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Non-antibiotic treatment of bacterial vaginosis—a systematic review

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Abstract

Purpose

Bacterial vaginosis (BV) is one of the most common vaginal complaints of women of reproductive age, characterized by a shift from a Lactobacillus-dominated vaginal microbiome towards a more diverse flora of facultative and obligately anaerobic bacteria. BV can increase the risk of preterm births, contracting sexually transmitted infections and developing other chronic health issues. Standard treatment for BV are antibiotics, however despite initial efficacy, they do not provide effective long-term treatment and recurrence or persistence prevention. This systematic review focuses on describing the current study situation and summarizing the newest data on the efficacy of alternative non-antibiotic options, namely probiotic products containing lactobacilli, lactic acid, sucrose gel, combination products with estriol, and supplementation of antibiotics.

Methods

We conducted a systematic literature search using the MEDLINE database and evaluated the 33 trials which met our inclusion criteria.

Conclusion

The diverse study designs produced extremely varied outcomes, but so far the results are promising. Furthermore, these alternatives have shown little to no adverse effects and are consequently generally considered safe to use. In general, the results of this review warrant more thorough trials with larger cohort sizes to provide sufficient evidence for these alternatives to be a part of official treatment recommendations.

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Acknowledgements

The authors are grateful for the support of Ms. Beritan Polat, secretary, for helping with ordering the identified publications.

Funding

The publication was not funded.

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Authors and Affiliations

  1. Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, University Clinic Inselspital Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland

    Fiona Damaris Tidbury, Susanna Weidlinger & Petra Stute

  2. Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland

    Anita Langhart

Authors
  1. Fiona Damaris Tidbury
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  2. Anita Langhart
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  3. Susanna Weidlinger
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  4. Petra Stute
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Contributions

FDT: literature search, manuscript writing; AL: literature search, table editing; SW: manuscript editing; PS: concept, funding, supervision FDT and AL: manuscript editing.

Corresponding author

Correspondence to Petra Stute.

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Conflict of interest

FDT, AL and SW declare no competing financial interests. PS has received an unrestricted grant from Schaer Pharma Service GmbH to conduct a multicenter RCT in women with BV comparing standard antibiotic treatment to a vaginal acid gel (cantonal ethic committee Bern: No. 2016_01992). The authors alone are responsible for the content and writing of the paper.

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404_2020_5821_MOESM1_ESM.docx

Supplementary file1 Supplementary table 1: Non-antibiotic treatment options for bacterial vaginosis. BV Bacterial Vaginosis, CFU Colony-forming Unit (DOCX 27 kb)

404_2020_5821_MOESM2_ESM.docx

Supplementary file2 Supplementary table 2: Non-antibiotic prevention options for bacterial vaginosis. BV Bacterial Vaginosis, CFU Colony-forming Unit (DOCX 19 kb)

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Tidbury, F.D., Langhart, A., Weidlinger, S. et al. Non-antibiotic treatment of bacterial vaginosis—a systematic review. Arch Gynecol Obstet 303, 37–45 (2021). https://doi.org/10.1007/s00404-020-05821-x

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