Ask not what your bacteria can do for you; ask what you can do for your bacteria!
No, but really. If you have high levels of anaerobic bacteria, what can you do about it? In many cases it will be obvious to you that something is a little… off. You should first go to your doctor to let them check it out first, double-check your concerns about the odd-smelling discharge you likely have.
Likely your doctor will tell you that you have bacterial vaginosis and probably will prescribe you with either metronidazole or clindamycin – those are the two most common antibiotics, and they specifically target the overgrowth of the offending anaerobic bacteria. While these two antibiotics do wonders in tamping down the levels of ‘bad bacteria’, they don’t actively help replenish the ‘good bacteria,’ the lactobacilli. After a course of metronidazole the Lactobacillus species that is predominantely recolonized are the L. iners bacteria. Remember: this Type 3 environment species is capable of living in a wider pH range and can endure more stressful conditions than the other species.
So while the medicine helps you recover from a Type 4 environment, you may end up in a Type 3 environment at the end. How do you help your body transition to the more favorable Type 1, 2, or 5?
This is where probiotics come in to help. Probiotics are live bacteria that can give you health benefits by supporting your endogenous bacteria. Most often one might think of yogurts with their live cultures meant to help bolster up your bacteria in your belly. When used in conjunction with prescribed antibiotics they are able to help support re-colonization of Lactobacilli, consequently improving cure rates and preventing recurrences of bacterial vaginosis.
Not just any probiotics will do, however. It’s been found that a combination of L. rhamnosus and L. reuteri added to the metronidazole treatment is effective in increasing the amount of lactobacilli and curing bacteria vaginosis. Potentially this is because they produce bacteriocins, the protective proteins that help prevent growth of pathogenic bacteria; L. rhamnosus and L. reuteri make Lactocin and Gasserin, respectively. Lactocin is particularly good at fighting against Gardnarella vaginalis.
There are some studies that show hopeful signs that probiotics may be helpful in fighting against persistent HPV infections as well. There have been both in vitro studies (cells grown in the lab) and in vivo studies (in a living organism) that give evidence that probiotics help increase the clearance rate of HPV. This could be a major help to preventing cervical cancer in the long run. By the age of 50, around 80% of women will have had HPV at some point in their life, nearly three-quarters of the total number of cases are HPV 16 and HPV 18, but over 90% of all cases are only temporary and clear on their own within 6 months to a year and a half. If we are able to improve clearance rate of the remaining 10% of HPV infections that persist and become CIN or cervical cancer, that would be an incredible step forward.
One in vitro study treated cells with HPV 16 with bifidobacterium adolescentis, a type of healthy bacteria often found in the intestines, and found a significant decrease in production of HPV mRNAs E6 and E7. These mRNAs are the templates for viral proteins needed for malignant transformation of the cells in your body. Because of their role in carcinogenesis, these proteins are called “oncoproteins.” Fewer mRNA templates doesn’t necessarily mean there will be less of the protein made in reality; there are lots of factors that affect protein production. Nonetheless the possibility still exists that this could be a future therapy for cells that have been virally transformed (have the viral DNA), there are still years of testing to be done.
Another in vitro study found L. gasseri (the bacteria dominant in Type 2 environments) is associated with a high rate of clearance of HPV infections. Both L. gasseri and L. crispatus (Type 1) are cytotoxic to cell cancer lines infected with HPV 18, but show no cytotoxic affect on normal cells. So if they exhibit toxic affects on HPV-infected cells, probiotics designed to support proliferation of these two bacteria may be able to help improve clearance rates in affected women.
The final study involves real women with real cases of low-grade cervical lesions. They were treated with oral doses or Lactobacillus caseii and found it improved clearance rate of the virus from 19% in untreated patients to 29% in women who received the probiotic. The treated women also were twice as likely to their lesions improved, too, 60% instead of 31% in untreated women. Currently one of the most common methods of lesion treatment is a LEEP (Loop electrosurgical excision procedure) procedure where an electrified tool simultaneously cuts out the affected cervical cells and cauterizes the wound. It’s a quick procedure typically lasting under 20 minutes and usually done at your doctor’s office. Most women have no problems with future pregnancies, but there is a small risk for cervical incompetence if they had to have a LEEP done with a larger loop. Perhaps this may yield a future treatment to help clear some of the lesions to reduce the amount of cervical tissue that has to be excised to help minimize future pregnancy complications.
Another way to support healthy bacteria is to give them food that helps them grow and survive, called prebiotics. By definition, prebiotics are “ingestible carbs, [including] fructo- and gluco-oligosaccharide families, which promote healthy bacteria already in the body.” So what does that mean? “Oligosaccharide” is the scientific name for a short chain of sugars, usually 3 to 10 individual sugars to be specific. In this case, fructooligosaccharides (FOS) and gluco-oligosaccharides (GOS) respectively are short chains of fructose or glucose – important sugars (carbohydrates) used by our body.
While the use of prebiotics has been most studied in the gastrointestinal tract, there are studies showing proof of concept that this may also work in the vaginal environment to help support healthy vaginal bacteria.
In in vitro studies, FOS and GOS both supported the growth and colonization of L. crispatus (Type 1), L. jenensii (Type 5), and L. vaginalis, but not the anaerobic bacteria Candida albicans, E. coli, or Gardnarella vaginalis. This is because the healthy bacteria are able to digest and use the FOS and GOS while the anaerobic bacteria cannot. This source gives the good bacteria an advantage, while starving out the bad bacteria.
A study involving women with bacterial vaginosis who were dosed with GOS via an intravaginal gel right after a course of metronidazole showed significant improvement in Lactobacillus recolonization and suppression of anaerobic bacteria.
All of this together shows hope for improving the vaginal environment and vaginal health by incorporating the use of probiotics and prebiotics into the current treatment plans.
Now that we all know a little (maybe a lot) more about our bodies and our symbiotic little creatures, hopefully this helps you understand your body better, understand your risk factors, and understand how to help your good bacteria flourish!
The information in this series is taken from a review, which you can read in full here. If you missed the previous installments, click below to learn more about your vaginal environment and how the bacteria can affect your health!
Part I: A Personal Relationship Between You and Your Bacteria
Part II: Connection to HPV & Cervical Health
Part III: How Bacteria Protect Your Vaginal Health
Part IV: How ‘Bad’ Bacteria Aid Viral Infection
1Mitra, A., Macintyre, D. A., Marchesi, J. R., Lee, Y. S., Bennett, P. R., & Kyrgiou, M. (2016). The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: What do we know and where are we going next? Microbiome,4(1). doi:10.1186/s40168-016-0203-0