The Restoration of the Vaginal Microbiota After Treatment for Bacterial Vaginosis with Metronidazole or Probiotics

Article (PDF Available)inMicrobial Ecology 65(3) · December 2012with434 Reads
DOI: 10.1007/s00248-012-0154-3 · Source: PubMed
Whether or not treatment with antibiotics or probiotics for bacterial vaginosis (BV) is associated with a change in the diversity of vaginal microbiota in women was investigated. One hundred fifteen women, consisting of 30 healthy subjects, 30 BV-positive control subjects, 30 subjects with BV treated with a 7-day metronidazole regimen, and 25 subjects with BV treated with a 10-day probiotics regimen, were analyzed to determine the efficacy and disparity of diversity and richness of vaginal microbiota using 454 pyrosequencing. Follow-up visits at days 5 and 30 showed a greater BV cure rate in the probiotics-treated subjects (88.0 and 96 %, respectively) compared to the metronidazole-treated subjects (83.3 and 70 %, respectively [p = 0.625 at day 5 and p = 0.013 at day 30]). Treatment with metronidazole reduced the taxa diversity and eradicated most of the BV-associated phylotypes, while probiotics only suppressed the overgrowth and re-established vaginal homeostasis gradually and steadily. Despite significant interindividual variation, the microbiota of the actively treated groups or participants constituted a unique profile. Along with the decrease in pathogenic bacteria, such as Gardnerella, Atopobium, Prevotella, Megasphaera, Coriobacteriaceae, Lachnospiraceae, Mycoplasma, and Sneathia, a Lactobacillus-dominated vaginal microbiota was recovered. Acting as vaginal sentinels and biomarkers, the relative abundance of Lactobacillus and pathogenic bacteria determined the consistency of the BV clinical and microbiologic cure rates, as well as recurrent BV. Both 7-day intravaginal metronidazole and 10-day intravaginal probiotics have good efficacy against BV, while probiotics maintained normal vaginal microbiota longer due to effective and steady vaginal microbiota restoration, which provide new insights into BV treatment.


    • "V ( Donders et al . , 2010 ; Ling et al . , 2013 ) . Further analysis of one pilot study that utilized probiotics in patients with BV revealed that probi - otics do not eliminate harmful taxonomy , as did antibiotics , but rather suppressed the overgrowth of bacterial strains associated with BV thus possibly leading to its enhanced effectiveness ( Ling et al . , 2013 ) . Additionally , it has been reported that inoculation of the uterine microbiome with Lactobacillus crispatus at the time of embryo transfer can increase implantation rates and reduce colonization of pathogenic microorganisms ( Sirota et al . , 2014 ) ."
    [Show abstract] [Hide abstract] ABSTRACT: Humans have evolved along with the millions of microorganisms that populate their bodies. These microbes (1014) outnumber human cells by 10 to 1 and account for 3 × 106 genes, more than ten times the 25,000 human genes. This microbial metagenome acts as our “other genome” and like our own genes, is unique to the individual. Recent international efforts such as the Human Microbiome Project (HMP) and the MetaHIT Project have helped catalog these microbial genomes using culture-independent, high-throughput, next-generation sequencing. This manuscript will describe recent efforts to define microbial diversity in the female reproductive tract because of the impact that microbial function has on reproductive efficiency. In this review, we will discuss current evidence that microbial communities are critical for maintaining reproductive health and how perturbations of microbial community structures can impact reproductive health from the aspect of infection, reproductive cyclicity, pregnancy, and disease states. Investigations of the human microbiome are propelling interventional strategies from treating medical populations to treating individual patients. In particular, we highlight how understanding and defining microbial community structures in different disease and physiological states have lead to the discovery of biomarkers and, more importantly, the development and implementation of microbial intervention strategies (probiotics) into modern day medicine. Finally this review will conclude with a literature summary of the effectiveness of microbial intervention strategies that have been implemented in animal and human models of disease and the potential for integrating these microbial intervention strategies into standard clinical practice.
    Full-text · Article · Mar 2015
    • "Schwebke and Desmond (32) reported 76.8% improvement in Amsel’s criteria after treatment with metronidazole. In another study, improvement rate of Amsel’s clinical criteria at five days and at one month after treatment with metronidazole was reported as 83.3% and 70%, respectively (33). In the present study, the majority of subjects in garlic and metronidazole groups had white homogenous discharge. "
    [Show abstract] [Hide abstract] ABSTRACT: Background:Bacterial vaginosis (BV) is one of the most common gynecological infections during reproductive age. Although metronidazole is one of the most effective medications recommended as the first-line treatment, it has various side effects. Because of the side effects and contraindications of some chemical medicines, using herbs has been investigated in treating BV.Objectives:The aim of this study was to compare the effect of garlic tablet (Garsin) and oral metronidazole in clinical treatment of the BV in women referred to Resalat Health Center, affiliated with Mazandaran University of Medical Sciences, in 2013.Patients and Methods:This randomized clinical trial was conducted on 120 married women aged 18 to 44 years who were diagnosed with BV by Amsel’s clinical criteria and Gram staining. Enrolled women were randomly allocated to two groups of 60 patients and were treated with either garlic tablet or oral metronidazole for seven days. Amsel’s criteria and Gram stain were assessed seven to ten days after beginning the treatment period and side effects were registered.Results:Amsel’s criteria were significantly decreased after treatment with garlic or metronidazole (70% and 48.3%, respectively; P < 0.001). Therapeutic effects of garlic on BV were similar to that of metronidazole (63.3% and 48.3%, respectively; P = 0.141). There were significant differences between the two treatment groups in terms of side effects; metronidazole was associated with more complications (P = 0.032).Conclusions:This study reveals that garlic could be a suitable alternative for metronidazole in treatment of BV in those interested in herbal medicines or those affected by side effects of metronidazole.
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    • "Amplicon pyrosequencing was performed with standard 454/Roche GS-FLX Titanium protocols, where equal molar of PCR product from each sample was pooled. To pool and sort multiple samples in a single 454 GS-FLX run, we used a set of 8-bp barcodes designed according to Fierer et al. [20,21,24,56575859. The main criterion of the barcodes is that the adjoining nucleotides are different because the single nucleotide repeats are the main source of errors in pyrosequencing technology. "
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    Full-text · Article · Jun 2013
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