Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: A Pilot Study Incorporating Microscopy and Sequencing.

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  • Additional Information
    • Source:
      Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : Nature Publishing Group, copyright 2011-
    • Subject Terms:
      Microscopy* ; Sequence Analysis*; Lactobacillus/*physiology ; Metronidazole/*pharmacology ; Probiotics/*pharmacology ; Vaginosis, Bacterial/*microbiology ; Vaginosis, Bacterial/*prevention & control; Administration, Intravaginal ; Adolescent ; Adult ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/pharmacology ; Female ; Humans ; Lactobacillus/genetics ; Metronidazole/administration & dosage ; Middle Aged ; Pilot Projects ; Secondary Prevention ; Young Adult
    • Abstract:
      Bacterial vaginosis (BV) is associated with HIV acquisition and adverse pregnancy outcomes. Recurrence after metronidazole treatment is high. HIV-negative, non-pregnant Rwandan BV patients were randomized to four groups (n = 17/group) after seven-day oral metronidazole treatment: behavioral counseling only (control), or counseling plus intermittent use of oral metronidazole, Ecologic Femi+ vaginal capsule (containing multiple Lactobacillus and one Bifidobacterium species), or Gynophilus LP vaginal tablet (L. rhamnosus 35) for two months. Vaginal microbiota assessments at all visits included Gram stain Nugent scoring and 16S rRNA gene qPCR and HiSeq sequencing. All interventions were safe. BV (Nugent 7-10) incidence was 10.18 per person-year at risk in the control group, and lower in the metronidazole (1.41/person-year; p = 0.004), Ecologic Femi+ (3.58/person-year; p = 0.043), and Gynophilus LP groups (5.36/person-year; p = 0.220). In mixed effects models adjusted for hormonal contraception/pregnancy, sexual risk-taking, and age, metronidazole and Ecologic Femi+ users, each compared to controls, had higher Lactobacillus and lower BV-anaerobes estimated concentrations and/or relative abundances, and were less likely to have a dysbiotic vaginal microbiota type by sequencing. Inter-individual variability was high and effects disappeared soon after intervention cessation. Lactobacilli-based vaginal probiotics warrant further evaluation because, in contrast to antibiotics, they are not expected to negatively affect gut microbiota or cause antimicrobial resistance.
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    • Grant Information:
      United Kingdom Wellcome Trust; MR/M017443/1 United Kingdom MRC_ Medical Research Council
    • Accession Number:
      0 (Anti-Bacterial Agents)
      140QMO216E (Metronidazole)
    • Publication Date:
      Date Created: 20200305 Date Completed: 20201124 Latest Revision: 20240328
    • Publication Date:
      20240329
    • Accession Number:
      PMC7054572
    • Accession Number:
      10.1038/s41598-020-60671-6
    • Accession Number:
      32127550