The role of lactobacilli and probiotics in maintaining vaginal health



The vaginal microbiota of healthy women consists typically of a diversity of anaerobic and aerobic microorganisms. Lactobacilli are the most prevalent and often numerically dominant microorganisms and are relevant as a barrier to infection. The capacity of lactobacilli to adhere and compete for adhesion sites in the vaginal epithelium and the capacity to produce antimicrobial compounds (hydrogen peroxide, lactic acid, bacteriocin-like substances), are important in the impairment of colonization by pathogens.


This review summarizes the role of lactic acid bacteria in preventing illness of the host, including bacterial vaginosis, yeast vaginitis, urinary tract infection and sexually transmitted diseases.


The administration of probiotics that colonize the vaginal tract can be important in maintaining a normal urogenital health and also to prevent or treat infections.

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  1. 1.

    Farage MA, Miller KW, Sobel JD (2010) Dynamics of the vaginal ecosystem-hormonal influences. Infect Dis Res Treat 3:1–15

    Article  Google Scholar 

  2. 2.

    Hickey RJ, Zhou X, Pierson JD, Ravel J, Forney LJ (2012) Understanding vaginal microbiome complexity from an ecological perspective. Transl Res 160:267–282

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  3. 3.

    Cribby S, Taylor M, Reid G (2008) Vaginal microbiota and the use of probiotics. Interdiscip Perspect Infect Dis 2008:256490

    PubMed Central  PubMed  Google Scholar 

  4. 4.

    Iannitti T, Palmieri B (2010) Therapeutical use of probiotic formulations in clinical practice. Clin Nutr 29:701–725

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Konings WN, Kok J, Kuipers OP, Poolman B (2000) Lactic acid bacteria: the bugs of the new millennium. Curr Opin Microbiol 3:276–282

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Reid G, Burton J (2002) Use of Lactobacillus to prevent infection by pathogenic bacteria. Microbes Infect 4:319–324

    PubMed  Article  Google Scholar 

  7. 7.

    Bolton M, Van Der Straten A, Cohen C (2008) Probiotics: potential to prevent HIV and sexually transmitted infections in women. Sex Transm Dis 35:214–225

    PubMed  Article  Google Scholar 

  8. 8.

    Döderlein A (1892) Das scheidensekret und seine bedeutung fur puerperalfieber. Zentralblatt fur Bakteriology 11:699

    Google Scholar 

  9. 9.

    Ma B, Forney LJ, Ravel J (2012) Vaginal microbiome: rethinking health and disease. Annu Rev Microbiol 66:371–389

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  10. 10.

    Boris S, Barbés C (2000) Role played by lactobacilli in controlling the population of vaginal pathogens. Microbes Infect 2:543–546

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SSK, McCulle SL, Karlebach S, Gorle R, Russell J, Tacket CO, Brotman RM, Davis CC, Ault K, Peralta L, Forney LJ (2011) Vaginal microbiome of reproductive-age women. PNAS 108:4680–4687

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Jin L, Tao L, Pavlova SI, So J-S, Kiwanuka N, Namukwaya Z, Saberbein BA, Wawer M (2007) Species diversity and relative abundance of vaginal lactic acid bacteria from women in Uganda and Korea. J Appl Microbiol 102:1107–1115

    CAS  PubMed  Google Scholar 

  13. 13.

    Antonio MAD, 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 180:1950–1956

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    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 33:59–62

    PubMed  Article  Google Scholar 

  15. 15.

    Aslim B, Kilic E (2006) Some probiotic properties of vaginal lactobacilli isolated from healthy women. Jpn J Infect Dis 59:249–253

    PubMed  Google Scholar 

  16. 16.

    Tamrakar R, Yamada T, Furuta I, Cho K, Morikawa M, Yamada H, Sakuragi N, Minakami H (2007) Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women. BMC Infect Dis 7:128

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Vitali B, Pugliese C, Biagi E, Candela M, Turroni S, Bellen G, Donders GGG, Brigidi P (2007) Dynamics of vaginal bacterial communities in women developing bacterial vaginosis, candidiasis, or no infection, analyzed by PCR-denaturing gradient gel electrophoresis and real-time PCR. Appl Environ Microbiol 73:5731–5741

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  18. 18.

