Erica L Plummer1,2, Catriona S Bradshaw1,2, Michelle Doyle2, Christopher K Fairley1,2, Gerald L Murray3,4,5, Deborah Bateson6,7, Lindi Masson1,8,9,10,11, Josephine Slifirski2, Gilda Tachedjian8,12,13, Lenka A Vodstrcil1,2. 1. Central Clinical School, Monash University, Melbourne, Victoria, Australia. 2. Melbourne Sexual Health Centre, Alfred Hospital, Carlton, Victoria, Australia. 3. Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia. 4. Murdoch Children's Research Institute, Parkville, Victoria, Australia. 5. Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia. 6. Family Planning New South Wales, Ashfield, New South Wales, Australia. 7. Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Camperdown, New South Wales, Australia. 8. Burnet Institute, Melbourne, Victoria, Australia. 9. Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa. 10. Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa. 11. Centre for the AIDS Programme of Research in South Africa, Durban, South Africa. 12. Department of Microbiology, Monash University, Clayton, Victoria, Australia. 13. Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute of Infection and Immunity, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE: The vaginal microbiota in bacterial vaginosis (BV) typically has low abundance of lactic acid producing lactobacilli. Lactic acid has properties that may make it effective for treating BV and/or restoring an optimal lactobacillus-dominated vaginal microbiota. We conducted a systematic review to describe the effect of intravaginal lactic acid-containing products on BV cure, and their impact on vaginal microbiota composition (PROSPERO registration: CRD42018115982). METHODS: PubMed, Embase and OVID were searched from inception to November 2019 to identify eligible studies. Included studies evaluated an intravaginal lactic acid-containing product and reported BV cure using established diagnostic methods, and/or vaginal microbiota composition using molecular methods. Studies were independently screened and assessed, and the proportion of women cured post-treatment was calculated. Study results were described in a qualitative manner. RESULTS: We identified 1,883 articles and assessed 57 full-texts for eligibility. Seven different lactic acid-containing products were evaluated and differed with respect to excipients, lactic acid concentration and pH. Most studies had medium or high risk of bias. Three trials compared the efficacy of a lactic acid-containing product to metronidazole for BV cure. One study found lactic acid to be equivalent to metronidazole and two studies found lactic acid to be significantly inferior to metronidazole. Two studies included a control group receiving a placebo or no treatment. One reported lactic acid to be superior than no treatment and the other reported lactic acid to be equivalent to placebo. Lactic acid-containing products did not significantly impact the vaginal microbiota composition. CONCLUSION: There is a lack of high-quality evidence to support the use of lactic acid-containing products for BV cure or vaginal microbiota modulation. However, adequately powered and rigorous randomised trials with accompanying vaginal microbiota data are needed to evaluate the efficacy of lactic acid as a BV treatment strategy.
OBJECTIVE: The vaginal microbiota in bacterial vaginosis (BV) typically has low abundance of lactic acid producing lactobacilli. Lactic acid has properties that may make it effective for treating BV and/or restoring an optimal lactobacillus-dominated vaginal microbiota. We conducted a systematic review to describe the effect of intravaginal lactic acid-containing products on BV cure, and their impact on vaginal microbiota composition (PROSPERO registration: CRD42018115982). METHODS: PubMed, Embase and OVID were searched from inception to November 2019 to identify eligible studies. Included studies evaluated an intravaginal lactic acid-containing product and reported BV cure using established diagnostic methods, and/or vaginal microbiota composition using molecular methods. Studies were independently screened and assessed, and the proportion of women cured post-treatment was calculated. Study results were described in a qualitative manner. RESULTS: We identified 1,883 articles and assessed 57 full-texts for eligibility. Seven different lactic acid-containing products were evaluated and differed with respect to excipients, lactic acid concentration and pH. Most studies had medium or high risk of bias. Three trials compared the efficacy of a lactic acid-containing product to metronidazole for BV cure. One study found lactic acid to be equivalent to metronidazole and two studies found lactic acid to be significantly inferior to metronidazole. Two studies included a control group receiving a placebo or no treatment. One reported lactic acid to be superior than no treatment and the other reported lactic acid to be equivalent to placebo. Lactic acid-containing products did not significantly impact the vaginal microbiota composition. CONCLUSION: There is a lack of high-quality evidence to support the use of lactic acid-containing products for BV cure or vaginal microbiota modulation. However, adequately powered and rigorous randomised trials with accompanying vaginal microbiota data are needed to evaluate the efficacy of lactic acid as a BV treatment strategy.
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