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Vicariotto F, Malfa P, Viciani E, Dell’Atti F, Squarzanti DF, Marcante A, Castagnetti A, Ponchia R, Governini L, De Leo V. Efficacy of Lactiplantibacillus plantarum PBS067, Bifidobacterium animalis subsp. lactis BL050, and Lacticaseibacillus rhamnosus LRH020 in the Amelioration of Vaginal Microbiota in Post-Menopausal Women: A Prospective Observational Clinical Trial. Nutrients 2024; 16:402. [PMID: 38337685 PMCID: PMC10857347 DOI: 10.3390/nu16030402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
The menopausal transition marks a significant physiological shift in women. Menopause-related symptoms can significantly affect a woman's quality of life and probiotics have emerged as a promising avenue. This study aims to investigate the benefits of probiotics in improving vaginal well-being and microbiota composition in post-menopausal women. A prospective observational clinical trial was carried out enrolling 50 post-menopausal healthy women, aged between 45 and 65 years old, taking a supplement containing Lactiplantibacillus plantarum PBS067, Bifidobacterium animalis subsp. lactis BL050, and Lacticaseibacillus rhamnosus LRH020 (3B CFU/day) for 28 days. Vaginal swabs were collected to evaluate microbiota fluctuation and the inflammatory pattern was recorded. A Vaginal Health Index was provided to evaluate vaginal well-being throughout the trial. Clinical outcomes revealed a decrease in menopausal symptoms. Significant improvements were observed across various parameters: a 50% enhancement in the VHI score (p < 0.0001), alongside substantial reductions in inflammatory cytokine levels. An 87.8% decrease in IL-6, 57.6% in IL-1β, and 40.8% in TNF-α was observed (p < 0.05). Moreover, the probiotic intervention facilitated the restoration of vaginal microbiota, evidenced by an increase in lactobacilli abundance. In conclusion, the combination of these specific probiotic strains, previously clinically tested in childbearing-age women, showed to be effective also for post-menopausal women.
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Affiliation(s)
| | - Patrizia Malfa
- R&D Department, SynBalance Srl, 21040 Origgio, VA, Italy;
| | - Elisa Viciani
- Wellmicro Srl, 40138 Bologna, BO, Italy; (E.V.); (A.M.); (A.C.)
| | - Federica Dell’Atti
- Immunomics Laboratory, Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), University of Eastern Piedmont, 28100 Novara, NO, Italy;
| | | | - Andrea Marcante
- Wellmicro Srl, 40138 Bologna, BO, Italy; (E.V.); (A.M.); (A.C.)
| | | | - Rosetta Ponchia
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, SI, Italy; (R.P.); (L.G.); (V.D.L.)
| | - Laura Governini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, SI, Italy; (R.P.); (L.G.); (V.D.L.)
| | - Vincenzo De Leo
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, SI, Italy; (R.P.); (L.G.); (V.D.L.)
- Medical Policlinic Colledoro, 53100 Siena, SI, Italy
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Silva VF, Refinetti P, Vicariotto F, Baracat EC, Soares JM. Oral probiotics and vaginal microbiome in post-menopause women: an opinion for the improvement of natural therapies in gynecology. Rev Assoc Med Bras (1992) 2024; 70:e702EDIT. [PMID: 38198300 PMCID: PMC10768674 DOI: 10.1590/1806-9282.702edit] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/27/2023] [Indexed: 01/12/2024]
Affiliation(s)
| | | | | | - Edmund Chada Baracat
- Universidade de São Paulo, Faculty of Medicine, Clinical Hospital, Department of Obstetrics and Gynecology, Structural and Molecular Gynecology Laboratory (LIM-58), Gynecology Discipline – Sao Paulo (SP), Brazil
| | - Jose Maria Soares
- Universidade de São Paulo, Faculty of Medicine, Clinical Hospital, Department of Obstetrics and Gynecology, Structural and Molecular Gynecology Laboratory (LIM-58), Gynecology Discipline – Sao Paulo (SP), Brazil
