Skip to main content

Advertisement

SpringerLink
Log in

Impact of vaginal ascorbic acid on abnormal vaginal microflora

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of vaginal ascorbic acid (vitamin C) as a treatment/maintenance regimen on increased vaginal pH and abnormal microflora on wet mounts in premenopausal women.

Methods

A randomized study of 140 asymptomatic, low-risk pregnant and non-pregnant premenopausal women with vaginal pH ≥ 4.5 and a variety of partly/completely disrupted Lactobacillus microflora patterns on wet mounts in five outpatient clinics was carried out. Participants were randomized to the intervention group [250 mg vitamin C tablets vaginally at bedtime once a day for 6 days (treatment phase), followed by a one tablet per week, for 12 weeks (maintenance phase)] or the control group (no treatment). Outcomes were evaluated 4 months after randomizing, i.e., 2–3 weeks after the last vitamin C tablet insertion.

Results

Normalization to normal flora was observed in 51.4 % of all ascorbic acid and in 24.3 % of control group patients (difference 27.1 %, 95 % CI 11.7–42.6, p < 0.05, ITT population). In the per protocol population, normalization was confirmed in 53.5 % of the intervention and 22.4 % of the control group (difference 31 %, 95 % CI 14.3–47.8, p < 0.05). Results of pregnant subgroup analysis showed better outcomes for the subgroup: difference of normalization rate between ascorbic acid and control group was 41.2 % (95 % CI 21.8–60.1, p < 0.05). Itching occurred in 19 %; 23 % of women reported irritation and 10 % stopped the treatment because of side effects.

Conclusions

Vaginal ascorbic acid improves abnormal vaginal pH and microflora, especially in pregnant women, but is not well tolerated by all women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Redondo-Lopez V, Cook RL, Sobel JD (1990) Emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora. Rev Infect Dis 12(5):856–872

    Article  PubMed  CAS  Google Scholar 

  2. Osset J, Bartolome RM, Garcia E, Andreu A (2011) Assessment of the capacity of Lactobacillus to inhibit the growth of uropathogens and block their adhesion to vaginal epithelial cells. J Infect Dis 183(3):485–491

    Article  Google Scholar 

  3. Amsel R, Totten PA, Spegiel CA (1983) Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74:14–22

    Article  PubMed  CAS  Google Scholar 

  4. Donders GGG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B (2002) Aerobic vagintis: abnormal vaginal flora entity that is distinct from bacterial vaginosis. Br J Obstet Gynecol 109:1–10

    Article  Google Scholar 

  5. Hay PE, Lamont RF, Taylor-Robinson D, Morgan DJ, Ison C, Pearson J (1994) Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 308(6924):295–298

    Article  PubMed  CAS  Google Scholar 

  6. Donders GG, Spitz B, Vereecken A, Van Bulck B (2008) The ecology of the vaginal flora at first prenatal visit is associated with preterm delivery and low birth weight. Open Infect Dis J 2:45–51

    Article  Google Scholar 

  7. Soper DE, Bump RC, Hurt WG (1990) Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 163:1016–1021

    Article  PubMed  CAS  Google Scholar 

  8. Wiesenfeld HC, Hillier SL, Krohn MA, Landers DV, Sweet RL (2003) Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis 36:663–668

    Article  PubMed  Google Scholar 

  9. Verstraelen H, Verhelst R (2009) Bacterial vaginosis: an update on diagnosis and treatment. Expert Rev Anti Infect Ther 7(9):1109–1124

    Article  PubMed  Google Scholar 

  10. Brocklehurst P, Gordon A, Heatley E, Milan SJ (2013) Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. doi:10.1002/14651858

    PubMed  Google Scholar 

  11. Austin MN, Beigi RH, Meyn LA, Hiller SL (2005) Microbiological response to treatment of bacterial vaginosis with topical clindamycin or metronidazole. J Clin Microbiol 43(9):4492–4497

    Article  PubMed  CAS  Google Scholar 

  12. Baltimore RS (2007) Consequences of prophylaxis for group B streptococcal infections of the neonate. Semin Perinatol 31(1):33–38

    Article  PubMed  Google Scholar 

  13. Polatti F, Rampino M, Mahnani P, Mascarucci P (2006) Vaginal pH-lowering effect of locally applies vitamin C in subjects with high vaginal pH. Gynecol Endocrinol 22(4):230–234

    Article  PubMed  CAS  Google Scholar 

  14. Petersen EE, Magnani P (2004) Efficacy and safety of Vitamin C vaginal tablets in the treatment of non-specific vaginitis. A randomized, double-blind, placebo-controlled study. Obstet Gynec 117:70–75

