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Open Access Highly Accessed Research article

Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses

Per-Göran Larsson1*, Erik Brandsborg2, Urban Forsum3, Sonal Pendharkar4, Kasper Krogh Andersen4, Salmir Nasic5, Lennart Hammarström4 and Harold Marcotte4

Author Affiliations

1 Department of Obstetrics and Gynaecology Kärnsjukhuset, Skaraborg hospital and University of Skövde, SE-541 85 Skövde, Sweden

2 Bifodan AS, Bogbinderivej 6, DK-3390 Hundested, Denmark

3 Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden

4 Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden

5 FoU Skas, Skaraborg hospital, SE-541 85 Skövde, Sweden

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BMC Infectious Diseases 2011, 11:223  doi:10.1186/1471-2334-11-223

Published: 19 August 2011

Abstract

Background

The primary objective of this study was to investigate if extended antibiotic treatment against bacterial vaginosis (BV) together with adjuvant lactobacilli treatment could cure BV and, furthermore, to investigate factors that could cause relapse.

Methods

In all, 63 consecutive women with bacterial vaginosis diagnosed by Amsel criteria were offered a much more aggressive treatment of BV than used in normal clinical practice with repeated antibiotic treatment with clindamycin and metronidazole together with vaginal gelatine capsules containing different strains of lactobacilli both newly characterised and a commercial one (109 freeze-dried bacteria per capsule). Oral clindamycin treatment was also given to the patient's sexual partner.

Results

The cure rate was 74.6% after 6 months. The patients were then followed as long as possible or until a relapse. The cure rate was 65.1% at 12 months and 55.6% after 24 months. There was no significant difference in cure rate depending on which Lactobacillus strains were given to the women or if the women were colonised by lactobacilli. The most striking factor was a new sex partner during the follow up period where the Odds Ratio of having a relapse was 9.3 (2.8-31.2) if the patients had a new sex partner during the observation period.

Conclusions

The study shows that aggressive treatment of the patient with antibiotics combined with specific Lactobacillus strain administration and partner treatment can provide long lasting cure. A striking result of our study is that change of partner is strongly associated with relapse of BV.

Trial registration

ClinicalTrials.gov: NCT01245322