Probiotics in the practice of a gynecologist: a new chapter in the treatment of vaginal infections and dysbiosis

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Vaginal infections and dysbiosis, including bacterial vaginosis (BV), candidal vulvovaginitis (CVV), aerobic vaginitis (AV) and other forms, are a pressing issue in gynecological practice. These diseases affect a large number of women of reproductive age and lead to the development of many clinical symptoms, such as abnormal discharge, itching, pain and discomfort in the vulvar area. In addition, infections can contribute to an increased risk of complications, such as PID, infertility and premature birth. High relapse rate after standard antibiotic therapy is a significant problem in clinical practice. Relapses occur in 50% of cases 6 months after treatment, indicating the insufficient effectiveness of traditional treatments aimed at destroying pathogenic microorganisms, but not restoring normal vaginal microbiota.

Disruption of the vaginal microbiome, primarily a decrease in the number of lactobacilli and the predominance of opportunistic flora, plays a key role in the pathogenesis of infections. A systematic literature review performed using PubMed, Scopus, and Cochrane Library databases for the period 2015–2025 allowed to summarize current data on the use of probiotics based on Lactobacillus spp. as an element of restorative therapy. The analysis showed that probiotics can help reduce relapses, modulate the inflammatory response, and increase the effectiveness of standard therapy, especially in patients with chronic or recurrent infections.

This article is aimed to the analysis of the role of probiotics in restoring vaginal microflora after treatment of bacterial vaginal infections and evaluation of their effectiveness in reducing the frequency of relapses. Using the analysis of existing data, the role of probiotics as an additional method of therapy aimed at restoring the balance of vaginal microbiota and preventing relapses is considered.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Inna Apolikhina

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov; I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: apolikhina@inbox.ru
ORCID iD: 0000-0002-4581-6295

Dr. Sci. (Med.), Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov; Professor, Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University (Sechenov University)

Ресей, Moscow; Moscow

Liana Tarnaeva

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov

Хат алмасуға жауапты Автор.
Email: li.tarnaeva@ya.ru
ORCID iD: 0009-0006-7500-7516

