Vaginal microbiota: Potential targets for vulvovaginal candidiasis infection Original paper

What was reviewed?

This paper reviewed the vaginal microbiota (VMB) and its relationship with vulvovaginal candidiasis (VVC), focusing on how disruptions in the vaginal microbial community contribute to the disease. It explored current antifungal treatment challenges, such as drug resistance and recurrence, and assessed emerging microbiome-based therapies including probiotics, postbiotics, synbiotics, and vaginal microbiota transplantation (VMT). The review synthesized findings from clinical trials, microbiome sequencing studies, and in vitro and animal research to evaluate how these interventions might restore vaginal microbial balance and improve VVC outcomes.

Who was reviewed?

The review drew on data from reproductive-age women, especially those affected by VVC or vaginal dysbiosis. It incorporated studies analyzing the vaginal microbial communities dominated by Lactobacillus species in healthy women versus dysbiotic communities associated with VVC. Clinical trials evaluating probiotic and postbiotic therapies and early-stage research on VMT were also included. The review highlighted key microbial signatures linked to vaginal health and infection, emphasizing the role of Candida species and the loss of protective Lactobacillus strains in disease progression.

Most important findings

The review identified that a healthy vaginal microbiota is dominated by Lactobacillus species, which produce lactic acid to maintain an acidic environment that suppresses Candida growth and modulates immune responses. Disruptions to this balance, through factors like antibiotics or hormonal changes, reduce Lactobacillus levels and raise vaginal pH, facilitating Candida overgrowth and VVC development. Conventional antifungal treatments face limitations due to resistance and recurrence. Probiotics, particularly Lactobacillus strains, demonstrated antifungal and immunomodulatory effects by competing with Candida, producing antimicrobial compounds, and supporting mucosal defenses. Postbiotics offer similar benefits without risks related to live microbes, while synbiotics enhance probiotic survival and activity. Vaginal microbiota transplantation is a promising but still experimental approach to restore microbial balance more effectively.

Greatest implications of this review

This review highlights the need to shift VVC management from solely antifungal drugs toward therapies that restore vaginal microbiota balance, aiming to reduce recurrence and drug resistance. Probiotics, postbiotics, synbiotics, and vaginal microbiota transplantation represent promising adjuncts or alternatives but require further high-quality clinical trials to confirm their safety, optimal protocols, and long-term efficacy. Integrating microbiome-focused treatments into clinical practice could improve patient outcomes by targeting the ecosystem dynamics underlying VVC rather than just the pathogen.