DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20170404

Role of probiotics in lower reproductive tract infection in women of age group 18 to 45 years

Rukshana Shamshu, Jayasree Vaman, Nirmala C.

Abstract


Background: This study has been designed to assess the effectiveness of the probiotic strains having Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in the management of lower genital infections (bacterial vaginosis and candidiasis) as an integral therapy with antibiotics.

Methods: Double blind, randomized placebo controlled study in women between 18-45 years attending Sree Avittom Thirunal Hospital (SATH), Government Medical College, Thiruvananthapuram, India with symptoms of bacterial vaginosis and vulvovaginal candidiasis. Women giving consent were given probiotics along with conventional antibiotics and were followed up over a period of two months. Outcome is measured as percentage of women showing a score of less than 4 at the end of thirty days of treatment, and sixty days of treatment in the test and control group in the case of bacterial vaginosis and no discharge and absence of hyphae and pseudohyphae in wet smear and gram stain in case of candidiasis.

Results: Out of 42 women studied, 32 had bacterial vaginosis and 10 had vulvovaginal candidiasis. 81.3% women with BV had a normal vaginal picture after sixty days of treatment as compared to placebo which was only 31.3%. The p value is 0.004 which is significant. In the treatment of VC, the percentage of women cured was the same in both probiotic and placebo group.

Conclusions: In the treatment of bacterial vaginosis, addition of probiotics to the conventional antibiotics can improve the cure rate of bacterial vaginosis and reduce the rate of recurrences. In the treatment of vulvovaginal candidiasis, addition of probiotics to the conventional antifungal did not have a significant improvement.

Keywords


Bacterial vaginosis, Genital infections, Probiotic, Vulvovaginal candidiasis

Full Text:

PDF

References


Wilson M. Bacterial biofilms and human disease. Science progress. 2001;84:235-54.

Savage DC. Microbial ecology of the gastrointestinal tract. Annu Rev Microbiol. 1977;31:107-33.

Costerton JW, Irwin RT, Cheng KJ. The bacterial glycocalyx in nature and disease. Annu Rev Microbiol. 1981;35:399-424.

Chan RCY, Bruce AW, Reid G. Adherence of cervical, vaginal and distal urethral normal microbial flora to human uroepithelial cells and the inhibition of adherence of uropathogens by competitive exclusion. J Urol. 1984;131:596-601.

Lamont RF, Sobel JD, Akins RA, Hassan SS,Chaiworapongsa T, Kusanovic JP, Romero R. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG. 2011; 118: 533-549.

Vasquez A, Jakobsson T, Ahrne S, Forsum U, Molin G. Vaginal Lactobacillus Flora of Healthy Swedish Women. Journal of Clinical Microbiology. 2002;40(8):2746-9.

Barbes BC. Role played by lactobacilli in controlling the population of vaginal pathogens. Microb. Infect. 2000;2:543-6.

Soper E, Berek S. Berek and Novak Gynaecology. 2007.

Galask RP. Vaginal colonization by bacteria and yeast. Am J Obstet Gynecol. 1988;158:993-5.

Aroutcheva A, Gariti D, Simon M, Shott S, Faro J, et al. Defense factors of vaginal lactobacilli. Am J Obstet Gynecol. 2001;185:375-9.

Bayer AS, Chow AW, Concepcion N, Guze LB. Susceptibility of 40 lactobacilli to six antimicrobial agents with broad gram-positive anaerobic spectra. Antimicrob Agents Chemother. 1978;14:720-2.

Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified “non-specific” vaginitis. Am J Obstet Gynecol. 1955;69:962-76.

Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N. Engl. J. Med. 2005;353;1899-911.

Amsel R, Totten PA, Spiegel CA, Chen KCS, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74:14-22.

Hillier SL. Diagnostic microbiology of bacterial vaginosis. Am J Obstet Gynecol. 1993;169:455-9.

