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Lactobacillus, in vaginitis [keywords]
- Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor(®)) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study. [JOURNAL ARTICLE]
- Breast Cancer Res Treat 2014 Apr 10.
Phase I pharmacokinetic (PK) study assessed circulating estrogens in breast cancer (BC) patients on a non-steroidal aromatase inhibitor (NSAI) with vaginal atrophy using vaginal ultra-low-dose 0.03 mg estriol (E3) and Lactobacillus combination vaginal tablets (Gynoflor(®)). 16 women on NSAI with severe vaginal atrophy applied a daily vaginal tablet of Gynoflor(®) for 28 days followed by a maintenance therapy of 3 tablets weekly for 8 weeks. Primary outcomes were serum concentrations and PK of E3, estradiol (E2), and estrone (E1) using highly sensitive gas chromatography-mass spectrometry. Secondary outcomes were clinical measures for efficacy and side effects; microscopic changes in vaginal epithelium and microflora; and changes in serum FSH, LH, and sex hormone-binding globulin. Compared with baseline, serum E1 and E2 did not increase in any of the women at any time following vaginal application. Serum E3 transiently increased after the first application in 15 of 16 women, with a maximum of 168 pg/ml 2-3 h post-insertion. After 4 weeks, serum E3 was slightly increased in 8 women with a maximum of 44 pg/ml. The vaginal atrophy resolved or improved in all women. The product was well tolerated, and discontinuation of therapy was not observed. The low-dose 0.03 mg E3 and Lactobacillus acidophilus vaginal tablets application in postmenopausal BC patients during AI treatment suffering from vaginal atrophy lead to small and transient increases in serum E3, but not E1 or E2, and therefore can be considered as safe and efficacious for treatment of atrophic vaginitis in BC patients taking NSAIs.
- [Effect of IL-1beta on growth properties of vaginal microsymbionts]. [English Abstract, Journal Article]
- Zh Mikrobiol Epidemiol Immunobiol 2013 Jul-Aug; (4):65-9.
Study the effect of IL-1beta in concentrations that are characteristic for vaginal normo- and pathocenosis on growth properties of vaginal microsymbionts.Concentration of IL-1beta in vaginal contents of women during bacterial vaginosis and normocenosis was determined by using enzume immunoassay. Changes of growth characteristics and biofilm formation ability of Staphylococcus aureus, Escherichia coli, Lactobacilus spp., Corynebacterium spp. under the effect of various IL-1beta concentrations by method of O'Toole G.A. (1999) were studied.IL-1beta in concentrations characteristic for normocenosis was shown to be able to cause stimulating effect on growth properties of lactobacilli and corynebacteria and suppress growth of S. aureus and E. coli in both plankton and biofilm cultures. IL-1beta concentrations characteristic for vaginal dysbiosis on the contrary result in suppression of growth of lactobacilli biomass against the background of stimulation of growth properties and biofilm formation ability of S. aureus and E. coli.Differential dose-dependent effect of IL-1beta on biomass growth and biofilm formation ability of vaginal microsymbionts is a mechanism of regulation of vaginal microbiocenosis.
- [Effect of Lactobacillus casei var rhamnosus (Gynophilus) in restoring the vaginal flora by female patients with bacterial vaginosis--randomized, open clinical trial]. [English Abstract, Journal Article, Randomized Controlled Trial]
- Akush Ginekol (Sofiia) 2013.:48-53.
The vaginal probiotics can increase the clinical and microbiological efficacy of the therapeutic regimens used for the treatment of bacterial vaginosis. The Aim of our study was to evaluate the effect of the application of Lactobacillus casei var rhamnosus (Gynophilus--probiotic species Lcr 35) in restoring the vaginal flora and prevention of relapses by female patients with anaerobic vaginal infection undergoing conventional (nitroimidazole) local and main therapy.In the study were included 60 women with established Amsel/Nugent bacterial vaginosis who were randomized in two groups. The first group patients (n-30 beginning/n-25 controls) underwent a 5 day treatment with two daily peroral doses of metronidazole 500 mg, with local application of metronidazole ovules 1000 mg at the 1st and the 3rd day (M+M). In the second group (n-30 beginning/n-26 controls) the therapeutic regimen was the same as in the first group, with additional 7 day treatment with Lactobacillus casei var rhamnosus - Lcr 35. (Gynophilus) vaginal ovules, two daily doses (M+M+G).30% to 40% was the difference/enhance of the clinical efficacy according to the clinical indicators when Lactobacillus casei var rhamnosus - Lcr 35 was added to the standard nitroimidazole therapy. Concerning the main clinical indicator: Amsel criteria, the improvement after the therapy in the first group (M+M) was 60% (n-15) and in the second group (M+M+G) 88.5% (n-23). According to the microbiological indicators the improvement in the first group (M+M) based on the vaginal flora evaluation (Nugent score) was 60% (n-15) and in the second group, after the addition of Lcr 35 it was 88.5% (n-23).The application of Gynophilus after conventional 5-nitroimidazole treatment for bacterial vaginosis increased the clinical and microbiological efficacy of the therapy by 25% - 30%. The microbial balance in the vaginal ecosystem was restored in the majority of patients (88%), which is a prerequisite for low percentage of bacterial vaginosis relapses.
