ABSTRACT
Background: Bacterial vaginosis [BV] is a relatively complex yet extremely common condition characterized by alteration of the vaginal ecology in which the normal flora, dominated by lactobacilli, is replaced by a mixed bacterial flora. BV is associated with adverse pregnancy outcome, increased risk for pelvic inflammatory disease and abnormal cervical cytology. BV can be treated with antibiotics such as metronidazole or clindamycin, either orally or vaginally. However, there is usually a high rate of recurrence. Probiotics are defined as live micro-organisms which, when administered in an adequate amount, confer a health benefit on the host. The aim of this study was to investigate the efficacy of vaginally administered Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 as probiotics in comparison to the standard oral metronidazole therapy in the treatment of symptomatic bacterial vaginosis
Patients and Methods: The study enrolled 60 women with BV. They were divided into two groups: Group [1] included 30 patients who received oral metronidazole tablets 500mg twice daily for one week and placebo vaginal capsules twice daily for five days. Group [II]: included 30 patients who received oral placebo tablets twice daily for one week and vaginal capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14] twice daily for five days. All participants were evaluated before initiation of treatment then 1 and 4 weeks thereafter. Follow up was based on clinical improvement, pH of vagina, whiff test, absence of clue cells in vaginal smears and Nugent score which is considered the standard for research
Results: After 4 weeks of follow up, the probiotic group had a significantly higher cure rate of BV [88%] than the metronidazole group [51%] [p = 0.01]. In addition, according to the Gram-stain Nugent score more women were assessed with "normal: vaginal micrbiota in the Probiotic group both after 1 week [p=0.05] and after 4 weeks [p=0.01]. Relapse was higher in the metronidazole treated group [4 out of 29 cases, who completed the study accounting for 13.8%] while there was no relapse in the probiotic treated group. Failure of cure was higher in metronidazole treated group [10 cases accounting for 34.4%] than probiotic treated group [3 cases accounting for 12%]
Conclusion: The results of the present study showed that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, taken vaginally, were effective in treatment, relapse prevention and normalization of the vaginal flora in women with bacterial vaginosis for which we recommend the use of Probiotics as an effective treatment option. Furthermore, testing sensitivity of isolates of BV for metronidazole resistance is recommended to find reasons of less efficacious metronidazole treatment