Probiotics are remarkable helpers of the human body. Probiotics are also critical for the prevention of vaginal infections and the healing of existing infections. Bacterial vaginosis (BV) is perhaps the most capable of being cured using the correct probiotics. As you may know, BV is an overgrowth of harmful bacteria in the vagina. This also is accompanied by a loss of the normal, probiotic bacteria in this microbiome (the microbial ecosystem of a specific location; such as the intestines, mouth, or vagina). Therefore, the restoration of the normal probiotic bacteria to a state of dominance in the vagina is curing BV.
Many women find that after using antibiotics, such as metronidazole or clindamycin, their BV returns. The rate of BV recurrence after antibiotic therapy is approximately 50%; some even estimate it to be closer to 70%. There is a very real population of women who have found it hard to eliminate BV as a result of the poor performance of regularly prescribed antibiotics. As research suggests, recurrence of this infection may be a result of Gardnerella vaginals, the primary bacterial pathogen causing BV, leaving a biofilm persisting in the vagina which assists in a relapse of the infection.
When the vagina has a thriving population of the right types of bacteria, it is more resistant to many types of infection in addition to BV. For instance, it is well understood that women with BV are somewhat more capable of acquiring a sexually transmitted disease. Therefore, using a probiotic in the vagina can be very beneficial. Concerning the general ways vaginal probiotics are beneficial, a clear overview of these benefits is given in the book Probiotics: A Clinical Guide. According to the book, probiotic vaginal bacteria provide four primary benefits:
- They stimulate the immune system
- They reduce the amount of available food and living sites
- They help to keep the vagina acidic by the production of weak organic acids
- They produce antimicrobial substances (such as bacteriocins and hydrogen peroxide)
What is Considered a Healthy Vaginal Microbiome?
Generally, the bacterial life present in a healthy vagina, are comprised nearly completely of lactic acid bacteria (LAB). LAB are most notably found in dairy foods and decomposing plants; and, produce lactic acid primarily, in the process of metabolizing carbohydrates. There are quite a few different genuses of these LAB. Lactobacillus, however, are of primary importance concerning vaginal health; as Lactobacilli make up approximately 90% of the bacteria in a healthy woman’s vagina. There is, of course, a great deal of variance in species and the amount of each species, from woman to woman; yet, a healthy vagina’s microbiotic diversity will still retain the aforementioned dominance of Lactobacilli. And, regardless of the exact aggregation, the synthesis of weak organic acids by LAB help maintain a low (acidic) vaginal pH; thus protecting the vagina from pathogens and promoting the development of acid loving, probiotic bacteria.
As you may have guessed, hormones--which greatly influence the physiological processes of the vagina--play a key role in the state of the vaginal microbiome. Estrogen is greatly responsible for the growth of the outer vaginal tissue (vaginal epithelium / vaginal mucosa) and the synthesis of glycogen (a sugar present in vaginal cells; glycogen is the primary storage form of glucose in human and animal cells) in this tissue. And, bacteria and fungus both use glycogen (and other types of carbohydrates) as a food source. As estrogen production declines, and preexisting estrogen is metabolized, the outer lining of the vagina thins and glycogen production is reduced. Thus, the reduction of sugar rich cells and influx of glycogen cause there to be less food for vaginal bacteria to consume. According to a study published in Translational Research [160.4 (2012): 267-282], this estrogen modulated transition is directly correlated with an increase in vaginal pH.
The regular sloughing of vaginal cells provides bacteria in the vagina with a source of glycogen. The most conspicuous shedding of vaginal cells, of course, is when women of reproductive age enter menses. Menstruation aside, this process of vaginal tissue renewal happens to some extent at all times in women. This natural process of vaginal cell growth, and subsequent cell loss, is not as prominent after menopause--due to the reduction of estrogen accompanying this physiological event. When a woman’s estrogen levels are low, there is a reduced amount of cells present in the vaginal epithelium. Low estrogen levels in women can cause a shift in the makeup of the vaginal microbiota--from one compromised by LAB to species that are strictly anaerobic (do not require oxygen for metabolism) and enteric bacteria (i.e., bacteria generally found in the digestive system).
