Alleviation of vulvovaginitis symptoms: can probiotics lead the treatment plan?

Disruption of vaginal microbiota equilibrium promotes infectious clinical syndromes with annoying symptoms, such as vaginal discharge, odour, irritation, pruritus, and vulvar burning. Although identifying and eradicating the pathogen involved has been the standard of care, regional microbiota restoration with probiotics has been gaining ground in recent years. This study aimed to assess the effectiveness of topical treatment for patients exhibiting vaginal discomfort symptoms. A clinical trial was conducted on the use of a topical regimen among reproductive-age women (n=70) with vaginal discomfort symptoms. We assessed their symptoms using a questionnaire, measured vaginal pH, and performed vaginal swabs for microscopy and cultivation. Over the next 4 days, patients received vaginal douches and suppositories with appropriate antibiotic treatment being added on the fourth day based on vaginal swab results. Patients returned 16 days later to fill out in the questionnaire again. The Wilcoxon signed-ranked test was then used to assess differences in symptomatology and pH between appointments. A reduction in vaginal pH was reported between the first and second visit (<0.001). The probiotic regimen exerted a beneficial effect in all vaginal manifestations: vulvovaginal itching, burning sensation, vaginal irritation, and vaginal discharge (<0.001 for all symptoms). Additionally, three out of the four symptoms were alleviated to a greater extent during the first four days of exclusive probiotic use than during the second phase (=0.007, =0.004, and =0.033). Our sample provided significant results regarding the benefits of for vaginal discomfort. We postulate that the greatest symptom improvement was achieved within the first 4 days of exclusive probiotic use, before the addition of antibiotics. This study agrees with the increasing literature on the contribution of probiotics toward vaginitis treatment.