    CAS  Google Scholar 

  15. Petersen EE, Genet M, Caserini M, Palmieri R (2011) Efficacy of vitamin C vaginal tablets in the treatment of bacterial vaginosis: a randomized, double-blind, placebo-controlled clinical trial. Arzneimittelforschung 61(4):260–265

    Article  PubMed  CAS  Google Scholar 

  16. Donders GG, Caeyers T, Tydhof P, Riphagen I, Van den Bosch T, Bellen G (2007) Comparison of two types of dipsticks to measure vaginal pH in clinical practice. Eur J Obstet Gynecol Reprod Biol 134(2):220–224

    Article  PubMed  CAS  Google Scholar 

  17. Larsson PG, Platz-Christensen JJ (1990) Enumeration of clue cells in rehydrated air-dried vaginal wet smears for the diagnosis of bacterial vaginosis. Obstet Gynecol 76:727–730

    PubMed  CAS  Google Scholar 

  18. Donders GG (1999) Microscopy of bacterial flora on fresh vaginal smears. Infect Dis Obstet Gynecol 7:126–127

    PubMed  CAS  Google Scholar 

  19. Lamont RF, Duncan SL, Mandal D, Bassett P (2003) Intravaginal clindamycin to reduce preterm birth in women with abnormal genital tract flora. Obstet Gynecol 101:516–522

    Article  PubMed  CAS  Google Scholar 

  20. Carey J, Klebanoff MA, Hauth JC, Hillier SL, Thom EA, Ernest JM et al (2000) Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 342:534–540

    Article  PubMed  CAS  Google Scholar 

  21. Ugwumadu A, Reid F, Hay P, Manyonda I (2004) Natural history of bacterial vaginosis and intermediate flora in pregnancy and effect of oral clindamycin. Obstet Gynecol 104:114–119

    Article  PubMed  CAS  Google Scholar 

  22. Ugwumadu A, Manyonda I, Reid F, Hay P (2003) Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomized controlled trial. Lancet 361:983–988

    Article  PubMed  CAS  Google Scholar 

  23. Eckert LO (2006) Acute vulvovaginitis. N Engl J Med 355:1244–1252

    Article  PubMed  CAS  Google Scholar 

  24. Parent D, Bossens M, Bayot D, Kirkpatrick C, Graft F, Wilkinson FE, Kaiser RR et al (1996) Therapy of bacterial vaginosis using exogeneously-applied Lactobacilli acidophili and a low-dose of estriol: a placebo-controlled multicentric clinical trial. Arzneimittelforschung 46:68–73

    PubMed  CAS  Google Scholar 

  25. Holley RL, Richter HE, Varner RE, Pair L, Schwebke JR (2004) A randomized, doule-blind clinical trial of vaginal acidification versus placebo for the treatment of symptomatic bacterial vaginosis. Sex Transm Dis 31:236–238

    Article  PubMed  CAS  Google Scholar 

  26. Fiorilli A, Molteni B, Milani M (2005) Successful treatment of bacterial vaginosis with a polycarbophil-Carbopol acidic vaginal gel: results from a randomised double-blind, placebo-controlled trial. Eur J Obstet Gynecol Reprod Biol 120(2):202–205

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank, Irena Rogovska, MD, PhD, from Riga Stradins University for help with the statistical analysis and the women who agreed to participate in the study. Grants for this project were provided by the Latvian Ministry of Education and Science (IZM RSU-ZP 07-5), European Social Fund.

Conflict of interest

We declare that we have no conflict of interest. We state that we have had full control of all primary data and we agree to allow the journal to review over data, if requested.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Riga Stradins University, Miera Street 45, Riga, 1013, Latvia

    Jana Zodzika, Dace Rezeberga, Natalija Vedmedovska, Olga Vasina, Inara Pundure, Ruta Bite, Ingrida Silberga, Julija Socenova & Olita Melngaile

  2. Department of Gynecology, Riga East University Hospital, Hipokrata Street 2, Riga, Latvia

    Jana Zodzika, Dace Rezeberga & Olga Vasina

  3. Department of Obstetrics and Gynecology, University of Antwerp, Prinsstraat 13, Antwerpen, Belgium

    Gilbert Donders

Authors
  1. Jana Zodzika
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dace Rezeberga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gilbert Donders
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natalija Vedmedovska
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olga Vasina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Inara Pundure
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ruta Bite
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ingrida Silberga
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Julija Socenova
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Olita Melngaile
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jana Zodzika.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zodzika, J., Rezeberga, D., Donders, G. et al. Impact of vaginal ascorbic acid on abnormal vaginal microflora. Arch Gynecol Obstet 288, 1039–1044 (2013). https://doi.org/10.1007/s00404-013-2876-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-013-2876-y

Keywords

Search

Navigation