Archives of Gynecology and Obstetrics

, Volume 281, Issue 6, pp 1065–1069 | Cite as

The use of Lactobacillus rhamnosus in the therapy of bacterial vaginosis. Evaluation of clinical efficacy in a population of 40 women treated for 24 months

  • Alessandro RossiEmail author
  • Thomas Rossi
  • Marco Bertini
  • Giorgio Caccia
General Gynecology



Bacterial vaginosis (BV) is the most prevalent vaginal disorder in adult women worldwide. A number of clinical studies indicate that re-establishment of the physiological ecosystem by re-colonization of vaginal mucosa by lactobacilli may be an effective therapy for BV both after initial antimicrobial therapy or when given alone. A vaginal pH <4.5 is considered physiological and its measurement has been reported as an objective parameter, very sensitive to alterations of vaginal microflora and correlated with clinically relevant BV.


The aims of this work were to assess the effectiveness of a long-term (24 months) intravaginal treatment with Lactobacillus rhamnosus (NORMOGIN®) on the vaginal pH and on the clinical symptoms in a group of 40 women affected by BV diagnosed by the Amsel criteria.


A prospective open clinical trial was performed in 40 consecutive cases evaluated for B.V. by the Amsel criteria.


Vaginal pH was above the physiological value of 4.5 in 36 out of 40 patients at the first visit. It returned under 4.5 value in 24/40 and 32/40 women after 12 and 24 months of treatment, respectively. pH values were significantly decreased at 12 month treatment (P < 0.001) and further reduction in pH values was found at 24 months of treatment (P < 0.02 vs. 12 months). The gradual return to a vaginal physiological pH was associated with a reduction of the intensity of symptoms as shown by the decrease in the symptoms score.


The present study supports the use of pH measurement for sensitive, objective, and simple therapy follow-up in women with BV and shows that long-term administration of vaginal tablets containing Lactobacillus rhamnosus represents an effective and safe treatment for restoring the physiological vaginal pH and controlling BV symptoms.


