Initiation of a New Frontier in Obstetrics and Gynaecolgy - The Role of Vaginal Microbiota Dysbiosis in Case of Gynaecological Diseases and the Potential Treatment with Antibiotics, Probiotics and Vaginal Microbiota transplantation - How Practical Will it be - A Systematic Review
Kulvinder Kochar Kaur1*, Gautam Allahbadia2 and Mandeep Singh3
1Scientific Director, Dr Kulvinder Kaur Centre for Human Reproduction, Jalandhar, Punjab, India
2Scientific Director, Rotunda-A Centre for Human Reproduction, Mumbai, India
3Consultant Neurologist, Swami Satyan and Hospital, Jalandhar, Punjab, India
*Corresponding Author: Kulvinder Kochar Kaur, Scientific Director, Dr Kulvinder Kaur Centre for Human Reproduction, Jalandhar, Punjab, India.
Received: October 31, 2020 ; Published: August 27, 2021
Learning from Gut microbiota experience, with the use utilization of probiotics mainly comprised by various Lactobacillus species here we tried to review the association of vaginal microbiota impairment possessing the characteristics of loss or absence of predominance of Lactobacillus in addition to enhancement of microbial diversity has been observed in the past few years to possess an intricate association with gynaecological diseases. Hence we did a systematic review utilizing the search engine pubmed, google scholar; web of science; embase; Cochrane review library utilizing the MeSH terms like vaginal microbiota; dysbiosis; candidiasis; trichomoniasis; HIV; HPV Infection; cervical cancer; atrophic vaginitis; bacterial vaginitis; Polycystic ovary syndrome (PCOS) correlation with dysbiosis; uterine fibroids; miscarriage prevention; preterm labour prevention; DUB; Probiotics; lactobacilli spp of vagina; other anaerobes in bacterial vaginitis (BV)from 2005 till date for latest updates in this field. We found a total of 75articles out of which we selected 50 articles for this review. No meta-analysis was done. At present antibiotic as well as probiotics can adequately cure BV, by correction of the Vaginal microbiota as well as escalating the Vaginal environment. Despite them having efficacy, the limitations are drug resistance in addition to high rate of recurrence. Here we have detailed further the significance of altered vaginal along with uterine microbiome in the aetiopathogenesis of certain gynaecological diseases, besides Initiation of miscarriages, preterm labour that brings a new paradigm In the treatment of these diseases like PCOS, uterine fibroids, etc. Further role of Vaginal microbiome transplantation (VMT) is discussed as a therapy in drug resistant chlamydiasis, trichomoniasis, besides escalation of HIV, HPV with disturbed vaginal microbiota that has become markedly prevalent with the correlation of AIDS with greater incidence of these resistant fungal infections. Hence generation of a Lactobacillus predominance in both vagina in addition to uterine cavity have been demonstrated to aid in reversal of conditions like PCOS. More randomized controlled trials are required for these to become the mainstay of treating PCOS that has no definite cure till date, besides prevention of acquisition of HPV and cervical cancer.
Keywords: Vaginal Microbiota; Dysbiosis; Lactobacillus Predominance; PCOS; VMT
- Lynch SV and Pedersen O. “The human intestinal microbiomein health and disease”. New England Journal of Medicine 375 (2016): 2369-2379.
- Falony G M., et al. “Population level analysis of gut microbiome variation”. Science 352 (2016): 560-564.
- Collins SM., et al. “The interplay between the intestinal microbiota and the brain”. Nature Review on Microbiology 11 (2012): 735-742.
- Food and Agricultural Organization (FAO). Report of a Joint FAO/WHO Working Group on Drafting Guidelines for the evaluation of Probiotics in Food. Canada (2002).
- World Health Organization and Food and Agricultural Organization in the United Nations. Health and Nutritional Properties in the Food including Powder milk with Live Lactic Acid Bacteria. FAO Nutrition Paper; FAO, Cordoba, Argentina 85 (2001): 1-33.
- Plaza-Diaz I., et al. “Effects of Lactobacillus paracasei CNCM I-4034, Bifidobacterium breve CNCM I-4035, and Lactobacillus thamnosus CNCM I-4036 on hepatic steatosis in Zucker rats”. Plos One 9 (2014): e98401.
- Bradford LL and Ravel J. “The vaginal microbiome:a contemporary perspective on fungi in women’s health and diseases”. Virulence 8 (2017): 342-351.
- Gupta S., et al. “Crosstalk between vaginal microbiome and female health: a review”. Microbe Pathogen 136 (2019): 103696.
- Hong X., et al. “The Association between vaginal microbiota and female infertility:a systematic review and, meta-analysis”. Archives of Gynecology and Obstetrics 302 (2020a): 569-578.
