Erfahrungsheilkunde 2017; 66(01): 44-50
DOI: 10.1055/s-0043-101612
Praxis
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Das vaginale Mikrobiom

Schützen und Regenerieren mit Probiotika
Gerhard Ernst Steyer
Further Information

Publication History

Publication Date:
12 April 2017 (online)

Zusammenfassung

Das humane vaginale Mikrobiom ist einzigartig. Es wird von Laktobazillen zu über 70 % dominiert und unterliegt hormonbedingt während des Lebens erheblichen Schwankungen. Bei bakterieller Vaginose entsteht begünstigt z. B. durch Gardnerella vaginalis ein schädlicher Biofilm, der auch durch Antibiotikaeinsatz meist nicht ganz zu beseitigen ist und chronisch-rezidivierend auftritt (Rezidivrate bis zu 50 % in 6–12 Monaten). Antibiotikagaben, die oft aus anderen Gründen erfolgen, können sogar eine vaginale Dysbiose verursachen. Mit oral verabreichten Probiotika (z. B. einer multi-strain Kombination aus L. crispatus, L. gasseri, L. jensenii und L. rhamnosus) gelingt es, den Biofilm aufzubrechen und die vaginale Mikrobiota wieder zu regenerieren.

Abstract

The human vaginal microbiome is unique and it is dominated by lactobacilli and modulated by hormones during life. Gardnerella vaginalis can promote a biofilm resulting in bacterial vaginosis, in most cases not successful treatable by antibiotics with recurrence rates in excess of 50 % within 6–12 months. Intake of antibiotics per se can cause vaginal dysbiosis. Oral probiotics (e. g. a multistrain-formulation containing L. crispatus, L. gasseri, L. jensenii and L. rhamnosus) can destroy the biofilm and regenerate vaginal microbiota.

