LONG-TERM PROBIOTIC IMPLEMENTATION TO RE-CREATE A BALANCED VAGINAL ECOSYSTEM: A PROMISING BOOST AGAINST HPV-INFECTION

Recine N., Palma E., Domenici L., Giorgini M., Pierangeli A., Benedetti Panici P.
Department of Gynecological, Obstetrics and Urologic Sciences, University "Sapienza" of Rome, Italy

Introduction:
An ever-increasing interest has developed in microbiota, with the belief that probiotics could be able to promote women’s well-being and illnesses in several ways. Commonly, human vaginal microbiota is lactobacilli-dominated but if not other microorganisms may grow reducing anti-bacterial defence mechanisms, promoting disorders such as bacterial vaginosis and yeast vaginitis, and then endorsing the occurrence of sexually transmitted diseases. We have guessed that this event might be the result of a transitional process, beginning by compromising the physiological vaginal eubiosis, increasing lactobacilli-mediated cytolysis and then reaching the stage of pathobiosis, when the vaginal ecosystem start to be defenceless and so vulnerable to a huge variety of infections. The aim of our study was to confirm that Lactobacillus rhamnosus BMX 54 long-lasting vaginal application in women with dysbiosis and concomitant HPV-infections might be able to have an advantageous effect on viral infection control by re-establishing the natural balanced ecosystem.

Methods:
This is a prospective study, performed between February 2012 and December 2015 at Department of Gynecological Obstetrics and Urologic Sciences, "Sapienza" University of Rome. A total of 117 patients with BV/vaginitis and associated HPV-infection documented as PAP-smear abnormalities (ASCUS, L-SIL or H-SIL histologically demonstrated as CIN1) and/or positive HPV-DNA were included in the study. Patients were consecutively randomized in two groups, standard treatment plus short-term lactobacillus implementation (group 1, n=60) vs standard treatment plus long-lasting probiotic treatment (group 2, n=57). Standard initial treatment for bacterial or yeast infections was metronidazole 500 mg (orally twice a day for 7 days) or fluconazole 150 mg (orally once a day for two consecutive days), respectively. Probiotic implementation (as Lactobacillus rhamnosus BMX54 vaginal tablets) was performed as follows: once a day for 10 days, once every 3 days for a month and then once every 5 days for another month in all patients. Then, patients belonging to long-term treatment arm (group 2) continued using probiotic vaginal tablets once a week for a 6-month period. All patients followed a strict follow-up (every 3 months) including, when indicated, PAP-smear, bacterioscopic exam and colposcopy check. HPV-DNA test was repeated at the end of the study period.

Results:
After a mean follow up of 15.6 months (range 9.6-24), probiotic long-term users demonstrated a chance twice higher to solve HPV-related cytological anomalies (71.9% vs 36.6%, p=0.04). Moreover, a total HPV-clearance was shown in 13.3% of control patients comparing with a percentage of 33.3% in probiotic users (p=0.05), assessed as negative HPV-DNA test documented at the end of the study period.

Discussion:
In this study, we used cytological and viral endpoints to evaluate a potential effect of probiotic long-term implementation in solving cervical abnormalities, through the re-creation of the physiological vaginal balance (eubiosis). The consistent percentage of clearance of PAP-smear abnormalities obtained in probiotic users was incredibly high and encouraging. Obviously, larger and randomized studies are warranted to confirm these boosting results, but we believe that eubiosis re-establishment is the key to tackle effectively even HPV-infection.

Keywords: Sexually transmitted diseases, Probiotics Implementation, Lactobacillus rhamnosus BMX54, HPV infection, PAP-smear abnormalities, Probiotics

Citation:
Recine N., et al. (2016). Long-term probiotic implementation to re-create a balanced vaginal ecosystem: A promising boost against HPV infection. Conference Proceedings of IPC2016. Paper presented at the International Scientific Conference on Probiotics and Prebiotics, Budapest (p. 63.). IPC2016

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