The problem of recurrent bacterial vaginosis: modern strategies




bacterial vaginosis, vaginal dysbiosis, antirelapse therapy, probiotic, lactic acid


Objective: to evaluate the clinical tolerability, effectiveness and stability of the therapeutic result when using different regimens for the treatment of recurrent bacterial vaginosis (BV) in women of reproductive age.
Materials and methods. 105 women of reproductive age with diagnosed recurrent symptomatic BV participated in the study. The participants were randomized into three comparable groups of 35 women each. A ten-day primary decontamination of the vaginal tract was carried out in all groups: intravaginal administration of the drug Tergynan for group 1 and Femiril suppositories in groups 2 and 3. After the initial treatment patients of group 3 received the vaginal probiotic suppositories Alactel Femi for 15 days, after that they used it twice a week No. 10.
The effectiveness of BV therapy was evaluated immediately after the antibacterial course and after a 6-month follow-up period based on the results of clinical examination and determination of vaginal pH.
Results. Subjective and objective signs of bacterial infection were not detected in all participants after the course of vaginal decontamination. The pH of vaginal secretion was within the normal range and did not differ statistically between the groups. After 6 month, according to the results of a gynecological examination and pH test, one recurrence of BV was confirmed in group 1 and 2. The patients of group 3 had no complaints about manifestations of reinfection, which, in combination with the data of pH-metry, allowed confirming the absence of BV recurrences in them. Additional use of a probiotic in a complex with lactic acid in group 3 was associated with a stable normalization of the acid-alkaline balance of the vaginal secretion: 4.43 ± 0.12 and 4.39 ± 0.14 in groups 1 and 2, respectively, against 4.02 ± 0 ,12 in the 3rd group (p < 0.05).
Conclusions. Obtained results indicate a more stable anti-relapse effectiveness and safety of the local use of Femiril, followed by the restoration of the physiological parameters of the vaginal biotope with a complex of probiotics and lactic acid in the Alactel femi. The effectiveness of this approach consists in combining the antibacterial effect of phytoextracts with the successive restoration of vaginal immunity and metabolism through persistent colonization of the mucous membrane with living lactobacilli of eubiotic origin.

Author Biographies

T.F. Tatarchuk, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

MD, professor, corresponding member of the NAMS of Ukraine, deputy director for research work, head of the Endocrine Gynecology Department;
Chief researcher, Department of Reproductive Health

N.F. Zakharenko, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

MD, professor, leading research fellow, Endocrine Gynecology Department

I.P. Manoliak, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine ”, Kyiv

PhD, obstetrician-gynecologist of the endocrine gynecology office

V.S. Solskyi, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

PhD, senior researcher, Endocrine Gynecology Department

T.M. Tutchenko, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; SSI “CIMT of the NAS of Ukraine», Kyiv

PhD, senior researcher of the Endocrine Gynecology Department;
Department of Reproductive Health


