morphology, including coccobacillar cells (not used in the vaccine). Påhlson and Larsson hypothesized, that the defining characteristic of the lactobacilli used in SolcoTrichovac is a missing -production, which has not been confirmed. Moreover, the correlation they found between bacterial cell morphology and health benefits, pointed towards an association between long uniform lactobacilli and decreased protection against vaginal infections, whereas polymorphic/shortened lactobacilli were described as innocuous inhabitants of the vaginal econiche. It seems, that the authors equated the strains used in SolcoTrichovac to those responsible for cytolytic vaginosis, which is generally considered a different condition, characterized by a lactobacillus overgrowth, rather than the depletion seen in patients colonized by the strains used in the vaccine. Various other properties that could potentially play a role in the (lack of) protective effect, like the ratio of -lactic acid to -lactic acid production (correlated to MMP-8 concentrations of the vaginal fluid), adhesion competition, self- and co-aggregation ability, production of bacteriocins, organic acids or biosurfactants, immunomodulatory properties, or toxin production such as seen in L. iners remain obscure for the time. Risk factors of colonization The inventor of lactobacillus vaccines, Újhelyi described the strains used in Gynevac as pathobionts to Trichomonas vaginalis. He considered colonization with "aberrant", unprotective strains of lactobacilli, and their persistence even after protozoan infection has been cleared, a chronic post-infectious complication, and introduced the term "lactobacillus syndrome" for the condition (not to be confused with the distinct pathologies of cytolytic vaginosis and vaginal lactobacillosis). Scattered reports suggest that some minority of Lactobacillus strains found in humans indeed enhance rather than inhibit parasite adhesion to the vaginal epithelium. In vitro preincubation of vaginal epithelial cells (VECs) with physiological concentrations (– CFU/ml) of Lactobacillus CBI3 (a human isolate of L. plantarum or L. pentosus) increased the number of T. vaginalis cells able to adhere to the VEC monolayer up to eightfold. McGrory and Garber reported a significant prolongation of T. vaginalis infection in estrogenized BALB/c mice intravaginally preinoculated with cells of L. acidophilus ATCC 4356 (originating from the human pharynx) in comparison to animals that had not been pretreated. Although initial infectivity in the two groups was comparable, at day 24 post-infection 69% of L. acidophilus-inoculated mice still showed positive T. vaginalis cultures, compared with only 11% of mice not harboring lactobacilli. Other hypothesized risk factors of colonization by lactobacilli of low protective value in general include prior antimicrobial treatment and congenital factors.