According to the authors of the Translational Research [160.4 (2012): 267-282] study, women who have gone through menopause are thought to have a reduced number of vaginal LAB and elevated amounts of anaerobic bacteria. This shift in the vaginal ecosystem is directly related to the reduction of estrogen in these postmenopausal women. Therefore, women who are past menopause may want to consider taking an estrogen supplement to ensure an optimum environment for LAB in the vagina. Therefore, what is considered normal vaginal flora for a woman of reproductive age may not be normal for a woman who has past menopause. Understanding this may play a key role in understanding why a probiotic with the correct Lactobacilli do not seem to help get rid of BV.
One informative study, which was published in BJOG: An International Journal of Obstetrics & Gynaecology [118.5 (2011): 533-549], discussed the composition of vaginal bacteria and outlined the importance of this bacteria. According the authors, there have been over 100 species discovered within the Lactobacillus genus; and, many of these species have been proven to inhabit the vagina. The authors state that the dominant Lactobacilli life in the vagina can range from one species holding the majority, to an aggregate of anywhere from two to four species of Lactobacillus holding dominance.
According to another research study, published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing [32.3 (2003): 287-296], the normal bacterial flora of the vagina can consist of around 23 different genuses of bacteria; with Lactobacillus bacteria being the most prominent colonizers of this ecosystem. Other bacterial genuses, found in vaginal flora, can include: Staphylococcus, Mycoplasma, Streptococcus, and Bacteroides.
Further disambiguation, of a healthy vaginal flora aggregate (in regards to the somewhat esoteric prevalence of non-Lactobacilli vaginal flora), is found in research published in the journal Infectious Diseases: Research and Treatment [3 (2010): 1]. This study also demonstrates the typical composition of a healthy vaginal microbiome. According to the research, a healthy vaginal ecosystem, in women of reproductive age, can easily be completely dominated by Lactobacilli; i.e., with no other bacteria living in the ecosystem. Other bacteria though, are often present; and, Streptococcus species, for example, can comprise approximately 39% of the total vaginal flora aggregate. Of the total Streptococci, Streptococcus alpha-hemolytic (prevalence can be over 30%), and nonhemolytic (they do not break down red blood cells) Streptococcus bacteria (prevalence can be as high as approximately 30%) can be major colonizers. Other genuses of bacteria which colonizing the vagina, according to the authors of this research, include the following:
Regarding Lactobacilli, we will address the Journal of Obstetric, Gynecologic, & Neonatal Nursing [32.3 (2003): 287-296] study again. According to Heather S. Jeavons, the author of this research, two species of Lactobacillus are the primary colonizers of the vagina. These two species are L. acidophilus and L. fermentum. This study also confirms the growing importance of L. acidophilus, and relates that L. acidophilus has a emerged as a prominent focus for vaginitis treatment and research.
According to the study, when endogeneous (resident bacteria in a body area) vaginal Lactobacilli are not thriving, a proliferation of a number of other organisms can occur. This overgrowth of atypical microbes can eventually result in a fungal or bacterial infection. Jeavons also reiterates and confirms what other research has stated: vaginal Lactobacilli produce lactic acid via their metabolism of glycogen stored in vaginal cells. The study additionally confirms lactic acid production of Lactobacilli acidifies the vagina--causing vaginal pH to be maintained at around 4.0 to 4.5. By keeping vaginal pH acidic to such a degree, many pathogens are not able to flourish. The most prevalent colonizers of the vagina, in the Lactobacillus genus, are the following species:
- Lactobacillus acidophilus
- Lactobacillus fermentum
- Lactobacillus crispatus
- Lactobacillus iners
A critical paper discussing the composition of the vaginal microbiome was published in PloS One [8.4 (2013): e60670]. The study used genetic identification (known as pyrosequencing) to determine bacterial species in vaginal samples provided by 163 women. The women in the study were allocated into three groups: 79 women were deemed healthy and served as controls, 11 women were assigned to the intermediate group (i.e., their vaginal flora composition was closer to that of a state of BV), and a final group of 73 women currently had BV and assigned ensuingly. The results of the study were in line with other research; healthy women’s vaginal microbiota was comprised of approximately 90% Lactobacilli. Of the Lactobacillus species, L. iners and L. crispatus accounted for most of the Lactobacilli. Concerning women in the intermediate group, G. vaginalis and L. iners were found found to have colonized this microbiome significantly more than other species. Finally, women who were suffering from BV were seen to have more colonization by other bacteria; with a more pronounced array of bacterial species in their vaginal samples. G. vaginalis colonization significantly dominated other species in the flora of women with BV; subsequently comprising about 30% of the total bacteria in the samples. The following three charts are presented in this study and visually illustrate the vaginal microbiome composition of the three groups of women analyzed by this research.
