title: Nucleic acid-based diagnosis of bacterial vaginosis and improved management using probiotic lactobacilli. Use of complementary therapies in a sexual health clinic setting Treatment of Bacterial Vaginosis with Lactobacilli Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis. Relationship of Vaginal Bacteria and Inflammation With Conception and Early Pregnancy Loss Following In-Vitro Fertilization Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. Rates of bacterial vaginosis in women undergoing in vitro fertilisation for different types of infertility Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. Therapy of bacterial vaginosis using exogenously-applied Lactobacilli acidophili and a low dose of estriol: a placebo-controlled multicentric clinical trial. A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. [Effectiveness of oral administration of Lactobacillus paracasei subsp. paracasei F19 in association with vaginal suppositories of Lactobacillus acidofilus in the treatment of vaginosis and in the prevention of recurrent vaginitis]. Bacterial vaginosis in pregnancy treated with yoghurt The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya Diagnosis and clinical manifestations of bacterial vaginosis. Women's satisfaction with an intravaginal Lactobacillus capsule for the treatment of bacterial vaginosis. Efficacy of Povidone-Iodine Vaginal Suppositories in the Treatment of Bacterial Vaginosis
abstract: Bacterial vaginosis ( BV ) is a common condition in women that represents an imbalance of the vaginal microflora , lactobacilli depletion , and excess growth of mainly anaerobic Gram-negative pathogens . Diagnosis is made using a series of tests or a Gram stain of a vaginal smear . Treatment with antibiotics is quite effective , but recurrences are common . A study of 55 vaginal sample s from 11 postmenopausal women showed the presence of BV by the Gram stain-based Nugent scoring system , and polymerase chain reaction-denaturing gradient gel electrophoresis showed that Bacteroides or Prevotella species were the most common isolates recovered ( 24 of 25 ) , with Escherichia coli , Staphylococcus aureus , and Streptococcus agalactiae also found in some sample s. In one case , only Gardnerella vaginalis was found . These findings illustrate that BV remains common even among otherwise healthy women , but it is not caused solely by either Gardnerella or Mobiluncus . Use of a FemExam system ( Cooper Surgical , Shelton , CT ) , based upon elevated pH and trimethylamine levels , to screen vaginal smears from 59 healthy women showed poor correlation with the Gram stain method . A r and omized , placebo-controlled trial of these subjects showed that the lactobacilli-dominant microbiota was restored in subjects with BV but not in controls , following 2 months of daily oral intake of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 . These studies show that nucleic acid-based methods are effective at identifying bacteria responsible for BV . If such methods could be used to develop a commercially available , self-use kit , women would be much better placed to take control of their own health , for example , using medicinal food or dietary supplement products such as the clinical ly proven probiotic strains L. rhamnosus GR-1 and L. fermentum RC-14 This prospect i ve cohort study examined the health-seeking behaviour of patients diagnosed with genital warts and vulvodynia who presented to Manly Sexual Health Service from March to June 2000 . A self-administered question naire was used to assess patients ' perceptions of their condition and their use of complementary therapies .  Thirty-seven patients with genital warts and 26 patients with vulvodynia participated in the study . The use of at least one  complementary health product or method  was reported by 59 % of patients with genital warts and 96 % of vulvodynia patients ( P < 0.001 ) . Having received conflicting information and being worried about the condition was significantly associated with visits to complementary health providers . Acknowledgement of this search for complementary therapies and open discussion can help patients make informed decisions and to avoid drug interactions , and should ultimately lead to better patient care 60 women with bacterial vaginosis were entered into a double blind , placebo-controlled treatment trial with lyophilized Lactobacillus acidophilus . The lactobacilli used were producing H2O2 . Immediately after completion of treatment , 16 out of 28 women who were treated with lactobacilli had normal vaginal wet smear results , in comparison to none of the 29 women treated with placebo . All