Probiotics and Prebiotics

Bacterial vaginosis (BV) is a common condition that affects most women at some stage. BV is characterised by reduced levels of vaginal lactobacilli and an over growth of e.g. Gardnerella vaginalis and Atopobium vaginae. This imbalance is used in diagnosis with the so-called Nugent-score. Probiotic lactobacilli have been investigated as an adjunct to antibiotic treatment and shown to be successful. However, most studies have investigated the effect of vaginally applied probiotics. Here, I report on the oral use of probiotics in BV. Two-week consumption of a combination of Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus La-14 by healthy women, resulted in vaginal colonisation in 85% of the women. Interestingly, colonisation still increased in the week after consumption was stopped. In vitro studies have shown that both strains and in particular L. acidophilus La-14 produce hydrogen peroxide; an important antimicrobial involved in the stabilisation of a healthy vaginal microbiota. Both strains were also shown to inhibit the growth of G. vaginalis and A. vaginae in vitro and prevented experimental vaginosis in mice. In a subsequent human study, 40 women with borderline BV, as judged by Nugent-score of 4-6 and vaginal symptoms were randomised to receive either probiotic treatment or placebo for 15 days. In the probiotic group, Nugent-score improved to below 3 (no BV) with no change in the placebo group. Symptoms of itching and vaginal discharge also improved significantly in the probiotic group. The combination of L. acidophilus La-14 and L. rhamnosus HN001 is beneficial in the management of BV.