Actively Fighting BV with Lactobacillus acidophilus
The popular probiotic L. acidophilus, which is frequently found in supplements designed to ameliorate gastrointestinal function, can also be used with significant success intravaginally. The production of metabolites, such as hydrogen peroxide, by this bacteria alone will halt the growth of the primary pathogen instigating BV: G. vaginalis. A thorough study confirming this was published in the journal Applied and Environmental Microbiology [62.3 (1996): 1089-1092]. The study was conducted by two scientists, and the focus of their research was directed at the interaction of Lactobacilli with two types of G. vaginalis bacteria: strains susceptible, and strains not susceptible, to metronidazole. A critical finding of the research, regarded supernatant fluid collected from areas where L. acidophilus was allowed to grow and develop. This fluid had a profound inhibitory action against G. vaginalis. The L. acidophilus strains 44i, 44s, L8, and J11 seemed to be the best at fighting normal G. vaginalis strains susceptible to metronidazole. Other G. vaginalis strains, which were resistant to metronidazole, were not as greatly impacted by the residual fluid derived from the culturing of L. acidophilus. The chart below, taken from this journal paper, illustrates these strains influence on the development of G. vaginalis (note that “MTZ” stands for metronidazole):
This same research tested 11 different strains of L. acidophilus, 2 strains of L. casei, 6 strains of L. jensenii, 3 strains of L. rhamnosus, and one strain of L. fermentum. These 23 strains of Lactobacillus all successfully inhibited G. vaginalis in a well diffusion assay (a petri dish that has a thin layer of agar [gel like growth material] that is inoculated with an organism. Small cylinders are removed from the agar and small amounts of a substance are added to these “wells.” The distance from the well to viable microbial growth is the zone of inhibition.). The supernatant fluid harvested from the location of Lactobacilli growth, created an average zone of inhibition of about 14 millimeters. The median pH of this supernatant fluid was approximately 4. In this test, L. fermentum supernatant fluid demonstrated the weakest inhibitory effect--having a zone of inhibition of 6.5 mm.
The inhibitory ability of these supernatant fluids, created by various species of Lactobacillus, differed somewhat between species. The researchers also found that as the pH of Lactobacilli supernatant fluid became more acidic, the zone of inhibition created by these fluids also increased. It is well known that many bacteria do not thrive well in an acidic environment. A strong reason for this is due to the cytoplasm (the fluid on the inside of a cell) of these bacteria becoming too acidic. This acidification interferes with metabolism and the movement of chemicals through the cell membranes of these bacteria. Interestingly, weak organic acids help to draw in hydronium ions (notated as “H+”, these are merely hydrogen ions; and, the more hydronium ions a substance contains, the more acidic the substance is) once a critical mass of these acids is reached. The ability of weak organic acids at high concentrations to draw in additional hydronium ions, is a key reason they can help mitigate pathogenic bacteria (as the presence of such an acid inside a bacterium can lead to even more acid entering it). Accordingly, this study found that the supernatant fluids of L. acidophilus cultures lost approximately 60% of their inhibitory power when the pH of these fluids was raised to 6.5.
L. acidophilus and Bacteriocin Production
In addition to producing lactic acid, L. acidophilus can also create bacteriocins--which are proteins or peptides that have an antagonistic effect on other bacteria. A study investigating this topic was published in the journal Infectious Diseases in Obstetrics and Gynecology [9.1 (2001): 33-39]. The study looked at the bacteriocin production of a particular strain of L. acidophilus, and examined how it affected strains of G. vaginalis. The authors of the study relate that bacteriocin from Lactobacilli can negatively affect a wide variety of anaerobic bacteria. As the primary bacteria causing BV are anaerobic, bacteriocin production is another reason why certain Lactobacilli are ideal for use as probiotics. Bacteriocin from Lactobacilli can also inhibit other species of Lactobacillus; serving to regulate even the development of other species in this genus. The study suggest this trait allows Lactobacilli to reduce competition, and subsequently dominate a particular environment.
