title: Bacterial vaginosis and the effect of intermittent prophylactic treatment with an acid lactate gel. Influence of three-day antimicrobial therapy and lactobacillus vaginal suppositories on recurrence of urinary tract infections. Why Do Different Criteria for ‘Cure’ Yield Different Conclusions in Comparing Two Treatments for Bacterial Vaginosis? 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 as prophylaxis for candidal vaginitis. Probiotics prophylaxis in children with persistent primary vesicoureteral reflux Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. Evaluation of two self-care treatments for prevention of vaginal candidiasis in women with HIV. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Candida vaginitis: Self‐Reported Incidence and Associated Costs Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Probiotics Feeding in Prevention of Urinary Tract Infection, Bacterial Sepsis and Necrotizing Enterocolitis in Preterm Infants Therapy of bacterial vaginosis using exogenously-applied Lactobacilli acidophili and a low dose of estriol: a placebo-controlled multicentric clinical trial. Activity of a Lactobacillus acidophilus-based douche for the treatment of bacterial vaginosis. 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. A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections Symptomatic candidiasis: Using self sampled vaginal smears to establish the presence of Candida, lactobacilli, and Gardnerella vaginalis.
abstract: Intermittent treatment with an acid lactate gel ( Lactal , ACO , Sweden ) reduced symptoms of  bacterial vaginosis ( BV )  and promoted the reestablishment of the normal vaginal flora of lactobacilli . Forty-two women seriously affected by recurrent BV were initially given acid gel ( lactate gel , pH 3.8 , 5 ml ) to be inserted into the vagina daily for 7 consecutive days . Thereafter they entered into a double blind clinical trial and were treated prophylactically 3 days monthly for 6 months with either lactate gel or a placebo gel . Women treated with the lactate gel were clinical ly improved , i.e. no signs of BV in 88 % compared to 10 % in the placebo group ( p less than 0.001 ) . The vaginal lactobacilli flora was reestablished in 83 % of the lactate group and in 16 % of the placebo group . Local intermittent application of lactate gel was found to be free of side effects and is a preferable alternative to repeated treatments with antibiotics in patients with recurrent BV Forty-one adult women with acute lower urinary tract infections ( UTI ) were r and omly treated for three days with norfloxacin or trimethoprim/sulfamethoxazole ( TMP/SMX ) . Infection was eradicated in 100 % of norfloxacin-treated patients and in 95 % of TMP/SMX-treated patients . UTI recurred in 29 % of patients treated with norfloxacin and in 41 % of those treated with TMP/SMX . Post-therapy vaginal administration of lactobacillus suppositories result ed in a recurrence rate of UTI of only 21 % , while in patients given  sterilized skim-milk suppositories the recurrence rate was 47 % . This study indicates that lactobacillus vaginal suppositories are safe and may be effective in reducing the recurrence of UTI following antimicrobial therapy Objective : The objective of this study was to determine why different criteria for response to treatment of bacterial vaginosis ( BV ) led to markedly different conclusions about treatment efficacy in a r and omized trial comparing metronidazole gel versus metronidazole/nystatin ovules . Study : We compared the impact of two treatment regimens on individual components of Amsel and Nugent criteria at follow-up visits 14 , 42 , and 104 days after initiating treatment . Results : Compared with gel , ovules more effectively eliminated amines , clue cells , and Gardnerella , Prevotella , or Mobiluncus morphotypes from vaginal fluid , thus achieving cure based on “ usual ” criteria ( absence of BV by Amsel or Nugent criteria ) , but did not more effectively restore Lactobacillus morphotypes or lower vaginal pH , thus not meeting Federal Drug Administration ( FDA ) criteria for cure . Conclusion : Because early vaginal recolonization by lactobacilli was poor after both gel and ovules , FDA draft criteria for cure missed marked differences in treatment efficacies against Gardnerella , clue cells , and amines . Cure defined more “ usually ” may give more useful information 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 OBJECTIVE To assess whether daily ingestion of yogurt containing Lactobacillus acidophilus prevents  vulvovaginal c and idal infections .  