Journal article Open Access
Background: A healthy vagina is characterized by hydrogen peroxide and acid-producing lactobacilli, which are crucial to maintain the physiological vaginal ecosystem and their depletion speeds up bacterial overgrowth with pH elevation, salidase and amine production, leading to the observed signs and symptoms of vaginal dysbiosis. An effective treatment should be combined of lactobacillary flora and low doses of estrogen to maintain the physiology of the vaginal epithelium.
Material and methods: This is a prospective randomized study that included 218 patients, who were divided into 2 groups according to the treatment regimen, performed between October 2018 and December 2019 at the Department of Obstetrics and Gynecology of Nicolae Testemitanu State University of Medicine and Pharmacy. Patients selected were divided into L1 (120 patients assigned to treatment with the combination of two microorganisms Lactobacillus rhamnosus and Lactobacillus reuteri with estriol 0.03 mg vaginal pessaries) and L2 (98 patients who were given Lactobacillus rhamnosus in vaginal capsules). The treatment regimen for both groups was the same – 1 pessary or 1 capsule once in 24 hours, in the evening, for 12 days. Patients were evaluated before treatment (visit 1) and on day 13 of treatment (visit 2) and 1 month after the end of treatment (visit 3).
Results: Of the 120 women included in the study in the first group and 98 in the second group, a significant improvement (normocenosis) according to the research physician and patients was found in 93.3% (112) patients of group 1 and 71.4% (70) patients in group 2, satisfactory improvement (consistent with the intermediate type of biocenosis) in 5% (6) patients of group 1 and 15.3% (14) patients from group 2, unsatisfactory result 1.7% (2) patients from group 1 and 13.3% (13) of patients of group 2 (later relapse was noted in these patients).
Conclusions: Probiotic treatment with vaginal Lactobacillus rhamnosus, Lactobacillus reuteri and low doses of estriol seems to be useful in hindering bacteria growth especially after antibiotic therapy; therefore this intervention may be considered a new prophylactic treatment for preventing recurrence of bacterial vaginosis, in particular in high-risk patients.