Bacterial Vaginosis is an abnormal vaginal condition that leads to complications like pelvic inflammatory disease ,preterm birth and infertility How probiotics helpful in bacterial vaginosis conditions

1. Dr.Pavithra.A
Pharm.d
BACTERIAL VAGINOSIS -BV

2.  Trillions of microbial organisms live in and on the surface of the human
body.
They can be found in and on nearly every part of the body, including the
gut, brain, ear, skin, nose, the oral, gastrointestinal, respiratory, urinary and
vaginal tracts and the bloodstream.
Why this Human
Micro biome is
essential for human
body ?
They contribute more to
Human survival
Without it the human body cannot
function.
Eg: Process of aging, digestion, proper
functioning of the immune system,

3. A complete human is made up of all visible organs and
all the invisible microbes (bacteria, viruses and fungi) that
reside within and in the body.

4.  The human microbiota, is made up of bacteria, yeasts and
other Eukarya, archaea (primitive single-cell organisms),
fungi, protozoa and non-living viruses (bacteriophages).
Bacteria comprise the vast bulk of the microorganisms
that inhabit our bodies
More than 1000 bacterial species are estimated to live in
the body.
Types of Microbiome in Human Body

6. The war between Good Vs Bad

7. Despite what we have
been led to believe, not
all bacteria are bad.
Good Vs Bad

8.  We live a high-stress life in a city, eat a diet high in sugar and processed foods,
with lots of alcohol and we take antibiotics regularly, this can reduce the levels of
good bacteria in our gastrointestinal tract
‘Dysbiosis’ (imbalance), where the bad bacteria have taken over.

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If this Dysbiosis happen in vagina ??????
Bacterial Vaginosis

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Microbiome fascinating facts
 Our body contains more microbes (bacteria) than human cells.
 The bacteria in the human microbiome consists of more than three million genes, compared with the
20-25,000 human genes we all carry.
 As well as the 100,000 billion microbes in the intestinal microbiome, the skin microbiome hosts 1,000
billion bacteria.
 Many people assume that the gut bacteria live in the stomach – they actually live in our intestines, as the
stomach environment is too acidic for them to survive, and primarily (95%) in our large intestine (colon).
 Our microbiome is made up of both good and bad bacteria – and that’s fine as long as the right balance
is maintained.

11. Vaginal environment
 The vagina is a dynamic ecosystem that contains approximately
10 8 to 10 9 bacterial colony forming units
 Normal vaginal discharge is clear to white, odorless, and of
high viscosity.
 The normal bacterial microbiota is dominated by Lactobacillus spp.
(i.e. L. crispatus), but a variety of other facultative and strict anaerobic
bacteria are also present at much lower levels.
The most predominant &stable lactobacillus among Asians
accounting for almost 50-80% of vaginal bacteria Lactobacillus
crispatus

12. Role of Lactobacillus in Healthy vagina
 Lactobacillus is the keystone species present in
the microbiota of the birth canal
 Lactic acid-producing bacteria
 Maintains acidic environment (pH < 4.5)
The most frequently detected Lactobacillus species
are Lactobacillus iners, L. crispatus, and L. gasseri.
Other species as L. jensenii, L. gallinarum.
 Approximately 108 lactobacillus cells can be found
per milliliter of vaginal fluid

13.  Forms a massive growth of biofilm, which tightly attaches to the vaginal epithelia surface,
creating the first line of defense mechanism against potential pathogens.
The vaginal fluid secreted from the stratified squamous epithelium contains specific organic
acids, peroxides, and polypeptides that act as antibacterial agents against pathogenic or
abnormal microbes
Vagina’s acid environment is an important defense mechanism against the proliferation of
pathogens.

