A COMPARATIVE OBSERVATIONAL STUDY ON EFFECTIVENESS OF PROBIOTICS AND ANTIBIOTICS IN BACTERIAL VAGINOSIS
Introduction: Bacterial vaginosis is a common vaginal dysbiosis in women of reproductive age. Bacterial vaginosis is a dysbiosis characterized by a reduction of Lactobacillus species, such as L. crispatus, L. gasseri, and L. Jensenii. Anti-microbial resistance of BV pathogens and low long-term cure rates have been increasing in the few years. Aim: Probiotics are proposed as an alternative treatment for BV applying live micro-organisms with the capacity to confer health benefits to the patient. Methods: Patients with white discharge per vagina with or without foul smell, and itching visiting Obstetrics and Gynecology OPD are subjected to Amsel criteria. Those test positive for 3 out of 4 are diagnosed to have bacterial vaginosis and were enrolled in the study. Result: Highest prevalence of bacterial vaginosis was at the age group of 26-30 years (28%), with the lowest prevalence (16%) above 40 years of age. Among group A (probiotics), 68% and 32% of women were in not working and working groups, respectively, when compared with group B (antibiotics), 64% and 36% of women were in not working and working groups. Nulligravida (28% and 32%), Singleton Pregnancy (32% and 16%) in Group A and Group B. We observed that patients treated with both antibiotics (50%) and probiotics (50%) had similar recurrence rates of BV. Conclusion: Hence it would be prudent to prefer probiotics in patients with BV, as they colonize other normal commensals and have similar efficacy as that of antibiotics. The other beneficial factors of probiotics include acceptability to patients and nil side effect profile.
Amegashie, C. P., Gilbert, N. M., Peipert, J. F., Allsworth, J. E., Lewis, W. G. and Lewis, A. L (2017) "Relationship between nugent score and vaginal epithelial exfoliation,” PLoS One, 12(5), e0177797. https://doi.org/10.1371/journal.pone.0177797
Anahtar, M. N. (2015) The Contribution of Cervicovaginal Microbiota and Hormonal Contraceptives to Genital Inflammation and HIV Acquisition Risk.
Bhalla, P. et al. (2007) "Prevalence of bacterial vaginosis among women in Delhi, India,” Indian Journal of Medical Research, 125(2), pp.167-172
Bitew, A., Mengist, A., Belew, H., Aschale, Y. and Reta, A. (2021) "The prevalence, antibiotic resistance pattern, and associated factors of bacterial vaginosis among women of the reproductive age group from felege Hiwot referral hospital, Ethiopia,” Infection and Drug Resistance, 14. pp. 2685-2696. https://doi.org/10.2147/IDR.S305329
Blackwell, A. L. (1999) "Vaginal bacterial phaginosis?” Sexually Transmitted Infections, 75(5), pp. 352–353 https://doi.org/10.1136/sti.75.5.352
Brocklehurst, P., Gordon, A., Heatley, E and Milan, S. J. (2013) "Antibiotics for treating bacterial vaginosis in pregnancy,” Cochrane Database of Systematic Reviews, 1. https://doi.org/10.1002/14651858.CD000262
Cherpes, T. L., Hillier, S. L., Meyn, L. A., Busch, J. L. and Krohn, M. A. (2008) "A delicate balance: Risk factors for acquisition of bacterial vaginosis include sexual activity, absence of hydrogen peroxide-producing lactobacilli, black race, and positive herpes simplex virus type 2 serology,” Sexually Transmitted Diseases, 35(1), pp. 78–83 https://doi.org/10.1097/OLQ.0b013e318156a5d0
DiFonzo, N. and Bordia, P. (1998) "Reproduced with permission of the copyright owner . Further reproduction prohibited without,” Journal of Allergy and Clinical Immunology, 130(2),p.556. https://doi.org/10.1016/j.jaci.2012.05.050
