Vaginal Infections--Do Probiotics Help? Research Sheds Light On Effective Strains, and Efficacy of Oral Dosage.

Article by Arnie Gitomer

A typical definition of “probiotics” reads like this: “Probiotics are bacteria or yeast organisms that may have beneficial effects on human physiology and health. Probiotic organisms are believed to work in part by enhancing digestion and immune function, by competing with pathogenic microorganisms for binding sites on mucosal surfaces, and by producing chemicals that inactivate or kill pathogens.” (Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011.)

The therapeutic benefits of probiotics have been applied to numerous and various health problems. One well recognized condition is bacterial vaginosis and similar vaginal infections. One question, when it comes to this conditions, is which strain or strains of probiotic organisms are most effective.

“. . . It should be noted that the normal bacterial flora differs substantially in different parts of the body, and that the capacity of specific probiotic strains to exert a beneficial effect may vary at different sites. For example, while L. rhamnosus GG has been found to be useful for preventing and treating certain gastrointestinal conditions, it was not effective at colonizing the vaginal mucosa. In contrast, L. rhamnosus GR-1 and L. reuteri RC-14 were relatively effective at colonizing the vaginal mucosa, and these organisms have been used with some success for preventing and treating vaginitis and recurrent urinary tract infections . . .” (Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011.)

The other question is how to best administer the probiotic supplement. In the case of vaginal infections, is it necessary to administer the probiotcs intravaginally, or does oral administration work?

A new study sheds light on this question. The study, “Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study.” by Vujic G, Jajac Knez A, Despot Stefanovic V, Kuzmic Vrbanovic V. Was published in Eur J Obstet Gynecol Reprod Biol. 2013 Feb 7. pii: S0301-2115(13)00013-4. doi: 10.1016/j.ejogrb.2012.12.031. [Epub ahead of print]
Their goal was to assess the efficacy of orally administered capsules containing the probiotics Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 compared to placebo in otherwise healthy women diagnosed with bacterial vaginosis.

It was a randomized, double-blind, multicentric, placebo-controlled trial, including a total of 544 subjects. Included were women older than 18 years of age, diagnosed with vaginal infection. Subjects received either probiotic (395 subjects or 72.6%) or identical-looking placebo capsules (149 subjects or 27.4%,) per day over a period of 6 weeks. Six and 12 weeks after the beginning of the study, subjects underwent two additional gynecological examinations and their vaginal swabs were evaluated by a clinical cytologist.

Here are the results. The mean follow-up period after the baseline visit was 44 days. After this period, restitution to balanced vaginal microbiota was reported in 40 subjects (26.9%) in the placebo group, compared to 243 subjects (61.5%) in the probiotic group. Differences between groups were statistically significant at p<0.001. After the additional 6 weeks of follow up, normal vaginal microbiota were still present in more than half (51.1%) of subjects in the probiotic group, but only in around one-fifth (20.8%) of subjects who were taking placebo (p<0.001).

The conclusion is that “oral probiotics could be an alternative, side effect-free treatment for one of the most common indications in gynecology, combining the good aspects of both metronidazole and vaginal capsules.”

In a related study, presented by Dr. Gaby in his book, Nutritional Medicine, similar positive results were shown, when combined with oral metronidazole therapy:
One hundred twenty-five women with bacterial vaginosis were treated with oral metronidazole (500 mg twice a day for 7 days), and were randomly assigned to receive, in double-blind fashion, 1 capsule twice a day of the combination of L. rhamnosus GR-1 and L. reuteri RC-14 or placebo for 30 days, beginning with the start of metronidazole therapy. Each capsule contained 109 viable cells of each strain. The probiotics were taken at least 1 hour after the antibiotic. Cure was defined as a normal Nugent score, a negative sialidase test, and no symptoms or signs of bacterial vaginosis at day 30. The cure rate was significantly higher in the active-treatment group than in the placebo group (88% vs. 40%; p < 0.001).

(Anukam K, Osazuwa E, Ahonkhai I, et al. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Microbes Infect 2006;8:1450–1454.)
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An example of an oral probiotic supplement containing the two strains mentioned is Fem-Dophillus, by Jarrow Formulas