Oommen Rebecca; Study on prevalence of bacterial vaginosis in women attending gynaecology OPD of SATH. 2009.

Taylor RD, McCaffrey M, Pitkin J, Lamont RF. Bacterial vaginosis in climacteric and menopausal women. Int. J. STDs AIDS. 2002;13:449-52.

Easmon CS, Hay PE, Ison CA. Bacterial vaginosis: a diagnostic approach. Genitourin Med. 1992;68:134-8.

Cook RL, Redondo-Lopez V, Schmitt C. Clinical, microbiological and biochemical factors in recurrent bacterial vaginosis. J Clin Microbiol. 1992;30;870-7.

Wiesenfeld H, Hillier S, Krohn MA, Landers D. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2005;36:663-8.

Koumans EM, Markowitz LE, Hogan V. Indications for therapy and treatment recommendations for bacterial vaginosis in non-pregnant and pregnant women: a synthesis of data. Clin Infect Dis. 2002;35 (Suppl. 2):152-72.

Wiesenfeld HC, Peipert J, Soper D, Ohmit SE, Hillier SL. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2002;194;1283-9.

Eckert LO, Moore DE, Patton DL, Agnew KJ, Eschenbach DA. Relationship of vaginal bacteria and inflammation with conception and early pregnancy loss following in-vitro fertilization. Infect Dis Obstet Gynecol. 2003;11:11-7.

Klebanoffm A, Schwebke JR, Zhang J, Nansel TR, Yu KF, Andrews W. Vulvovaginal symptoms in women with bacterial vaginosis. Obstet Gynecol. 2002;104:267-72.

Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1992;29:297-301.

Suvarna VC, Boby VU. Probiotics in human health: A current assessment. Current science. 2005;88:1744-48.

Reid G, Beuerman D, Heinemann C, Bruce AW. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immuno Med Microbiol. 2001;32:37-41.

Bruce N, Fraser C, Heinemann, Owen J, Henning B. Oral probiotics can resolve urogenital infections. FEMS Immunol. Med. Microbiol. 2001;30:49-52.

Gregor R, Jass J, McCormick JK. Potential Uses of Probiotics in Clinical Practice. Clin Microbiol Rev. 2003;16:658-72.

Barrons R, Tassone D. Use of Lactobacillus probiotics for bacterial genitourinary infections in women: a review. Clin Ther. 2008;30:453-68.

Borchers AT, Selmi C, Meyers FJ, Keen CL, Gershwinm E. Probiotics and immunity. J Gastroenterol. 2009;44:26-46.

Mastromarino P, Brigidi P, Macchia S. Characterization and selection of vaginal Lactobacillus strains for the preparation of vaginal tablets. J Appl Microbiol. 2002;93:884-93.

Bradshaw CS, Morton AN, Hocking J. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193:1478-86.

Reid GD, Charbonneau JE, Kochanowski B, Beuerman D, Poehner R, Bruce AW. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol. Med. Microbiol. 2003;35:131-4.

Reid G, Charbonneau D, Gonzalez S, Gardiner G, Erb J, Bruce AW. Ability of Lactobacillus GR-1 and RC-14 to stimulate host defences and reduce gut translocation and infectivity of Salmonella typhimurium. Nutraceut Food. 2002;7:168-73.

Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B. Oral probiotics can resolve urogenital infections. FEMS Immunol Med. Microbiol. 2001:30;49-52.

Anukam KC, Osazuwa E, Osemene GI, Ehigiagbe F, Bruce AW, Reid G. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect. 2006;8:2772-6.

Anukam K, Osazuwa E, Ahonkhai I, Osemene G, Bruce AW, Reid G. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus gR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebocontrolled trial. Microbes Infect. 2006;8:1450-4.

Williams AB, Yu C, Tashima K. Evaluation of two self-care treatments for prevention of vaginal candidiasis in women with HIV.J Assoc Nurses AIDS Care. 2001;12:51-7.