Lactobacilli reduce recurrences of vaginal candidiasis in pregnant women: a randomized, double-blind, placebo-controlled study

Abstract

Aims The aim of this study was to investigate the effects of lactobacilli strains in preventing the recurrences of vaginal candidiasis (VC) in 78 pregnant women with VC (lactobacilli, n = 39; placebo, n = 39) and the potential benefits on quality of life. Methods and Results The lactobacilli putative probiotic (SynForU‐HerCare; two capsules/day of 9·5 log CFU per capsule) or placebo was administered for 8‐weeks in a randomized, double‐blind, placebo‐controlled study. Subjects were assessed for vaginal and gut health conditions at baseline, week‐4 and week‐8 via questionnaires. The vulvovaginal symptom questionnaire not only covered aspects pertaining to vulvovaginal symptoms but also the quality of life impacts such as emotional, social and sexual. The administration of lactobacilli reduced symptoms of irritation (P = 0·023) and discharge (P = 0·011) starting week‐4 and continued after week‐8 (P < 0·05), accompanied by reduced symptoms for burning after week‐8 (P = 0·046) as compared to the placebo. Patients consuming lactobacilli also showed reduced concern about symptoms after week‐4 (P = 0·010) and continued after week‐8 (P = 0·001), accompanied by reduced impairment of daily activities attributed to vulvovaginal symptoms (P = 0·012) and continued after week‐8 (P = 0·026). Insignificant differences were observed for sexual impacts between treatment groups. The administration of lactobacilli also reduced recurrences of both emotional and social stress as compared to the placebo at both week‐4 and week‐8 (P < 0·05). Patients consuming lactobacilli showed higher defecation times per week at week‐4 (P = 0·010) and week‐8 (P = 0·001) as compared to the placebo group, indicating the potential to reduce risks of pregnancy‐induced constipation. Conclusions Lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC. Significance and Impact of the Study The study demonstrated the preventive and modulatory roles of lactobacilli strains against VC in pregnant women. Taken altogether, our present data illustrated that lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC, thus could be a potential strategy for the maintenance of vaginal health during pregnancy.

Comparing the Effect of Probiotic and Fluconazole on Treatment and Recurrence of Vulvovaginal Candidiasis: a Triple-Blinded Randomized Controlled Trial

“…There are very few studies that have used probiotics alone to treat or prevent the recurrence of VVC [ 38 , 39 ], while most works have used probiotics as an adjunctive therapy after treatment with an antifungal drug [ 26 , 31 , 40 ]. However, the antifungal effect of probiotics has been reported in many studies [ 41 , 42 ].…”

Probiotics Reduce Vaginal Candidiasis in Pregnant Women via Modulating Abundance of Candida and Lactobacillus in Vaginal and Cervicovaginal Regions

“…The study design population has been described previously [8]. Briefly, this was a randomized, double-blinded, placebo-controlled study, enrolling pregnant women at 14-32 weeks of pregnancy and confirmed with VC by an obstetrics and gynaecology specialist and/or a medical doctor.…”

“…However, this has caused various concerns attributed to the emergence of drug-resistant yeasts, while prolonged exposure to fluconazole, as in cases of recurrences, can shift the predominant vaginal yeast flora from Candida albicans to more intrinsically azole-resistant species such as Candida krusei or Candida glabrata, typically in immunosuppressed women, and may be exacerbated in healthy women by use of over-the-counter products for self-treatment of VVC. Cross-resistance between OTC drugs (miconazole, clotrimazole, and tioconazole) and fluconazole has been observed in clinical isolates of C. glabrata and C. albicans [7,8].…”

“…These strains of lactobacilli were developed primarily for women's health with patents in Taiwan (2013) and China (2018), specifically for their ability to adhere to HeLa cells (a human cervical carcinoma cell line) and to produce hydrogen peroxide, which inhibits infectious urogenital bacteria in women such as Salmonella, Escherichia coli, C. albicans, and Gardnerella vaginalis [13,14]. Our previous randomized, double-blind and placebo-controlled study involving 78 pregnant women with VC showed that the oral administration of SynForU-HerCare for 8 weeks reduced VVC symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC as compared to the placebo, indicating that probiotics could be a potential strategy for the maintenance of vaginal health during pregnancy [8].…”

Open source anaerobic and temperature-controlled in vitro model enabling real-time release studies with live bacteria

“…This increases the need for reliable in vitro methods to study the release of probiotics from such drug delivery systems and ensure that the probiotics stay alive during the in vitro study. The most common drug delivery systems for probiotics are the traditionally used capsules besides polymeric particles and microdevices [4,6,7].…”