    Brolazo EM, Simões JA, Nader MEF, Tomás MSJ, Gregoracci GB, Marconi C (2009) Prevalência e caracterização de espécies de lactobacilos vaginais em mulheres em idade reprodutiva sem vulvovaginites. Rev Bras Ginecol Obstet 31:189–195

    PubMed  Article  Google Scholar 

  19. 19.

    Schwebke JR (2001) Role of vaginal flora as a barrier to HIV acquisition. Curr Infect Dis Rep 3:152–155

    PubMed  Article  Google Scholar 

  20. 20.

    Burton JP, Reid G (2002) Evaluation of the bacterial vaginal flora of 20 postmenopausal women by direct (Nugent score) and molecular (polymerase chain reaction and denaturing gradient gel electrophoresis) techniques. J Infect Dis 186:1770–1780

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Reid G, Bocking A (2003) The potential for probiotics to prevent bacterial vaginosis and preterm labor. Am J Obstet Gynecol 189:1202–1208

    PubMed  Article  Google Scholar 

  22. 22.

    Falagas ME, Betsi GI, Athanasiou S (2007) Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect 13:657–664

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Nugent RP, Krohn MA, Hillier SL (1991) Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29:297–301

    CAS  PubMed Central  PubMed  Google Scholar 

  24. 24.

    Dover SE, Aroutcheva AA, Faro S, Chikindas ML (2008) Natural antimicrobials and their role in vaginal health: a short review. Int J Probiot Prebiot 3:219–230

    Google Scholar 

  25. 25.

    Donati L, Di Vico A, Nucci M, Quagliozzi L, Spagnuolo T, Labianca A, Bracaglia M, Ianniello F, Caruso A, Paradisi G (2010) Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet 281:589–600

    PubMed  Article  Google Scholar 

  26. 26.

    Rampersaud R, Randis TM, Ratner AJ (2012) Microbiota of the upper and lower genital tract. Semin Fetal Neonatal Med 17:51–57

    PubMed Central  PubMed  Article  Google Scholar 

  27. 27.

    Reid G (2008) Probiotics and prebiotics—progress and challenges. Int Dairy J 18:969–975

    CAS  Article  Google Scholar 

  28. 28.

    Wilks M, Wiggins R, Whiley A, Hennessy E, Warwick S, Porter H, Corfield A, Millar M (2004) Identification and H2O2 production of vaginal lactobacilli from pregnant women at high risk of preterm birth and relation with outcome. J Clin Microbiol 42:713–717

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  29. 29.

    Charlier C, Cretenet M, Even S, Le Loir Y (2009) Interactions between Staphylococcus aureus and lactic acid bacteria: an old story with new perspectives. Int J Food Microbiol 131:30–39

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Reid G, Kim SO, Köhler GA (2006) Selecting, testing and understanding probiotic microorganisms. FEMS Immunol Med Microbiol 46:149–157

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Aroutcheva A, Gariti D, Simon M, Shott S, Faro J, Simoes JA, Gurguis A, Faro S (2001) Defense factors of vaginal lactobacilli. Am J Obstet Gynecol 185:375–379

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Conti C, Malacrino C, Mastromarino P (2009) Inhibition of herpes simplex virus type 2 by vaginal lactobacilli. J Physiol Pharmacol 60:19–26

    PubMed  Google Scholar 

  33. 33.

    Matu MN, Orinda GO, Njagi ENM, Cohen CR, Bukusi EA (2010) In vitro inhibitory activity of human vaginal lactobacilli against pathogenic bacteria associated with bacterial vaginosis in Kenyan women. Anaerobe 16:210–215

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Klebanoff SJ, Watts DH, Mehlin C, Headley CM (1999) Lactobacilli and vaginal host defense: activation of the human immunodeficiency virus type 1 long terminal repeat, cytokine production, and NF-κB. J Inf Dis 179:653–660

    CAS  Article  Google Scholar 

  35. 35.