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Vicariotto F, Malfa P, Torricelli M, Lungaro L, Caio G, De Leo V. Beneficial Effects of Limosilactobacillus reuteri PBS072 and Bifidobacterium breve BB077 on Mood Imbalance, Self-Confidence, and Breastfeeding in Women during the First Trimester Postpartum. Nutrients 2023; 15:3513. [PMID: 37630704 PMCID: PMC10458832 DOI: 10.3390/nu15163513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Background: The post-delivery period could be characterized by psychological distress (e.g., anxiety, sadness, and irritability), leading to postpartum depression (PPD). Objective: The present clinical study assesses the effect of probiotic supplementation containing Limosilactobacillus reuteri PBS072 and Bifidobacterium breve BB077 (4 × 109 CFU/day) on the mother's mood and breastfeeding quality during the first trimester after delivery. Methods: A Randomized, Double-Blind, Controlled (RDBPC) trial was carried out on 200 healthy new mothers divided into an active group taking a supplement containing Limosilactobacillus reuteri PBS072 and Bifidobacterium breve BB077 (4 × 109 CFU/day) plus multivitamins and a control group (multivitamin complex only) for 90 days. Symptoms related to maternal depression and breastfeeding quality were evaluated at days 45 and 90 using the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Results: At days 45 and 90, the probiotic treatment significantly ameliorated the mothers' mood compared to the control treatment (p < 0.001). Likewise, the breastfeeding quality and the baby's cries significantly improved in the probiotic group (p < 0.001). Conclusions: Microbiota alterations could influence a post-delivery woman's mental state. According to our results, L. reuteri PBS072 and B. breve BB077 are potential candidates that are able to improve stress resilience in the postpartum period.
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Affiliation(s)
| | | | - Michela Torricelli
- Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, 53100 Siena, SI, Italy;
| | - Lisa Lungaro
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, FE, Italy; (L.L.); (G.C.)
| | - Giacomo Caio
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, FE, Italy; (L.L.); (G.C.)
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
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Murina F, Vicariotto F, Lubrano C. Efficacy of an orally administered combination of Lactobacillus paracasei LC11, cranberry and D-mannose for the prevention of uncomplicated, recurrent urinary tract infections in women. Urologia 2020; 88:64-68. [PMID: 32954992 DOI: 10.1177/0391560320957483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most women experience a urinary tract infection (UTI) at least once in their lifetime. The present study determined the efficacy and safety of a combination of Lactobacillus paracasei LC11, cranberry and D-mannose (Lactoflorene Cist®) in the prophylaxis of recurrent uncomplicated UTIs in premenopausal women. METHODS This single-centre study enrolled premenopausal women aged 18-50 years with an acute UTI and a history of recurrent uncomplicated UTIs. Patients were first treated with fosfomycin (3 g once a day for 2 days) to eliminate any underlying infection, followed by treatment with Lactoflorene Cist® once a day for 10 days/month for 90 days (Group 1), Lactoflorene Cist® once daily for 90 days (Group 2) or no treatment (Group 3; control). The main study endpoint was the rate of UTI recurrence during the study period. Any adverse events with treatment were also recorded. RESULTS A total of 55 women (mean age 39.3 years; range: 20-46) were enrolled in the study. A significantly higher proportion of patients in the control group experienced UTIs during the study period compared with the two treatment groups (52.9% vs 16.0% in Group 1 and 15.5% in group 2; p < 0.01). Similarly, a higher proportion of patients in Group 1 (65.8%) and Group 2 (68.7%) remained UTI-free during the study versus the control group. No adverse events were reported in the treated patients. CONCLUSION Prophylactic treatment with Lactoflorene Cist® was effective and safe in the management of recurrent uncomplicated UTIs in premenopausal women.
