and eventually knock out the infective organisms.
For example, researchers from the School of Medicine at Italy’s Università degli Studi di Siena (Delia et al. 2006) treated 60 healthy women with vaginosis with either a vaginal suppository containing Lactobacillus acidophilus or a suppository containing Lactobacillus acidophilus and Lactobacillus paracasei F19. At the end of three months of treatment—and again three months afterward—both groups showed significant improvement in vaginosis, a significant reduction in vaginal pH, and significant decrease in vagina odor.
The other comment to note is how many patients were not improved by the antibiotic-only treatment. What is the ramification of this? As other research shows, unresolved infections following antibiotic treatment increases the risk of antibiotic-resistance.
This is not saying that probiotic treatment will necessarily be effective for every case. It is also not medical advice.
Learn more about how probiotics are proven to fight infections.
REFERENCES:
Kovachev S, Dobrevski-Vacheva R. [Probiotic monotherapy of bacterial vaginosis: a open, randomized trial]. Akush Ginekol (Sofiia). 2013;52 Suppl 1:36-42.
Kovachev S, Dobrevski-Vacheva R. [Effect of Lactobacillus casei var rhamnosus (Gynophilus) in restoring the vaginal flora by female patients with bacterial vaginosis--randomized, open clinical trial]. Akush Ginekol (Sofiia).
Delia A, Morgante G, Rago G, Musacchio MC, Petraglia F, De Leo V. Effectiveness of oral administration of Lactobacillus paracasei subsp. paracasei F19 in association with vaginal suppositories of Lactobacillus acidofilus in the treatment of vaginosis and in the prevention of recurrent vaginitis. Minerva Ginecol. 2006 Jun;58(3):227-31.