 
  • Literatur

  • 1 Atashili J, Poole C, Ndumbe PM. et al. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS 2008; 22 (12) 1493-1501
  • 2 Blaser MJ, Falkow S. What are the consequences of the disappearing human microbiota. Nature Reviews Microbiology 2009; 7 (12) 887-894
  • 3 Bradshaw CS, Sobel JD. Current treatment of bacterial vaginosis – limitations and need for innovation. J Infect Dis 2016; 214 (Suppl. 01) S14-20
  • 4 Cox C, Watt AP, McKenna JP. et al. Mycoplasma hominis and Gardnerella vaginalis display a significant synergistic relationship in bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2016; 35 (03) 481-487
  • 5 Döderlein A. Das Scheidensekret und seine Bedeutung für das Puerperalfieber. Leipzig: Besold Verlag; 1892
  • 6 Danielsson D. The genital econiche: focus on microbiota and bacterial vaginosis. Ann NY Acad Sci 2011; 1230: 48-58
  • 7 Domig KJ, Kiss H, Petricevic L. et al. Strategies for the evaluation and selection of potential vaginal probiotics from human sources: an exemplary study. Benef Microbes 2014; 5 (03) 263-272
  • 8 Dominguez-Bello MG, De Jesus-Laboy KM, Shen N. et al. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nature Med 2016; 22 (03) 250-253
  • 9 ESIDOG Leitlinien 2017: „Vaginale Infektionen. Bakterielle Vaginose (Aminkolpitis, Gardnerella-Infektion)“. European Society for Infectious Diseases in Obstetrics and Gynecology. Im Internet: www.oeggh.at/esidog [accsessed 17.1.2017]
  • 10 Farage M, Maibach H. Lifetime changes in the vulva and vagina. Arch Gyn Obst 2006; 273 (04) 195-202
  • 11 Harrison JP, Angel R, Cockell CS. Astrobiology as a framework for investigating antibiotic susceptibility: a study of Halomonas hydrothermalis. J R Soc Interface 2017; 14 (126) pii: 20160942 DOI: 10.1098/rsif.2016.0942
  • 12 Hickey R, Forney L. Gardnerella vaginalis does not always cause bacterial vaginosis. J Infect Dis 2014; 210: 1682-1693
  • 13 Hickey RJ, Zhou X, Settles ML. et al. Vaginal microbiota of adolescent girls prior to the onset of menarche resemble those of reproductive-age women. MBio 2015; 24 6 (02) DOI: 10.1128/mBio.00097-15 0
  • 14 Homayouni A, Bastani P, Zivadi S. et al. Effects of probiotics on the recurrence of bacterial vaginosis: a review. J Low Genit Tract Dis 2014; 18: 79-86
  • 15 Huang B, Fettweis JM, Brooks JP. The changing landscape of the vaginal microbiome. Clin Lab Med 2014; 34 (04) 747-761
  • 16 Hughes G, Webber MA. New ways to kill biofilms. Novel approaches to the treatment of bacterial biofilm infections. Br J Pharmacol 2017; DOI: 10.1111/bjph.13706 0
  • 17 Hviid A, Svanström H, Frisch M. Antibiotic use and inflammatory bowel diseases in childhood. Gut 2011; 60 (01) 49-54
  • 18 Kaufmann U, Domig KJ, Lippitsch CI. et al. Ability of an orally administered lactobacilli preparation to improve the quality of the neovaginal microflora in male to female transsexual women. Eur J Obstet Gynecol Reprod Biol 2014; 172: 102-105
  • 19 Kyrgiou M, Mitra A, Moscicki AB. Does the vaginal microbiota play a role in the development of cervical cancer?. Transl Res 2017; 179: 168-182
  • 20 Kiss H, Kögler B, Petricevic L. et al. Vaginal Lactobacillus microbiota of healthy women in the late first trimester of pregnancy. BJOG 2007; 114 (11) 1402-1407
  • 21 Koenig JE, Spor A, Scalfone N. et al. Succession of microbial consortia in the developing infant gut microbiome. Proc Nati Ac Sci USA 2011; 108 (Suppl. 01) 4578-4585
  • 22 Laxmi U, Agrawal S, Raghunandan C. et al. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med 2012; 25 (01) 64-67
  • 23 Ma B, Forney LJ, Ravel J. Vaginal microbiome: rethinking health and disease. Annu Rev Microbiol 2012; 66: 371-389
  • 24 Machado A, Cerca N. Influence of biofilm formation by Gardnerella vaginalis and other anaerobes on bacterial vaginosis. J Infect Dis 2015; 212 (12) 1856-1861
  • 25 Machado D, Castro J, Palmeira-de-Oliveira A. et al. Bacterial vaginosis biofilms: challenges to current therapies and emerging solutions. Front Microbiol 2016; 20 (06) DOI: 10.3389/fmicb.2015.01528 0
  • 26 Mastromarino P, Vitali B, Mosca L. Bacterial vaginosis: a review on clinocal trials with probiotics. New Microbiol 2013; 36: 229-238
  • 27 Mendling W. Vaginal microbiota. Adv Exp Med Biol 2016; 902: 83-93