Ehrström, S., Daroczy, K., Rylander, E., Samuelsson, C., Johannesson, U., Anzén, B. and Påhlson, C. (2010) "Lactic acid bacteria colonization and clinical outcome after probiotic supplementation in conventionally treated bacterial vaginosis and vulvovaginal candidiasis,” Microbes and Infection, 12(10), pp. 691–699. https://doi.org/10.1016/j.micinf.2010.04.010
Eschenbach, D. A., Thwin, S. S., Patton, D. L., Hooton, T. M., Stapleton, A. E., Agnew, K., Winter, C., Meier, A. and Stamm, W. E . (2000) "Influence of the normal menstrual cycle on vaginal tissue, discharge, and microflora,” Clinical Infectious Diseases an official publication of the Infectious Diseases Society of America, 30(6), pp. 901–907. https://doi.org/10.1086/313818
Faruqui, A. A. and Chitra, D. (2020) "Evaluation of Efficacy and Safety of Oral Fixed-dose Combination of Probiotics in Bacterial Vaginosis,” Journal of SAFOMS, 7(2), pp. 62–65.https://doi.org/10.5005/jp-journals-10032-1185
Gray, R. H., Kigozi, G., Serwadda, D., Makumbi, F., Nalugoda, F., Watya, S., Moulton, L., Chen, M. Z., Sewankambo, N. K., Kiwanuka, N., Sempijja, V., Lutalo, T., Kagayii, J., Wabwire-Mangen, F., Ridzon, R., Bacon, M. and Wawer, M. J. (2009) "The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda.,” American Journal of Obstetrics and Gynecology, 200(1), pp. 42.e1–7. https://doi.org/10.1016/j.ajog.2008.07.069
Heczko, P.B., Tomusiak, A., Adamski, P.,Jakimiuk, A. J., StefaÅ„ski, G., MikoÅ‚ajczyk-CichoÅ„ska, A., Suda-Szczurek, M. and Strus, M. (2015) "Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial,” BMC Women's Health, 15(1), p. 115. https://doi.org/10.1186/s12905-015-0246-6
Katare, A. P.,Pavani, S., Jyothilakshmi, G. and Shashikala Reddy, P. (2020) "Role Of Probiotics In The Treatment Of Bacterial Vaginosis,” IOSR Journal of Dental and Medical Sciences, 19(6), pp. 33–37. doi: 10.9790/0853-1906033337
Koumans, E. H., Sternberg, M., Bruce, C., McQuillan, G., Kendrick, J., Sutton, M. and Markowitz, L. E. (2007) "The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health,” Sexually Transmitted Diseases, 34(11),pp. 864–869 https://doi.org/10.1097/OLQ.0b013e318074e565
Lin, T.-C. et al. (2021) "Improvement of Bacterial Vaginosis by Oral Lactobacillus Supplement: A Randomized, Double-Blinded Trial,” Applied Sciences, 11(3), p. 902. https://doi.org/10.3390/app11030902
McClelland, R. S. et al. (2018) "Evaluation of the association between the concentrations of key vaginal bacteria and the increased risk of HIV acquisition in African women from five cohorts: a nested case-control study,” The Lancet Infectious Diseases. https://doi.org/10.1016/S1473-3099(18)30058-6
Melo, J. et al. (2008) "Low prevalence of HIV and other sexually transmitted infections in young women attending a youth counselling service in Maputo, Mozambique,” Tropical Medicine and International Health, 13(1), pp. 17–20.https://doi.org/10.1111/j.1365-3156.2007.01972.x
Narasimha Rao, J. V. and Chandini, J. (2017) "THE ASSOCIATION OF BACTERIAL VAGINOSIS WITH ADVERSE PREGNANCY OUTCOMES,” Journal of Evidence Based Medicine and Healthcare. https://doi.org/10.18410/jebmh/2017/602
Pang, P., Zheng, K., Wu, S., Xu, H., Deng, L., Shi, Y.and Chen, X. (2018) "Baicalin Downregulates RLRs Signaling Pathway to Control Influenza A Virus Infection and Improve the Prognosis,” Evidence-based Complementary and Alternative Medicine. 2018, 4923062. https://doi.org/10.1155/2018/4923062
Pavlova, S.I., Kiliç,A.O., Mou, S.M. and Tao, L. (1997) "Phage infection in vaginal lactobacilli: An in vitro study,” in Infectious Diseases in Obstetrics and Gynecology, 5(1), pp. 36-44. https://doi.org/10.1002/(SICI)1098-0997(1997)5:1<36::AID-IDOG9>3.0.CO;2-V