women harboured Bacteroides at inclusion . Bacteroides was eliminated from the vagina of 12 out of 16 healthy women after treatment . Only three of the women who received the Lactobacillus suppository were free of bacterial vaginosis after the subsequent menstruation This study enrolled 125 premenopausal women diagnosed with bacterial vaginosis ( BV ) by presence of vaginal irritation , discharge and ' fishy ' odor , and Nugent criteria and detection of sialidase enzyme . The subjects were treated with oral metronidazole ( 500 mg ) twice daily from days 1 to 7 , and r and omized to receive oral Lactobacillus rhamnosus GR-1 ( 1 x 10(9 ) ) and Lactobacillus reuteri RC-14 ( 1 x 10(9 ) ) or placebo twice daily from days 1 to 30 . Primary outcome was cure of BV as determined by normal Nugent score , negative sialidase test and no symptoms or signs of BV at day 30 . A total of 106 subjects returned for 30-day follow-up , of which 88 % were cured in the antibiotic/probiotic group compared to 40 % in the antibiotic/placebo group ( p<0.001 ) . Of the remaining subjects , 30 % subjects in the placebo group and none in the probiotic group had BV , while 30 % in the placebo and 12 % in the probiotic group fell into the intermediate category based upon Nugent score , sialidase result and clinical findings . High counts of Lactobacillus sp. ( > 10(5 ) CFU/ml ) were recovered from the vagina of 96 % probiotic-treated subjects compared to 53 % controls at day 30 . In summary , this study showed efficacious use of lactobacilli and antibiotic in the eradication of BV in black African women To compare and assess ingestion of yogurt that contained live Lactobacillus acidophilus with pasteurized yogurt as prophylaxis for  recurrent bacterial vaginosis ( BV ) and c and idal vaginitis  , we design ed a crossover trial during which patients were examined monthly for  c and idal infection and BV while they were receiving either a pasteurized yogurt or a yogurt that contained live L acidophilus .  Forty-six patients in 2 groups of 23 were r and omly assigned to each of the study groups . At least 28 ( 61 % ) participated during the first 4 months of the study . Seven patients completed the entire study protocol . We concluded that daily ingestion of 150 mL of yogurt , enriched with live L acidophilus , was associated with an increased prevalence of colonization of the rectum and vagina by the bacteria , and this ingestion of yogurt may have reduced episodes of BV Objective : The aim of this study was investigate the impact of vaginal flora and vaginal inflammation on conception and early pregnancy loss following  in-vitro fertilization ( IVF ) . Methods : We enrolled 91 women who were undergoing IVF .  At embryo transfer  ( ET ) , all of the women had quantitative vaginal culture , ET catheter-tip culture , and vaginal Gram stain scored for bacterial vaginosis and quantitated for polymorphonuclear leukocytes ( PMNs ) . Conception and early pregnancy loss were compared with culture and Gram stain results . Statistical analyses included the Chi-square test , Fisher 's exact test and the Mann – Whitney U-test . Results : The overall live birth rate ( LBR ) was 30 % ( 27/91 ) , and the rate of early pregnancy loss was 34 % ( 14/41 ) . In women with bacterial vaginosis , intermediate flora and normal flora , the conception rates were 30 % ( 3/10 ) , 39 % ( 12/31 ) and 52 % ( 26/50 ) , respectively ( p = 0.06 for trend ) . Early pregnancy loss occurred in 33 % ( 1/3 ) , 42 % ( 5/12 ) and 31 % ( 8/26 ) of women , respectively ( p = 0.06 , comparing intermediate and normal flora ) . The vaginal log concentration of hydrogen peroxide-producing lactobacilli was 7.3 ± 1.7 in women with a live birth ( n = 27 ) and 4.9 ± 2.5 in those with early pregnancy loss ( n = 14 ) ( p = 0.1 ) . Conclusions : IVF patients with bacterial vaginosis and with a decreased vaginal log concentration of hydrogen peroxide-producing lactobacilli may have decreased conception rates and increased rates of early pregnancy loss . A larger prospect i ve treatment trial design ed to evaluate the impact on IVF outcomes of optimizing the vaginal flora prior to IVF may be warranted Forty-two healthy women were r and omized to receive one of three encapsulated Lactobacillus rhamnosus GR-1 plus Lactobacillus fermentum RC-14 probiotic dosage regimens or L. rhamnosus GG by mouth each day for 28 days . However , the vaginal flora , assessed by Nugent scoring , was only normal in 40 % of the cases , and 14 patients had asymptomatic bacterial vaginosis . Treatment with L. rhamnosus GR-1/L. fermentum RC-14 once and twice daily correlated with a healthy vaginal flora