Clue cells in bacterial vaginosis: Immunofluorescent identification of the adherent gram-negative bacteria as gardnerella vaginalis
International Journal of Gynecology and Obstetrics
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Objective: To assess, among women with HIV, whether long-term oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation can prevent bacterial vaginosis (BV) and enhance the cure rate of metronidazole among those with BV. Methods: A randomized, double-blind, placebo-controlled trial conducted among 65 HIV-infected women with an aberrant microbiota (Nugent score 4-10) who were randomized to receive daily probiotics or placebo for 6 months. Those with BV (Nugent score 7-10) additionally received metronidazole for 10 days (400 mg twice daily). Results: We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment. Among women with an intermediate vaginal flora, probiotics tended to increase the probability of a normal vaginal flora (odds ratio 2.4; P = 0.1) and significantly increased the probability of a beneficial vaginal pH (odds ratio 3.8; P = 0.02) at follow-up. Conclusion: Supplementation of probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not enhance the cure of BV among women living with HIV, but may prevent the condition among this population. Trial registration: NCT00536848. © 2010 International Federation of Gynecology and Obstetrics All rights reserved.