Probiotic Lactobacilli as a Promising Alternative Treatment for Vulvovaginal Candidiasis
Vulvovaginal candidiasis (VVC) is a common condition characterized by severe symptoms and high recurrence rates. Probiotic lactobacilli are being investigated as alternatives to azole treatments. Although the vaginal microbiota is generally not depleted of lactobacilli during VVC, studies indicate that the functionality and antimicrobial activity of the lactobacilli are impaired.
Exploring Microbial Functionality and Treatment Impact
We selected three strains from the Lactobacillus genus complex (L. rhamnosus GG, L. pentosus KCA1 and L. plantarum WCFS1) based on in vitro evaluation and formulated them into a gel for vaginal application. This gel was evaluated in 20 patients with acute VVC, who were followed for four weeks, including a 10-day treatment period. The microbiome was assessed through 16S rRNA (bacteria) and internal transcribed spacer (ITS; fungi) amplicon sequencing, supplemented with quantitative PCR, culture, and microscopy for Candida evaluation. 45% of women did not require rescue medication (3 × 200 mg fluconazole), suggesting an improvement in their symptoms. These women had similar final fungal concentrations as women treated with fluconazole. Furthermore, fluconazole appeared to reduce the number of endogenous lactobacilli. Our study highlights important considerations for the future selection of lactobacilli for probiotic use in VVC and the need to investigate the possible negative effects of azoles on the vaginal bacterial community.
Authors: Eline F. M. Oerlemans, Gert Bellen, Ingmar Claes, Tim Henkens, Camille Nina Allonsius, Stijn Wittouck, Marianne F. L. van den Broek, Sander Wuyts, Filip Kiekens, Gilbert G. G. Donders, and Sarah Lebeer