- Hong X., et al. “Association between Polycystic ovary syndrome and vaginal microbiome: a case controlled study”. Clinical Endocrinology 93 (2020b): 52-60.
- Chen C., et al. “The microbiota continuum along the female reproductive tract and its relation to uterine related diseases”. Nature Communication 8 (2017): 875.
- Kulvinder Kochar Kaur., et al. “The association of dietary fatty acids and gut microbiota alterations in the development of neuropsychiatric diseases: A systematic review”. Obesity Research – Open Journal 1 (2020): 19-45.
- Kulvinder Kochar Kaur., et al. “Have Probiotics and Synbiotics passed the test of time to be implemented in management of obesity and related metabolic disorders-a comprehensive review”. Advances in Obesity, Weight Management and Control 1 (2019): 21-28.
- Kulvinder Kochar Kaur., et al. “Will Probiotics Provide the Answer for Therapy of Non-alcoholic Fatty Liver Disease (NAFLD)? - A Systematic Review”. Biochemistry and Physiology 9 (2020): 257.
- Kulvinder Kochar Kaur., et al. “Advances in Probiotics use with the utilization of engineering technology for diseases beyond Obesity, Non Alcoholic Fatty Liver Disease, to treat neurodegenerative diseases, metabolic diseases like Type1 diabetes, infectious diseases and infections -A Systematic Review”. Journal of Endocrinology1 (2020): 1-12.
- Kulvinder Kochar Kaur., et al. “Can Targeting Gut Microbiota in Perinatal Events Aid in Prevention of Type 1 Diabetes Development - Influence T1D Genes Crosstalk with Environmental Factors". Acta Scientific Microbiology 7 (2021): 1-5.
- Kulvinder Kochar Kaur., et al. “Exploring the causes of preexposure prophylaxis of HIV failure-future developments for overcoming the same-a mini review”. Journal of Human Virology and Retrovirology 1 (2019): 1-5.
- Kulvinder Kochar Kaur., et al. “HPV Related Disease and Cancers-Increased incidence of HPV-Positive Oropharyngeal Cancers”. Acta Scientific Microbiology 7 (2019): 1-4.
- Kulvinder Kochar Kaur., et al. “Role of Chlamydiae Trachomatis in Human Reproduction - A Short Communication”. Acta Scientific Microbiology 9 (2017): 1-6.
- Kulvinder Kochar Kaur., et al. “A Systematic Review of Aetiopathogenesis of Cervical Cancer Development-Role of HPV, Cervical Cancer Stem Cells and Micro RNA and Utilizing these as Novel Targets for Treatment - An Update”. Acta Scientific Cancer Biology11 (2019).
- Kulvinder Kochar Kaur., et al. “Increasing Virulence of Vulvovaginal Candididiasis (VVC) in the Modern Era with Reducing Immunity by Different Candida Species Along with Increasing Resistance and Management -An Update". Acta Scientific Microbiology 12 (2019): 03-09.
- Kulvinder Kochar Kaur. “Editorial-Despite Gardasil 9 Success Not Reached in Complete Eradication of High Risk Human Papilloma Virus-What is the Next Step for Cervical, Oropharyngeal Cancers Prevention". Acta Scientific Cancer Biology3 (2020): 01-02.
- Kulvinder Kochar Kaur., et al. “Utilization of Dolutegravir and Lamivudine as Combination as A Single Tablet in Therapy of HIV-1 Infection". Acta Scientific Microbiology 3 (2020): 01-08.
- Torcia MG. “Interplay among vaginal microbiome, immune response, and sexually trasmitted viral infections”. International Journal of Molecular Sciences 20 (2019): 266.
- Ravel Jetal. “Vaginal microbiome of reproductive age women”. Proceedings of the National Academy of Sciences of the United States of America 108 (2011): 4680-4687.
- Liu Z., et al. “Revealing the interaction between Intra uterine adhesions and vaginal microbiota using high throughput sequencing”. Molecular Medicine Reports 19 (2019): 4167-7414.
- Han Y., et al. “Role of vaginal microbiota dysbiosis in gynaecological diseases and the potential interventions”. Frontiers in Clinical Microbiology 12 (2021): 643422.
- Onderdonk AB., et al. “The human microbiome during bacterial vaginosis”. Clinical Microbiology Review 29 (2016): 223-38.
- Ma D., et al. “Vaginal microbiota transplantation for the treatment of bacterial vaginosis: a conceptual analysis”. FEMS Microbiology Letter 366 (2019): fnzo25.
- Sobel JD and Sobel R. “Current treatment options for Vulvo vaginal candidiasis caused by azole resistant Candida species”. Expert Opinion on Pharmacotherapy 19 (2018): 971-977.
- Li T., et al. “Local probiotic Lactobacillus crispatus and Lactobacillus delbrueckii exhibit strong antifungal effects against Vulvo vaginal candidiasis in a rat model”. Frontiers in Microbiology 10 (2019): 1033.
