Probiotics are a Good Choice for the Treatment of Bacterial Vaginosis Original paper

What was Reviewed?

The meta-analysis reviewed the efficacy of probiotics as a treatment option for bacterial vaginosis (BV). The authors systematically analyzed 20 randomized controlled trials (RCTs) involving 2093 participants to assess whether probiotics, used alone or alongside antibiotics, could improve BV cure rates and restore healthy vaginal microbiota. The review evaluated the clinical cure rates, recurrence rates, adverse effects, and microbial outcomes associated with probiotic administration, considering different probiotic strains, dosages, administration routes, and treatment durations.

Who was Reviewed?

The meta-analysis included RCTs that enrolled women diagnosed with bacterial vaginosis. These participants came from diverse populations, including various age groups and geographic locations. The included studies assessed the effects of probiotic therapy compared to placebo or standard antibiotic treatment, with follow-up periods ranging from a few weeks to several months. The reviewed trials involved women with symptomatic BV, recurrent BV, and asymptomatic cases diagnosed based on standard clinical criteria.

What were the most Important Findings?

This meta-analysis demonstrated that probiotics improved the clinical cure rate of bacterial vaginosis and reduced recurrence compared to control groups. The data consistently showed that probiotics, whether administered orally or intravaginally, enhanced treatment outcomes, with intravaginal probiotics showing slightly better performance. Notably, probiotics used alongside antibiotics provided additional clinical benefit beyond antibiotics alone, suggesting a synergistic relationship.

Beyond clinical outcomes, the review emphasized critical microbial shifts. Women receiving probiotics consistently exhibited an increased abundance of beneficial Lactobacillus species, particularly Lactobacillus crispatus and Lactobacillus jensenii. At the same time, pathogenic bacteria associated with BV, such as Gardnerella vaginalis and Atopobium vaginae, decreased. This microbial rebalancing supports the hypothesis that probiotics help restore vaginal eubiosis, reducing both symptoms and the risk of recurrence. The study’s microbiome findings are especially valuable for understanding how probiotics can modify the vaginal ecosystem in BV patients.

What are the Implications of this Review?

This meta-analysis provides strong evidence supporting the use of probiotics as a safe and effective adjunct or alternative treatment for bacterial vaginosis. It underscores the clinical benefit of probiotics in enhancing cure rates, reducing recurrence, and promoting a healthy vaginal microbiota dominated by Lactobacillus species. The findings suggest that clinicians should consider integrating probiotic therapy, particularly intravaginal formulations, into BV treatment protocols. Furthermore, this analysis supports the role of microbiome-targeted therapies in restoring microbial balance and reducing the risk of recurrent infections. The microbial associations identified here, particularly the positive shifts toward Lactobacillus dominance, provide valuable microbial signatures for future BV management and intervention strategies.