Lactic acid as a key factor in restoring vaginal microbiota: physiological and clinical aspects

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Background: Despite the efficacy of antimicrobial therapy for inflammatory diseases of the lower genital tract, the high recurrence rate and growing resistance of microorganisms make it necessary to search for and implement alternative or adjuvant approaches aimed at restoring a healthy vaginal microbiome. Lactic acid is a key metabolite of lactobacilli and it plays a vital role in maintaining the vaginal microbiota by providing an acidic environment that inhibits the growth of pathogens and modulates the local immune response.

Objective: To organize the current literature data on the role of lactic acid in the pathogenesis of bacterial and viral vaginitis and on the use of acid-containing medications to restore vaginal microbiota, maintain fertility; to analyze the data in menopausal and pregnant women.

Materials and methods: The Russian and foreign databases, namely eLibrary, PubMed, and Russian Science Citation Index (RSCI), were analyzed for the keywords, ‘lactic acid’, ‘lactobacilli’, ‘microbiota’, ‘dysbiosis’, ‘bacterial vaginosis’, ‘human papillomavirus’, ‘genital herpes’, and ‘genital infections’. Literature sources were selected for analysis according to the objective.

Results: This article summarizes the data on the physiological functions of lactic acid and its mechanisms of action, including its antimicrobial, viricidal and immunomodulatory effects. The possibilities of using lactic acid in the therapy of bacterial vaginosis, vaginitis of nonspecific and mixed etiology, viral infections in pregnant and postmenopausal women are considered. The article highlights the data on the role of lactic acid in maintaining fertility, preparing the endometrium for implantation and reducing the risk of obstetric complications. The high safety of topical application of lactic acid is emphasized, especially in the context of the limitations of antibacterial therapy in pregnant women and in the setting of recurrent bacterial vaginosis.

Conclusion: Lactic acid is not only a metabolite providing physiological acidity of the vaginal environment, but also an active component of innate immunity, capable of resisting both bacterial and viral infections. Its use in vaginal preparations represents a valid strategy for restoring vaginal microbiota and preventing recurrent vaginal infections.

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Sobre autores

Niso Nazarova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Autor responsável pela correspondência
Email: n_nazarova@oparina4.ru
ORCID ID: 0000-0001-9499-7654

Dr. Med. Sci., Leading Researcher

Rússia, Moscow

Anastasia Devyatkina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: grinasta26@mail.ru
ORCID ID: 0009-0006-1742-7555

Resident

Rússia, Moscow

Elena Mezhevitinova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: mejevitinova@mail.ru
ORCID ID: 0000-0003-2977-9065

Dr. Med. Sci., Leading Researcher at the Scientific Polyclinic Department

Rússia, Moscow

Vera Prilepskaya

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_prilepskaya@oparina4.ru
ORCID ID: 0000-0003-3993-7629

Dr. Med. Sci., Professor, Honored Scientist of the Russian Federation, Head of the Scientific Polyclinic Department

Rússia, Moscow

Leyla Alieva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: leylaalieva00@mail.ru
ORCID ID: 0009-0008-3417-6721

Resident

Rússia, Moscow

Elena Sycheva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: el.bona@mail.ru
ORCID ID: 0000-0002-2527-7853

PhD, Doctor at the Scientific Polyclinic Department

Rússia, Moscow

Vera Muravieva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_muravieva@oparina4.ru
ORCID ID: 0000-0003-0383-0731

PhD (Bio), Senior Researcher at the Laboratory of Molecular Microbiology, Department of Microbiology and Clinical Pharmacology

Rússia, Moscow

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