Vaginal flora

Another approach is to transfer the entire microbiome of a healthy donor instead of individual bacteria. That a microbiome transfer can work in principle has already been shown with stool transplants for intestinal infections such as therapy-refractory Clostridium difficile-associated diarrhoea (CDAD). Vaginal microbiome transplantation (VMT) could help analogously patients suffering from symptomatic, recurrent bacterial vaginosis. In a first exploratory study, five women were treated with VMT.

In four of them, VMT led to complete long-term remission by the end of the follow-up period. No side effects were observed in any of the five participants. However, remission required repeat VMT in three patients, including a donor switch in one case.

Another approach to bring the vaginal flora back into balance is to take prebiotics. These are indigestible food components that are supposed to promote the growth of beneficial bacteria such as lactobacilli. Examples include dietary fibres such as inulin and oligofructose. However, sufficient evidence that prebiotics are effective is lacking. The same applies to the numerous home remedies from tea tree oil to yoghurt to vinegar water. In the worst case, they can actually do harm instead of good.

Patients who want to take probiotics to prevent a recurrence of vaginal infections should be prepared for the fact that it can take weeks to months until the colonisation is back in balance. The pharmacy team can advise affected women that the way they care for their intimate parts can also help prevent vaginal infections or their recurrence. Lukewarm water is usually enough to clean the vaginal area.