Regarding LAB in general, LAB bacteriocins are generally proteins or fragments of proteins. The majority of bacteriocins produced by LAB can be classified into four distinct groups; with each group holding specific biochemical and genetic characteristics. A study providing a solid delineation of this classification was published in the journal Microbiology [141.7 (1995): 1629-1635]. As the study indicates, LAB bacteriocins are comprised by the following classes:
- Complex bacteriocins having chemical moieties (segments) that are not protein
- Small weight, peptides that are not easily degraded by heat
- Large weight, proteins that are easily altered by heat
- Lantibiotics, very small weight proteins containing the amino acid lanthionine
This same research effort sought to understand a potent bacteriocin, known as acidocin B, which is produced by L. acidophilus. Acidocin B is a protein capable of inhibiting a number of bacteria outside of the Lactobacillus genus; while only inhibiting a few Lactobacilli species. The study authors state there is little similarity between acidocin B and other bacteriocins produced by LAB. This study demonstrates acidocin B, a rather unique chemical generated by L. acidophilus, can help to keep a number of unwanted bacteria suppressed in a microbiome.
According to a study published in Applied and Environmental Microbiology [45.6 (1983): 1808-1815], bacteriocin produced by L. acidophilus does not harm all types of bacteria. Yet, bacteriocin from L. acidophilus was found to be bactericidal (lethal against bacteria) and capable of affecting multiple types of bacteria. The bacteriocin produced by L. acidophilus examined in this research was lactacin B. The process by which lactacin B damages other bacteria starts with adsorption (i.e., a bacterium comes into physical contact with the poison and it coats the surface of the bacterium to some extent). The research stated certain types of bacteria that come into contact with lactacin B are not damaged by this protein. Two strains of L. acidophilus, which produced lactacin B, were not harmed by this chemical.
The Lactobacillus Acidophilus Complex
Before 1980, many different types of similar bacteria were considered to be the species L. acidophilus. However, in 1980, it was found there was a high amount of difference between the bacteria classified as L. acidophilus. As a result, these bacteria were given their own taxonomic designation; being initially allocated into six species. With the steady accumulation of further research, three additionally species were added to the L. acidophilus complex. The species comprising this complex are quite similar; and, it is occasionally not possible to differentiate them based on phenotypic (physically apparent) characteristics. Genetic profiles are therefore used to accurately distinguish individual species within this group. The acidophilus complex contains the following nine species:
- Lactobacillus acidophilus
- Lactobacillus crispatus
- Lactobacillus gallinarum
- Lactobacillus gasseri
- Lactobacillus amylolyticus
- Lactobacillus jensenii
- Lactobacillus amylovorus
- Lactobacillus johnsonii
- Lactobacillus iners
According to the Translational Research [160.4 (2012): 267-282] study, Lactobacillus bacteria are the key microbes that support the health of the vagina. Bacteria of the acidophilus complex can produce both lactic acid and hydrogen peroxide; this in turn is perhaps the foundational reason for their probiotic importance. Additionally, the primary colonizers of the vagina are all species within the acidophilus complex. Concerning this point, the authors of this study state:
In general, the presence of high numbers of lactic acid bacteria in the vagina is often equated with “healthy” and low numbers, or absence thereof, as being “abnormal.” ...[In] the 1980s, it was determined that L. acidophilus was not a single species, but rather a group of closely related, obligately homofermentative species collectively known as the Lactobacillus acidophilus complex. Because species within this complex are difficult to distinguish phenotypically [by physical characteristics] or biochemically [by nutritional and metabolic capabilities], they were differentiated on the basis of DNA homology. All of the Lactobacillus spp. found to be prevalent in the vagina today are members of this complex.
