Oral use of probiotics as an adjunctive therapy to fluconazole in the treatment of yeast vaginitis: A study of nigerian women in an outdoor clinic

Abstract

Background: Vulvovaginal candidiasis (VVC) is one of the major urogenital infections for which women seek medicaltreatment or use self-prescribed antifungals. The objective of this study was to investigate whether probiotic lactobacilli canbe used as an adjunctive treatment in the management of VVC in Nigerian women. Patients and methods: Fifty-ninepremenopausal women attending health clinics were diagnosed with vaginal yeast infection by both clinical assessment and standard laboratory culture techniques. After informed consent, they were randomized blindly to receive a conventional single oral dose of fluconazole (150 mg) and a daily probiotic capsule containing Lactobacillus hamnosus GR-1 and Lactobacillus reuteri RC-14 or placebo for 3 months (90 days). Results: At day 7, 47 of the 59 patients attended for follow-up.Seven of the 33 on probiotics (23%) and 2 of 14 on placebo (14%) had evidence of yeast infection by culture on day 7 ( p 0.1), indicating a cure rate of approximately 80% with single dose fluconazole. However, of the 26 subjects who reported at day 90, 79% who received probiotics were free of yeast infection compared with 43% on placebo ( p 0.1490). PCR confirmed this finding, as 75% in the probiotics group were negative for heat shock protein specific for Candida albicans at day 90. A PCR primer set specific for L. rhamnosus GR-1 and L. reuteri RC-14 revealed the presence of the Lactobacillus strains on day 90 in 25% of the subjects who took probiotics. All the patients in the placebo group (100%) had two or three recurrences during the 90 day follow-up, while 53% of the probiotics group had one to two recurrences ( p 0.05). Conclusion: The study shows that adjunctive treatment of VVC with probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not impact the cure rate at day 7, but did lead to fewer vulvovaginitis recurrences. Problems with patients returning for follow-up appointments suggest the need for a more active education programme in Nigeria on clinical trials per se and probiotics in particular. Clinical Trial Registration Number:.