- [Probiotic monotherapy of bacterial vaginosis: a open, randomized trial]. [English Abstract, Journal Article, Randomized Controlled Trial]
- Akush Ginekol (Sofiia) 2013.:36-42.
The aim of the current research is to establish the clinical and microbiological efficacy of the therapy with local probiotics in the treatment of anaerobic vaginal infections and the therapy's effect upon vaginal flora.381 (100%) women with bacterial vaginitis are included in the research. They were randomized into three groups. In the first group 143 women who were treated with local (10 applications) probiotics vaginal medicine, containing live lactobacillus types Lactobacillus acidophilus, Lactobacillus rhamnosus. In the second group 126 patients were treated with five days oral administration of Clindamycin (tabl.x 600 mg) BID and local therapy of two vaginal ovules containing each 1000 mg Metronidazole, which were administered intravaginal every other day. In the third group 112 women were treated with the same therapy as the second group and in addition started from the day 5 after it were administered locally probiotic medicine containing Lactobacillus acidophilus u Lactobacillus rhamnosus. The efficacy of the therapeutic scheme was evaluated via comparison of patients' clinical complains in the different groups, of data from clinical examinations (Amsel) and microbiological tests (Nugent) for each patient.Thirty five-forty days after the probiotic therapy, the clinical efficacy in this group (Amsel) is 42.7% and microbiological efficacy (Gram preparation - Nugent)--41.3%. They are lower than the results which we received in the groups where the combine nitroimidazole/incozamide treatment was performed with or without local probiotic. The second group: clinical efficacy--51.6%, microbiological (Nugent)--46.4%. The highest clinical--87.5% and microbiological--80.3% efficacy showed the combine nitroimidazole/lincozamide/probiotic treatment in the third group.Our results show that the local monotherapy with probiotics has fewer efficacies in comparison to the combine therapeutic schemes for treatment of vaginal disbacteriosis with dominant anaerobic species.
- [Efficacy of combined 5-nitroimidazole and probiotic therapy of bacterial vaginosis: randomized open trial]. [English Abstract, Journal Article, Randomized Controlled Trial]
- Akush Ginekol (Sofiia) 2013; 52(3):19-26.
The aim of the current research is to identify the clinical and microbiological effect of 5-nitroimidazol therapy for the treatment of bacterial vaginosis and in combination with probiotics and the influence of such therapy upon vaginal flora.Women (n = 539) with bacterial vaginosis who meet the criteria were included in the study. They were randomized into two groups with the following therapeutic regimes: in the first group (n = 242 women) the treatment included applications of 2g BID tinidazole for two days and vaginal suppositories of 1000 mg metronidazol at day 1 and 3 (T+M). In the second group (n = 297) the women were cured with the same treatment as those in the first group. In addition to it from the fifth day of the treatment was added a topical administration of vaginal probiotic which contains species of alive lactobacilli: Lactobacillus acidophilus, Lactobacillus rhamnosus (T+M+P). The efficacy from the therapy was evaluated using the clinical compliances of the women, the data from the clinical examination and the microbiological tests results.The results showed expected increase of clinical therapy efficacy (Amsel - criteria) from 42.8% (T+M; n = 211/242) to 84.06% (T+M+P; n = 274/297) in groups and of microbiological efficacy (Nugent) from 44.7% (T+M; n = 211/242) to 83.3% (T+M+P; n = 274/297), in follow up 35-40 days from the beginning of treatment. The percentage of women with normal vaginal flora on 35-40 day after the therapy increase with 57% in the (T+M) first group while in the second group (T+M+P) with 94%.Combining the therapies of 5-nitroimidazoles and vaginal probiotic reduce bacterial vaginosis recurrence and restores permanently normal vaginal flora.
- Prevalence of Gardnerella vaginalis among women with lactobacillus-predominant vaginal flora. [Journal Article]
- Sex Transm Infect 2014 Feb; 90(1):61-3.
To determine the prevalence of Gardnerella vaginalis in women with normal vaginal flora.Women without symptoms or signs of vaginal infection and five or fewer lifetime sexual partners were recruited for a longitudinal study of vaginal flora. Negative Amsel criteria and a Nugent score of 0-3 were required for enrolment. Vaginal specimens were self-collected daily for Gram stain and every 3 days for PCR for G vaginalis for 30 days. Women completed daily diaries recording sexual activity, symptoms and menses.Twenty women were recruited for the study with 19 completing all specimens and 1 lost to follow-up. During the 30-day study period, 13/19 (68.4%) of women had normal Nugent scores (0-3) whereas 6/19 (31.6%) of women had at least 2 days of Nugent scores in the intermediate range (p=0.09). Among the 19 women, 9 (47%) were negative for G vaginalis by PCR throughout the study period whereas 10 (53%) had at least one specimen that demonstrated the presence of G vaginalis by PCR. Of those women with intermediate flora on Gram stain during the course of the study 5/6 (83.3%) were positive for G vaginalis while 5/13 (38.5%) of those women with only normal Nugent scores were positive for G vaginalis. Thus, 61.5% of women with normal Nugent scores had no evidence of G vaginalis by serial PCR.Gardnerella may not be part of the normal flora in women with optimal vaginal health.