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Affiliation(s)
- Filippo Murina
- Lower Genital Tract Disease Unit, V. Buzzi Hospital-University of Studies of Milan, Milan, Italy
| | - Franco Vicariotto
- Lower Genital Tract Disease Unit, V. Buzzi Hospital-University of Studies of Milan, Milan, Italy
| | - Chiara Lubrano
- Lower Genital Tract Disease Unit, V. Buzzi Hospital-University of Studies of Milan, Milan, Italy
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Murina F, Vicariotto F. Evaluation of an Orally Administered Multistrain Probiotic Supplement in Reducing Recurrences Rate of Bacterial Vaginosis: A Clinical and Microbiological Study. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/aid.2019.93011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Murina F, Vicariotto F, Di Francesco S. Thymol, eugenol and lactobacilli in a medical device for the treatment of bacterial vaginosis and vulvovaginal candidiasis. New Microbiol 2018; 41:220-224. [PMID: 29874389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
The aim of this non-interventional, observational, multicentre, open-label study was to assess the effectiveness of a vaginal gel containing extracts of Thymus vulgaris and Eugenia caryophyllus in conjunction with two specific lactobacilli strains (Lactobacillus fermentum LF10 and Lactobacillus plantarum LP02) specifically formulated in slow-release vaginal capsules, in treating bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) or recurrent vulvovaginal candidiasis disease (RVVC) [Estromineral Probiogel (EPB) in Italy, or Saugella Probiogel; Meda Pharma - Mylan Group]. There was a statistically significant improvement in pruritus, burning, vulvovaginal oedema and erythema, dyspareunia and vaginal secretions in all diagnostic groups. At the end of the study, the microbiological evaluation was normal in 80.0% of cases with BV, 62.5% of cases with VVC and 100.0% with RVVC. The clinical data allow EPB to be recommended in the acute treatment of VVC and BV, suggesting that EPB is a useful maintenance treatment if there are recurrent episodes. Controlled studies are needed to confirm the efficacy of EPB in the treatment of recurrences and to identify the most appropriate dosage regimen.
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Affiliation(s)
- Filippo Murina
- Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Italy
| | - Franco Vicariotto
- Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Italy
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Vicariotto F, DE Seta F, Faoro V, Raichi M. Dynamic quadripolar radiofrequency treatment of vaginal laxity/menopausal vulvo-vaginal atrophy: 12-month efficacy and safety. Minerva Obstet Gynecol 2018; 69:342-349. [PMID: 28608667 DOI: 10.23736/s0026-4784.17.04072-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Twelve-month extension of a previous spontaneous exploratory study investigating safety and efficacy of a new low-energy dynamic quadripolar radiofrequency (DQRF) device in: A) premenopausal women with symptoms of vaginal laxity, with special reference to dysuria, urinary incontinence and unsatisfactory sexual life (vaginal laxity arm of the study); B) postmenopausal women with vulvovaginal atrophy/genitourinary syndrome of menopause (VVA/GSM) and VVA/GSM-related symptoms (VVA/GSM arm of the study). DQRF treatment schedule in both study arms: 4 to 6 procedures of 15 to 20 min every 14 days (vaginal laxity, range 12-17 days; VVA/GSM, range 13-16). Operative temperatures in vaginal target tissues during procedure: vaginal laxity, 42 °C (range 40-43 °C); VVA/GSM, 40 °C (range 40-42 °C). METHODS In the vaginal laxity arm of the study, 25 women with subjective sensation of vaginal introital laxity (very to slightly loose). Assessment of urinary incontinence, satisfaction with sexual relationship and contribution of pelvic organ prolapse: Vaginal Laxity Questionnaire (VLQ, Italian certified translation) and short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12, Italian certified translation). Further evaluation of sexual gratification: Sexual Satisfaction Questionnaire (SSQ). In the VVA/GSM arm of the study, 32 women with objective evidence of VVA and vaginal dryness and/or dyspareunia as most bothersome symptoms. Assessment of VVA/GSM symptoms and overall satisfaction with sexual life: specifically designed 10-cm visual analogue scales. RESULTS All 4 to 6 planned DQRF sessions were well tolerated in both the vaginal laxity and VVA/GSM arms of the study, with no troubling pain, thermal injury or other immediate adverse effects during all the procedures. All screened women completed the planned DQRF treatment sessions in both arms of the extension study. There was no participant attrition with only a few occasionally missing visits over the 12-month follow-up period. Improvements were rapid in self-perception of introital looseness and related symptoms like dysuria/urinary incontinence and unrewarding sexual relationship (vaginal laxity patients) and atrophy-related symptoms including painful and unsatisfactory sexual activity (VVA/GSM patients). Participating women consistently reported wide-spectrum strong clinical improvements by the end of the planned DQRF sessions. Clinical improvements remained steady for the whole follow-up period in postmenopausal women; a statistically non-significant tendency to slight deterioration in VLQ, PISQ-12 and SSQ mean scores was detected after 6 to 9 months of follow-up in the vaginal laxity arm of the study. CONCLUSIONS Safety was excellent during all DQRF procedures and over the 12 months following the end of the treatment sessions. VLQ, PISQ-12 and SSQ scores (women with vaginal laxity), VAS self-evaluation of VVA/GSM symptoms and overall satisfaction with sexual life (women with VVA/GSM symptoms) improved rapidly, reaching almost normal levels by the last DQRF session and suggesting rapid, but also persistent, vaginal rejuvenation in both indications. A late tendency to some slight deterioration in women treated for vaginal laxity suggests such women might benefit from new DQRF treatments 6 to 9 months after the previous cycle.