in up to 90 % of patients , and 7/11 patients with bacterial vaginosis converted to normal or intermediate scores within 1 month . Ingestion of L. rhamnosus GG failed to have an effect . This study confirms the potential efficacy of orally administered lactobacilli as a non-chemotherapeutic means to restore and maintain a normal urogenital flora , and shows that over 10(8 ) viable organisms per day is the required dose Objective To assess whether the rate of bacterial vaginosis ( BV ) is higher in women with tubal factor infertility compared with those with other causes of infertility Bacterial vaginosis ( BV ) is particularly common in black women , and in Nigeria it is often caused by Mycoplasma , as well as Atopobium , Prevotella and Gardnerella sp. Antimicrobial metronidazole oral therapy is poorly effective in eradicating the condition and restoring the Lactobacillus microbiota in the vagina . In this study , 40 women diagnosed with BV by discharge , fishy odor , sialidase positive test and Nugent Gram stain scoring , were r and omized to receive either two dried capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 each night for 5 days , or 0.75 % metronidazole gel , applied vaginally twice a day ( in the morning and evening ) . Follow-up at day 6 , 15 and 30 showed cure of BV in significantly more probiotic treated subjects ( 16 , 17 and 18/20 , respectively ) compared to metronidazole treatment ( 9 , 9 and 11/20 : P=0.016 at day 6 , P=0.002 at day 15 and P=0.056 at day 30 ) . This is the first report of an effective ( 90 % ) cure of BV using probiotic lactobacilli . Given the correlation between BV and HIV , and the high risk of the latter in Nigeria , intravaginal use of lactobacilli could provide women with a self-use therapy , similar to over-the-counter anti-yeast medication , for treatment of urogenital infections BACKGROUND The relationship between lactobacilli and other microbes and the association with  vaginal pH  in the female genital tract were examined . The study also included evaluation of the possibility of supplying probiotics to the genital tract by using panty liners impregnated with the probiotic strain Lactobacillus plantarum LB931 . METHODS This was a r and omized , placebo-controlled , double-blind , multicenter study involving 191 healthy fertile women . Specified microbes were counted and vaginal pH was measured once a month for five consecutive months . RESULTS Major individual variations in the genital microflora composition and the vaginal pH were found among the women . The number of lactobacilli was significantly related to vaginal pH ( p<0.001 ) and approximately 70 % of the women were permanent carriers of individual lactobacilli strains . Women with high numbers of lactobacilli were less prevalent with Group B streptococci than women with low numbers ( p=0.036 ) , and these women had a lower mean vaginal pH. The number of lactobacilli also correlated with the prevalence of yeast . LB931 could be found in 86 % of the labial sample s and 54 % of the vaginal sample s. CONCLUSIONS High numbers of lactobacilli may contribute to a low vaginal pH and seem to have a negative influence on Group B streptococci . LB931 could be transferred from the panty liners to both the vagina and the labial fold The efficacy of vaginal tablets ( Gynoflor ) containing 50 mg of a lyophilisate of viable , H2O2-producing Lactobacillus acidophilus ( at least 10(7 ) colony forming units/tablet ) and 0.03 mg estriol ( CAS 50 - 27 - 1 ) for the treatment of bacterial vaginosis ( BV ) was tested in a multicentric , r and omised , placebo-controlled clinical trial with parallel-group design . 32 non-menopausal women with positive diagnoses for BV , including intermediate cases , participated in the trial . Patients were diagnosed using the classical clinical parameters of BV according to Amsel and using microscopic analysis of the Gram-stained vaginal smear . A positive clinical diagnosis of BV required at least 2 of the following 4 clinical criteria to be positive ; greyish-white , homogeneous leukorrhea ; vaginal pH > 4.5 ; KOH test for volatile amines ; presence of clue cells . Microscopic diagnosis of BV , on the other h and , was obtained if examination of the Gram-stained vaginal smear showed less than 6 lactobacilli per field of view ( 1000 x magnification ) . This corresponds to another definition of BV as " lactobacilli deficiency syndrome " . The efficacy of the 6-day therapy with 1 - 2 vaginal tablets daily was evaluated using both clinical and microscopic analysis . Using Amsel 's classical clinical parameters of BV , the cure rate ( defined as < or = 1 of the 4 clinical