    Wasiela M, Misiak G, Pieczara A, Kalinka J (2008) Association between hydrogen peroxide Lactobacillus species and bacterial vaginosis-related bacteria in vaginal fluid of pregnant women. Arch Perinatol Med 14:23–27

    Google Scholar 

  36. 36.

    Kim YH, Kim CH, Cho MK, Na JH, Song TB, Oh JS (2006) Hydrogen peroxide-producing lactobacilli in the vaginal flora of pregnant women with preterm labor with intact membranes. Int J Gynaecol Obstet 93:22–27

    PubMed  Article  Google Scholar 

  37. 37.

    Muench DF, Kuch DJ, Wu H, Begum AA, Veit SJ, Pelletier M-E, Soler-García ÁA, Jerse AE (2009) H2O2-producing lactobacilli inhibit gonococci in vitro but not during experimental genital tract infection. J Infect Dis 199:1369–1378

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  38. 38.

    O’Hanlon DE, Lanier BR, Moench TR, Cone RA (2010) Cervicovaginal fluid and semen block the microbicidal activity of hydrogen peroxide produced by vaginal lactobacilli. BMC Infect Dis 10:1–8

    Article  Google Scholar 

  39. 39.

    Gillor O, Nigro L, Riley M (2005) Genetically engineered bacteriocins and their potential as the next generation of antimicrobials. Curr Pharm Des 11:1067–1075

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Ocaña VS, de Ruiz Pesce, Holgado AA, Nader-Macías ME (1999) Characterization of a bacteriocin-like substance produced by a vaginal Lactobacillus salivarius strain. Appl Environ Microbiol 65:5631–5635

    PubMed Central  PubMed  Google Scholar 

  41. 41.

    Pascual LM, Daniele MB, Giordano W, Pájaro MC, Barberis IL (2008) Purification and partial characterization of novel bacteriocin L23 produced by Lactobacillus fermentum L23. Curr Microbiol 397–402

  42. 42.

    Vera Pingitore E, Hébert EM, Nader-Macías ME, Sesma F (2009) Characterization of salivaricin CRL 1328, a two-peptide bacteriocin produced by Lactobacillus salivarius CRL 1328 isolated from the human vagina. Res Microbiol 160:401–408

    PubMed  Article  Google Scholar 

  43. 43.

    Dezwaan DC, Mequio MJ, Littell JS, Allen JP, Rossbach S, Pybus V (2007) Purification and characterization of enterocin 62-6, a two-peptide bacteriocin produced by a vaginal strain of Enterococcus faecium: potential significance in bacterial vaginosis. Microb Ecol Health D 19:241–250

    CAS  Article  Google Scholar 

  44. 44.

    Karaoğlu ŞA, Aydin F, Kiliç SS, Kiliç AO (2002) Antimicrobial activity and characteristics of bacteriocins produced by vaginal lactobacilli. Turk J Med Sci 33:7–13

    Google Scholar 

  45. 45.

    Coudeyras S, Jugie G, Vermerie M, Forestier C (2008) Adhesion of human probiotic Lactobacillus rhamnosus to cervical and vaginal cells and interaction with vaginosis-associated pathogens. Infect Dis Obstet Gynecol 2008:549640

    PubMed Central  PubMed  Article  Google Scholar 

  46. 46.

    Zárate G, Nader-Macias ME (2006) Influence of probiotic vaginal lactobacilli on in vitro adhesion of urogenital pathogens to vaginal epithelial cells. Lett Appl Microbiol 43:174–180

    PubMed  Article  Google Scholar 

  47. 47.

    Boris S, Suárez JE, Vázquez F, Barbés C (1998) Adherence of human vaginal lactobacilli to vaginal epithelial cells and interaction with uropathogens. Infect Immun 66:1985–1989

    CAS  PubMed Central  PubMed  Google Scholar 

  48. 48.

    Anukam KC (2007) The potential role of probiotics in reducing poverty-associated infections in developing countries. J Infect Dev Ctries 1:81–83

    Google Scholar 

  49. 49.