DESIGN Crossover trial for at least 1 year during which patients were examined for c and idal infections and colonizations while receiving either a yogurt-free or a yogurt-containing diet . Patients served as their own controls . SETTING Ambulatory infectious disease center in a teaching hospital providing tertiary care . PATIENTS Thirty-three women with recurrent c and idal vaginitis were eligible after recruitment from community practice s and clinics and through advertising . Twelve patients were eliminated for protocol violations . Of the remaining 21 patients , 8 who were assigned to the yogurt arm initially refused to enter the control phase 6 months later . Thus , 13 patients completed the protocol . INTERVENTIONS Women ate yogurt for 6 months of the study period . MEASUREMENTS Colonization of lactobacilli and c and ida in the vagina and rectum ; c and idal infections of the vagina . MAIN RESULTS Thirty-three eligible patients were studied . A threefold decrease in infections was seen when patients consumed yogurt containing Lactobacillus acidophilus . The mean ( + /- SD ) number of infections per 6 months was 2.54 + /- 1.66 in the control arm and 0.38 + /- 0.51 per 6 months in the yogurt arm ( P = 0.001 ) . C and idal colonization decreased from a mean of 3.23 + /- 2.17 per 6 months in the control arm to 0.84 + /- 0.90 per 6 months in the yogurt arm ( P = 0.001 ) . CONCLUSION Daily ingestion of 8 ounces of yogurt containing Lactobacillus acidophilus decreased both c and idal colonization and infection Probiotics , beneficial living microorganisms , have been proven to be effective in preventing gastrointestinal infections , but their effect in preventing urinary tract infection ( UTI ) is inconclusive . A prospect i ve r and omized controlled study was done to compare the preventive effect of probiotics with conventional antibiotics in children with persistent primary vesicoureteral reflux ( VUR ) . One hundred twenty children who had had persistent primary VUR after antibiotic prophylaxis for 1 year were r and omly allocated into a probiotics ( Lactobacillus acidophilus 108 CFU/g 1 g b.i.d . , n = 60 ) or an antibiotics ( trimethoprim/sulfamethoxazole 2/10 mg/kg h.s . , n = 60 ) prophylaxis group during the second year of follow-up . The incidence of recurrent UTI was 18.3 % ( 11/60 ) in the probiotics group , which was not different from 21.6%(13/60 ) in the antibiotic group ( P = 0.926 ) . The causative organisms of recurrent UTI were not significantly different between the two groups ( P = 0.938 ) . Even after stratification by VUR grade , age , gender , phimosis , voiding dysfunction and renal scar , the incidence of recurrent UTI did not differ significantly between the two groups ( P > 0.05 ) . The development of new renal scar was not significantly different between the two groups ( P > 0.05 ) . In conclusion , probiotics prophylaxis was as effective as antibiotic prophylaxis in children with persistent primary VUR We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal ( NM ) therapy for preventing urinary tract infection ( UTI ) in postmenopausal women with recurrent UTI . Over a period of 9 months , 86 women received an  estriol-containing vaginal pessary ( 0.5 mg estriol ) twice weekly , and 85 women received NM ( 100 mg ) once daily . We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM ( P=.0003 ) . Twenty-eight women ( 32.6 % ) who received estriol had no episodes of UTI versus 41 women ( 48.2 % ) in the NM group . There was a significant increase in the number of superficial cells in women who received estriol , whereas in the NM group , no such changes occurred . However , there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol . Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women Abstract Objective To test whether oral or vaginal lactobacillus can prevent  vulvovaginitis after antibiotic treatment . Design R and omised , placebo controlled , double blind , factorial 2 × 2 trial . Setting Fifty general practice s and 16 pharmacies in Melbourne , Australia . Participants Non-pregnant women aged 18 - 50 years who required a short course of oral antibiotics for a non-gynaecological infection : 278 were enrolled in the study , and results were available for 235 . Interventions Lactobacillus preparations taken orally or vaginally , or both , from enrolment until four days after completion of their antibiotic course . Main outcome measures Participants ' reports