Recurrent bacterial vaginosis: possible ways of correction
Keywords:bacterial vaginosis, anti-relapse therapy, probiotic, prebiotic
Research objective: to increase the effectiveness of bacterial vaginosis (BV) treatment in women of reproductive age.
Materials and methods. The study involved 64 women of reproductive age with BV. After a course of local antibiotic therapy participants were divided into 2 groups: patients of group I were not prescribed local remedies to restore the vaginal microflora, patients of group II were prescribed vaginal prebiotic suppositories Folial № 10. No additional drugs were used in subgroups IA and IIA, while oral probiotic Maxibalance was prescribed in subgroups IB and IIB. The effectiveness of BV treatment was evaluated at the first, third and sixth months of the observation period according to the results of clinical examination and vaginal pH evaluation by litmus strips.
Results. The course of BV in subgroup IA was characterized by prevailing number of relapses and their early appearance. 1 case of BV recurrence was found among patients of subgroup IA at the 1st month of follow-up, 6 and 8 BV episodes were found at 3 and 6 months of follow-up respectively. Sequential treatment with antibiotics and oral probiotics (subgroup IIB) was associated with the onset of 3 BV relapses on 4–5 months from baseline. Local prebiotic (subgroup IIA) after the vaginal sanation was associated with BV reoccurrence in only one patient at the end of the study. No relapses of BV were detected in subgroup IIB during the study.
Conclusions. Permanent imbalance of vaginal normocenosis creates optimal conditions for chronic and recurrent diseases of dysbiosis nature, especially BV. Despite the sensitivity of the anaerobic flora to the recommended antibacterial medications, their use as monotherapy in BV treatment is often insufficient. The results of the study demonstrate a significant anti-relapse efficiency of consecutive treatment by antibacterial drugs and a complex of probiotic + prebiotic. This effect is probably based on the restoration of vaginal immunity and metabolism by stable colonization of the vaginal mucosa with live lactobacilli of eubiotic origin.
- Kosei, N.V., Tatarchuk, T.F., Vetoh, H.V. “Empiric therapy of vaginitis as a method of preventing the development of an ascending infection.” Reproductive endocrinology 2.4 (2012): 70–3.
- Allsworth, J.E., Peipert, J.F. “Prevalence of bacterial vaginosis: 2001–2004 National Health and Nutrition Examination Survey data.” Obstet Gynecol 109.1 (2007): 114–20.
- Tatarchuk, T.F. “Modern approach to the treatment of nonspecific vaginitis.” Reproductive endocrinology 2.22 (2015): 85–8.
- Sherrard, J., Wilson, J., Donders, G., et al. “European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge.” Int J STD & AIDS 29.13 (2018): 1258–72.
- Chen, K.C., Forsyth, P.S., Buchanan, T.M., Holmes, K.K. “Amine content of vaginal fluid from untreated and treated patients with nonspecific vaginitis.” J Clin Invest 63 (1979): 828–35.
- Sobel, J.D., Karpas, Z., Lorber, A. “Diagnosing vaginal infections through measurement of biogenic amines by ion mobility spectrometry.” Eur J Obstet Gynecol Reprod Biol 163 (2012): 81–4.
- Briselden, A.M., Moncla, B.J., Stevens, C.E., Hillier, S.L. “Sialidases (neuraminidases) in bacterial vaginosis and bacterial vaginosis-associated microflora.” J Clin Microbiol 30 (1992): 663–6.
- Vdovychenko, Y.P., Gopchuk, O.М. “Bacterial vaginosis – monotherapy with combination drugs.” Woman's health 1.107 (2016): 132–6.
- Tatarchuk, T.F., Kalugina, G.A., Petrova, V.V., et al. “Vaginal discharge syndrome. Problem with many unknowns.” Reproductive endocrinology 3.53 (2020): 102–8.
- Brotman, R.M., Klebanoff, M.A., Tonia, R., et al. “Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection.” J Infect Dis 202 (2010): 1907–15.
- Rathod, S.D., Krupp, K., Klausner, J.D., et al. “Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis.” Sex Transm Dis 38 (2011): 882–6.
- Chu, D.M., Seferovic, M., Pace, R.M., Aagaard, K.M. “The microbiome in preterm birth.” Best Pract Res Clin Obstet Gynaecol 52 (2018): 103–13.
- Leitich, H., Bodner-Adler, B., Brunbauer M., et al. “Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis”. Am J Obstet Gynecol 189.1 (2003): 139–47.
- Bradshaw, C.S., Vodstrcil, L.A., Hocking, J.S., et al. “Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use.” Clin Infect Dis 56 (2013): 777–86.
- Swidsinski, A., Doerffel, Y., Loening-Baucke, V., et al. “Gardnerella Biofilm involves Females and Males and is sexually transmitted.” Gynecol Obstet Invest 70 (2010): 256–63.
- Sidashenko, O.I., Voronkova, O.S., Sirokvasha, O.A.,Vinnikov, A.I. “Biofilm as a special form of bacterial organization and its role in infectious processes.” Bulletin of problems in biology and medicine 3.103 (2013): 36–41.
- Mason, M.J., Winter, A.J. “How to diagnose and treat aerobic and desquamative inflammatory vaginitis.” Sex Transm Infect 93 (2017): 8–10.
