Vitamin C vaginal tablets represent a compelling microbiome-based therapy for recurrent bacterial vaginosis. By restoring vaginal pH and supporting Lactobacillus reestablishment, this intervention validates both its therapeutic role and the microbial signature of BV.
Validation of Vitamin C as a Microbiome-Based Therapy for Recurrent Bacterial Vaginosis
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Divine Aleru
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Divine Aleru
I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
Vitamin C vaginal tablets represent a compelling microbiome-based therapy for recurrent bacterial vaginosis. By restoring vaginal pH and supporting Lactobacillus reestablishment, this intervention validates both its therapeutic role and the microbial signature of V.
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Divine Aleru
Researched by:
-
Divine Aleru
ID
Divine Aleru
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
Overview 
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References Overview
Recurrent bacterial vaginosis (BV) is increasingly understood as a biofilm-associated condition driven by microbial imbalance and impaired host defense.[1] Vitamin C vaginal tablets act as a microbiome-targeted intervention (MBTI) by lowering vaginal pH, thereby creating an inhospitable environment for BV-associated anaerobes while favoring the regrowth of protective Lactobacillus species.[2] Clinically, this leads to significantly reduced recurrence rates. These effects not only establish Vitamin C as a valid MBTI but also reinforce the underlying microbiome signature of BV, characterized by Lactobacillus depletion and anaerobe overgrowth.
Validation of Vitamin C as an MBTI
Vitamin C (ascorbic acid), delivered via silicon-coated vaginal tablets, exerts its effects through pH modulation and redox activity. The acidic environment it creates selectively suppresses pathogenic bacteria like Gardnerella vaginalis, Atopobium vaginae, and Prevotella spp., while supporting acidophilic Lactobacillus spp. In a randomized controlled trial, six cycles of Vitamin C prophylaxis led to a significantly lower BV recurrence rate (16.2% vs. 32.4%, P = 0.024) compared to placebo.[3] Moreover, a Kaplan-Meier survival analysis confirmed prolonged protection over time.[4] These results were achieved without significant adverse events, highlighting the safety and tolerability of the intervention. Mechanistically, Vitamin C reduces oxidative stress and indirectly modulates cytokine activity by restoring healthy flora, although its direct immunomodulatory role requires further study.
Microbial Effects Summary Table
| Microbial Effect of Vitamin C | Microbiome Signature of BV |
|---|---|
| Increased Lactobacillus spp. | Depleted in BV; restoration supports vaginal homeostasis |
| Decreased Gardnerella vaginalis, Prevotella spp. | Elevated in BV; associated with biofilm and recurrence |
| Decreased Atopobium vaginae | Strongly linked to biofilm persistence and treatment failure |
Validation of the Microbiome Signature of Bacterial Vaginosis
Bacterial vaginosis (BV) disrupts the microbiome by depleting Lactobacillus and promoting the overgrowth of anaerobic species such as Gardnerella vaginalis, Atopobium vaginae, Mobiluncus, and Prevotella. This dysbiosis facilitates biofilm formation and inflammatory responses, contributing to chronicity and treatment resistance. Vitamin C’s ability to lower vaginal pH below 4.5 selectively inhibits these anaerobes, aligning with in vitro data on their pH susceptibility. The resulting microbial shifts, observed clinically through reduced relapse rates and microbial restoration, align directly with the pathognomonic signature of BV.
Dual Validation
The clinical and microbial outcomes associated with Vitamin C vaginal tablets confirm their role as a microbiome-targeted intervention in bacterial vaginosis. The selective suppression of BV-associated taxa alongside the reestablishment of Lactobacillus not only supports the therapeutic value of Vitamin C but also validates the BV microbiome signature as a clinically accurate diagnostic and treatment-guiding framework. This dual validation advances both precision in microbial diagnostics and innovation in host-microbiome therapeutics.
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Efficacy of Vitamin C Vaginal Tablets in Preventing Recurrence of Bacterial Vaginosis: A Randomized Controlled Trial
June 10, 2013
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Bacterial Vaginosis •
Bacterial Vaginosis
Did you know?
Bacterial vaginosis (BV) increases the risk of acquiring HIV by up to 60% in women due to the disruption of the protective vaginal microbiome and the resulting inflammation that facilitates the virus’s entry.
This study demonstrates that 250 mg vitamin C vaginal tablets reduce the recurrence of bacterial vaginosis, offering an effective and safe prophylactic treatment.
What was Studied?
This study evaluated the efficacy of vitamin C vaginal tablets as a prophylactic treatment for recurrent bacterial vaginosis (rBV). The research was a randomized, double-blind, placebo-controlled clinical trial involving 142 women who had been successfully treated for a recent episode of BV using either metronidazole or clindamycin. These women were randomly assigned to receive either vitamin C or a placebo for six months, to prevent the recurrence of BV.
Who was Studied?
The study involved 142 women aged between 18 and 50 years who had a history of recurrent episodes of bacterial vaginosis, defined as at least two acute episodes in the past year. After successful treatment of a BV episode, participants were randomized into two groups: one receiving 250 mg of vitamin C vaginal tablets and the other a placebo. The study participants were monitored for recurrence of BV for six months.
What were the Most Important Findings?
The study demonstrated that the use of vitamin C vaginal tablets significantly reduced the recurrence rate of BV in women compared to the placebo group. After three months of treatment, the recurrence rate in the vitamin C group was 6.8%, whereas the placebo group had a recurrence rate of 14.7%. After six months, the recurrence rate was 16.2% in the vitamin C group, compared to 32.4% in the placebo group, which was statistically significant (P = 0.024). The vitamin C treatment also showed a significant pH-lowering effect, which is thought to contribute to the inhibition of pathogen overgrowth. Additionally, the Kaplan-Meier survival analysis indicated that the vitamin C group had a significantly lower probability of experiencing a BV relapse (P = 0.029). The treatment was well tolerated, with minimal adverse events, mostly local reactions like itching and burning.
