Recent research is proving that both external and internal use of probiotics are effective for treating vaginosis and vaginitis. The research is also showing that probiotics are effective with or without additional treatment with antibiotics.
Vaginosis is the alteration of the normal microbiological ecology. Vaginitis is an overgrowth of pathogenic bacteria, and their resulting infection. They often occur together.
Yogurt drink tested
In a 2017 study, Austrian and German university hospital researchers tested a yogurt drink on 36 women with vaginosis. For four weeks they gave the women either a placebo or a drink containing:
- Lactobacillus bulgaricus
- Streptococcus thermophilus
- Lactobacillus crispatus
- Lactobacillus gasseri
- Lactobacillus jensenii
- Lactobacillus rhamnosus
After four weeks, the researchers found those who drank the yogurt drink each day had significantly better symptoms (including discharge and odor) and improved resolution. After the four weeks, none of the women in the yogurt group had vaginosis symptoms, while more than a third of the placebo group continued to have symptoms.
Probiotics increase effectiveness of antibiotic treatment
Researchers from Poland’s Jagiellonian University Medical College tested 578 women with vaginosis and aerobic vaginitis in a number of clinics across Poland. The doctors gave all the patients standard antibiotic treatment for 10 days. In addition, patients were given either a placebo or probiotic treatment for the next 10 days. The probiotic was given orally in the form of a capsule.
Those patients who were given the probiotic supplement had significantly less recurrence of vaginosis and vaginitis. Their recurrence rates were 76 percent lower than the placebo group. For those who did have a recurrence, those who took the probiotics had a 51 percent increased period of time on average before experiencing the relapse.
Vagina application of probiotics also effective
Research has also shown that applying probiotics to the vagina also speeds recovery of vaginosis and vaginitis.
In a 2013 study, Bulgarian hospital researchers treated 60 women with bacterial vaginosis with antibiotic treatment alone or antibiotic treatment followed by probiotic treatment, applied to the vagina.
The first group was given metronidazole orally with two local applications over a five day period. The second group was given the same treatment for the first five days and then given local application of Lactobacillus casei var rhamnosus – also called Lactobacillus rhamnosus.
After the two treatments, the researchers found that 60% of the patients in the first group had resolution of their infections, while the group receiving the probiotic treatment experienced an 88.5% resolution.
The researchers also noted that the restoration of the vagina probiotics in the second group would help prevent future infections, stating that the probiotic 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.”
As to whether probiotic treatment alone will outperform antibiotic treatment, this latter issue is important. Antibiotic treatment has two consequences: One that it does also knock out the healthy flora of the vagina, leaving the vagina open to new opportunistic infections.
Secondly, the infective bacteria and yeasts can also become resistant to the antibiotic. This of course has been the evolving case among many bacteria that are increasingly becoming resistant to our antibiotic arsenal.
Are probiotics better than antibiotic therapy for vaginosis?
As to whether a probiotic treatment will beat the conventional antibiotic treatment for vaginosis, another 2013 study from Bulgaria hospital researchers studied 381 women with bacterial vaginosis.
They split the patients into three groups. They gave 143 patients 10 applications (twice a day for five days) of Lactobacillus acidophilus and Lactobacillus rhamnosus. The second group of 126 patients were given the oral antibiotic Clindamycin with two treatments of local antibiotic Metronidazole treatment. A third group of 112 women was given the same antibiotic treatment for first days followed by the probiotic treatment, again with local application of Lactobacillus acidophilus and Lactobacillus rhamnosus.
The researchers then followed up with the patients between 46 and 40 days after the probiotic treatment ended. They found that the patients given the probiotic-only treatment was 41% microbiologically effective and was 43% clinically effective – meaning their symptoms were resolved.
Meanwhile the effectiveness of the antibiotic treatment alone was 47% and 52% effective, respectively.
However, the best results were obtained from the combined therapy, which resulted in 87% clinically effectiveness according to the researchers.
This of course means that like the first study mentioned, the infection was knocked out by the antibiotics and then the flora environment was restored by the probiotics.
Some issues with these studies
The above studies and others illustrate that probiotics provide a bonafide treatment for vaginosis – especially when combined with antibiotics. Right?
The obvious shortcoming of much of the research is that the probiotic treatment was ridiculously short. Testing for a week or 10 days is woefully short for a full treatment regimen of probiotics.
In practical application, natural practitioners will typically suggest the probiotic application continues for at least 45 days to two months to get full resolution. During this time the probiotics will increasingly colonize the vagina and eventually knock out the infective organisms.
For example, in 2006, researchers from the School of Medicine at Italy’s Università degli Studi di Siena treated 60 healthy women with vaginosis with either a vaginal suppository containing Lactobacillus acidophilus or a suppository containing Lactobacillus acidophilus and Lactobacillus paracasei F19.
At the end of three months of treatment—and again three months afterward—both groups showed significant improvement in vaginosis, a significant reduction in vaginal pH, and significant decrease in vagina odor.
In addition, most natural doctors will suggest both vagina application and oral use of probiotic supplements. Most of the research has focused on one or the other.
The other concern to note about antibiotic treatment is how many patients are not improved by the antibiotic-only treatment. What is the ramification of this? As other research shows, unresolved infections following antibiotic treatment increases the risk of antibiotic resistance.
This is not saying that probiotic treatment will necessarily be effective for every case. Talk to your doctor if you believe you have a vagina infection.
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Heczko PB, Tomusiak A, Adamski P, Jakimiuk AJ, Stefański G, Mikołajczyk-Cichońska A, Suda-Szczurek M, Strus M. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health. 2015 Dec 3;15:115. doi: 10.1186/s12905-015-0246-6.
Kovachev S, Dobrevski-Vacheva R. Probiotic monotherapy of bacterial vaginosis: a open, randomized trial. Akush Ginekol (Sofiia). 2013;52 Suppl 1:36-42.
Kovachev S, Dobrevski-Vacheva R. Effect of Lactobacillus casei var rhamnosus (Gynophilus) restoring vaginal flora by female patients with bacterial vaginosis–randomized, open clinical tria]. Akush Ginekol (Sofiia).
Delia A, Morgante G, Rago G, Musacchio MC, Petraglia F, De Leo V. Effectiveness of oral administration of Lactobacillus paracasei subsp. paracasei F19 in association with vaginal suppositories of Lactobacillus acidofilus in the treatment of vaginosis and in the prevention of recurrent vaginitis. Minerva Ginecol. 2006 Jun;58(3):227-31.
Case Adams is a California Naturopath and a Board Certified Alternative Medicine Practitioner with a PhD in Natural Health Sciences, and diplomas in Homeopathy, Aromatherapy, Bach Flower Remedies, Blood Chemistry, Clinical Nutritional Counseling and Colon Hydrotherapy. He has authored 26 books on natural healing strategies.