Reducing the Risk of Bacterial Vaginosis During Conception with Lactobacillus Probiotics
Lactobacillus probiotics can help maintain healthy vaginal flora and may reduce the risk of bacterial vaginosis (BV) during conception, especially when used as complementary therapy with antibiotics for those with recurrent BV. 1
Understanding Bacterial Vaginosis
- BV is characterized by replacement of normal hydrogen peroxide-producing Lactobacillus species with anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis 1
- BV is the most prevalent cause of vaginal discharge and malodor, with up to 50% of women being asymptomatic 1
- BV during pregnancy is associated with adverse outcomes including premature rupture of membranes, preterm labor, preterm birth, and postpartum endometritis 2, 3
Risk Factors for BV
- Multiple sexual partners increase the risk of BV 1
- New sexual partners also increase risk 1
- Women who have never been sexually active are rarely affected 2, 1
- Previous history of preterm birth increases risk 1
Evidence for Lactobacillus Probiotics in BV Prevention
- Probiotics containing Lactobacillus species can help maintain healthy vaginal flora 1
- Meta-analyses show that probiotic supplementation significantly improves BV cure rates when used as complementary therapy with antibiotics 1
- Lactobacillus rhamnosus BMX 54 has been shown to be useful in preventing recurrence of BV, particularly after antibiotic therapy 4
- Oral administration of Lactobacillus gasseri TM13 and Lactobacillus crispatus LG55 can help restore vaginal health in patients recovering from BV 5
Recommended Approach for BV Prevention During Conception
- For women with recurrent BV planning conception, consider Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 at a dose of at least 10 CFU/day 6
- Probiotic supplementation is most effective when used for at least 2 months 6
- For women with active BV, standard treatment with metronidazole (500 mg orally twice daily for 7 days) should be completed before conception attempts 3, 7
- Following antibiotic treatment, vaginal probiotics containing Lactobacillus species can help maintain normal flora and prevent recurrence 4, 8
Important Considerations
- Treatment of male sexual partners has not been shown to prevent recurrence of BV and is not recommended 2, 3, 1
- If BV occurs during pregnancy, all symptomatic women should be treated 3, 7
- High-risk pregnant women (those with history of preterm delivery) with asymptomatic BV may benefit from evaluation and treatment 3, 7
- Avoid douching as it disrupts normal vaginal flora and increases BV risk 1
Monitoring and Follow-up
- Monitor for symptoms of BV: homogeneous white discharge, fishy odor, vaginal pH >4.5 3
- If symptoms develop, seek prompt treatment before continuing conception attempts 3, 7
- Regular use of probiotics may help maintain vaginal pH below 4.5, which is crucial for preventing BV 4, 8
Lactobacillus probiotics represent a promising approach for maintaining vaginal health and reducing BV risk during conception. While they may not completely prevent BV in all cases, evidence suggests they can significantly reduce recurrence rates, especially when used following standard antibiotic treatment for active infections.