Bacterial Vaginosis Support

Dear Friends

Bacterial vaginosis (BV) is the most common cause of vaginal symptoms among women.  According to NHANES, data collected between 2001–2004, 29.2% of women ages 14–49 in the United States have BV.  84% of these women with are asymptomatic (Koumans, 2007). Women with BV have an increased risk of miscarriage, preterm labor and delivery, and postpartum infections.

Diagnosis via vaginal swab (wet mount), whiff test, vaginal pH, oligonucleotide probe of DNA of bacteria present are standard. Bacterial vaginosis usually causes the vaginal pH to rise above 4.5 due to the microbial species present. Diagnosis of BV is difficult because of its complex polymicrobial nature indicative of dysbiosis.

BV has high relapse rates and associated complications.  BV diagnosis includes a decrease in vaginal lactobacilli species and increase in the anaerobes population of microbes, including, most commonly Gardnerella vaginosis or A.vaginae (Shipitsyn,2013).  Vaginal bacterial communities differ dramatically between healthy patients and patients with BV, with G. vaginalis present in over 90% of BV cases (Verstraelen & Swidsinski, 2013).  G. vaginalis is up to 70% of asymptomatic healthy women. When G. vaginalis biofilms form they can establish synergistic relationships with other pathogenic anaerobes.

A Therapeutic Food protocol for Bacterial Vaginosis Support

• Cranberry Pomegranate Synbiotic: 2-3 capsules bid to tid
• Beta Glucan High Potency Synbiotic: 1-2 tsp at night before bed in water.
• Garlic, organic: 1-2 capsules 1-tid
• Be Regular: 1-2 servings as needed for regularity.
• Phyto Power: 1-2 capsules bid to tid.

Food Science

Probiotics

• The probiotic species Lactobacillus are the more common normal vaginal flora that help to protect the vagina against infection by maintaining a normal vaginal pH through lactic acid fermentation of glucose and glycogen and hydrogen peroxide production (Steece, 2011).
• A Cochrane review (2005) noted 2 studies that reported a beneficial effect of probiotics in the treatment of BV.  In one study cure rates for BV treated with Lactobacilli at 30 days were 60% (P = 0.004) and 88% (P < 0.005), more than double the effect of controls.  Another trial reported a 35% reduction in recurrent episodes of BV compared with placebo (Barrons, 2008).
• Reid et al (2001) found that of the 60% of women with asymptomatic Bacterial Vaginosis as diagnosed by a Nugent scoring, and 90% of symptomatic women with BV reverted to normal after 28 days of taking oral Lactobacillus species.  7 out of 11 women with symptomatic BV converted to normal after one month on the probiotics.
• A clinical trial by Karkut G (1984) found that 80% of women with nonspecific vaginitis who used an intravaginal lactobacillus preparation had improvement or resolution of symptoms.
• A controlled trial by Shaleev (1996) of women with recurrent BV or vaginal candidiasis that ate 5 ounces of yogurt containing live Lactobacillus acidophilus daily had more than a 50% reduction in recurrences, while women who consumed pasteurized yogurt that did not contain the bacteria had only a slight reduction.
• An in vitro study by McMillian et al (2011) found that biofilms mimicking aerobic vaginosis, BV and UTI with Escherichia coli, Atopobium vaginae and Gardnerella vaginalis  were affected by lactobacillus probiotic administration. Lactobacillus killed E. coli and secreted products of L. rhamnosus GR-1 decreased E. coli cell density, and increased cell death. BV biofilms with Lactobacilli infiltrated BV biofilms and caused bacterial cell death, while Metronidazole produced holes in the biofilm but did not eradicate the organisms.

Note:  In terms of the probiotic organisms the Cranberry Pomegranate Synbiotic contains L. acidophilus, L. casei (both important beneficial vaginal organisms) and B. longum; and the Beta Glucan Synbiotic contains L. acidophilus, L. rhamnosus, L. plantarum, S. thermophilus and B. longum.  Click their links here to see the full formulas.

Garlic

• A randomized clinical trial in Iran by Mohammadzadeh et al. (2014) of 120 married women aged 18 to 44 with BV by Amsel’s were treated with either garlic tablet or oral metronidazole for seven days. Amsel’s criteria were significantly decreased after treatment with garlic or metronidazole (70% and 48.3%, respectively; P < 0.001). Therapeutic effects of garlic on BV were similar to that of metronidazole (63.3% and 48.3%, respectively; P = 0.141). There were significant differences between the two treatment groups in terms of side effects; metronidazole was associated with more complications (P = 0.032).

Bibliography

• Barrons, R, Tassone, D. (2008). Use of Lactobacillus Probiotics for Bacterial Genitourinary Infections in Women: A Review. Clinical Therapeutics, 30(3): 453-468.
• Chierico, FD, Vernocchi, P, Bonizz,i, L, Carsetti  R., Castellazzi,,B, Dallapiccola, AM, de Vos,, W, Guerzoni, ME, Manco, M, Marseglia, GL, Muraca M, Roncada, P, Salvatori, G, Signore, F, Urbani, A, Putignani, L (2012).  Early-life gut microbiota under physiological and pathological conditions: The central role of combined meta-omics-based approaches. Journal of Proteomics Translational Proteomics, 15(3):4580-4587.
• Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, Markowitz LE. (2007)  The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health.Sex Transm Dis, 34(11):864-9.
• Mcmillan, A, Dell, M, Zellar, MP, Cribby, S, Martz, S, Hong, E Fu, J, Abbas, A, Dang, T, Miller, W, Reid, G. (2011). Disruption of urogenital biofilms by lactobacilli. Colloids and Surfaces B: Biointerfaces, 86:58-64.
• Mohammadzadeh, F., Dolatian, M., Jorjani, M., Alavi Majd, H., & Borumandnia, N. (2014). Comparing the Therapeutic Effects of Garlic Tablet and Oral Metronidazole on Bacterial Vaginosis: A Randomized Controlled Clinical Trial. Iranian Red Crescent Medical Journal, 16(7), e19118. http://doi.org/10.5812/ircmj.19118
• Money, D. (2005). The laboratory diagnosis of bacterial vaginosis. The Canadian Journal of Infectious Diseases & Medical Microbiology, 16(2), 77–79.
• Reid G, Beuerman, D, Heinemann C, Bruce, AW. (2001). Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunology and Medical Microbiology; 32: 37-41.
• Shalev E, Battino S, Weiner E, et al. (1996) Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent Candidal vaginitis and bacterial vaginosis. Arch Fam Med, 5:593–6.
• Shipitsyna, E., Roos, A., Datcu, R., Hallén, A., Fredlund, H., Jensen, J. S., Unemo, M. (2013). Composition of the Vaginal Microbiota in Women of Reproductive Age – Sensitive and Specific Molecular Diagnosis of Bacterial Vaginosis Is Possible? PLoS ONE, 8(4), e60670. http://doi.org/10.1371/journal.pone.0060670.
• Steece, R. (2011). Bacterial Vaginosis, Vulvovaginal Candidiasis, and Trichomoniasis. Society of Armed Forces Medical Laboratory Scientists (SAFMLS). Presented on March 28-31, 2011 New Orleans, Louisiana.

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