What are the Implications of this Study?
The study highlights the potential of vitamin C vaginal tablets as an effective prophylactic treatment for recurrent bacterial vaginosis. By lowering vaginal pH, vitamin C helps re-establish a more acidic environment, preventing the overgrowth of harmful anaerobic bacteria, such as Gardnerella vaginalis. This finding is significant for women with recurrent BV, particularly those with antibiotic-resistant strains or those who experience frequent recurrences after antibiotic therapy. Given the safety profile and efficacy of vitamin C, it presents a promising alternative or complementary approach to current BV treatments, offering a simple and non-invasive way to manage this chronic condition.
Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions
January 20, 2016
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Bacterial Vaginosis •
Bacterial Vaginosis
Did you know?
Bacterial vaginosis (BV) increases the risk of acquiring HIV by up to 60% in women due to the disruption of the protective vaginal microbiome and the resulting inflammation that facilitates the virus’s entry.
This review discusses bacterial vaginosis, biofilm formation, and emerging therapies targeting biofilms for more effective BV treatments.
What was reviewed?
The paper provides a comprehensive review of bacterial vaginosis (BV), its association with biofilm formation, and challenges related to current treatment strategies. The review explores the microbial composition of BV, focusing on the primary pathogen, Gardnerella vaginalis, and the complex nature of BV biofilms, which contribute to the high recurrence rates of the infection. The review presents emerging therapeutic alternatives targeting BV biofilms, including natural antimicrobial agents and biofilm disruptors.
Who was reviewed?
The review examined various studies, clinical trials, and scientific literature that explored the microbial nature of bacterial vaginosis (BV), focusing on biofilm formation and its implications for treatment. It also reviewed the role of G. vaginalis and other anaerobic bacteria in the pathogenesis of BV, along with current and emerging treatment strategies targeting these biofilms. The review synthesized information from studies that investigated the efficacy of traditional therapies, such as metronidazole and clindamycin, as well as novel biofilm-disrupting agents like DNases, probiotics, and plant-derived antimicrobials.
What were the most important findings?
The review emphasizes the polymicrobial nature of bacterial vaginosis, with a marked decrease in beneficial lactobacilli species and an increase in anaerobic bacteria, such as Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp., Bacteroides spp., and Prevotella spp. A major highlight of the paper is the critical role of biofilms in BV pathogenesis, as these microbial communities exhibit significant resistance to conventional antibiotic treatments like metronidazole. This biofilm formation creates a dense matrix that protects the bacteria from immune system clearance and limits the effectiveness of standard therapies. Biofilms composed primarily of G. vaginalis are particularly resilient, contributing to treatment failure and the recurrence of BV. The review further discusses how researchers are exploring novel therapies, such as DNases, retrocyclins, probiotics, and plant-derived antimicrobials, to overcome biofilm-related antibiotic resistance. The paper also identifies the need for more research into multi-species biofilm interactions to develop more effective treatments for BV.
What are the implications of this review?
The implications of this review are significant for the clinical management of BV. The findings highlight the need for new treatment strategies that can specifically target biofilms, which are a major obstacle to the eradication of BV. Given the high recurrence rates of BV despite current antibiotic therapies, exploring alternative treatments that can disrupt biofilm structures, such as biofilm disruptors and natural antimicrobials, is essential. Clinicians may benefit from being aware of emerging treatments that could offer better outcomes, particularly for recurrent BV cases that do not respond well to standard treatments. Additionally, the review underscores the importance of considering the entire microbiome, including lactobacilli, when developing treatment plans to ensure that therapies do not disrupt the beneficial microbial community, which is crucial for vaginal health.
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.
Microbiome-Targeted Interventions (MBTIs)
Microbiome Targeted Interventions (MBTIs) are cutting-edge treatments that utilize information from Microbiome Signatures to modulate the microbiome, revolutionizing medicine with unparalleled precision and impact.
References
- Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions. Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N. (Front Microbiol. 2016 Jan 20;6:1528.)
- Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trial. Krasnopolsky VN, Prilepskaya VN, Polatti F, Zarochentseva NV, Bayramova GR, Caserini M, Palmieri R.. (J Clin Med Res. 2013 Aug;5(4):309-15.)
- Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions. Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N.. (Front Microbiol. 2016 Jan 20;6:1528)
- Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trial. Krasnopolsky VN, Prilepskaya VN, Polatti F, Zarochentseva NV, Bayramova GR, Caserini M, Palmieri R.. (J Clin Med Res. 2013 Aug;5(4):309-15.)
Machado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N
Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging SolutionsFront Microbiol. 2016 Jan 20;6:1528.
Read ReviewKrasnopolsky VN, Prilepskaya VN, Polatti F, Zarochentseva NV, Bayramova GR, Caserini M, Palmieri R.
Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trialJ Clin Med Res. 2013 Aug;5(4):309-15.
Read ReviewMachado D, Castro J, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Cerca N.
Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging SolutionsFront Microbiol. 2016 Jan 20;6:1528
Read ReviewKrasnopolsky VN, Prilepskaya VN, Polatti F, Zarochentseva NV, Bayramova GR, Caserini M, Palmieri R.
Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trialJ Clin Med Res. 2013 Aug;5(4):309-15.
Read Review