of symptoms of post-antibiotic vulvovaginitis , with microbiological evidence of c and idiasis provided by a self obtained vaginal swab . Results Overall , 55/235 ( 23 % ( 95 % confidence interval 18 % to 29 % ) ) women developed post-antibiotic vulvovaginitis . Compared with placebo , the odds ratio for developing post-antibiotic vulvovaginitis with oral lactobacillus was 1.06 ( 95 % confidence interval 0.58 to 1.94 ) and with vaginal lactobacillus 1.38 ( 0.75 to 2.54 ) . Compliance with antibiotics and interventions was high . The trial was terminated after the second interim analysis because of lack of effect of the interventions . Given the data at this time , the chances of detecting a significant reduction in vulvovaginitis with oral or vaginal lactobacillus treatment were less than 0.032 and 0.0006 respectively if the trial proceeded to full enrolment . Conclusions The use of oral or vaginal forms of lactobacillus to prevent post-antibiotic vulvovaginitis is not supported by these results . Further research on this subject is unlikely to be fruitful , unless new underst and ings about the pathogenesis of post-antibiotic vulvovaginitis indicate a possible role for lactobacillus 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 Vaginal c and idiasis ( VC ) is a common concern for women living with HIV infection . The authors evaluated the effectiveness of two self-care approaches to prophylaxis of VC among HIV-infected women , weekly intravaginal application of Lactobacillus acidophilus or weekly intravaginal application of clotrimazole tablets , in a r and omized , double-blind , placebo-controlled trial . VC was defined as a vaginal swab positive for C and ida species in the presence of signs/symptoms of vaginitis and the absence of a diagnosis of Trichomonas vaginalis or bacterial vaginosis . Thirty-four episodes of VC occurred among 164 women followed for a median of 21 months . The relative risk of experiencing an episode of VC was 0.4 ( 95 % CI = 0.2 , 0.9 ) in the clotrimazole arm and 0.5 ( 95 % CI = 0.2 , 1.1 ) in the Lactobacillus acidophilus arm . The estimated median time to first episode VC was longer for clotrimazole ( p = .03 , log rank test ) and Lactobacillus acidophilus ( p = .09 , log rank test ) compared with placebo . Vaginal yeast infections can be prevented with local therapy . Education about self-care for prophylaxis of VC should be offered to HIV-infected women BACKGROUND Recurrent urinary tract infections are a problem for many postmenopausal women .  Estrogen replacement restores atrophic mucosa , lowers vaginal pH , and may prevent urinary tract infections . METHODS We enrolled 93 postmenopausal women with a history of recurrent urinary tract infections in a r and omized , double-blind , placebo-controlled trial of a topically applied intravaginal estriol cream . Midstream urine cultures were obtained at enrollment , monthly for eight months , and whenever urinary symptoms occurred . Vaginal cultures and pH measurements were obtained at entry and after one and eight months . The women were assigned to receive either estriol ( n = 50 ) or placebo ( n = 43 ) , both administered intravaginally ; 36 and 24 , respectively , completed the eight months of follow-up . RESULTS The incidence of urinary tract infection in the group given estriol was significantly reduced as compared with that in the group given placebo ( 0.5 vs. 5.9 episodes per patient-year , P < 0.001 ) . Survival analysis showed that more of the women in the estriol group than in the placebo group remained free of urinary tract infection ( P < 0.001 ) . Lactobacilli were absent in all vaginal cultures before treatment and reappeared after one month in 22 of 36 estriol-treated women ( 61 percent ) but in none of the 24 placebo recipients ( P < 0.001 ) . With estriol the mean vaginal pH declined from 5.5 to 3.8 ( P < 0.001 ) , whereas there was no significant change with placebo . The rate of vaginal colonization with Enterobacteriaceae fell from 67 percent to 31 percent in estriol recipients but was virtually unchanged ( from 67 to 63 percent ) in the placebo recipients ( P < 0.005 ) . Side effects were minor , but caused 10 estriol recipients ( 28 percent ) and 4 placebo recipients ( 17 percent ) to discontinue treatment . CONCLUSIONS The intravaginal administration of estriol prevents recurrent urinary tract infection in postmenopausal women , probably by modifying the vaginal flora BACKGROUND & AIMS Pouchitis is the major long-term complication after ileal pouch-anal