    Reid G, Burton J, Hammond J, Bruce AW (2004) Nucleic acid-based diagnosis of bacterial vaginosis and improved management using probiotic lactobacilli. J Med Food 7:223–228

    PubMed  Article  Google Scholar 

  50. 50.

    Ehrström S, Daroczy K, Rylander E, Samuelsson C, Johannesson U et al (2010) Lactic acid bacteria colonization and clinical outcome after probiotic supplementation in conventionally treated bacterial vaginosis and vulvovaginal candidiasis. Microbes Infect 12:691–699

    PubMed  Article  Google Scholar 

  51. 51.

    Marcone V, Rocca G, Lichtner M, Calzolari E (2010) Long-term vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis. Int J Gynaecol Obstet 110:223–226

    PubMed  Article  Google Scholar 

  52. 52.

    Garg S, Goldman D, Krumme M, Rohan LC, Smoot S, Friend DR (2010) Advances in development, scale-up and manufacturing of microbicide gels, films, and tablets. Antiviral Res 88S:S19–S29

    Article  Google Scholar 

  53. 53.

    Maggi L, Mastromarino P, Macchia S, Brigidi P, Pirovano F, Matteuzzi D, Conte U (2000) Technological and biological evaluation of tablets containing different strains of lactobacilli for vaginal administration. Eur J Pharm Biopharm 50:389–395

    CAS  PubMed  Article  Google Scholar 

  54. 54.

    Burton JP, Cadieux PA, Reid G (2003) Improved understanding of the bacterial vaginal microbiota of women before and after probiotic instillation. Appl Environ Microbiol 69:97–101

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  55. 55.

    Eriksson K, Carlsson B, Forsum U, Larsson P-G (2005) A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules. Acta Derm Venereol 85:42–46

    PubMed  Article  Google Scholar 

  56. 56.

    Czaja CA, Stapleton AE, Yarova-Yarovaya Y, Stamm WE (2007) Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women. Infect Dis Obstet Gynecol 2007:35387

    PubMed Central  PubMed  Article  Google Scholar 

  57. 57.

    Drago L, de Vecchi E, Nicola L, Zucchetti E, Gismondo MR, Vicariotto F (2007) Activity of a Lactobacillus acidophilus—based Douche for the treatment of bacterial vaginosis. J Altern Complem Med 13:435–438

    Article  Google Scholar 

  58. 58.

    Kale V, Trivedi R, Muley P (2008) Proposed design of a dissolution apparatus for vaginal formulations containing probiotics. Dissolut Technol 15:27–29

    CAS  Google Scholar 

  59. 59.

    Larsson P-G, 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 Womens Health 8:3

    PubMed Central  PubMed  Article  Google Scholar 

  60. 60.

    Kaewnopparat S, Kaewnopparat N (2009) Formulation and evaluation of vaginal suppositories containing Lactobacillus. World Acad Sci Eng Technol 55:25–28

    Google Scholar 

  61. 61.

    Uehara S, Monden K, Nomoto K, Seno Y, Kariyama R, Hiromi K (2006) A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. Int J Antimicrob Agents 28S:S30–S34

    Article  Google Scholar 

  62. 62.

    Barrons R, Tassone D (2008) Use of Lactobacillus probiotics for bacterial genitourinary infections in women: a review. Clin Ther 30:453–468

    CAS  PubMed  Article  Google Scholar 

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This work was supported by National Funds from FCT—Fundação para a Ciência e a Tecnologia through project PEst-OE/EQB/LA0016/2011. Financial support for author S. Borges was provided by PhD fellowship, SFRH/BD/45496/2008 (FCT—Fundação para a Ciência e a Tecnologia). Editing of this manuscript by Dr P.A. Gibbs is gratefully acknowledged.

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The authors have no conflicts of interest to disclose.

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Correspondence to Paula Teixeira.

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Borges, S., Silva, J. & Teixeira, P. The role of lactobacilli and probiotics in maintaining vaginal health. Arch Gynecol Obstet 289, 479–489 (2014).

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  • Urogenital tract
  • Lactobacilli
  • Vaginal microbiota
  • Probiotics