Obstetrician-Gynecologist, Postgraduate Student

Ресей, Moscow

Әдебиет тізімі

  1. Petrova M. I., Van Den Broek M., Balzarini J., et al. Vaginal microbiota and its role in HIV transmission and infection. FEMS Microbiol Rev. 2013;37(5):762–792. https://dx.doi.org/10.1111/1574-6976.12029
  2. France M.T., Mendes-Soares H., Forney L.J. Genomic comparisons of Lactobacillus crispatus and Lactobacillus iners reveal potential ecological drivers of community composition in the vagina. Appl Environ Microbiol. 2016;82(24):7063–7073. https://dx.doi.org/10.1128/AEM.02385-16
  3. Serrano M.G., Parikh H.I., Brookset J.P. et al. Racioethnic diversity in the dynamics of the vaginal microbiome during pregnancy. Nat Med. 2019;25(6):1001–1011. https://dx.doi.org/10.1038/S41591-019-0465-8
  4. Tachedjian G., Aldunate M., Bradshaw C.S., Cone R.A. The role of lactic acid production by probiotic Lactobacillus species in vaginal health. Res Microbiol. 2017;168(9–10):782–792. https://dx.doi.org/10.1016/j.resmic.2017.04.001
  5. McClelland R.S., Lingappa J.R., Srinivasan S., et al. Evaluation of the association between the concentrations of key vaginal bacteria and the increased risk of HIV acquisition in African women from five cohorts: a nested case-control study. Lancet Infect Dis. 2018;18(5):554–564. https://dx.doi.org/10.1016/S1473-3099(18)30058-6
  6. Donders G.G.G., Bellen G., Rezeberga D. Aerobic vaginitis in pregnancy. BJOG. 2011;118(10):1163–1170. https://dx.doi.org/10.1111/J.1471-0528.2011.03020.X
  7. Stapleton A.E., Au-Yeung M., Hootonet T.M. et al. Randomized, placebo-controlled phase 2 trial of a lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin Infect Dis. 2011;52(10):1212–1217. https://dx.doi.org/10.1093/CID/CIR183
  8. Goodman C., Keating G., Georgousopoulou E., et al. Probiotics for the prevention of antibiotic-associated diarrhoea: A systematic review and meta-analysis. BMJ Open. 2021;11(8). https://dx.doi.org/10.1136/BMJOPEN-2020-043054
  9. Probiotics and Prebiotics. World Gastroenterology Organisation. Accessed: Jun. 10, 2025. [Online]. Available: https://www.worldgastroenterology.org/guidelines/probiotics-and-prebiotics
  10. Guarner F. et al. World Gastroenterology Organisation Global Guidelines: Probiotics and Prebiotics. J Clin Gastroenterol. 2024;58(6):533–553. https://dx.doi.org/10.1097/MCG.0000000000002002
  11. Ouwehand A.C. et al. Probiotics reduce symptoms of antibiotic use in a hospital setting: A randomized dose response study. Vaccine. 2014;32(4):458–463. https://dx.doi.org/10.1016/j.vaccine.2013.11.053
  12. Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food including Powder Milk with Live Lactic Acid Bacteria. 2002. Accessed: May 14, 2025. [Online]. Available: https://openknowledge.fao.org/handle/20.500.14283/y6398e
  13. Аполихина И.А., Тарнаева Л.А. Пробиотики для поддержания экосистемы влагалища. Медицинский совет. 2024;18(17):86–90. [Apolikhina I.A., Tarnaeva L.A. The role of probiotics in maintaining vaginal ecosystem. Meditsinskiy Sovet.2024;18(17):86–90. (In Russ.)] https://doi.org/10.21518/ms2024-489
  14. Liu P., Lu Y., Li R., Chen X. Use of probiotic lactobacilli in the treatment of vaginal infections: In vitro and in vivo investigations. Front Cell Infect Microbiol. 2023;13:1153894. https://dx.doi.org/10.3389/FCIMB.2023.1153894/XML/NLM
  15. Petrova M.I., Lievens E., Malik S., et al. Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health. Front Physiol. 2015;6:81. https://dx.doi.org/10.3389/FPHYS.2015.00081
  16. Gupta V., Mastromarino P., Garg R. Effectiveness of Prophylactic Oral and/or Vaginal Probiotic Supplementation in the Prevention of Recurrent Urinary Tract Infections: A Randomized, Double-Blind, Placebo-Controlled Trial. Clinical Infectious Diseases. 2024;78(5):1154–1161. https://dx.doi.org/10.1093/CID/CIAD766
  17. Vahedpoor Z. et al. Vaginal and oral use of probiotics as adjunctive therapy to fluconazole in patients with vulvovaginal candidiasis: A clinical trial on Iranian women. Curr Med Mycol. 2021;17(3):36–43. https://dx.doi.org/10.18502/CMM.7.3.7803
  18. Reid G., Charbonneau D., Erb J., et al. 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(2):131–134. https://dx.doi.org/10.1016/S0928-8244(02)00465-0
  19. Cohen C.R., Wierzbicki M.R., French A.L., et al. Randomized trial of Lactin-V topPrevent recurrence of bacterial vaginosis. N Engl J Med. 2020;382(20):1906–1915. https://dx.doi.org/10.1056/NEJMOA1915254
  20. Lev-Sagie A., Goldman-Wohl D., Cohen Y., et al. Vaginal microbiome transplantation in women with intractable bacterial vaginosis. Nat Med. 2019;25(10):1500–1504. https://dx.doi.org/10.1038/S41591-019-0600-6
  21. Lebeer S., Oerlemans E., Claes I., et al. Topical cream with live lactobacilli modulates the skin microbiome and reduce acne symptoms. bioRxiv 2018:463307. https://dx.doi.org/10.1101/463307
