Probiotics Use in Bacterial Vaginosis and Vulvovaginal Candidiasis

The female lower genital tract, consisting of vagina and ectocervix, is an ecological niche where several aerobe and anaerobe microorganisms coexist in a dynamic balance. The homeostasis of the vaginal ecosystem results from complex interactions and synergies among the host and different microorganisms that colonize the vaginal mucosa. In healthy women, the vaginal ecosystem is dominated by Lactobacillus spp., but a diverse array of other bacteria can be present in much lower numbers. Mainly frequent undesirable organisms are yeasts (Candida albicans, Candida tropicalis, Candida krusei), anaerobic bacteria responsible for vaginosis (Gardnerella vaginalis, Atopobium vaginae, Prevotella, Veillonella), uropathogens (Escherichia coli, Proteus, Klebsiella, Serratia), and sexually transmitted viruses (HIV, Herpes virus). Lactobacilli are involved in maintaining the normal vaginal microflora by preventing overgrowth of pathogenic and opportunistic organisms. Bacterial vaginosis (BV) represents the most common vaginal syndrome afflicting fertile, postmenopausal and pregnant women, with an incidence rate ranging from 5% to 50%. BV is a complex, polymicrobial disorder characterized by an overgrowth of strict or facultative anaerobic bacteria (Gardnerella vaginalis, Prevotella, Mobiluncus, Mycoplasma hominis) and a reduction of lactobacilli particularly those producing hydrogen peroxide. Women with BV typically complain of vaginal discomfort and homogeneous malodorous vaginal discharge, which is more noticeable after unprotected intercourse, although a substantial fraction of women are asymptomatic. Vaginitis is a common gynecological condition which may significantly affect the patient’s quality of life and is one of the most common reasons for gynecologic consultation. It is characterized by abnormal or increased discharge, itching, burning, irritation, and sometimes even painful urination or vaginal bleeding. The most common causative agents of vaginitis in adults are Candida spp. and Trichomonas vaginalis. Vulvovaginal candidiasis (VVC) accounts for the majority of vaginitis cases. There are tens of different species of Candida and the most common causative agent for vaginitis is Candida albicans. It has been estimated that 75% of women can be affected by VVC at least once during their lifetime. Between 40% and 50% of these women is affected by recurrent VVC, and 5% to 8% experience chronic Candida infections.