Bacterial Vaginosis Is Not a Simple Ecological Disorder

Abstract

Eighty-four patients with bacterial vaginosis were examined in an open randomized trial, the aim of which was to define clinical results and the microbiological panorama after topical treatment for 1 week with either an acetic acid jelly (A), an estrogen cream (B), a fermented milk product (C) or metronidazole (D). After exclusion because of chlamydia infection (15 cases) or for other reasons, 61 cases remained for complete evaluation 4 weeks after the start of treatment. Clinical cure was obtained in 3 cases out of 17 on regimen A, in 1 out of 16 on regimen B, in 1 of 14 on regimen C, and in 13 out of 14 on regimen D. The patients were conclusively either symptomless or symptomatic when examined on 113 occasions. Statistically significant reduction after treatment resulting in relief of symptoms was observed in the numbers of corynebacteria and anaerobic cocci, whereas lactobacilli increased in numbers. The instillation of high numbers of Lactobacillus acidophilus (C) into the vagina cured only 1 patient and did not influence the predominance of lactobacilli in the vagina at the follow-up examination. The difference in microbiological profile of women in symptomatic and asymptomatic conditions becomes still more apparent when the results of the present and previously published studies on the subject by the present group of investigators are combined. The symptomatic woman is significantly more often harboring corynebacteria, Gardnerella vaginalis, peptostreptococci, peptococci, eubacteria and Bacteroides species. Lactobacilli are significantly reduced in numbers. However, only 51 % of our previously symptomatic, but now symptomless women show predominant growth of lactobacilli, which is less than expected for healthy women. Therefore, lactobacilli may not be the specific factor that protects against bacterial vaginosis.

Vaginal pH-lowering effect of locally applied vitamin C in subjects with high vaginal pH

“…Two possible hypotheses arise concerning the lack of permanence of acetic acid: quick absorption and metabolism by the vaginal mucosa; and poor adhesiveness of the gel to the vaginal mucosa and clearance of the product by vaginal discharge. In a randomized clinical trial using an acetic acid gel compared with metronidazole, Fredricsson and co-workers [11] obtained cure in only three of 17 cases treated with acetic acid gel, whereas 13 of 14 were cured with oral metronidazole. It appears to us not very appropriate to compare the efficacy of an antibiotic versus an acidifying agent, especially without selecting an appropriate patient population.…”

Vaginal Microbiota and the Use of Probiotics

“…Fredricsson et al [90] conducted an open-label trial to compare the cure rates of 61 women with BV given one of four intravaginal products. Patients were diagnosed with BV if ≥3 Amsel criteria were present.…”

Association Analysis on Recurrence of Bacterial Vaginosis Revealed Microbes and Clinical Variables Important for Treatment Outcome

“…Some clinical and demographic variables have been reported to correlate with post-treatment recurrence of BV, including a past history of BV and a regular sex partner (Bradshaw et al, 2006). In addition, it was reported that several Lactobacillus species, including L. gasseri, L. brevis , and L. acidophilus , could reduce BV recurrence (Neri et al, 1993; Shalev et al, 1996; Anukam et al, 2006), although such findings were controversial (Fredricsson et al, 1989; Hallen et al, 1992; Eriksson et al, 2005). Of note, these studies all used simple, traditional methods of clinical microbiology, which are inadequate to characterize the complex and dynamic composition of vaginal microbiota (Ravel et al, 2011).…”