Treating BV with Lactobacillus crispatus
According to a study published in BMC Infectious Diseases [16.1 (2016): 180], the presence of L. crispatus can be viewed as one of the best indicators for the absence of BV. The study found that women with L. crispatus had a reduction of L. iners; and the converse was also true. Therefore, the study shows a strong negative correlation between these two bacteria. The research found about 37% of women without BV lacked L. crispatus; and, all of the women with BV greatly lacked this probiotic. The authors state that other studies have found an association between L. iners and BV; but, when L. iners dominates, this also strongly indicates no occurrence of BV. As mentioned, L. iners is one of the primary colonizers of the vaginal flora; and, it is also a member of the acidophilus complex. To provide an additional voice on this topic, a 2005 study published in the 113 volume of APMIS states L. iners and L. crispatus are two of the most commonly found species in the vaginal environment. This same research also explained that the Lactobacillus flora, in a healthy vagina, is homogeneous; typically comprised of one or two different species in this genus. Therefore, it is not unusual to have L. iners predominate in a healthy vagina. Referring back to the BMC Infectious Diseases [16.1 (2016): 180] study, the authors of this work help confirm BV is the overgrowth of many different types bacteria; whereas a healthy vagina will be dominated by very few Lactobacillus species. The following remarks were taken from this 2016 study:
Key findings of this paper
This work confirmed the presence of two clusters of bacterial populations [in healthy women], dominated by either Lactobacillus iners or Lactobacillus crispatus and three distinct clusters in the BV positive women. The cluster profiles in BV positive subjects were relatively high in bacterial species diversity and dominated by a variety of anaerobic species... Based on [cited research of this study] and our data of Dutch women, the bacterial diversity and overall abundance of the genus Lactobacillus could be considered sufficient as molecular markers to determine BV in the majority of subjects.
Again concerning the BMC Infectious Diseases [16.1 (2016): 180] study, this paper provides a vivid representation of L. crispatus and L. iners colonization and how the presence of these two Lactobacilli can influence a woman’s Nugent and Amsel scores. The chart below (after the explanation of the Nugent and Amsel scoring systems) clearly indicates a high amount of one of these two Lactobacilli, or aggregate quantity of the two (both L. crispatus and L. iners), results in a negative Amsel test result and a low Nugent score. This clearly shows adding L. crispatus to the vagina is a key way to protect the vagina from the onset of BV. But, this chart doesn’t mean too much if you do not know what Nugent and Amsel scores are. These scores are simply the results of the Nugent test and Amsel test. These two tests are often given at clinics for the purpose of confirming the presence of BV. It is very common to see these tests referred to in research regarding BV. If you have been to a sexual health clinic, you may have had one of these tests done. To clarify what these, somewhat esoteric, tests exactly are, the following explanations provide the answer:
- Nugent Scoring System: In 1991, a study by Nugent et al., outlined a system for diagnosing BV via the analysis of vaginal smear bacteria. Primarily, a reduction of Lactobacilli (denoted by a score of 0 to 4), the presence of G. vaginalis (denoted by a score of 0 to 4), and the presence of Mobiluncus species (denoted by a score of 0 to 2) are looked for in vaginal smears. The absence of Lactobacilli and the abundance of G. vaginalis and Mobiluncus species all engender higher Nugent scores. Nugent scores range from 0 to 10; with higher scores being more indicative of BV. Scores from 7 to 10 are common for women with BV (Sha, et al.; 2005).
- Amsel Criterion Assessment: This test is based on well understood clinical criteria of BV; as set forth by Amsel et al. in 1983. The test is comprised of four criterions; and, if a woman is positive for three of these criteria, a clinical diagnosis of BV can be given. The four criteria of this test are: the presence of a homogenous vaginal discharge, the creation of a strong “fishy” odor when a solution of 10% potassium hydroxide is added to the woman’s vaginal discharge, the presence of clue cells (cells of the vaginal lining that are covered with bacteria to the point their appearance is altered), and a vaginal pH that is higher than 4.5 (Sha, et al.; 2005).
Probiotic Capsules, Suppositories, & Supplements
According to the research, it is important to have a vaginal microbiota that is dominated by Lactobacillus bacteria. The species of Lactobacillus in a probiotic supplement is going to be the quintessential determinant of a supplement’s healing efficacy. As many studies have shown, not all types of Lactobacillus produce hydrogen peroxide; and, the production of lactic acid can also vary between species. Given that hydrogen peroxide and lactic acid both help to prevent BV, the best probiotic tablets / pills / suppositories / etc. will contain some type of Lactobacillus that is efficient at producing these two chemicals. The species of Lactobacillus that normally dominate vaginal flora are perhaps the most prudent to use intravaginally. The two best Lactobacillus species to look for in a BV probiotic may very well be L. acidophilus and L. crispatus. By getting highly ideal strains of L. acidophilus and L. crispatus reintroduced into the vaginal microbiome, you are certainly going to help treat a case of BV.
