Harnessing Probiotics and Prebiotics for the Prophylaxis and Treatment of Bacterial Vaginosis

Introduction

The human vaginal microbiome forms a close association with the host and serves as a critical determinant of vaginal health. This dynamic vaginal microflora has critical implications for preventing urogenital infections. The vaginal micro milieu is composed of Lactic acid bacteria (LAB) and the lactic acid produced by them maintains the low pH of the vagina, and the antimicrobial, anti-inflammatory products inhibit the growth of harmful bacteria. The glycogen-rich vaginal milieu of high estrogen states stimulates the proliferation of Lactobacilli in the vaginal microenvironment¹. However, factors like antibiotic usage, hormonal changes, menses, pregnancy, immune status of the patient, chronic stress, sexual practices and vaginal douching can alter the vaginal microbial community². Dysbiosis of this microenvironment lacking significant numbers of Lactobacillus spp. and elevated pH may lead to the proliferation of various anaerobic and facultative anaerobic pathogenic bacteria such as Gardnerella, Prevotella, Atopobium, Mobiluncus, Mycoplasma, Ureaplasma, Streptococcus, Dialister, Bacteroides etc. and cause bacterial vaginosis (BV) and other urinary tract infections².

The use of antibiotics against these bacterial infections only gives temporal relief and may cause serious conditions of antibiotic resistance and kill a wide range of beneficial vaginal microbes³. Hence the use of probiotics and prebiotics could be a potent alternative remedy for bacterial vaginosis and other bacterial infections and helps to optimize, maintain, and restore the vaginal acidic environment and vaginal ecosystem.

Many single and multi-probiotic strains, such as Lacticaseibacillus rhamnosus, Lact. acidophilus, Limosilactobacillus reuteri, Lact. gasseri,Lactiplantibacillus plantarum, Limosilactobacillus fermentum, Levilactobacillus brevis,Lact. delbrueckii, Ligilactobacillus salivarius, B. longum, Bifdobacterium bifdum, etc are well-studied and characterized and commercially available for the treatment of bacterial vaginosis and vaginitis³. Prebiotics such as polysaccharides, oligosaccharides, and carbohydrates can also optimize, maintain, and restore the vaginal acidic environment and vaginal ecosystem⁴. However, a combination of probiotics and prebiotics (biotherapeutics) to populate healthy vaginal microbiota to prevent or treat infection will be perhaps more realistic.

Worldwide studies on probiotics, prebiotics, and commercial synbiotic products for vaginal health are in a nascent state. There must be a need for a good understanding and validation of vaginal microbes for the prophylaxis and treatment of urinary tract infections. Hence,...