14. Bacterial Vaginosis (BV)
 Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age
women.
 The term ‘Bacterial vaginosis” was coined to describe abnormal bacterial flora of the vagina
characterized by an overgrowth of anaerobic bacteria and Gardneralla Vaginalis with marked
decrease in the presence of Lactobacillus.
 Bacterial Vaginosis –Affects 1 in 3 women aged 15 to 44 years

15. Bacterial Composition
Aerobic
bacteria
Excesses of
Anaerobic
bacteria
↓ Lactobacillus spp.
↑ Gardnerella vaginalis
Prevotella spp
Bacteroides spp.
Mobilincus spp.
Micoplasma hominis

16. Healthy vagina vs Bacterial Vaginosis

17. Commonly reported BV symptoms
Thin white or gray vaginal discharge
Pain, itching, or burning in the vagina
Painful urination
A strong fish-like odor, especially after sex

18. Diagnosis Of Bacterial Vaginosis

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Definition Of Bacterial Vaginosis
Amsel Criteria

20. Pathogenesis of Bacterial Vaginosis

21. Correlation between Lactobacillus, pH value, and pathogenic germs in the emergence of
bacterial vaginosis.
Development of bacterial vaginosis
Reduction of lactobacillus population
Reduction of H2O2 production
Excessive growth of
bacterial vaginosis-
associated bacteria
Increased pH -
value

22. Spread of Pathogens from Vagina to Upper
reproductive tract
Ascending of
Infection
Micro-organisms ascends from vagina into endometrium, fallopian tubes,
causing PID, Endometritis, PTB, Infertility & Poor ART outcome

23. CONVENTIONAL TREATMENT OPTIONS…
DRUGS (ANTIBIOTICS)
ORAL
Oral metronidazole 500 mg twice daily for 7 days
VAGINAL GEL
metronidazole vaginal gel 0.75 % for 5 days
CREAM
Clindamycin cream 2% intravaginaly for 7 days
Anti-microbial therapy kills both Pathogens as well as Good bacteria.
This maximizes the chances of Relapse of Bacterial Vaginosis

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Presenting a novel approach….
Prevents relapse & ensure high cure
rate in Bacterial Vaginosis

25. Probiotics: Probiotic term derived from Greek word
Pro (favor) and bios (life).

27. Prebiotics
 The term prebiotic where pre means “Before”
 Prebiotic was described as “a non-digestible food ingredient that beneficially affects
the host by selectively stimulating the growth and/or activity of one or a limited number
of bacteria in the colon, and thus improves host health”
 prebiotics ; are simply speaking the preferential “FOOD” for friendly beneficial
bacteria colonizing the digestive tract

28. Name
How do they work ?
 Increase a number of Bifidobacterium and lactic acid bacteria
 Growth of bifidobacteria

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How Probiotic helpful in Bacterial Vaginosis

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(A)Lactobacillus-dominated vaginal microbiome environment.
Vaginal Lactobacillus species, such as Lactobacillus crispatus,
produce lactic acid, bacteriocins, and hydrogen peroxide (H2O2),
which may provide protection against bacterial vaginosis (BV)
related bacteria and other infections.

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(B) BV microbiome environment
 BV-related bacteria (mainly Gardnerella) induce inflammation
in the vaginal tract and form a biofilm on vaginal epithelial cells.
 Short chain fatty acids (SCFAs) produced by BV-related bacteria,
increase vaginal pH.
 In addition, catabolism of amino acids and mucosal proteins
results in amines and a thinner mucosal layer in the vaginal tract.

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Pretreatment such as antibiotic, bacteriophage, anti-biofilm, or
antimicrobial agents, in combination with vaginal probiotic species
and vaginal administration, increase the probability of successful
colonization.
Treatment of BV with probiotics

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Selecting specific probiotics for normal
vaginal flora
Probiotics Microbiome
Produce
Lactic acid
pH < 4
Hydrogen
peroxide
(h2o2)
Bacteriocin /
Bio
surfactant
Kills
Gardernella
Vaginal
Symptoms
relief
L. crispatus,
L. Rhamnosus
L. jensenii
L. gasseri
l.Reuteri
L.Plantarum,fermentum,Acidophilus
Vaginal Bacteria      
For reinstating normal vaginal flora we need a probiotic which can produce
Lactic acid , Hydrogen peroxide (H2O2), Bacteriocins & Antibiotic toxic hydroxyl radicals

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