• The role of probiotics in the treatment of bacterial vaginosis: A review of evidence and strategies
  • Mohammad Reza Ahmadian mehrgo,1 Haniye Fayezi,2,*
    1. 1- Bachelor Student of Cellular and Molecular, Department of Cellular and Molecular, Faculty of new Sciences, Islamic Azad University, Medical Sciences, Tehran, Iran.
    2. 2- Ph.D. candidate of Microbiology, Department of Microbiology, Faculty of Biological Sciences, Islamic Azad University, Tehran North Branch, Tehran, Iran.


  • Introduction: Bacterial vaginosis (BV) is the most widespread form of vaginal dysbiosis, affecting millions of women globally. It is particularly common among women of reproductive age, with substantial implications for pregnancy outcomes and gynecological health. The disorder results from a shift in the vaginal microbiome, where protective Lactobacillus species decline and anaerobic bacteria, including Gardnerella vaginalis, dominate. This imbalance disrupts the natural acidic environment and weakens vaginal immunity, predisposing women to infections, infertility, and obstetric complications. Conventional antibiotic therapy, while effective in the short term, is undermined by recurrence rates approaching 50–70% within a year. In this context, probiotics especially hydrogen peroxide producing lactobacilli have emerged as a promising adjunct for restoring long-term microbial balance.
  • Methods: This review synthesized findings from in-vitro and clinical research on the therapeutic potential of probiotics in BV. Mechanistic studies highlight that probiotic strains inhibit pathogen adhesion to vaginal epithelium and produce lactic acid, hydrogen peroxide, and bacteriocins that directly suppress BV-associated organisms. Clinical trials were further examined, with a particular focus on outcomes when probiotics were administered alongside standard antibiotic regimens.
  • Results: Evidence from 173 participants across clinical investigations revealed that women receiving oral probiotics in combination with antibiotics experienced significantly lower recurrence compared to antibiotic-only groups. More than half of the women without probiotic supplementation reported three or more BV recurrences annually, underscoring the inadequacy of antibiotics alone. Vaginally administered probiotics showed additional promise, suggesting that local delivery may further enhance microbial reconstitution. Nevertheless, optimal strain selection, dosage, and treatment duration remain areas requiring further exploration.
  • Conclusion: Collectively, the available data indicate that probiotics represent a safe, sustainable, and effective adjunct to conventional therapy. Their use not only reduces recurrence rates but also empowers a patient centered approach to women’s health by harnessing the protective role of natural lactobacilli. Incorporating probiotics into daily practice whether as oral supplements or vaginal formulations may therefore transform BV management from transient relief toward lasting vaginal health.
  • Keywords: Bacterial vaginosis, Lactobacillus, Probiotics, Vaginal microbiome, Women’s health