Objective. This study was performed to evaluate the efficacy and safety of a prebiotic treatment in the balance recovery of the vaginal flora in subjects previously treated for bacterial vaginosis (BV). Study Design. A randomized trial was carried out on 42 subjects with an active prebiotic group compared to a placebo group. The main evaluation criterion was the quantification of the vaginal flora measured by the Nugent score. Secondary criteria included vaginal pH and BV recurrence. Results. After 8 days of treatment, all subjects who received the prebiotic had a normal Nugent score, whereas 33% of the subjects treated with placebo had an intermediate or positive Nugent score. After 16 days of application, a normal Nugent score was maintained in all subjects treated with the prebiotic, whereas in the placebo group 24% of the subjects still had an elevated Nugent score. Moreover, the maintenance of (or reversion to) a normal flora was associated with the maintenance of (or reversion to) physiological pH values. Conclusions. The intravaginal gel treatment improves the recovery of a normal vaginal flora after the treatment of a BV episode, which should warrant a reduction in the risk of further recurrences. 1. Introduction Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge in reproductive age women [1]. Microbiologically, BV is associated with marked changes in microbial flora, characterised by loss or reduction of Lactobacilli and the concurrent high concentration of numerous other bacterial species, mainly Gardnerella vaginalis, Atopobium vaginae, but also anaerobes such as Prevotella spp. and Mobiluncus spp. [2]. The discharge results in part from degradation of the normal vaginal mucin gel, which is efficiently performed by mucin-degrading enzymes produced by BV-associated bacteria [3]. The odor, usually described as “fishy,” is derived from volatilization of the amines produced by the metabolism of anaerobic bacteria that characterize this disorder [4]. BV is not an infectious condition per se, though it can be responsible for adverse outcomes in pregnant women including premature ruptures of membranes, premature deliveries, chorioamnionitis, postpartum endometritis, and postpartum infant complications [5]. Studies have shown that risk factors for bacterial vaginosis are use of intrauterine devices, new or multiple sex partners, use of vaginal douches, or low levels of estrogen, for example, during menopause or due to oral contraceptives [6–9]. Standard treatment for BV consists of oral or intravaginal antibiotics, which
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