Effectiveness of oral probiotics and metronidazole compared with oral probiotics and metronidazole pessaries in the treatment of bacterial vaginosis in Chinese women

Min Zhao, Jiao Wang

Abstract

Chinese guidelines recommend oral or metronidazole pessaries for treating bacterial vaginosis (BV). Although oral metronidazole has high bioavailability, it often causes adverse effects, which may be minimized by using the pessaries. This study compared the effectiveness, adverse effects, and recurrence rates between two groups of women receiving oral probiotics plus 200 mg metronidazole pessaries and those receiving oral probiotics plus 400 mg oral metronidazole. Women with BV were treated for 7 days with either regimen for one month. Both groups showed significant improvement in vaginal pH and Nugent scores (p < 0.0001), with greater improvement in vaginal pH in the pessary group. Oral metronidazole was associated with side effects, including metallic taste, headache, dizziness, and gastrointestinal disturbances, while pessaries caused vulvar itching. Recurrence at 12 months was lower in the pessary group compared to the oral group (24% vs. 37%, p = 0.0105). We conclude that probiotics combined with metronidazole (especially in pessary form) showed effective treatment outcomes with manageable side effects in Chinese women with BV.

Full Text:

PDF

References

Peebles K, Velloza J, Balkus JE, McClelland RS and

Barnabas RV. High global burden and costs of

bacterial vaginosis: A systematic review and meta

analysis. Sex Transm Dis 2019; 46(5):304–311.

Qi F, Fan S, Fang C, Zhang L, Zhang Y, Li H, Zhou W, Wei

S and Wang H. Orally administrated Lactobacillus

gasseri TM13 and Lactobacillus crispatus LG55 can

restore the vaginal health of patients recovering from

bacterial vaginosis. Front Immunol 2023; 14:1–12.

Zhang R, Liu Z, Zhang Y, Zhang D and Liao Q. Natural

progress history of asymptomatic bacterial vaginosis

in Chinese Han women and associated risk factors.

Postgrad Med 2022; 134(7):659–667.

Ravel J, Moreno I and Simón C. Bacterial vaginosis and its

association with infertility, endometritis, and pelvic

inflammatory disease. Am J Obstet Gynecol 2021;

(3):251–257.

Cooperative Group of Infectious Disease, Chinese Society of

Obstetrics and Gynecology, Chinese Medical

Association. Guideline for diagnosis and treatment of

bacterial vaginosis (2021 revised edition). Chin J

Obstet Gynecol 2021; 56(1):3–6 [Article in Chinese].

Xiao B, Niu X, Han N, Yang Y, Xu Y, Zhang L, Sun Y,

Zhang R and Wang Y. Predictive value of the

composition of the vaginal microbiota in bacterial

vaginosis, a dynamic study to identify recurrence

related flora. Sci Rep 2016; 6:1–9.

Abou Chacra L, Fenollar F and Diop K. Bacterial vaginosis:

What do we currently know? Front Cell Infect

Microbiol 2022; 11:1–13.

Lee LL, Rowland J, Ling CH and Fiakos E. A quantity survey

of intravenous administration of metronidazole in its

different forms in a tertiary teaching hospital. Intern

Med J 2010; 40(8):592–596.

Watkins E, Chow CM, Lingohr-Smith M and others.

Bacterial vaginosis treatment patterns, associated

complications, and health care economic burden of

women with Medicaid coverage in the United States.

Ann Pharmacother 2024; 58(5):480–493.

Morgia G, Lo Giudice A, Carrino M, Barbalace F, Costa F,

D'Agostino D and Russo GI. Efficacy of

Palmitoylethanolamide, Epilobium and Calendula

suppositories for the treatment of patients with

chronic prostatitis/chronic pelvic pain syndrome type

III. Arch Ital Urol Androl 2024; 96(2):1–4.

Lyu J, Gao M, Zhao S, Zhang J, Li Q, Wang Y, Zhang Y,

He L, Zhang Q and Xu X From whole genomes to

probiotic candidates: A study of potential lactobacilli

strains selection for vaginitis treatment. Heliyon

; 10(9):1–13.

Sethi S, Kanaujia R, Yadav R, Kumar A, Gupta S, Agarwal

M, Sharma R, Bhattacharya S and Singh

M. Association of intermediate Nugent Score and bacterial

vaginosis with sexually transmitted

infections and vulvovaginal candidiasis. Indian J

Dermatol Venereol Leprol 2023; 90(3):296–301.

Vodstrcil LA, Muzny CA, Plummer EL, Sobel JD and

Bradshaw CS. Bacterial vaginosis: drivers of

recurrence and challenges and opportunities in

partner treatment. BMC Med 2021; 19(1):1–12.

Zhang Y, Yu D, Yang Q and Li W. Diagnostic efficacy of

physical examination, preoperative ultrasound,

and/or computed tomography in detecting lymph

node metastasis: A single-center retrospective

analysis of patients with squamous cell carcinoma of

the head and neck. Oral Surg Oral Med Oral Pathol

Oral Radiol 2022; 134(3):386–396.

Chen L, Cheng Y, Zhou L, Zhang L and Deng X.

Quantitative shear wave elastography compared to

standard ultrasound (qualitative B-mode grayscale

sonography and quantitative power Doppler) for

evaluation of achillotendinopathy in treatment-naïve

individuals: A cross-sectional study. Adv Clin Exp

Med 2022; 31(8):847–854.

Chen C, Hao L, Zhang Z, Liu Y, Zhang L, Li H, Liu L,

Wang H, Sun Y and Yang X. Cervicovaginal

microbiome dynamics after taking oral probiotics. J

Genet Genomics 2021; 48(8):716–726.

Martoni CJ, Frederiksen AKS, Damholt A and Leyer G.

Effects of a 10-strain oral probiotic on parameters of

vaginal health and microbial community: A pilot

clinical study. Int J Womens Health 2022; 14:29–39.

Reznichenko H, Henyk N, Maliuk V, Pasichnyk A,

Zhumagaliyeva A, Salimov R, Salakhov E, Kulyk O,

Voznyuk I and Pavlenko M . Oral intake of

lactobacilli can be helpful in symptomatic bacterial

vaginosis: A randomized clinical study. J Low Genit

Tract Dis 2020; 24(3):284–289.

Recine N, Palma E, Domenici L, Giorgini M, Imperiale L,

Sassu C, Musella A, Marchetti C, Muzii L and

Benedetti Panici P. Restoring vaginal microbiota:

biological control of bacterial vaginosis. A

prospective case-control study using Lactobacillus

rhamnosus BMX 54 as adjuvant treatment against

bacterial vaginosis. Arch Gynecol Obstet 2016;

(1):101–107.

Husain S, Allotey J, Drymoussi Z, Wilks M, Fernandez

Felix BM, Whiley A, Dodds J, Thangaratinam S,

McCourt C, Prosdocimi EM, Wade WG, de Tejada

BM, Zamora J, Khan K and Millar M.Effects of oral

probiotic supplements on vaginal microbiota during

pregnancy: a randomised, double-blind, placebo

controlled trial with microbiome analysis. BJOG

; 127(2):275–284.

Delfstra NS, Uijen AA, Vos MC, Akkermans R, Lagro

Janssen AL

and Teunissen DAM. Patient

characteristics and factors contributing to recurrence

of bacterial vaginosis presented in primary care. Fam

Pract 2023; 40(5-6):655–661.

Sobel JD and Sobel R. Current and emerging

pharmacotherapy for recurrent bacterial vaginosis.

Expert Opin Pharmacother 2021; 22(12):1593–1600

Refbacks

  • There are currently no refbacks.