Microbiome Therapy: A New Treatment for Bacterial Vaginosis

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Bacterial vaginosis (BV) is a common bacterial infection of the vagina that can occur during pregnancy. In fact, it is the most common vaginal condition in women during their reproductive years, ages 15 through 44. In the United States, BV affects about 30 percent of women in this age group. BV has been covered by The Pulse and you can learn more about the basics here.

BV is troublesome for any woman because it causes vaginal discharge along with burning and itching. It can be treated with antibiotics, but it comes back within 12 weeks in about three-fourths of women, and may need to be treated again. In some cases, BV will go away on its own, but BV is especially problematic for pregnant women. During pregnancy, it has been linked to an increased risk of pre-term labor and giving birth to a low-birth-weight baby.

Now, a new study from researchers at the University of California San Francisco (UCSF) has discovered a promising new treatment that may reduce the risk of recurrence and may also be used to prevent BV during pregnancy and decrease the risk of premature labor and low birth weight. The new treatment uses the microbiome, called microbiome therapy.

The microbiome is the population of microbes that normally inhabits your body. We all have about 10 times more microbes than cells in our body. In the vagina there is a balance of healthy and harmful bacteria that coexist. In normal circumstances, the healthy bacteria outnumber the harmful bacteria. BV occurs when the balance is upset and harmful bacteria take over.

The new microbiome therapy uses a healthy bacteria species called Lactobacillus, which is produced into a powdered form. The medication is called LACTIN-V. Women can self-administered the powder directly into the vagina using an applicator. Once in the vagina, LACTIN-V produces lactic acid that inhibits the growth of harmful bacteria.

The study is reported in the May 2020 issue of The New England Journal of Medicine. Researchers recruited 228 women with BV. All the women were treated with an antibiotic vaginal gel, called metronidazole. After treatment, some women were treated with the LACTIN-V microbiome therapy. Another group of women were randomly assigned to received only the antibacterial gel treatment followed by a placebo.

The women in the treatment group applied the LACTIN-V powder once per day for 5 days and then continued applications at twice per week for 10 weeks. The other group used the placebo at the same rate. After 12 weeks, the researchers found a significant reduction in BV recurrence in the LACTIN-V group compared to the placebo group. LACTIN-V reduced the risk of BV recurrence by about 40 percent. There were no safety issues found in the treatment group.

Before LACTIN-V gets FDA-approval, there may need to be a larger trial completed, but the researchers are hopeful this trial will confirm their findings and lead to approval. In the meantime, make sure to let your pregnancy care giver know about any symptoms of BV, which may include:

  • A thin, white-to-gray vaginal discharge with a strong odor
  • Burning pain when passing urine
  • Pain, burning, and itching in and around the vagina

In addition to being dangerous during pregnancy, BV may also increase your risk of contracting a sexually transmitted disease like chlamydia or gonorrhea. In Africa, BV has been linked to a higher risk of spreading HIV.

The cause of BV is not completely understood. It rarely occurs in women who are not sexually active. You can reduce your risk of this infection by limiting your number of sex partners, not douching, and using a condom.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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