criteria positive ) two weeks after the start of therapy was 77 % in the verum group and 25 % in the placebo group . Four weeks after the start of therapy , the cure rate was 88 % in the verum group and 22 % in the placebo group . At both control examinations , the cure rate for the test group was significantly higher than that for the placebo group ( p < 0.05 , Fisher 's exact test , 2-sided , significance level 0.05 ) . In addition , the trial showed that after 6 days of treatment with the test preparation , the lactobacilli were capable of recolonising the vagina . A significant increase in the number of lactobacilli was observed in the Gram-stained vaginal smear for the patient group treated with the test preparation compared to the placebo patient group ( p < 0.05 , Fisher 's exact test , 2-sided , significance level 0.05 ) , two and four weeks after the start of the 6-day treatment The expected 4-week cure rate after conventional treatment of bacterial vaginosis are only 65 - 70 % . In an attempt to improve the cure rate by adding probiotic lactobacilli we performed a double-blind placebo-controlled study of adjuvant lactobacilli treatment after an open treatment with vaginal clindamycin ovules .  Women with bacterial vaginosis as defined by Amsel 's criteria were treated with clindamycin ovules . Vaginal smears were collected and analysed according to Nugent 's criteria . During the following menstruation period the women used , as an adjuvant treatment , either lactobacilli-prepared tampons or placebo tampons . The lactobacilli tampons were loaded with a mixture of freeze-dried L. fermentum , L. casei var . rhamnosus and L. gasseri . The cure rate was recorded after the second menstruation period . There was no improvement in the cure rate after treatment with lactobacilli-containing tampons compared to placebo tampons ; the cure rates as defined by Amsel 's criteria were 56 % and 62 % , respectively , and 55 % and 63 % , as defined by Nugent 's criteria . This is the first study to report cure rates for women with ' intermediate ' wet smear ratings according to Nugent 's classification and this group had an overall cure rate of 44 % . The cure rate of treatment of bacterial vaginosis was not improved by using lactobacilli-prepared tampons for one menstruation Urogenital infections afflict an estimated one billion people each year . The size of this problem and the increased prevalence of multi-drug resistant pathogens make it imperative that alternative remedies be found . A r and omized , placebo-controlled trial of 64 healthy women given daily oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 for 60 days showed no adverse effects . Microscopy analysis showed restoration from asymptomatic bacterial vaginosis microflora to a normal lactobacilli colonized microflora in 37 % women during lactobacilli treatment compared to 13 % on placebo ( P=0.02 ) . Lactobacilli were detected in more women in the lactobacilli-treated group than in the placebo group at 28 day ( P=0.08 ) and 60 day ( P=0.05 ) test points . Culture findings confirmed a significant increase in vaginal lactobacilli at day 28 and 60 , a significant depletion in yeast at day 28 and a significant reduction in coliforms at day 28 , 60 and 90 for lactobacilli-treated subjects versus controls . The combination of probiotic L. rhamnosus GR-1 and L. fermentum RC-14 is not only safe for daily use in healthy women , but it can reduce colonization of the vagina by potential pathogenic bacteria and yeast AIM The aim of this paper was to estimate the effectiveness of the contemporary oral administration of Lactobacilllus paracasei subsp paracasei F19 in association with vaginal suppositories containing Lactobacilllus acidofilus in the treatment of bacterial vaginosis and in the prevention of recurrent vaginitis . METHODS We have recruited 60 women in good health , aged between 18 and 40 years with suspect or confirmed diagnosis of bacterial vaginosis . The women were r and omized in 2 groups : Group A treated with vaginal suppositories containing Lactobacillus acidofilus ( Calagin , SIFFRA , Florence ) ; Group B treated with the same vaginal suppositories + probiotic containing Lactobacilllus paracasei subsp paracasei F 19 for oral administration ( Gene-filus F19 , SIFFRA , Florence ) . The patients were examined at the end of therapy ( 3 months ) and then after 3 months from the end of treatment . RESULTS In both groups at end of therapy there was a significant reduction of vaginal pH , an improvement of sniff test and of the subjective symptomatology after 3 months of treatment which still decreased during follow-up ( 3 months ) . In Group B there was a meaningful reduction of vaginal pH and of sniff test at the end of therapy and a maintenance of positive effect also after 3 months . CONCLUSIONS The results obtained in this study show that the therapy with vaginal Lactobacillus in the treatment of bacterial vaginosis is successful . The association of oral administration is useful to balance the vaginal environment with the intestinal microflora with improvement of long-term results . The use of probiotics was determinant in the treatment of a pathology like bacterial vaginosis and as an alternative to the conventional local antibiotic therapies As various drugs might have an effect on the fetus during pregnancy , the use of drugs should be minimized in the pregnant woman . Since bacterial vaginosis ( BV ) can be associated with prematurity and postpartum complications , we search ed for alternative therapy for its cure during pregnancy . Commercial yoghurt incorporates both factors necessary for maintaining the protective mechanism of the vagina , vaginal pH and lactobacilhis . A total of 32 women with BV in the first trimester of pregnancy were treated with intravaginal application of yoghurt . The result was favorable indicating that the continuous correction of vaginal pH and lactobaccillus flora is crucial for normal vaginal ecology . During pregnancy , a local treatment restoring the normal acidity and vaginal flora , without systemic effect , may be preferable to any other treatment Objective To evaluate the effectiveness of live lactobacilli in combination with low dose oestriol for restoration of the vaginal flora after anti‐infective treatment Objective : To assess the association between vaginal douching and sexually transmitted infections ( STI ) among a group of female sex workers ( FSWs ) in Nairobi , Kenya . Methods : This study was part of a r and omised , placebo controlled trial of monthly prophylaxis with 1 g of azithromycin to prevent STIs and HIV infection in a cohort of Nairobi FSWs . Consenting women were administered a question naire and screened for STIs . Results : The seroprevalence of HIV-1 among 543 FSWs screened was 30 % .  HIV infection was significantly associated with bacterial vaginosis ( BV ) , trichomoniasis , gonorrhoea , and the presence of a genital ulcer . Regular douching was reported by 72 % of the women , of whom the majority inserted fluids in the vagina , generally after each sexual intercourse . Water with soap was the fluid most often used ( 81 % ) , followed by salty water ( 18 % ) , water alone ( 9 % ) , and a commercial antiseptic ( 5 % ) . Douching in general and douching with soap and water were significantly associated with bacterial vaginosis ( p = 0.05 and p = 0.04 respectively ) . There was a significant trend for increased frequency of douching and higher prevalence of BV . There was no direct relation observed between douching and risk for HIV infection or other STIs . Conclusion : The widespread habit of douching among African female sex workers was confirmed . The association between vaginal douching and BV is of concern , given the increased risk of HIV infection with BV , which has now been shown in several studies . It is unclear why we could not demonstrate a direct association between douching and HIV infection . Further research is required to better underst and the complex relation between douching , risk for bacterial vaginosis , and risk for HIV and other STIs Among 640 r and omly selected women who were attending a sexually transmitted disease clinic and did not have trichomoniasis , 33 % had bacterial vaginosis as defined by a composite of four clinical criteria : ( 1 ) Vaginal discharge was homogeneous ; ( 2 ) vaginal discharge had a pH greater than or equal to 4.7 ; ( 3 ) vaginal discharge had an amine-like odor when mixed with 10 % potassium hydroxide ; ( 4 ) vaginal discharge contained clue cells representing greater than or equal to 20 % of vaginal epithelial cells . Previously published Gram stain criteria for bacterial vaginosis correlated better than results of semiquantitative cultures for Gardnerella vaginalis with presence or absence of clue cells and with composite clinical criteria . Of 293 women with bacterial vaginosis by Gram stain criteria , 65 % had symptoms of increased vaginal discharge and /or vaginal malodor , while 74 % had signs of characteristic homogeneous vaginal discharge or amine-like odor . Elevated vaginal pH was the least specific and amine-like odor the least sensitive sign of bacterial vaginosis . Gram stain criteria for bacterial vaginosis were not associated with the concentrations of endocervical or vaginal