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Affiliation(s)
| | - Francesco DE Seta
- University of Trieste and SIGITE (Società Italiana Ginecologia della Terza Età, Italian Society for Golden Age Gynaecology), Trieste, Italy
| | - Valentina Faoro
- GCare Multidisciplinary Group for Women Health, Trieste, Italy
| | - Mauro Raichi
- Clinical Pharmacology and Biophysics Consultant, Milan, Italy
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Gambacciani M, Biglia N, Cagnacci A, Caruso S, Cicinelli E, DE Leo V, DI Carlo C, Farris M, Gambera A, Guaschino S, Lanzone A, Paoletti AM, Russo N, Vicariotto F, Villa P, Volpe A. Menopause and hormone replacement therapy: the 2017 Recommendations of the Italian Menopause Society. Minerva Obstet Gynecol 2017; 70:27-34. [PMID: 28975776 DOI: 10.23736/s0026-4784.17.04151-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last decade, the risk benefits ratio of hormone replacement therapy (HRT) has been reevaluated mainly in tens of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these recommendations is to provide a simple and updated reference on postmenopausal HRT. The term HRT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential, when progestogen is added to ERT for 10-14 days a month, or continuous combined when progestogen is administered continuously every day along with a fixed amount of estrogen, In the everyday language, HRT includes also tibolone and the tissue-selective estrogen complex.
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Affiliation(s)
- Marco Gambacciani
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy -
| | | | - Angelo Cagnacci
- Department of Obstetrics Gynecology and Pediatrics, Azienda Sanitaria Universitaria Integrata Udine, Udine, Italy
| | - Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, School of Medicine, University of Bari, Bari, Italy
| | - Vincenzo DE Leo
- Department of Obstetrics and Gynecology, University of Siena, Santa Maria le Scotte Polyclinic, Siena, Italy
| | - Costantino DI Carlo
- Department of Obstetrics and Gynecology, Magna Græcia University, Catanzaro, Italy
| | | | - Alessandro Gambera
- Department of Gynecological Endocrinology, University of Brescia, Brescia, Italy
| | | | - Antonio Lanzone
- Department of Obstetrics and Gynecology and Pediatrics, Sacro Cuore Catholic University, Rome, Italy
| | - Anna M Paoletti
- Department of Surgery, Obstetrics, and Gynecology, University of Cagliari, Cagliari University Hospital, Cagliari, Italy
| | | | | | - Paola Villa
- Department of Obstetrics and Gynecology and Pediatrics, Sacro Cuore Catholic University, Rome, Italy
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Benincà G, Bosoni D, Vicariotto F, Raichi M. Efficacy and safety of Dynamic Quadripolar RadioFrequency, a new high-tech, high-safety option for vulvar rejuvenation. ACTA ACUST UNITED AC 2017. [DOI: 10.15761/ogr.1000115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vicariotto F, Raichi M. Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device. Minerva Ginecol 2016; 68:225-236. [PMID: 27206062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND This paper was a spontaneous, non-sponsored exploratory study to investigate the safety and efficacy of two schedules of thermal treatment with a new low-energy dynamic quadripolar radiofrequency (DQRF) device in: A) premenopausal women referring perception of vaginal introital laxity and related symptoms, with special reference to dysuria and urinary incontinence and unsatisfactory sexual activity (vaginal laxity arm of the study); B) postmenopausal women with vaginal atrophy and dryness and other vulvo-vaginal atrophy and genitourinary syndrome of menopause (VVA/GSM) related symptoms (VVA/GSM arm of the study). METHODS As for the vaginal laxity arm of the study, 12 women with perception of very to slightly loose vaginal introital laxity underwent five 20-min DQRF thermal treatment sessions every 14±1 days. A Vaginal Laxity Questionnaire (VLQ, certified Italian translation) and short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12, Italian certified translation) were used to assess urinary incontinence, sexual gratification and the contribution of any concomitant pelvic organ prolapse. As for the VVA/GSM arm of the study, 13 women with objective evidence of VVA and vaginal dryness and/or dyspareunia rated as moderate/severe most bothersome symptoms underwent four 10-min DQRF sessions every 10±1 days. Specifically designed visual analogue scales (VAS) for VVA/GSM symptoms and overall satisfaction with sexual