Remember, scientific findings regarding the normal flora of the vagina indicate that one, or a few species of Lactobacillus, regularly comprise the majority of the bacterial life in the vagina. Thus, when you look for a probiotic tablet or pill for treating BV, you should focus on adding just one or two species of Lactobacillus to the vagina. But again, how aggressively an individual strain of Lactobacillus fights the bacteria causing BV is a strong determinant of its therapeutic effect. Conversely, if you select a probiotic with less suitable types of bacteria, you are going to see poor, if any, results.
Concerning ameliorating BV via probiotics, introducing these bacteria into the vagina has been proven to be beneficial. A study looking at the use of probiotics intravaginally, as a measure to prevent BV, demonstrated this. The study was published in the American Journal of Obstetrics and Gynecology [203.2 (2010): 120-e1]. Study participants were women who had a history of recurrent BV. The female participants were assigned into two groups: an experiment arm (those who used the probiotic) of 58 women, and a control arm (those who received a placebo) of 62 women. Women in the experiment group took one capsule of 8 billion CFUs of bacteria (L. acidophilus was one of the bacteria in the probiotic) intravaginally for 7 consecutive days, then did not use the probiotic for 7 days, and finally used the capsules again intravaginally for the last 7 days. Those women who used the probiotic capsules intravaginally had a rate of BV recurrence of just 15.8%; and, the women who did not take the capsule had a BV recurrence rate of 45%. The long term outcomes of the participating women in the study are illustrated by the table below (which was included in the study):
The authors of this research also state that women who use antibiotics to get rid of BV often develop the infection again. According to the study, the standard treatment for BV is vaginal clindamycin or metronidazole given vaginally or orally. The study goes on to explain that the success rates for curing BV, with such antibiotics, is as low as 52%; and, recurrence rates are commonly 50% at 6 to 12 months after treatment. The study also refers to a 2008 study which reported all G. vaginalis strains become resistant to metronidazole in recurrent cases of BV.
Safely Curing BV in Just 3 Days Naturally
Recurrent BV is a very real problem for many women. Being attacked by BV only a time or two is something that many would like to avoid--let alone deal with a cycle of infection recurrence. Like many women, Jennifer O’Brien found herself dealing with recurrent outbreaks of BV. Jennifer struggled with this infection for quite awhile; and, it really began to hurt her quality of life. Jennifer learned, as many women do, that prescription drugs would not solve her problem. Jennifer found that her BV would go away consistently after using a prescription treatment; but, it was only a matter of time before the infection would return. There were no clear options she could find to end this problem; and, it was ruining her life.
Jennifer would regularly deal with vaginal burning and itching; and the classic unpleasant odor and discharge BV routinely causes. And, being intimate with her boyfriend was difficult. Although she could be free of symptoms for some time, the symptoms could always come back unexpectedly. The long courses of antibiotics Jennifer was taking also began to negatively influence her health. Routine bouts of fatigue and occasional yeast infections started to happen from the antibiotics.
Eventually, Jennifer decided to stop relying on antibiotics and took matters into her own hands. She began to investigate BV and develop a solid understanding of what this condition is, and how to actually get rid of it. It took a considerable amount of work, but eventually Jennifer did put together a novel plan to permanently cure her BV. Jennifer found that her approach did in fact work; and work very well. Jennifer found that her approach to treating BV would permanently cure it in 3 days. Also, Jennifer developed a in-depth approach to addressing the underlying causes of BV, that would correct these issues in 30 to 60 days.
Shortly after recognizing her success, Jennifer wrote a book about her treatment plan. Her book outlines the system she developed to permanently cure BV in 3 days. Also included in her book is the system for correcting underlying issues that lead to BV. Since Jennifer published her book, more than 130,000 women from multiple countries have seen remarkable success with Jennifer’s system. Jennifer states that 98.2% of those who give her treatment approach a try are satisfied with the results they see. She also provides a 60 day, 100% refund period for those who want to give her book a try without risking too much.
Jennifer O’Brien’s book is available at her personal website, and you can also find out more about her life and the struggle she had with BV there as well.