- Niu X., et al. “Lactobacillus crispatus modulates vaginal epithelial cells innate immune response to Candida albicans”. Chinese Medical Journal (Engl) 130 (2018): 273-279.
- Yeh SL., et al. “Inhibitory effects of a soluble dietary fiber from Amorphophallus konjac on cytotoxicity and DNA damage induced by faecal water in Caco2 cells”. Planta Medica 73 (2007): 1384-1388.
- Edwards T., et al. “Trichomonas Vaginalis Clinical relevance, pathogenicity and diagnosis”. Critical Reviews on Microbiology 42 (2016): 406-417.
- Phulkan N., et al. “A cell surface aggregation promoting factor from Lactobacillus gasseri contributes to inhibition of Trichomonas Vaginalis adhesion to human vaginalectocervical cells”. Infection and Immunity 86 (2018): e00987.
- Brotman RM., et al. “Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial and trichomonas genital tract infection”. Journal of Infectious Diseases 202 (2010): 1907-1915.
- Jaisamran U., et al. “Ultra low dose estriol and Lactobacilli in the treatment of post menopausal vaginal atrophy”. Climacteric 16 (2013): 347-355.
- Shen J., et al. “Effects of low dose estrogen therapy on the vaginal microbiome of Women with Atrophic Vaginitis”. Scientific Report 6 (2016): 24380.
- Mitra A J., et al. “The vaginal microbiome, human pappiloma virus infection and cervical epithelial neoplasia: what do we know and where are we going next?” Microbiome 4 (2016): 58.
- Piyahilake CJ., et al. “Cervical microbiota associated with higher grade cervical epithelial neoplasia in women infected with high risk human pappiloma viruses”. Cancer Prevention Research (Phila) 9 (2016): 357-366.
- Verhoeven V., et al. “Probiotics enhance the clearance of human pappiloma virus related cervical lesions :a prospective controlled pilot study”. European Journal of Cancer Prevention 22 (2013): 46-51.
- Palma E., et al. “Longterm Lactobacillus rhmnosus BMX 54application to restore a balanced vaginal ecosystem: a promising solution against HIV infection”. BMC Infectious Disease 18 (2018): 13.
- Gosmann C., et al. “Lactobacillus deficient cervico vaginal bacterial communities are associated with increased HIV acquisition in young South African women”. Immunity 46 (2017): 29-37.
- Unemo M., et al. “Anti microbial resistance in Neisseria gonorrhoeae and treatment for gonorrhoea”. Methods in Molecular Biology (1997): 37-58.
- Molemaar MC., et al. “The two sided role of the vaginal microbiome in Chlamydia trachomatis and Mycoplasma genitalium pathogenesis”. Journal of Reproductive Immunology 130 (2018): 11-17.
- Zhang H., et al. “Identification of a strong and Specific anti Chlamydial N-acylhydrazone”. PLoS One 12 (2017): e0185783.
- Mastromarino P., et al. “Effects of vaginal Lactobacilli in Chlamydia trachomatis infection”. International Journal of Medical Microbiology 304 (2014): 654-661.
- Carlsson I., et al. “Complications related to Induced abortion:a combined retrospective and longitudinal follow up study”. BMC Womens Health 18 (2018): 158.
- Bjartling C., et al. “The Association between Mycoplasma genitalium pelvic inflammatory disease after termination of pregnancy”. BJOG 117 (2010): 361-364.
- Low N., et al. “Perioperative antibiotics to prevent infection after first trimester abortion”. Cochrane Database of System Review (2012): CD005217.
- Haas DM., et al. “Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology”. Cochrane Database of System Review (2019): CD003511.
- Jin P and Xie Y. “Treatment strategies for women with Polycystic ovary syndrome”. Gynecological Endocrinology 34 (2018): 272-277.
- Shamashi SG., et al. “The effect of probiotics, prebiotics, synbiotics on hormonal and inflammatory indices in women with Polycystic ovary syndrome:a systematic review and, meta-analysis”. European Journal of Nutrition 59 (2020): 433-450.
- , et al. “A role for the Endometrial microbiome in dysfunctional menstrual bleeding”. Antonie Leeuwenhoek 111 (2018): 933-943.
- DeLong K., et al. “Vaginal microbiotatransplantation: the next frontier”. The Journal of Law, Medicine and Ethics 47 (2019): 555-567.
- Lev Sagai A., et al. “Vaginal microbiome transplantation in women with intractable bacterial vaginosis”. Nature Medicine 47 (2019): 555-567.
- Chen T., et al. “Dysbiosis of the rat vagina is efficiently rescued by vaginal microbiota transplantation or probiotics combination”. International Journal of Antimicrobial Agents 57 (2021): 106277.