inflammatory cells but were significantly associated with a clinical diagnosis of pelvic inflammatory disease . After adjusting for coinfection , sexual behavior , and other variables , bacterial vaginosis remained associated with adnexal tenderness ( odds ratio = 9.2 , p = 0.04 ) . Bacterial vaginosis , previously implicated as a risk factor for obstetric infections , may be a risk factor for pelvic inflammatory disease OBJECTIVE To assess women 's satisfaction with a vaginal capsule containing human-derived , H(2)O(2)-producing Lactobacillus crispatus at completion of a r and omized , placebo-controlled study for treatment of bacterial vaginosis ( BV ) . METHODS Women aged 14 - 35 years with BV were r and omized  to Lactobacillus or placebo intravaginal capsule twice daily for 3 days monthly for 3 months . Attitudes were assessed with a st and ardized scale at the final follow-up visit , and associations of satisfaction with clinical and gram stain cure of BV were determined . RESULTS Four hundred twenty-four women were r and omized at enrollment , and 232 ( 55 % ) provided data on satisfaction at the final visit . Overall , satisfaction with the capsule was high and was independent of subjects ' race , age , and prior history of BV . Report of satisfaction with the capsule , belief that it contained healthy bacteria , and belief that its use improved vaginal health were directly related to clinical cure and to improved Nugent score . Except for women who had BV at the final follow-up visit , most subjects believed that the capsule contained healthy bacteria independent of any outcome reflecting cure . Willingness to use the capsule again was not significantly related to whether subjects experienced clinical cure or normalization of Nugent score at either visit . Adverse effects were rare and were largely related to a perceived difference in vaginal discharge . CONCLUSIONS Satisfaction with an intravaginal capsule and positive beliefs about its use for BV treatment were prevalent , especially among women with a clinical and microbiological response to BV therapy . However , most women expressed willingness to use the product again regardless of clinical response . Acceptability of and interest in alternative BV treatments , such as L. crispatus intravaginal applications , are high A prospect i ve , r and omized clinical trial was performed to study the efficacy of povidone iodine ( Betadine ® ) suppositories for the treatment of bacterial vaginosis ( BV ) in comparison to capsules containing lactobacilli ( Döderlein Med ® ) .  Seventy patients with BV included in the study were r and omly assigned to be either treated with povidone iodine suppositories or lactobacilli . Patients were treated once a day for 5 days . Initial examinations took place on the first day of the study with follow-up examinations on days 8 and 15 . The examinations included clinical parameters , patient evaluation , secretion screens , and quantitative and qualitative microbiological tests of vaginal flora . Both treatment groups showed improvement of clinical parameters , condition of secretions and subjective state of health . At day 15 there was a trend towards a better efficacy of the treatment with povidone iodine but this was not significant . However , patients with acute BV treated with povidone iodine had significantly better scores after 15 days . Both treatments were well tolerated . The microbiological examinations showed an increase of the mean number of lactobacilli in the vagina on day 8 after initiation of treatment with lactobacilli , but a decrease on day 15 . Contrary to that the lactobacilli counts from patients treated with povidone iodine suppositories decreased after the first week but increased in the second one . Potentially pathogenic germs , e.g. Gardnerella , Bacteroides and Enterobacteria were reduced in a higher extent and with a longer lasting effect after treatment with povidone iodine suppositories than with capsules containing lactobacilli . The results of this study show that native lactobacilli rapidly re-colonize after the antiseptic treatment with povidone iodine . Therefore , there is no need to use lactobacilli in addition
target: The results do not provide sufficient evidence for or against recommending probiotics for the treatment of BV .
background: BACKGROUND The dominance of lactobacilli in healthy vaginal microbiota and its depletion in bacterial vaginosis ( BV ) has given rise to the concept of oral or vaginal instillation of probiotic Lactobacillus strains for the management of this condition .
  OBJECTIVES To ascertain the efficacy of probiotics in the treatment of BV .