Nancy Toedter Williams


Am J Health Syst Pharm. 2010;67(6):449-458. 

In This Article

Genitourinary Infections

Abnormal vaginal microbiota may lead to symptomatic infections, including vulvovaginal candidiasis (VVC). Lactobacilli, especially Lactobacillus crispatus and Lactobacillus iners, are the predominant vaginal microorganisms in healthy premenopausal women. When the normal vaginal microflora is disrupted, such as with use of broad-spectrum antibiotics, overgrowth of Candida albicans may occur, causing VVC. Restoring the normal flora with lactobacilli may help treat this genital infection.[53] Hilton et al.[54] conducted a study involving 28 women with a history of recurrent VVC who also had signs and symptoms of active VVC. After the administration of vaginal suppositories containing LGG twice daily for seven days, all of the women reported an improvement in vaginal symptoms and reduced vaginal erythema and discharge. Reid et al.[55] investigated the ability of an orally administered solution containing L. rhamnosus GR-1 and L. fermentum RC-14 to colonize the vagina in 10 women who were asymptomatic for infection but who had a history of recurrent urogenital infections, primarily recurrent VVC. The probiotic solution was administered twice daily for 14 days. Within one week, one or both of the Lactobaccillus strains were recovered from the vaginas of all 10 women, and no VVC occurred during the study. Hilton et al.[56] found that consumption of 8 oz of yogurt containing L. acidophilus daily for six months reduced vaginal colonization and infection by Candida species in a crossover trial involving 33 women with recurrent VVC, 13 of whom completed the protocol. The mean number of candidal infections of the vagina and candidal colonization in the vagina and rectum were significantly lower in the women who consumed yogurt versus the control group (0.38 versus 2.54, p = 0.001 and 0.84 versus 3.23, p = 0.001, respectively). However, these three studies had important methodological limitations, including small sample sizes, inadequate controls, and lack of blinding. Two of the studies lacked detailed statistical analyses,[54,55] one study had a high attrition rate,[56] and more than half of the women in one study had recently completed treatment with antifungal medications.[54] Therefore, it is difficult to reliably conclude whether probiotics can prevent recurrent VVC.


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