  1. Kosey, 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.
  2. 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.
  3. Bautista, C.T., Wurapa, E., Sateren, W.B., et al. “Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections.” Mil Med Res 3 (2016): 4.
  4. Kenyon, C., Colebunders, R., Crucitti, T. “The global epidemiology of bacterial vaginosis: a systematic review.” Am J Obstet Gynecol 209.6 (2013): 505–23.
  5. Sobel, J.D. “Bacterial vaginosis.” Annu Rev Med 51 (2000): 349–56.
  6. Tatarchuk, T.F. “Modern approach to the treatment of nonspecific vaginitis.” Reproductive endocrinology 2.22 (2015): 85–8.
  7. Workowski, K.A., Bolan, G.A. “Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines.” MMWR Recomm Rep 64 (2015): 69–72.
  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.” International Journal of STD & AIDS 29.13 (2018): 1258–72.
  9. 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.
  10. 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.
  11. 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.
  12. Delgado-Diaz, D.J., Tyssen, D., Hayward, J.A., et al. “Distinct immune responses elicited from cervicovaginal epithelial cells by lactic acid and short chain fatty acids associated with optimal and non-optimal vaginal microbiota.” Front Cell Infect Microbiol 9 (2019): 446.
  13. 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.
  14. Hall-Stoodley, L., Stoodley, P. “Evolving concepts in biofilm infections.” Cell Microbiol 11.7 (2009): 1034–43.
  15. Machado, A., Cerca, N. “Influence of biofilm formation by Gardnerella vaginalis and other anaerobes on bacterial vaginosis.” J Infect Dis 212.12 (2015): 1856–61.
  16. Swidsinski, A., Mendling, W., Loening-Baucke, V., et al. “Adherent biofilms in bacterial vaginosis.” Obstet Gynecol 106.5.1 (2005): 1013–23.
  17. Mason, M.J., Winter, A.J. “How to diagnose and treatbaerobic and desquamative inflammatory vaginitis.” Sex Transm Infect 93 (2017): 8–10.
  18. Castro, J., Machado, D., Cerca, N. “Unveiling the role of Gardnerella vaginalis in polymicrobial Bacterial Vaginosis biofilms: the impact of other vaginal pathogens living as neighbors.” ISME J 13.5 (2019): 1306–17.
  19. Tatarchuk, T.F., Kalugina, L.V., Petrova, G.A., et al. “Vaginal discharge syndrome. Problem with many unknowns.” Reproductive endocrinology 3.53 (2020): 102–8.
  20. 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.
  21. 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.
  22. Wiggins, R., Hicks, S.J., Soothill, P.W., et al. “Mucinases and sialidases: their role in the pathogenesis of sexually transmitted infections in the female genital tract.” Sex Transm Infect 77 (2001): 402–8.
  23. Ness, R.B., Soper, D.E., Holley, R.L., et al. “Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial.” Am J Obstet Gynecol 186.5 (2002): 929–37. DOI: 10.1067/mob.2002.121625
  24. van Oostrum, N., De Sutter, P., Meys , J., Verstraelen, H. “Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis.” Hum Reprod 28 (2013): 1809–15.
  25. van Teijlingen, N.H., Helgers, L.C., Zijlstra-Willems, E.M., et al. “Vaginal dysbiosis associatedbacteria Megasphaera elsdenii and Prevotella timonensis induce immune activation via dendritic cells.” J Reprod Immunol 138 (2020): 103085.
  26. Spandorfer, S.D., Neuer, A., Giraldo, P.C., et al. “Relationship of abnormal vaginal flora, proinflammatory cytokines and idiopathic infertility in women undergoing IVF.” J Reprod Med 46 (2001): 806–10.
  27. Chu, D.M., Seferovic, M., Pace, R.M., Aagaard, K.M. “The microbiome in preterm birth.” Best Pract Res Clin Obstet Gynaecol 52 (2018): 103–3.
  28. 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.
  29. 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.
  30. Bradshaw, C., Morton, A., Hocking, J., et al. “High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence.” J Infect Dis 1.193.11 (2006): 1478–86. DOI: 10.1086/503780
  31. Swidsinski, A., Mendling, W., Loening-Baucke, V., et al. “An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole.” Am J Obstet Gynecol 198.1 (2008): 97.e1-6.