- Administration of oral and vaginal prebiotic lactoferrin for a woman with a refractory vaginitis recurring preterm delivery: appearance of lactobacillus in vaginal flora followed by term delivery. [Journal Article, Research Support, Non-U.S. Gov't]
- J Obstet Gynaecol Res 2014 Feb; 40(2):583-5.
Lactoferrin (LF) is one of the prebiotics present in the human body. A 38-year-old multiparous woman with poor obstetrical histories, three consecutive preterm premature rupture of membrane at the 19th, 23rd and 25th week of pregnancy, was referred to our hospital. She was diagnosed as having refractory vaginitis. Although estriol vaginal tablets were used for 4 months, the vaginitis was not cured. We administrated vaginal tablets and oral agents of prebiotic LF, resulting in a Lactobacillus predominant vaginal flora. When she was pregnant, she continued to use the LF, and the Lactobacillus in the vaginal flora was continuously observed during pregnancy. An elective cesarean section was performed at the 38th week of pregnancy. When the administration of LF was discontinued after the delivery, Lactobacillus in the vaginal flora was disappeared.
- Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. [Journal Article]
- Menopause 2014 May; 21(5):450-8.
The vaginal microbiota helps protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota in premenopausal, perimenopausal, and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA).Eighty-seven women (aged 35-60 y) were classified as premenopausal (n = 30), perimenopausal (n = 29), or postmenopausal (n = 28) according to Stages of Reproductive Aging Workshop guidelines. Midvaginal bacterial community composition was characterized by 16S ribosomal RNA gene analysis.Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, or Lactobacillus jensenii, and two (CST IV-A and CST IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B was characterized by Atopobium. There were significant associations between menopause stage and CST (P = 0.004) and between VVA and CST (P = 0.002). Perimenopausal women were more likely to be classified as CST IV-A or L. gasseri CST, whereas postmenopausal women were often classified as CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared with women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A versus L. crispatus CST (adjusted odds ratio, 25.89; 95% credible interval, 2.98-406.79).A distinct bacterial community state (CST IV-A) with a low relative abundance of Lactobacillus is associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate, and restore vaginal microbiota homeostasis, which would provide stronger evidence for a causal relationship with VVA and ultimately improve the treatment and prevention of atrophic vaginitis in menopause.
- Vaginal microbiota and viral sexually transmitted diseases. [Journal Article, Review]
- Ann Ig 2013 Sep-Oct; 25(5):443-56.
Healthy vaginal microbiota is an important biological barrier to pathogenic microorganisms. When this predominantly Lactobacillus community is disrupted, decreased in abundance and replaced by different anaerobes, bacterial vaginosis (BV) may occur. BV is associated with prevalence and incidence of several sexually transmitted infections. This review provides background on BV, discusses the epidemiologic data to support a role of altered vaginal microbiota for acquisition of sexually transmitted diseases and analyzes mechanisms by which lactobacilli could counteract sexually transmitted viral infections.
- Reciprocal interference between Lactobacillus spp. and Gardnerella vaginalis on initial adherence to epithelial cells. [Journal Article, Research Support, Non-U.S. Gov't]
- Int J Med Sci 2013; 10(9):1193-8.
Bacterial vaginosis (BV) is the most common vaginal disorder in women of child-bearing age. It is widely accepted that the microbial switch from normal microflora to the flora commonly associated with BV is characterized by a decrease in vaginal colonization by specific Lactobacillus species together with an increase of G. vaginalis and other anaerobes. However, the order of events leading to the development of BV remains poorly characterized and it is unclear whether the decrease in lactobacilli is a cause or a consequence of the increase in the population density of anaerobes. Our goal was to characterize the interaction between two Gardnerella vaginalis strains, one of which was isolated from a healthy woman (strain 5-1) and the other from a woman diagnosed with BV (strain 101), and vaginal lactobacilli on the adherence to cervical epithelial cells. In order to simulate the transition from vaginal health to BV, the lactobacilli were cultured with the epithelial cells first, and then the G. vaginalis strain was introduced. We quantified the inhibition of G. vaginalis adherence by the lactobacilli and displacement of adherent lactobacilli by G. vaginalis. Our results confirmed that pathogenic G vaginalis 101 had a higher capacity for adhesion to the cervical epithelial cells than strain 5-1. Interestingly, strain 101 displaced L. crispatus but not L. iners whereas strain 5-1 had less of an effect and did not affect the two species differently. Furthermore, L. iners actually enhanced adhesion of strain 101 but not of strain 5-1. These results suggest that BV-causing G. vaginalis and L. iners do not interfere with one another, which may help to explain previous reports that women who are colonized with L. iners are more likely to develop BV.