- Swidsinski, A., Mendling, W., Loening-Baucke, V., et al. “Adherent biofilms in bacterial vaginosis.” Obstet Gynecol 106.5.1 (2005): 1013–23.
- Tetz, V.V. “The effect of antimicrobial agents and mutagen on bacterial cells in colonies.” Med Microbiol Lett 5 (1999): 426–36.
- Austin, M.N., Beigi, R.H., Meyn, L.A., Hillier, S.L. “Microbiologic Response to Treatment of Bacterial Vaginosis with Topical Clindamycin or Metronidazole.” J Clin Microbiol 43.9 (2005): 4492–7. DOI: 10.1128/JCM.43.9.4492-4497.2005
- Cook, R.L., Redondo-Lopez, V., Schmitt, C., et al. “Clinical, microbiological, and biochemical factors in recurrent bacterial vaginosis.” J Clin Microbiol 30.4 (1992): 870–7.
- Flynn O'Brien, R. “Bacterial vaginosis: many questions – any answers?” Curr Opin Pediatr 17.4 (2005): 473–9.
- Nagaraja, P. “Antibiotic resistance of Gardnerella vaginalis in recurrent bacterial vaginosis.” Ind J Med Microbiol 26.2 (2005): 155–7.
- Schuyler, J.A., Mordechai, E., Adelson, M.E., et al. “Identification of intrinsically metronidazole-resistant clades of Gardnerella vaginalis.” Diagn Microbiol Infect Dis 84.1 (2016): 1–3.
- Tamrakar, R., Yamada, T., Furuta, I., et al. “Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women.” BMC Infect Dis 7.7 (2007): 128.
- Wang, Z., He, Y., Zheng, Y. “Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis.” Int J Environ Res Public Health 16.20 (2016): 3859.
- Heczko, P.B., Tomusiak, A., Adamski, P., et al. “Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial.” BMC Women’s Health 15 (2015): 115. DOI: 10.1186/s12905-015-0246-6
- Wang, Y., Wu, Y., Wang, Y., et al. “Antioxidant Properties of Probiotic Bacteria.” Nutrients 9.5 (2017): 521.
- Maldonado Galdeano, C., Cazorla, S.I., Lemme Dumit, J.M., Vélez, E. “Perdigón G Beneficial Effects of Probiotic Consumption on the Immune System.” Ann Nutr Metab 74.2 (2019): 115–24.
- Lepargneur, J.P. “Lactobacillus crispatus as biomarker of the healthy vaginal tract.” Ann Biol Clin (Paris) 74.4 (2016): 421–7.
- Oduyebo, O.O., Anorlu, R.I., Ogunsola, F.T. “The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women.” Cochrane Database Syst Rev 3 (2009): CD006055.
- Huang, H., Song, L., Zhao, W. “Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta-analysis of randomized clinical trials.” Arch Gynecol Obstet 289.6 (2014): 1225–34.
- Tan, H., Fu, Y., Yang, C., Ma, J. “Effects of metronidazole combined probiotics over metronidazole alone for the treatment of bacterial vaginosis: a meta-analysis of randomized clinical trials.” Arch Gynecol Obstet 295.6 (2017): 1331–9.
- Livzan, M.A. “Bacterial vaginosis: site of oral probiotic therapy.” Therapist 2 (2009): 52–5.
- Lipova, E.V., Yakovlev, A.B., Pakhomova, A.I. “Bacterial vaginosis as a dysbiotic syndrome: ways to solve the problem.” Obstetrics and gynecology: news, opinions, training 1 (2016): 59–67.
- Huang, Y.F., Liu, P.Y., Chen, Y.Y., et al. “Three-combination probiotics therapy in children with salmonella and rotavirus gastroenteritis.” J Clin Gastroenterol 48.1 (2011): 37–42.
- Szajewska, H., Guarino, A., Hojsak, I., et al. “Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics.” J Pediatr Gastroenterol Nutr 58.4 (2014): 531–9.
- Uglova, N.D. “Probiotics in the treatment of bacterial vaginosis.” Medicinal Bulletin 4.52 (2013): 29–32.
- Gibson, G.R., Hutkins, R., Sanders, M.E., et al. “Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics.” Nat Rev Gastroenterol Hepatol 14.8 (2017): 491–502.
- Roberfroid, M., Gibson, G.R., Hoyles, L., et al. “Prebiotic effects: metabolic and health benefits.” Br J Nutr 104.2 (2010): S1–63.
- Reid, G., Bruce, A.W., Taylor, M. “Instillation of Lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract infections.” Microecol Ther 23 (1995): 32–45.
- Coste, I., Judlin, P., Lepargneur, J.P., Bou-Antoun, S. “Safety and efficacy of an intravaginal prebiotic gel in the prevention of recurrent bacterial vaginosis: a randomized double-blind study.” Obstet Gynecol Int (2012): 147867. DOI: 10.1155/2012/147867
- Rousseau, V., Lepargneur, J.P., Roques, C., et al. “Prebiotic effects of oligosaccharides on selected vaginal lactobacilli and pathogenic microorganisms.” Anaerobe 11.3 (2015): 145–53.
- Amsel, R., Totten, P.A., Spiegel, C.A., et al. “Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations.” Am J Med 74 (1983): 14–22.
How to Cite
Copyright (c) 2021 Н.Ф. Захаренко, І.П. Маноляк
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.