  22. Небышинец Л.М., Тесакова М.Л., Грудницкая Е.Н., Гарбузова Е.И. Обоснование и опыт применения пробиотиков для лечения заболеваний мочеполовой системы. Медицинские новости. 2017;6:39-42. (Nebyshynets L.M., Tesakova M.L., Hrudnitskaya E.N., Harbuzova E.I. The rationale and experience of using probiotics for the treatment of diseases of the genitourinary system. Meditsinskie novosti. 2017;6:39–42. (In Russ.)].
  23. Muzny C.A., Schwebke J.R. Pathogenesis of bacterial vaginosis: discussion of current hypotheses. JID. 2016;214(Suppl 1):S1–S5. https://dx.doi.org/10.1093/INFDIS/JIW121
  24. Hardy L., Jespers V., Dahchour N., et al. Unravelling the bacterial vaginosis-associated biofilm: a multiplex Gardnerella Vaginalis and Atopobium vaginae fluorescence in situ hybridization assay using peptide nucleic acid probes. PLoS One. 2015;10(8):e0136658. https://dx.doi.org/10.1371/JOURNAL.PONE.0136658
  25. Леонова М.В. Пробиотики в лечении вагинальных инфекций: эффективность с позиции доказательной медицины. Медицинский совет. 2020;(13):148–154. [Leonova M.V. Probiotics in the treatment of vaginal infections: efficacy from the perspective of evidence-based medicine. Meditsinskiy Sovet. 2020;13:148–154. (In Russ.)] https://dx.doi.org/10.21518/2079-701X-2020-13-148-154
  26. Bradshaw C.S., Brotman R.M. Making inroads into improving treatment of bacterial vaginosis - striving for long-term cure. BMC Infect Dis. 2015;15(1);292. https://dx.doi.org/10.1186/S12879-015-1027-4
  27. Machado A., Cerca N. Influence of biofilm formation by gardnerella vaginalis and other anaerobes on bacterial vaginosis. JID. 2015;212(12):1856–1861. https://dx.doi.org/10.1093/INFDIS/JIV338
  28. 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. 2014;289(6):1225–1234. https://dx.doi.org/10.1007/S00404-013-3117-0
  29. Mastromarino P., Macchiaa S., Meggiorini L., et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect. 2009;15(1):67–74. https://dx.doi.org/10.1111/j.1469-0691.2008.02112.x
  30. Bacterial Vaginosis – STI Treatment Guidelines. Accessed: May 14, 2025. [Online]. Available: https://www.cdc.gov/std/treatment-guidelines/bv.htm
  31. Overview. Prostatitis (acute): antimicrobial prescribing. Guidance. NICE. Accessed: May 14, 2025. [Online]. Available: https://www.nice.org.uk/guidance/ng110
  32. Vaginitis in nonpregnant patients: ACOG Practice Bulletin, Number 215. Obstet Gynecol. 2020;135(1):e1–e17. https://dx.doi.org/10.1097/AOG.0000000000003604
  33. Sherrard J., Wilson J., Donders G., et al. 2018 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. 2018;29(13):1258–1272. https://dx.doi.org/10.1177/0956462418785451
  34. Farr A., Swidsinski S., Surbek D., et al. Bacterial Vaginosis: Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/028, June 2023). Geburtshilfe Frauenheilkd. 2023;83(11):1331-1349. https://dx.doi.org/10.1055/a-2169-8539
  35. Fan A., Yue Y., Geng N., et al. Aerobic vaginitis and mixed infections: comparison of clinical and laboratory findings. Arch Gynecol Obstet. 2013;287(2):329–335. https://dx.doi.org/10.1007/S00404-012-2571-4
  36. Tempera G.G., Furneri P.M. Management of aerobic vaginitis. Gynecol Obstet Invest. 2010;70(4):244–249. https://dx.doi.org/10.1159/000314013
  37. Verstraelen H., Verhelst R., Claeys G., et al. Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora. BMC Microbiol, 2009;9:116. https://dx.doi.org/10.1186/1471-2180-9-116
  38. Gille C., Böer B., Marschal M., et al. Effect of probiotics on vaginal health in pregnancy. EFFPRO, a randomized controlled trial. Am J Obstet Gynecol. 2016;215(5):608.e1–608.e7. https://dx.doi.org/10.1016/J.AJOG.2016.06.021
  39. Sobel J.D. Vulvovaginal candidosis. Lancet. 2007;369(9577):1961–1971. https://dx.doi.org/10.1016/S0140-6736(07)60917-9
  40. Workowski K.A., Bachmann L.H., Chan P.A., et al. Sexually Transmitted Infections Treatment Guidelines, 2021,” MMWR Recommendations and Reports.2021;70(4):1–187. https://dx.doi.org/10.15585/MMWR.RR7004A1
  41. Donders G.G.G., Bellen G., Mendling W. Management of recurrent vulvo-vaginal candidosis as a chronic illness. Gynecol Obstet Invest. 2010;70(4):306–321. https://dx.doi.org/10.1159/000314022
  42. Denning D.W., Kneale M., Sobel J.D., Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018;18(11): e339–e347. https://dx.doi.org/10.1016/S1473-3099(18)30103-8
  43. Gulati M., Nobile C.J. Candida albicans biofilms: development, regulation, and molecular mechanisms. Microbes and infection / Institut Pasteur. 2016;18(5):310. https://dx.doi.org/10.1016/J.MICINF.2016.01.002
  44. Parolin C., Marangoni A., Laghi L., et al. Isolation of vaginal lactobacilli and characterization of anti-candida activity. PLoS One. 2015;10(6): e0131220. https://dx.doi.org/10.1371/JOURNAL.PONE.0131220
  45. Xie H.Y., Feng D., Wei D.M., et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev. 2017;11(11):CD010496. https://dx.doi.org/10.1002/14651858.CD010496.PUB2
  46. Dong H., Rowland I., Tuohy K.M., et al. Selective effects of Lactobacillus casei Shirota on T cell activation, natural killer cell activity and cytokine production. Clin Exp Immunol. 2010;161(2):378–388. https://dx.doi.org/10.1111/J.1365-2249.2010.04173.X

Қосымша файлдар

Қосымша файлдар
Әрекет
1. JATS XML

© Bionika Media, 2025