Probiotic formulation prevents microbiologic recurrence of bacterial vaginosis; no information about effect on symptoms

Reference

Cohen CR, Wierzbicki MR, French AL, et al. Randomized trial of Lactin-V to prevent recurrence of bacterial vaginosis. N Engl J Med 2020;382(20):1906-1915.

Synopsis

These researchers identified 228 women with confirmed BV and negative test results for sexually transmitted infections. All of the women received 5 days of metronidazole 0.75% gel to treat their initial infection. They were then randomized in a 2:1 ratio to vaginal application of a special formulation of Lactobacillus crispatus (Lactin-V) or matching placebo. It was applied daily for a week and then twice weekly for 10 weeks. Groups were balanced at baseline, with a mean age of 31 years, a racially diverse group of participants, and almost all women having had a previous BV, with 50% having 5 or more previous episodes. Regular vaginal samples were obtained to test for microbiologic recurrence. Recurrence was less likely in the active treatment group at 12 weeks (30% vs 45%; P = .01; number needed to treat [NNT] = 7) and at 24 weeks (39% vs 54%; P < .05; NNT = 7). The authors do not report how many patients had a symptomatic recurrence, though. The likelihood of mild or moderate abnormal discharge was similar between groups (67% for active therapy and 70% for placebo), as was the likelihood of abnormal vaginal odor (57% vs 52%).