life were used. RESULTS No adverse effects, including thermal burns or injuries, were reported during or after treatments in either arm of the study. Eleven of the enrolled women completed the five planned DQRF treatment sessions in the vaginal laxity arm of the study; 12 women completed the four DQRF sessions planned in the VVA/GSM arm of the study. Clinically and statistically significant improvements in self-perceived sensation of looseness and symptoms like dysuria/urinary incontinence and sexual function in the vaginal laxity arm of the study as well as VVA/GSM symptoms and overall satisfaction with sexual life in the VVA/GSM arm of the study. Improvements were already reported at the first assessment visit before the end of the planned DQRF sessions of each arm of the study, after, respectively, 56±4 and 30±3 days. CONCLUSIONS The DQRF treatment was well tolerated, with no pain during the procedure and no untoward effect reported over the 2-month follow-up periods in both the vaginal laxity and VVA/GSM arms of the study. Improvements in self-reported VLQ and PISQ-12 scores (vaginal laxity arm) and VAS self-evaluation of VVA/GSM symptoms and overall satisfaction with sexual life (VVA/GSM arm of the study) were rapid and persistent. This suggests rapid and persistent vaginal rejuvenation as the basis of subjective improvement in symptoms and decreased sexual distress in both indications, including dysuria and urinary incontinence in menopausal women. Such promising exploratory findings deserve confirmation in larger studies.
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Affiliation(s)
- Franco Vicariotto
- Società Italiana Menopausa (Italian Menopause Society), Pavia, Italy -
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Vicariotto F. Menopause and nutraceuticals. CMI 2015. [DOI: 10.7175/cmi.v9i3.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Vicariotto F, Mogna L, Del Piano M. Effectiveness of the two microorganisms Lactobacillus fermentum LF15 and Lactobacillus plantarum LP01, formulated in slow-release vaginal tablets, in women affected by bacterial vaginosis: a pilot study. J Clin Gastroenterol 2014; 48 Suppl 1:S106-12. [PMID: 25291116 DOI: 10.1097/mcg.0000000000000226] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bacterial vaginosis (BV) is the most common reason for abnormal vaginal discharge in reproductive-age women and one of its most important causative agents is the gram-variable bacterium Gardnerella vaginalis. BV is not accompanied by significant local inflammation, whereas the "fishy odor" test is always positive. In contrast, aerobic vaginitis (AV) is predominantly associated with Escherichia coli, but Streptococcus agalactiae and Staphylococcus aureus are also involved. Standard treatment of BV consists of oral or intravaginal antibiotics, although these are unable to spontaneously restore normal flora characterized by a high concentration of lactobacilli. The main limitation is the inability to offer a long-term defensive barrier, thus facilitating relapses and recurrences. This study was undertaken firstly to assess the ability of selected lactobacilli to in vitro antagonize G. vaginalis to determine an association with a strain able to inhibit E. coli, thus identifying a possible use in AV. The second step of the study was to conduct a human pilot trial in women affected by BV using an association of the most promising and active bacteria. MATERIALS AND METHODS For this purpose, neutralized supernatants of individual lactobacilli were tested at percentages ranging from 0.5% to 4% to determine their ability to hinder the growth of G. vaginalis American Type Culture Collection 10231. The bacterium that was able to exert the strongest inhibition was subsequently tested with Lactobacillus plantarum LP01 in a human intervention, placebo-controlled, pilot trial involving 34 female subjects (aged between 18 and 50, mean 34.7±8.9, no menopausal women) diagnosed with BV. The 2 microorganisms Lactobacillus fermentum LF15 (DSM 26955) and L. plantarum LP01 (LMG P-21021) were delivered to the vagina by means of slow-release vaginal tablets, also containing 50 mg of tara gum. The amount of each strain was 400 million live cells per dose. The women were instructed to apply a vaginal tablet once a day for 7 consecutive nights, followed by 1 tablet every 3 nights for a further 3-week application (acute phase) and, finally, 1 tablet per week to maintain a long-term vaginal colonization against possible recurrences. A clinical examination was performed and the Nugent score was