- Google Books -- Martin H. Floch, Adam S. Kim. “Probiotics: A Clinical Guide.” SLACK Incorporated, 2010. ISBN: 9781556429095
- http://dx.doi.org/10.1016/j.trsl.2012.02.008 -- Hickey, Roxana J., et al. "Understanding vaginal microbiome complexity from an ecological perspective." Translational Research 160.4 (2012): 267-282. PubMed PDF
- http://dx.doi.org/10.1111/j.1471-0528.2010.02840.x -- Lamont, Ronald F., et al. "The vaginal microbiome: new information about genital tract flora using molecular based techniques." BJOG: An International Journal of Obstetrics & Gynaecology 118.5 (2011): 533-549. PubMed PDF
- http://dx.doi.org/10.1177/0884217503253439 -- Jeavons, Heather S. "Prevention and treatment of vulvovaginal candidiasis using exogenous Lactobacillus." Journal of Obstetric, Gynecologic, & Neonatal Nursing 32.3 (2003): 287-296. PubMed
- http://dx.doi.org/10.4137/IDRT.S3903 -- Farage, Miranda A., Kenneth W. Miller, and Jack D. Sobel. "Dynamics of the vaginal ecosystem--hormonal influences." Infectious Diseases: Research and Treatment 3 (2010): 1. PDF Available Here
- http://dx.doi.org/10.1371/journal.pone.0060670 -- Shipitsyna, Elena, et al. "Composition of the vaginal microbiota in women of reproductive age–sensitive and specific molecular diagnosis of bacterial vaginosis is possible?." PloS one 8.4 (2013): e60670. PubMed PDF
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC167872/ -- McLean, Nigel W., and Jacqueline A. McGroarty. "Growth inhibition of metronidazole-susceptible and metronidazole-resistant strains of Gardnerella vaginalis by Lactobacilli in vitro." Applied and environmental microbiology 62.3 (1996): 1089-1092. PubMed PDF
- http://dx.doi.org/10.1155/S1064744901000060 -- Aroutcheva, Alla A., Jose A. Simoes, and Sebastian Faro. "Antimicrobial protein produced by vaginal Lactobacillus acidophilus that inhibits Gardnerella vaginalis." Infectious diseases in obstetrics and gynecology 9.1 (2001): 33-39. PubMed PDF
- http://dx.doi.org/10.1099/13500872-141-7-1629 -- Leer, Rob J., et al. "Genetic analysis of acidocin B, a novel bacteriocin produced by Lactobacillus acidophilus." Microbiology 141.7 (1995): 1629-1635. PubMed
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC242543/ -- Barefoot, Susan F., and Todd R. Klaenhammer. "Detection and activity of lactacin B, a bacteriocin produced by Lactobacillus acidophilus." Applied and Environmental microbiology 45.6 (1983): 1808-1815. PubMed PDF
- http://dx.doi.org/10.1186/s12879-016-1513-3 -- Dols, Joke AM, et al. "Molecular assessment of bacterial vaginosis by Lactobacillus abundance and species diversity." BMC infectious diseases 16.1 (2016): 180. PubMed Central PDF, PubMed
- http://dx.doi.org/10.1111/j.1600-0463.2005.apm1130201.x -- Forsum, Urban, et al. "Bacterial vaginosis–a microbiological and immunological enigma." Apmis 113.2 (2005): 81-90. PubMed
- http://dx.doi.org/10.1128/JCM.43.9.4607-4612.2005 -- Beverly, E. Sha, et al. "Utility of Amsel criteria, Nugent score, and quantitative PCR for Gardnerella vaginalis, Mycoplasma hominis, and Lactobacillus spp. for diagnosis of bacterial vaginosis in human immunodeficiency virus-infected women." Journal of clinical microbiology 43.9 (2005): 4607-4612. PubMed PDF
- http://dx.doi.org/10.1155/2005/230319 -- Money, Deborah. "The laboratory diagnosis of bacterial vaginosis." Canadian Journal of Infectious Diseases and Medical Microbiology 16.2 (2005): 77-79. PubMed PDF
- http://dx.doi.org/10.1016/j.ajog.2010.05.023 -- Ya, Wang, Cheryl Reifer, and Larry E. Miller. "Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study." American journal of obstetrics and gynecology 203.2 (2010): 120-e1. PubMed
***This article and the material on this website MAY have slight errors. Make sure you check out our disclaimer.