Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: Safety and Preliminary Efficacy by Microscopy and Sequencing

van de Wijgert, Janneke, Verwijs, Marijn, Agaba, Stephen, Bronowski, Christina, Mwambarangwe, Lambert, Uwineza, Mireille, Lievens, Elke, Nivoliez, Adrien, Ravel, Jacques and Darby, Alistair ORCID: 0000-0002-3786-6209 (2020) Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: Safety and Preliminary Efficacy by Microscopy and Sequencing. Scientific Reports, 10 (1). 19001156-.

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Official URL: http://dx.doi.org/10.1101/19001156

Abstract

Bacterial vaginosis (BV) is associated with HIV acquisition and adverse pregnancy outcomes. Recurrence after metronidazole treatment is high. HIV-negative, non-pregnant Rwandan BV patients were randomized to four groups (n=17/group) after seven-day oral metronidazole treatment: behavioral counseling only (control), or counseling plus intermittent use of oral metronidazole, Ecologic Femi+ vaginal capsule (containing multiple Lactobacillus and one Bifidobacterium species), or Gynophilus LP vaginal tablet (L. rhamnosus 35) for two months. Vaginal microbiota assessments at all visits included Gram stain Nugent scoring and 16S rRNA gene qPCR and HiSeq sequencing. All interventions were safe. BV (Nugent 7-10) incidence was 10.18 per person-year at risk in the control group, and lower in the metronidazole (1.41/person-year; p=0.004), Ecologic Femi+ (3.58/person-year; p=0.043), and Gynophilus LP groups (5.36/person-year; p=0.220). In mixed effects models adjusted for hormonal contraception/pregnancy, sexual risk-taking, and age, metronidazole and Ecologic Femi+ users, each compared to controls, had higher Lactobacillus and lower BV-anaerobes concentrations and/or relative abundances, and were less likely to have a dysbiotic vaginal microbiota type by sequencing. Inter-individual variability was high and effects disappeared soon after intervention cessation. Lactobacilli-based vaginal probiotics warrant further evaluation because, in contrast to antibiotics, they are not expected to negatively affect microbiota or cause antimicrobial resistance.

Item Type:	Article
Uncontrolled Keywords:	Infectious Diseases, Prevention, Pediatric, Clinical Trials and Supportive Activities, Clinical Research, Biotechnology, Complementary and Integrative Health, Infection, 3 Good Health and Well Being
Depositing User:	Symplectic Admin
Date Deposited:	16 Apr 2020 14:52
Last Modified:	14 Mar 2024 18:10
DOI:	10.1038/s41598-020-60671-6
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3082682