  32. Alves, P., Castro, J., Sousa, C., et al. “Gardnerella vaginalis outcompetes 29 other bacterial species isolated from patients with bacterial vaginosis, using in an in vitro biofilm formation model.” J Infect Dis 210.4 (2014): 593–6. DOI: 10.1093/infdis/jiu131
  33. Flynn O’Brien, R. “Bacterial vaginosis: many questions – any answers?” Curr Opin Pediatr 17.4 (2005): 473–9.
  34. Nagaraja, P. “Antibiotic resistance of Gardnerella vaginalis in recurrent bacterial vaginosis.” Ind J Med Microbiol 26.2 (2005): 155–7.
  35. 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.
  36. Machado, D., Castro, J., Palmeira-de-Oliveira, A., et al. “Bacterial vaginosis biofilms: challenges to current therapies and emerging solutions.” Front Microbiol 6 (2016): 1528. DOI: 10.3389/fmicb.2015.01528
  37. Rather, M., Dar, B., et al. “Chemical composition, antioxidant and antibacterial activities of the leaf essential oil of Juglans regia L. and its constituents.” Phytomedicine 19.13 (2012): 1185–90. DOI: 10.1016/j.phymed.2012.07.018
  38. Paudel, P., Satyal, P., Dosoky, N., et al. “Juglans regia and J. nigra, two trees important in traditional medicine: A comparison of leaf essential oil compositions and biological activities.” Nat Prod Commun 10 (2013): 1481–6.
  39. Sosto, F., Benvenuti, C., CANVA Study Group. “Controlled study on thymol + eugenol vaginal douche versus econazole in vaginal candidiasis and metronidazole in bacterial vaginosis.” Arzneimittelforschung 61.2 (2011): 126–31. DOI: 10.1055/s-0031-1296178
  40. Murina, F., Vicariotto, F., Di Francesco, S. “Thymol, eugenol and lactobacilli in a medical device for the treatment of bacterial vaginosis and vulvovaginal candidiasis.” New Microbiol 41.3 (2018): 220–4.
  41. Hellinger, R., Koehbach, J., Fedchuk, H., et al. “Immunosuppressive activity of an aqueous Viola tricolor herbal extract” J Ethnopharmacol 151.1 (2014): 299–306.
  42. Angotti, L.B., Lambert, L.C., Soper, D.E. “Vaginitis: Making Sense of Over-the-Counter Treatment Options.” Infect Dis Obstet Gynecol (2007): 97424. DOI: 10.1155/2007/97424
  43. Pazhohideh, Z., Mohammadi, S., Bahrami, N., et al. “The effect of Calendula officinalis versus metronidazole on bacterial vaginosis in women: A double-blind randomized controlled trial.” J Adv Pharm Technol Res 9.1 (2018): 15–9.
  44. Zielińska, A., Nowak, I. “Abundance of active ingredients in sea-buckthorn oil.” Lipids Health Dis 16 (2017): 95.
  45. Webb, L. “Probiotics for preventing recurrent bacterial vaginosis.” JAAPA 34.2 (2021): 19–22. DOI: 10.1097/01.JAA.0000731484.81301.58
  46. Chen, W., Luo, Y., Yuan, L., et al. “The restoration of the vaginal microbiota after treatment for bacterial vaginosis with metronidazole or probiotics.” Microb Ecol 65.3 (2013): 773–80. DOI: 10.1007/s00248-012-0154-3
  47. 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.
  48. 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.
  49. Loh, J.T., Gupta, S.S., Friedman, D.B., et al. “Analysis of protein expression regulated by the Helicobacter pylori ArsRS two-component signal transduction system.” J Bacteriol 192.8 (2010): 2034–43. DOI: 10.1128/JB.01703-08
  50. Hearps, A.C., Tyssen, D., Srbinovski, D., et al. “Vaginal lactic acid elicits an anti-inflammatory response from human cervicovaginal epithelial cells and inhibits production of pro-inflammatory mediators associated with HIV acquisition.” Mucosal Immunol 10.6 (2017): 1480–90. DOI: 10.1038/mi.2017.27
  51. Mitchell, C., Manhart, L.E., Thomas, K., et al. “Behavioral predictors of colonization with Lactobacillus crispatus or Lactobacillus jensenii after treatment for bacterial vaginosis: a cohort study.” Infect Dis Obstet Gynecol (2012): 706540. DOI: 10.1155/2012/706540
  52. Аmsel, 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

Tatarchuk, T., Zakharenko, N., Manoliak, I., Solskyi, V., & Tutchenko, T. (2023). The problem of recurrent bacterial vaginosis: modern strategies. REPRODUCTIVE ENDOCRINOLOGY, (67), 56–62.