Context: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women during their fertile years. BV prevalence runs from 10%-50%, in part due to the high rate of recurrence after standard treatment. Women with BV may experience a decreased quality of life and are at risk of serious obstetric complications. Limited data are available regarding optimal management strategies for preventing recurrence of BV, emphasizing the importance of the availability of a comprehensive source of scientific information and therapeutic strategies.
Objective: The aim of this study was to evaluate the frequency and clinical relevance of the recurrence of BV and to collect and review data about prophylactic approaches based on probiotic supplementation with lactobacilli (LB).
Methods: A review of the literature was performed, based on combinations of the following keywords: bacterial vaginosis, bacterial vaginosis recurrences, vaginal discharge, vaginal flora, LB, Lactobacillus rhamnosus, and probiotic supplementation.
Outcome measures: The studies were evaluated in terms of the cure rates for BV, incidence of recurrence of BV, decrease in patients' discomfort, maintenance of a healthy vaginal recolonization, and occurrence of complications and side effects.
Results: Recurrence of BV after standard therapy is a relevant clinical problem, with an incidence of 30%-40% and a significant impact on women's quality of life and on their risk of infrequent but serious obstetric complications. Therefore, finding effective prophylactic therapies to avoid or decrease the recurrence of BV is important. Even when they are effective, typical antibacterial regimens for long-term maintenance are known to have side effects. Different schemes of treatment with exogenous LB have proven effective in preventing recurrence of BV, even in patients at high risk for relapse.
Conclusions: Probiotic supplementation with vaginal LB proved to be crucial in hindering bacteria growth after antibiotic therapy; therefore this intervention may be considered a new adjuvant treatment for preventing recurrence of BV, even in high-risk patients.