  • 28 Miller EA, Beasley De AE, Dunn RR. et al. Lactobacilli dominance and vaginal pH: why is the human vaginal microbiome unique?. Frontiers Microbiol 2016; DOI: 10.3389/fmicb.2016.01936 0
  • 29 Mirmonsef P, Hotton AL, Gilbert D. et al. Glycogen levels in undiluted genital fluid and their relationship to vaginal pH, estrogen, and progesterone. PLoS One 2016; DOI: 10.1371/journal.pone.0153553 0
  • 30 Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas 2016; 91: 42-50
  • 31 Nasioudis D, Linhares IM, Ledger WJ. et al. Bacterial vaginosis: a critical analysis of current knowledge. BJOG 2017; 124 (01) 61-69
  • 32 Niers LE, Timmerman HM, Rijkers GT. et al. Identification of strong interleukin-10 inducing lactic acid bacteria which down-regulate T helper type 2 cytokines. Clin Exp Allergy 2005; 35 (11) 1481-1489
  • 33 Niers L, Martín R, Rijkers G. et al. The effects of selected probiotic strains on the development of eczema (the PandA study). Allergy 2009; 64 (09) 1349-1358
  • 34 Nunn KL, Forney LJ. Unraveling the dynamics of the human vaginal microbiome. Yale J Biol Med 2016; 89 (03) 331-337
  • 35 Parma M, Stella Vanni V, Bertini M. et al. Probiotics in the prevention of recurrences of bacterial vaginosis. Altern Ther Health Med 2014; (Suppl. 01) 52-57
  • 36 Petricevic L, Witt A. The role of Lactobacillus casei rhamnosus Lcr35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis. BJOG 2008; 115 (11) 1369-1374
  • 37 Petricevic L, Domig KJ, Nierscher FJ. Characterisation of the oral, vaginal and rectal Lactobacillus flora in healthy pregnant and postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2012; 160 (01) 93-99
  • 38 Petricevic L, Kaufmann U, Domig KJ. et al. Molecular detection of Lactobacillus species in the neovagina of male-to-female transsexual women. Sci Rep 2014; DOI: 10.1038/srep03746 0
  • 39 Petrova MI, van den Broek M, Balzarini J. et al. Vaginal microbiota and its role in HIV transmission and infection. FEMS Microbiol Rev 2013; 37 (05) 762-792
  • 40 Petrova MI, Reid G, Vaneechoutte M. et al. Lactobacillus iners: Friend or Foe?. Trends Microbiol 2016; DOI: 10.1016/j.tim.2016.11.007 0
  • 41 Polatti F. Bacterial vaginosis, Atopobium vaginae and Nifuratel. Curr Clin Pharmacol 2012; 7: 36-40
  • 42 Ravel JP, Gajer P, Abdo G. et al. Vaginal microbiome of reproductive-age women. Proc Nat Ac Sci USA 2011; (Suppl. 01) 4680-4687
  • 43 Redelinghuys MJ, Ehlers MM, Dreyer AW. et al. Normal flora and bacterial vaginosis in pregnancy: an overview. Cit Rev Microbiol 2016; 42: 352-363
  • 44 Rodríguez JM. The origin of human milk bacteria: is there a bacterial entero-mammary pathway during late pregnancy and lactation?. Adv Nutr 2014; 5 (06) 779-784
  • 45 Sanders ME, Guarner F, Guerrant R. et al. An update of the use and investigation of probiotics in health and disease. Gut 2013; 62: 787-796
  • 46 Senok AC, Verstraelen H, Temmerman M. et al. Probiotics for the treatment of bacterial vaginosis (Review). Cochrane Database Syst Rev 2009; 4: 1-28
  • 47 Steyer GE, Pfeife J. Multispezies-Probiotika und Antibiotika. Review zur klinischen Evidenz bei der Prävention von Antibiotika-Assoziierter Diarrhoe (AAD) und Clostridium difficile-Infektionen (CDI). Int J Orthomol Med 2013; 141: 34-38 et 144 15–20
  • 48 Steyer GE. Mikrobiom perinatal spiegelt Mikrobiom im Alter. Probiotika bei bakterieller Vaginose. GynAktiv 2016; 6: 35
  • 49 Steyer GE. Mamas orales Mikrobiom. Paed Paedol Feb 2017; [im Druck] 0
  • 50 Strus M, Chmielarcyk A, Kochan P. et al. Studies on the effects of probiotic Lactobacillus mixture given orally on vaginal and rectal colonization and on parameters of vaginal health in women with intermediate vaginal flora. Eur J Obstet Gynecol Repr Biol 2012; 161: 210-215
  • 51 Swidsinski A, Mendling W, Loening-Baucke V. et al. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazol. Am J Obstet Gynecol 2008; 198: 97.e1-6
  • 52 Walker WA, Iyengar RS. Breast milk, microbiota, and intestinal immune homeostasis. Pediatr Res 2015; 77 (01) –2 220-228
  • 53 Witkin SS, Linhares IM. Why do lactobacilli dominate the human vaginal microbiota?. BJOG 2016; DOI: 10.1111/1471-0528.14390 0
  • 54 Worbs T, Hammerschmidt SI, Förster R. Dendritic cell migration in health and disease. Nat Rev Immunol 2017; 17 (01) 30-48