Priestley, C. J. F., Jones, B. M., Dhar, J. and Goodwin, L. (1997) "What is normal vaginal flora?,” Sexually Transmitted Infections, 73(1), pp. 23–28. https://doi.org/10.1136/sti.73.1.23
Russo, R., Karadja, E. and De Seta, F. (2019) "Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomised clinical trial,” Beneficial Microbes, 10(1), pp. 19–26. https://doi.org/10.3920/BM2018.0075
Schlosser, B. J. and Mirowski, G. W. (2010) "Approach to the patient with vulvovaginal complaints,” Dermatologic Therapy, 23(5), pp.438-448. https://doi.org/10.1111/j.1529-8019.2010.01348.x
Seña, A.C., Goldstein, L. A., Ramirez, G., Parish, A. J. and McClelland, R. S.et al. (2021) "Bacterial Vaginosis and Its Association With Incident Trichomonas vaginalis Infections: A Systematic Review and Meta-Analysis,” Sexually Transmitted Diseases, 48(12), e192–e201. https://doi.org/10.1097/OLQ.0000000000001537
Sheehy, O., Santos, F., Ferreira, E. and Berard, A. (2015) "The Use of Metronidazole During Pregnancy: A Review of Evidence,” Current Drug Safety, 10(2), pp. 170–179. https://doi.org/10.2174/157488631002150515124548
Sweet, R. L. (2000) "Gynecologic Conditions and Bacterial Vaginosis: Implications for the Non-Pregnant Patient,” Infectious Diseases in Obstetrics and Gynecology, 8(3-4), pp. 184–190. https://doi.org/10.1155/S1064744900000260
Taha, T. E., Hoover, D. R., Dallabetta, G. A., Kumwenda, N. I., Mtimavalye, L. A., Yang, L. P., Liomba, G. N., Broadhead, R. L., Chiphangwi, J. D. andMiotti, P. G. (1998) "Bacterial vaginosis and disturbances of vaginal flora: Association with increased acquisition of HIV,” AIDS, 12(13), pp. 1699–1706. https://doi.org/10.1097/00002030-199813000-00019
Ugwumadu, A. H. N. (2002) "Bacterial vaginosis in pregnancy,” Current Opinion in Obstetrics and Gynecology, 14(2), pp. 115–118. https://doi.org/10.1097/00001703-200204000-00003
Vani, P. S. S., Goud, P.M., Saba, N. , Susmitha, P. and Gupta, V.. (2018) "role of probiotics in vaginitis as adjuvant treatment to augment the women health Role of Probiotics in Vaginitis as Adjuvant Treatment to Augment the Women Health,” IOSR Journal of Pharmacy and Biological Sciences, 13(1)(February), pp. 07–16. doi: 10.9790/3008-1301060716
Vujic, G., Jajac Knez, A., Despot Stefanovic, V. and Kuzmic Vrbanovic, V. (2013) "Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study,” European Journal of Obstetrics &
Gynecology and Reproductive Biology, 168(1), pp. 75–79. https://doi.org/10.1016/j.ejogrb.2012.12.031
Waigwa, S., Doos, L., Bradbury-Jones, C. and Taylor, J. (2018) "Effectiveness of health education as an intervention designed to prevent female genital mutilation/cutting (FGM/C): A systematic review,” Reproductive Health, 15(1), p. 62. https://doi.org/10.1186/s12978-018-0503-x
van de Wijgert, J. H. H. M., Verwijs, M.C., Agaba, S.K., Bronowski, C., Mwambarangwe, L., Uwineza, M., Lievens, E., Nivoliez, A., Ravel, J. and Darby, A. C(2020) "Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: A Pilot Study Incorporating Microscopy and Sequencing,” Scientific Reports, 10(1), p. 3884. https://doi.org/10.1038/s41598-
-60671-6
Workowski, K. A. (2015) "Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines,” Clinical Infectious Diseases. https://doi.org/10.1093/cid/civ771
Ya, W., Reifer, C. and Miller, L. E. (2010) "Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study,” American Journal of Obstetrics and Gynecology, 203(2), pp. 120.e1-120.e6. https://doi.org/10.1016/j.ajog.2010.05.023
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