The Rationale for Probiotics in Female Urogenital Healthcare

Gregor Reid PhD MBA, BSc (Hons); Jeremy Burton PhD; Estelle Devillard PhD

Disclosures
In This Article

Practical Steps for Clinical Practice

For the general practice physician, it is difficult to apply probiotic concepts to patient care because products especially designed for female urogenital health are not yet available. In terms of diagnosis of abnormal vaginal microbiota, a simple Gram stain of a vaginal swab can determine, with reasonable effectiveness, the extent to which the vagina contains or has depleted numbers of lactobacilli. The dominant presence of Gram-negative rods, yeast, or Gram-positive cocci is suggestive of an infectious or potentially infectious state. In many women, this imbalance seems to self-correct on a regular basis for reasons not yet understood, but in others an asymptomatic condition progresses to a symptomatic one that will require treatment. The easily performed Gram stain can also indicate whether a patient is likely to have BV or yeast vaginitis.

The antibiotic or antifungal to be prescribed should have limited adverse effect on the indigenous bowel and vaginal microbiota. Such agents as nitrofurantoin and some newer classes of macrolides and cephalosporins may not induce a yeast vaginitis, a condition that has long been associated with antibiotic eradication of indigenous microflora.[95]

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