Best Probiotics for Bacterial Vaginosis
Bacterial vaginosis (BV) affects approximately 29.2% of females aged 14-49.1 While it is not considered to be a sexually transmitted infection (STI), it is considered an infection or “dysbiosis” in the vagina. Dysbiosis means that there is an imbalance of microbial life.
The vagina normally has a population of bacteria that keeps away bad bacteria. The normal residents of the vagina belong in the Lactobacillus family. They create lactic acid which acidifies the vagina and bacteriocins which keeps away bad bacteria like Gardnerella vaginalis which is one of the main causes of BV.
Antibiotics are commonly prescribed for bacterial vaginosis but they do not restore the normal vaginal microbes that help keep BV at bay. In fact, these antibiotics may cause further disruptions to the vaginal microflora. Metronidazole gel 0.75% (mg/g) is used to treat BV. Concentrations as low between 1-4% can disrupt Lactobacillus growth while concentrations of 5% will completely stop Lactobacillus growth.2
In one study 96% of normal women without BV had hydrogen peroxide producing intravaginal Lactobacilli compared to only 6% of women with BV. Furthermore, 36% of normal women had non hydrogen-peroxide Lactobacilli compared with only 6% of women with BV. Hydrogen peroxide producing Lactobacillus species seem to be correlated with a lower incidence of BV.3 Here is a list of hydrogen peroxide and non hydrogen peroxide producing Lactobacilli that are the best probiotics for bacterial vaginosis.
| Lactobacillus Speies | H2O2 Production | Number of Normal Women (n=28) with the Species | Number of Women with BV (n=67) with the Species |
| L. acidophilus | + | 3 | 0 |
| L. jensenii | + | 3 | 2 |
| L. acidophilus and L. jensenii | + | 4 | 0 |
| L. catenaforme | + | 3 | 0 |
| L. acidophilus and L. leichmannii | + | 1 | 0 |
| Lactobacillus sp. unknown | + | 2 | 0 |
| Lactobacillus sp. not further identified | + | 7 | 1 |
| L. jensenii and L. brevis | + and - | 1 | 0 |
| L. jensenii and Lactobacillus sp. unknown | + and - | 1 | 0 |
| L. acidophilus and Lactobacillus sp. unknown | - and + | 1 | 0 |
| L. fermentum and Lactobacillus sp. unknown | - and + | 1 | 0 |
| L. jensii and L. delbrueckii | + and - | 0 | 1 |
| L. acidophilus | - | 0 | 3 |
| L. acidophilus and L. delbrueckii | - and - | 0 | 1 |
| L. acidophilus and Lactobacillus sp. unknown | - and - | 0 | 1 |
| L. delbrueckii | - | 0 | 3 |
| L. brevis | - | 0 | 1 |
| L. fermentum | - | 0 | 1 |
| L. helveticus | - | 0 | 3 |
| L. leichmannii | - | 0 | 1 |
| L. salivarius and Lactobacillus sp. unknown | - and - | 0 | 1 |
| L. fermentum and L. brevis | - | 0 | 2 |
| Lactobacillus sp. unknown | - | 0 | 2 |
| Lactobacillus sp. not further identified | - | 0 | 8 |
| Nonviable for ID | N/A | 0 | 4 |
| No Lactobacillus | 1 | 32 |
Source: https://jcm.asm.org/content/27/2/251.short
As you can see from the chart, many different Lactobacillus species normally live and thrive in the vagina. These organisms work to acidify and protect the vagina from harmful organisms. From the chart it is also evident that the best probiotics for bacterial vaginosis and general vaginal health are hydrogen peroxide producing Lactobacillus bacteria.
Lactobacillus acidophilus may be one of the best probiotics to prevent yeast infection and bacterial vaginosis as it has been found to be effective at rebalancing and maintaining healthy vaginal microflora. These friendly bacteria deter the growth of Candida and fungi, the cause of yeast infections4, as well as the growth of Gardnerella vaginalis, the cause of bacterial vaginosis5.
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Sources:
- https://www.cdc.gov/std/bv/stats.htm
- https://www.hindawi.com/journals/idog/2001/419310/abs/
- https://jcm.asm.org/content/27/2/251.short
- https://www.ncbi.nlm.nih.gov/pubmed/16790461
- https://www.sciencedirect.com/science/article/pii/S1198743X14633723
About the Author:
Dr. Bryan Do, D.O. is an osteopathic physician whose research interests include gastroenterology, immunology, and dermatology. He is particularly interested in the role of probiotics in the gut-brain-skin axis and has written many articles on the topic. He graduated from University of California, Los Angeles (UCLA) before graduating from Marian University College of Osteopathic Medicine in Indianapolis, Indiana and becoming a Doctor of Osteopathic Medicine. Osteopathic physicians are taught to take a holistic approach to medicine and to consider mind, body, and spirit when treating a patient. Osteopathic physicians receive training in Osteopathic Manipulative Medicine (OMM) in addition to the standard rigorous medical school curriculum. Both physicians with a Doctor of Osteopathic Medicine (D.O.) degree as well as a Doctor of Medicine (M.D.) can practice medicine.