Vaginal microflora Vaginal pH Lactobacillus rhamnosus vaginal tablets 


Conflict of interest statement



  1. 1.
    Antonio MA, Hawes SE, Hillier SL (1999) The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis 180:1950–1956CrossRefPubMedGoogle Scholar
  2. 2.
    Fredricks DN, Fiedler TL, Marrazzo JM (2005) Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 353:1899–1911CrossRefPubMedGoogle Scholar
  3. 3.
    Anukam KC, Osazuwa EO, Ahonkhai I, Reid G (2006) Lactobacillus vaginal microbiota of women attending a reproductive health care service in Benin city, Nigeria. Sex Transm Dis 33:59–62CrossRefPubMedGoogle Scholar
  4. 4.
    Eschenbach DA (1993) History and review of bacterial vaginosis. Am J Obstet Gynecol 169(2 Pt 2): 441–445Google Scholar
  5. 5.
    Hill GB (1993) The microbiology of bacterial vaginosis. Am J Obstet Gynecol 169:450–454PubMedGoogle Scholar
  6. 6.
    Holst E (1987) Bacterial vaginosis microbiological and clinical findings. Eur J Clin Microbiol 6(5):536–541CrossRefPubMedGoogle Scholar
  7. 7.
    Sobel JD (2005) What’s new in bacterial vaginosis and trichomoniasis? Infect Dis Clin North Am 19:387–406CrossRefPubMedGoogle Scholar
  8. 8.
    Hillier SL, Kiviat NB, Hawes SE, Hasselquist MB, Hanssen PW, Eschenbach DA, Holmes KK (1996) Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 175:435–441CrossRefPubMedGoogle Scholar
  9. 9.
    Ralph SG, Rutherford AJ, Wilson JD (1999) Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. BMJ 319:220–223PubMedGoogle Scholar
  10. 10.
    Haggerty CL, Hillier SL, Bass DC, Ness RB (2004) Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 39:990–995CrossRefPubMedGoogle Scholar
  11. 11.
    Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK (1983) Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74:14–22CrossRefPubMedGoogle Scholar
  12. 12.
    Marcone V, Calzolari E, Bertini M (2008) Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: hot to lower the rate of bacterial vaginosis recurrences. New Microbiol 31:429–433PubMedGoogle Scholar
  13. 13.
    ACOG technical bulletin (1996) Vaginitis. Number 226–July 1996 (replaces No. 221, March 1996). Committee on technical bulletins of the American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 54(3):293–302Google Scholar
  14. 14.
    CDC—Centers for Disease Control and Prevention (2006) Pathogenesis of abnormal vaginal flora. Am J Obstet Gynecol 182:872–878Google Scholar
  15. 15.
    Parent D, Bossens M, Bayot D, Kirkpatrick C, Graf F, Wilkinson FE, Kaiser RR (1996) Therapy of bacterial vaginosis using exogenously-applied Lactobacilli acidophili and a low dose of estriol: a placebo-controlled multicentric clinical trial. Arzneim Forsch/Drug Res 46(1):68–73Google Scholar
  16. 16.
    Sobel JD (1997) Vaginitis. N Engl J Med 337:1896–1903CrossRefPubMedGoogle Scholar
  17. 17.
    Owen MK, Clenney TL (2004) Management of vaginitis. Am Fam Physician 70:2125–2132PubMedGoogle Scholar
  18. 18.
    Hay PE (1998) Recurrent bacterial vaginosis. Dermatol Clin 16:769–773, xii–xiiiGoogle Scholar
  19. 19.
    Carey JC, Klebanoff MA, Hauth JC, Hillier SL, Thom EA, Ernest JM, Heine RP et al (2000) Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med 342:534–540CrossRefPubMedGoogle Scholar
  20. 20.
    Stewart PS, Costerton JW (2001) Antibiotic resistance of bacteria in biofilms. Lancet 358:135–138CrossRefPubMedGoogle Scholar
  21. 21.
    Swidinski A, Mendling W, Loening-Baucke V, Swidinski S, Dorffel Y, Scolze J, Lochs H, Verstraelen H (2008) An adherent Gardnerella Vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol 198:97–99Google Scholar
  22. 22.
    Rossi A, Cattadori F, Corti B (2003) L’ecosistema vaginale: come proteggerlo, come conservarlo. La Rivista italiana di Ostetricia e Ginecologia 17:21–23Google Scholar
  23. 23.
    Riordan T, Macaulay ME, James JM (1990) A prospective study of genital infections in a familyplanning clinic.1. Microbiological findings and their association with vaginal symptoms. Epidemiol Infect 104:47–53CrossRefPubMedGoogle Scholar
  24. 24.
    Pavletic AJ, Hawes SE, Geske JA, Bringe K, Polack SH (2004) Experience with routine vaginal pH testing in a family practice setting. Infect Dis Obstet Gynecol 12:63–68CrossRefPubMedGoogle Scholar
  25. 25.
    Schmidt H, Hansen JG (1994) A wet smear criterion for bacterial vaginosis. Scand J Prim Health Care 12:233–238CrossRefPubMedGoogle Scholar
  26. 26.
    Thompson DA, Yeh-Kuang Tsai, Gilman RH (2000) Sexually transmitted diseases in a family planning and an antenatal clinic in Peru. Sex Trans Dis 27:386–392CrossRefGoogle Scholar
  27. 27.
    Hellberg D, Nilsson S, Mardh P-A (2001) The diagnosis of bacterial vaginosis and vaginal flora changes. Arch Gynecol Obstet 265:11–15CrossRefPubMedGoogle Scholar
  28. 28.
    Reid G, Millsap K, Bruce AW (1994) Implantation of Lactobacillus casei var-rhamnosus into vagina. Lancet 344(8931):1229CrossRefPubMedGoogle Scholar
  29. 29.
    Reid G, Bruce AW (2006) Probiotics to prevent urinary tract infections: the rationale and evidence. World J Urol 24:28–32CrossRefPubMedGoogle Scholar
  30. 30.
    Larsson PG, Stray-Pedersen B, Ryttig KR, Larsen S (2008) Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study. BMC Women’s Health 8:3CrossRefPubMedGoogle Scholar
  31. 31.
    Harmanli OH, Cheng GY, Nyirjest P, Chatwani A, Gaughan JP (2000) Urinary tract infections in women with bacterial vaginosis, part 1. Obstet Gynecol 95(5):710–712CrossRefPubMedGoogle Scholar
  32. 32.
    Eriksson K, Carlsson B, Forsum U, Larsson PG (2005) A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules. Acta Derm Venereol 85:42–46CrossRefPubMedGoogle Scholar
  33. 33.
    Anukam KC, Osazuwa E, Osemene GI, Ehigiagbe F, Bruce AW, Reid G (2006) Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect 8:2772–2776CrossRefPubMedGoogle Scholar
  34. 34.
    Falagas ME, Betsi GI, Athanasiou S (2007) Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect 13(7):657–664CrossRefPubMedGoogle Scholar
  35. 35.
    Reid G (2001) Probiotic agents to protect the urogenital tract against infection. Am J Clin Nutr 73:437S–443SPubMedGoogle Scholar
  36. 36.
    Bruce AW, Reid G, McGroarty JA, Taylor M, Preston C (1992) Preliminary study on the prevention of recurrent urinary tract infection in adult women using intravaginal lactobacilli. Intnl Urogynecol J 3:22–25CrossRefGoogle Scholar
  37. 37.
    Hilton E, Rindos P, Isenberg HD (1995) Lactobacillus GG vaginal suppositories and vaginitis. J Clin Microbiol 33(5):1433PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Alessandro Rossi
    • 1
    Email author
  • Thomas Rossi
    • 2
  • Marco Bertini
    • 3
  • Giorgio Caccia
    • 4
  1. 1.Centro Diagnostico Varesino, CDV srlVareseItaly
  2. 2.Department of Obstetrics and GynecologyUniversity of InsubriaVareseItaly
  3. 3.Pharmacology and Chemotherapy DivisionUniversity of PisaPisaItaly
  4. 4.E.O.C. Ente Ospedaliero Cantonale (O.B.V. Ospedale Beata Vergine)MendrisioSwitzerland

Personalised recommendations