quantified for each patient at enrollment (d0), after 28 days (d28), and at the end of the second month of relapse prevention (d56). A statistical comparison was made between d28, or d56, and d0, and between d56 and d28 to quantify the efficacy against possible recurrences. RESULTS L. fermentum LF15 showed the strongest in vitro inhibitory activity towards G. vaginalis American Type Culture Collection (ATCC) 10231 after both 24 and 48 hours. In the human trial, the 2 lactobacilli selected, namely L. fermentum LF15 and L. plantarum LP01, significantly reduced the Nugent score below the threshold of 7 after 28 days in 22 patients of 24 in the active group (91.7%, P<0.001). Eight women (33.3%) recorded a Nugent score between 4 and 6, evidence of an intermediate situation, whereas the remaining 14 (58.3%) showed a score <4, therefore suggesting the restoration of physiological vaginal microbiota. At the end of the second month, only 4 women registered a Nugent score >7, definable as BV (16.7%, P=0.065 compared with d28). In the placebo group, no significant differences were recorded at any time. CONCLUSIONS BV, also known as vaginal bacteriosis is the most common cause of vaginal infection in women of childbearing age. Furthermore, BV is often asymptomatic as about 50% of women with this condition have no symptoms at all and the prevalence rate in apparently healthy women is around 10%. This study suggests the ability of the 2 strains L. fermentum LF15 and L. plantarum LP01 to counteract acute Gardnerella infections effectively and significantly improve the related uncomfortable symptoms in a very high percentage of women. This could be partially attributed to the presence of tara gum, which is able to create a mechanical barrier against Gardnerella on the surface of vaginal mucosa as a primary mechanism. Furthermore, long-term physiological protection seems to be established, thanks to the integration of the 2 lactobacilli into the vaginal microbiota and to their adhesion to the epithelial cells of the mucosa. In the light of the additional in vitro inhibitory activity against E. coli, their prospective use in AV could also prove interesting.
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Affiliation(s)
- Franco Vicariotto
- *Gynaecology Unit, "San Pio X" Nursing Home, Milan †Biolab Research Ltd. ‡Gastroenterology Unit, Maggiore della Carità Hospital, Novara, Italy
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Drago L, De Vecchi E, Nicola L, Zucchetti E, Gismondo MR, Vicariotto F. Activity of a Lactobacillus acidophilus–Based Douche for the Treatment of Bacterial Vaginosis. J Altern Complement Med 2007; 13:435-8. [PMID: 17532736 DOI: 10.1089/acm.2006.6040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Bacterial vaginosis is characterized by alteration of the normal vaginal microflora, in which a mixed anaerobic bacterial flora becomes prevalent over the population of lacobacilli. Because administration of probiotics might be of some utility in restoring a normal flora, the present study aimed to evaluate the effect of a Lactobacillus acidophilus-strain-based douche on the vaginal environment in bacterial vaginosis. PATIENTS AND METHODS In an open-label pilot evaluation, 40 women with bacterial vaginosis as defined by Amsel's criteria were treated for 6 days with a douche containing L. acidophilus. Vaginal smears were collected from the patients and analyzed according to Nugent's criteria at the time of diagnosis, after 6 days of treatment, and again at 20 days after the last treatment. At the same times, determination of vaginal pH and a Whiff test were performed. RESULTS The Nugent score decreased significantly from bacterial vaginosis or an intermediate flora toward a normal flora during treatment, and remained low during the follow-up period for almost all of the patients, indicating bacterial vaginosis in 52.5% and in 7.5% of the patients before treatment and at follow-up, respectively. After treatment, significant decreases in vaginal pH were observed, to less than pH 4.5 in 34/40 women, and the odor test became negative in all of the patients. CONCLUSIONS In this preliminary study, treatment of bacterial vaginosis with a vaginal douche containing a strain of L. acidophilus contributed to the restoration of a normal vaginal environment.
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Affiliation(s)
- Lorenzo Drago
- Laboratory of Clinical Microbiology, Department of Preclinical Sciences LITA Vialba, University of Milan, Milan, Italy.
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