The RCT also found that probiotic supplementation could reduce the recurrence of vagina candidiasis while increasing bowel frequency at the same time.
Vagina candidiasis is an infection usually caused by the fungus Candida Albicans. Overgrowth of the fungus could be caused by changes in hormone levels, immune conditions, and taking antibiotics for chemotherapy.
It can often lead to a burning sensation in the vagina vulva and the production of white, yellow curd-like discharge, as well as causing itch.
Pregnant women are at higher risk of vaginal candidiasis, regardless of their age and trimester. The infection could also go on to infect newborns, especially those who are born premature or have low birth weight.
A previous study by Pendhakar et al showed that a balanced vaginal microbiota which includes Lactobacillus jensenii and Lactobacillus crispatus could prevent the overgrowth of fungus.
Writing in the Journal of Applied Microbiology, researchers from Universiti Sains Malaysia found out that a six-strain Lactobacillus probiotic formulation could significantly improve symptoms and reduce the recurrence of vagina candidiasis.
“Of all vulvovaginal symptoms being evaluated in the present study, probiotic exerted a more prominent effect against vaginal burning, irritation, and discharge.
“While probiotics were administered orally, health beneficial effects occurring at vaginal sites may be attributed to increased immune-modulatory parameters that affect the host,” the researchers said.
Study design
Seventy-eight pregnant women with vaginal candidiasis completed the study.
They were randomised to take either the placebo or the multi-strain probiotics formulation trademarked SynForU-HerCare.
This formulation is developed by Taiwan firm Synbio Tech and consists of six proprietary probiotic strains, namely Lactobacillus plantarum LP115, Lactobacillus helveticus LA25, Lactobacillus rhamnosus LRH10, Lactobacillus paracasei LPC12, Lactobacillus fermentum LF26, and Lactobacillus delbrueckii subsp. lactis LDL114 in the ratio of 3:3:3:6:1:3.
The formulation has been commercialised and used in finished products such as Cran-Max 34 from He-Yi Biotechnology and Simibaoer from Lin Din Biomedical.
Existing studies showed that these strains could adhere to the HeLa cells – a human cervical carcinoma cell line – and could produce hydrogen peroxide which inhibit infectious urogenital bacteria, such as Salmonella, E.coli, C. albicans, and Gardnerella vaginalis.
During the RCT, all patients were treated with the insertion of the anti-fungal medicine clotrimazole and took two capsules of either placebo or probiotics.
Effects of the trial were then assessed via the vulvovaginal symptoms questionnaire (VSQ) – a 21-item questionnaire.
The study was supported by the Graduate Research Assistant scheme of Universiti Sains Malaysia.
Reduced irritation and discharge
The probiotic group showed a quicker reduction in the symptoms of irritation and discharge. Significant improvements were seen from week four of the trial. In contrast, the placebo group only reported significant improvements at week eight.
At week four, the scores for vagina discharge had significantly reduced from 1.00 to 0.85±0.06 for the probiotic group, with a p-value of 0.011.
However, at week four, the score for the placebo group only reduced from 0.92±0.04 to 0.90±0.05, where the p value was higher than 0.05, and was thus not a significant change.
In terms of irritation, the score for the probiotic group dropped from 0.69±0.07 to 0.44±0.08 by week four, which was a significant change with a p-value of 0.023.
In contrast, in the placebo group, the score reduced from 0.51±0.08 to 0.31±0.07, which was not a significant change, since the p-value was higher than 0.05.
Significant reduction in burning sensation was also reported for the probiotic group at week eight, which was not seen in the placebo group.
Recurrence of vaginal candidiasis
Recurrence of vaginal candidiasis was seen in both groups during the RCT, but reduced recurrence was seen in the probiotic group.
“Patients consuming lactobacilli showed reduced recurrences as compared to the placebo at both week four (p=0.002 Vs p=0.018) and week eight (p=0.0002 Vs p=0.003),” said the researchers.
Increased bowel movement
Increased bowel movement was reported in the probiotic group. The researchers said this indicated that probiotic supplementation could reduce the risk of pregnancy-induced constipation.
Constipation was defined as three or less times of defecation per week.
In the probiotic group, weekly defecation frequency increased from 9.51±0.77 to 10.54±0.85 between the start and end of the trial.
As for the placebo group, this frequency reduced from 8.13±0.69 to 6.85±0.58 by the end of the trial.
Insignificant differences were seen in the frequency of sexual intercourse between both groups.
Source: Journal of Applied Microbiology
Lactobacilli Reduce Recurrences of Vaginal Candidiasis in Pregnant Women: A Randomized, Double-Blind, Placebo-Controlled Study
DOI: 10.1111/jam.15158
Authors: Min-Tze Liong et al
