Could Probiotics Be an Option for Treating and Preventing Urogenital Infections?

Gregor Reid, PhD, MBA, Andrew W. Bruce, MD, FRCS

In This Article


Probiotics can be viewed as "the use of microorganisms to confer health benefits to the host." The concept of probiotics came from the belief that a disrupted microflora in the host could be restored by exogenous application of bacteria commonly found in that niche. Probiotic therapy was likely practiced many hundreds of years ago via fermented milk products such as those used by Nobel Laureate Elie Metchnikoff in the early part of the 20th century. Because of the association with milk fermentation, most probiotic organisms have been ingested as dairy products to confer benefits to the gut. However, the therapy is far from restricted to this milieu, and applications to urogenital infections date back at least to 1915. Unfortunately, scientific advances in chemotherapy and a failure to fund investigations into what retains health rather than what causes disease led to a period of about 50-70 years in which few studies were done on probiotics. Indeed, the field was maligned by many scientists and clinicians, who categorized them as either alternative therapy or "an old wife's tale." (The latter term is especially inappropriate.) For example, to our knowledge, no federal government medical research funding in Canada has been awarded for probiotic therapeutics for at least the past 15 years.

It seems timely and rational to consider the potential place that probiotics may have in preventing and treating infections. The most common bacteria used in probiotic therapy (ie, for application to the gut, oral cavity, nasopharnyx, skin, and urogenital tract) are lactic acid bacteria, especially lactobacilli, but other organisms such as bifidobacteria and Saccharomyces have also been selected. Unfortunately, a cautionary note is warranted: Many of the preparations readily available through health food stores and over-the-counter at pharmacies are ineffective or at least not clinically proven to be effective. They may contain contaminants, dead bacteria,[44,45] and strains that possess no anti-uropathogenic activity. In addition, many of the claims about the preparations may be inappropriate, and ingredients may be incorrectly stated on the package label. Also, statements made on Web sites that promote certain probiotics do not relate to the specific product being sold.[46]

However, a number of probiotic products have been thoroughly researched, and good clinical evidence of their efficacy is currently available or will be in the near future. These include organisms that promote intestinal health, such as Lactobacillus rhamnosus GG (ConAgra, USA, and Valio, Finland),[47]Lactobacillus johnsonii LJ1 (Nestle, Switzerland),[48]Lactobacillus casei strain Shirota (Yakult, Japan),[49] and Lactobacillus acidophilus NCFM (Rhodia, Minnesota).[50] It has been established that L acidophilus NCFM and L rhamnosus GG are not ideal for urogenital applications.[51,52] Efforts have been made to identify suitable Lactobacillus strains for urogenital use.[29,40,41,53,54,55,56] Two strains specifically selected for urogenital applications[57,58,59,60,61,62] (see below), namely L rhamnosus GR-1 and L fermentum RC-14, have now been found to have additional attributes for intestinal health (Reid G, Charbonneau D, Erb J, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial. Manuscript in preparation).


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.