anastomosis for ulcerative colitis . Most patients have relapsing disease , and no maintenance treatment study has been performed . We evaluated the efficacy of a probiotic preparation ( VSL#3 ) containing 5 x 10(11 ) per gram of viable lyophilized bacteria of 4 strains of lactobacilli , 3 strains of bifidobacteria , and 1 strain of Streptococcus salivarius subsp . thermophilus compared with placebo in maintenance of remission of chronic pouchitis . METHODS Forty patients in clinical and endoscopic remission were r and omized to receive either VSL#3 , 6 g/day , or an identical placebo for 9 months . Patients were assessed clinical ly every month and endoscopically and histologically every 2 months or in the case of a relapse . Fecal sample s were collected for stool culture before and after antibiotic treatment and each month during maintenance treatment . RESULTS Three patients ( 15 % ) in the VSL#3 group had relapses within the 9-month follow-up period , compared with 20 ( 100 % ) in the placebo group ( P < 0.001 ) . Fecal concentration of lactobacilli , bifidobacteria , and S. thermophilus increased significantly from baseline levels only in the VSL#3-treated group ( P < 0.01 ) . CONCLUSIONS These results suggest that oral administration of this new probiotic preparation is effective in preventing flare-ups of chronic pouchitis Background and Objectives : Incidence of  C and ida vaginitis by age and racial or ethnic group is poorly described . Goal : Estimate incidence , cumulative probability of presumed C vaginitis by age , racial or ethnic group , and associated costs . Study Design :  R and om digit‐dialing survey of 2000 US women . Results : A total of 6.5 percent ( 95 % CI , 5.4‐7.5 % ) of women older than 18 years reported a least one episode of presumed C vaginitis during the previous 2 months . Women reporting a 1‐year period with four or more episodes comprised 8.0 % of the sample but accounted for 37.2 % of women reporting episodes . Black women reported approximately three times more yeast infections in the previous 2 months ( 17.4 % ; 95 % CI , 11.2‐23.5 % ) than white women ( 5.8 % ; 95 % CI , 4.7‐6.9 % ) . Conclusion : The high incidence and the propensity for recurrence underscore the need for a better underst and ing of the epidemiology and pathogenesis , and stress the need for the development of more accurate , rapid diagnostics and effective treatments 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 : It has been suggested that probiotics can reduce the overgrowth of pathogens in the bowels of preterm infants and contribute to the reduction of the incidence of nosocomial infections in neonatal intensive care units ( NICUs ) . The purpose of this study was to evaluate the effectiveness of Lactobacillus GG supplementation in reducing the incidence of urinary tract infections ( UTIs ) , bacterial sepsis and necrotizing enterocolitis ( NEC ) in preterm infants . Methods : A double-blind study was conducted in 12 Italian NICUs . Newborn infants with a gestational age <33 weeks or birthweight < 1,500 g were r and omized to receive st and ard milk feed supplemented with Lactobacillus GG ( Dicoflor ® , Dicofarm , Rome , Italy ) in a dose of 6 × 109 colony-forming units ( cfu ) once a day until discharge , starting with the first feed or placebo . Results : Five hundred eighty-five patients were studied . The probiotics group ( n = 295 ) and the placebo group ( n = 290 ) exhibited similar clinical characteristics . The duration  of Lactobacillus GG and placebo supplementation was 47.3 ± 26.0 and 48.2 ± 24.3 days , respectively . Although UTIs ( 3.4 vs. 5.8 % ) and NEC ( 1.4 vs. 2.7 % ) were found less frequently in the probiotic group compared to the control group , these differences were not significant . Bacterial sepsis was more frequent in the probiotics group ( 4.4 % , n = 11 ) than in the placebo group ( 3.8 % , n = 9 ) , but the difference was not significant . Conclusion : Seven days of Lactobacillus GG supplementation starting with the first feed is not effective in reducing the incidence of UTIs , NEC and sepsis in preterm infants . Further studies are required to confirm our results in lower birthweight population 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 OBJECTIVES Bacterial vaginosis is characterized by alteration of the normal vaginal microflora , in which a mixed anaerobic bacterial flora becomes prevalent over the population of lacobacilli . Because administration of probiotics might be of some utility in