Probiotic shows promise for asymptomatic bacterial vaginosis: Study

Writing in the journal Nutrients​, they reported that after two months of oral probiotic supplementation, participants had fewer strains associated with dysbiosis and double the amount of beneficial Lactobacillus ​species.​

“Our preliminary results suggest that the multi-strain oral probiotic is a beneficial treatment specifically targeting the dysbiotic vaginal microenvironment,” wrote the researchers from the University of Rome “Sapienza”. 

The vaginal microbiota and health​

The vaginal microbiota is dominated by different Lactobacillus ​species that protect vaginal and genital health. When the microbial balance is disrupted, it can lead to an overgrowth of unbeneficial bacteria and yeasts, causing infections such as BV, Candida albicans ​or ​chlamydia.  

Research​ indicates that genital microbial dysbiosis is also associated with non-infectious conditions and events such as infertility, induced abortions, miscarriage, polycystic ovarian syndrome and uterine fibroids. 

Currently, doctors treat microbial disorders with antibiotics such as metronidazole, clotrimazole and azithromycin, however the researchers note that side effects and high recurrence rates suggest a need for alternative therapeutic tools.

Previous studies ​have shown that oral Lactobacillus​ probiotics enhance the colonization of beneficial bacteria and improve microbial balance in asymptomatic women.

Study details

The prospective observational pilot study used a subset of participants from a larger study on vaginal microbiota composition in women with endometriosis. Researchers enrolled 50 healthy women between the ages of 20 and 40 without genital or urinary infections and without recent antibiotic use. 

Participants took two daily capsules of the probiotic CDS22 formula (marketed under the trade names Visbiome, De Simone and Vivomixx). The formula contains eight live freeze-dried bacterial species: four lactobacilli ​strains, three bifidobacteria strains, and Streptococcus salivarius subsp. thermophilus.​

The researchers analyzed the study group’s microbiota at baseline and after two months of the intervention using vaginal swabs and DNA analysis. They assessed them for BV by evaluating the Gram stain Nugent score of vaginal smears.

Of the 50 women, 13 had a Nugent score indicating asymptomatic BV, and 37 had a healthy genital microbiota. 

After two months of probiotic supplementation, women with BV showed a significant decrease in the diversity of vaginal bacteria. Bacteria associated with dysbiosis, such as  Megasphaera ​spp., significantly decreased, while Lactobacillus​ spp. doubled.  

Conversely, women with a healthy vaginal microbiota showed no difference before and after supplementation. 

“This is particularly important from a clinical perspective, since a preventive approach based on the administration of an oral probiotic, especially in women with asymptomatic BV, may help in reducing the risk for urogenital infections or reproductive complications, as well as improving the overall quality of life,” the researchers wrote. 

They called for future larger studies with metagenomic methods to detect the presence of low-abundance bacteria and identify individual microbial profiles that would enable a personalized treatment approach. 

Source: Nutrients ​2024, 16(20), 3469
doi: 10.3390/nu16203469​
“A multi-strain oral probiotic improves the balance of the vaginal microbiota in women with asymptomatic bacterial vaginosis: Preliminary evidence”
Authors: S. Filardo et al.