restoring a normal flora , the present study aim ed to evaluate the effect of a Lactobacillus acidophilus-strain-based douche on the vaginal environment in bacterial vaginosis . PATIENTS AND METHODS In an open-label pilot evaluation , 40 women with bacterial vaginosis as defined by Amsel 's criteria were treated for 6 days with a douche containing L. acidophilus . Vaginal smears were collected from the patients and analyzed according to Nugent 's criteria at the time of diagnosis , after 6 days of treatment , and again at 20 days after the last treatment . At the same times , determination of vaginal pH and a Whiff test were performed . RESULTS The Nugent score decreased significantly from bacterial vaginosis or an intermediate flora toward a normal flora during treatment , and remained low during the follow-up period for almost all of the patients , indicating bacterial vaginosis in 52.5 % and in 7.5 % of the patients before treatment and at follow-up , respectively . After treatment , significant decreases in vaginal pH were observed , to less than pH 4.5 in 34/40 women , and the odor test became negative in all of the patients . CONCLUSIONS In this preliminary study , treatment of bacterial vaginosis with a vaginal douche containing a strain of L. acidophilus contributed to the restoration of a normal vaginal environment 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 Changes in the indigenous vaginal microflora with uropathogenic bacteria can predispose women to frequently recurring bacterial cystitis . Lactobacilli used as probiotics have played an important role in preventing the colonization of pathogenic bacteria in the vagina . A prospect i ve clinical pilot study was performed to confirm the safety and effectiveness of Lactobacillus vaginal suppositories against the recurrence of bacterial urinary tract infection ( UTI ) . The patients enrolled in the study were instructed to administer vaginal suppositories containing the strain Lactobacillus crispatus GAI 98322 . A significant reduction in the number of recurrences was noted , without any adverse complication ( P=0.0007 ) . The administration of vaginal suppositories containing L. crispatus GAI 98332 seemed to be a safe and promising treatment for the prevention of recurrent UTI Objective To evaluate the effectiveness of live lactobacilli in combination with low dose oestriol for restoration of the vaginal flora after anti‐infective treatment In a prospect i ve cohort study , 10 symptomatic women with recurrent vulvovaginal c and idiasis were taught how to prepare vaginal smears of their own vaginal fluids on days 7 , 14 , 21 , and 28 . The 40 smears were stained with the PAS- method and examined by three different cytopathologists for presence of C and ida . Thereafter , the smears were restained with Giemsa-stain to determine presence of lactobacilli , Gardnerella vaginalis ( " clue cells " ) and neutrophils . All three cytopathologists unequivocally established C and ida blastospores and (pseudo)hyphae in 27 out of the 40 PAS-stained vaginal smears , whereas in the remaining 13 smears C and ida was not found . All 10 patients had C and ida  in their smears during the second half of their menstrual cycle . Self sample d smears prove to be reliable for establishing the presence of C and ida in symptomatic patients with c and idiasis . C and ida is associated with a lactobacillus-predominated vaginal flora , but with the absence of Gardnerella vaginalis . Further studies may be directed towards the interaction between the various members of the vaginal flora . This study should open molecular methodology for determining the possible interactions of lactobacilli and C and ida
target: Overall , lactobacilli were beneficial for the treatment of patients with bacterial vaginosis .
  No clear benefit was seen for c and idiasis or urinary tract infection .
  In conclusion , the use of certain lactobacillus strains such as L. rhamnosus GR-1 and L. reuteri for prevention and treatment of recurrent urogenital infection is promising , especially for recurrent bacterial vaginosis .
background: Abstract Probiotics are increasingly being used to treat and prevent urogenital infections .
  However , a critical assessment of their efficacy in major urogenital infections is lacking .
  We report the results of a systematic review to determine the efficacy of probiotics for prevention or treatment of three major urogenital infections : bacterial vaginosis , vulvovaginal c and idiasis , and urinary tract infection .