Long-term Lactobacillus rhamnosus BMX 54 application to restore a balanced vaginal ecosystem: a promising solution against HPV-infection
Open accessAbstract
BACKGROUND: Over recent years, a growing interest has developed in microbiota and in the concept of maintaining a special balance between Lactobacillus and other bacteria species in order to promote women's well-being. The aim of our study was to confirm that vaginal Lactobacilli long-lasting implementation in women with HPV-infections and concomitant bacterial vaginosis or vaginitis might be able to help in solving the viral infection, by re-establishing the original eubiosis. METHODS: A total of 117 women affected by bacterial vaginosis or vaginitis with concomitant HPV-infections were enrolled at Department of Gynecological Obstetrics and Urological Sciences, La Sapienza University, Rome, Italy between February 2015 and March 2016. Women were randomized in two groups, standard treatment (metronidazole 500 mg twice a day for 7 days or fluconazole 150 mg orally once a day for 2 consecutive days) plus short-term (3 months) vaginal Lactobacillus implementation (group 1, short probiotics treatment protocol group, n = 60) versus the same standard treatment plus long-lasting (6 months) vaginal Lactobacillus rhamnosus BMX 54 administration (group 2, treatment group, n = 57). RESULTS: After a median follow up of 14 months (range 9-30 months) the chance to solve HPV-related cytological anomalies was twice higher in probiotic long-term users (group 2) versus short probiotics implementation group (group 1) (79.4% vs 37.5%, p = 0.041). Moreover, a total HPV-clearance was shown in 11.6% of short schedule probiotics implementation patients compared to a percentage of 31.2% in vaginal Lactobacilli long term users (p = 0.044), assessed as negative HPV-DNA test documented at the end of the study period. CONCLUSIONS: The consistent percentage of clearance of PAP-smear abnormalities and HPV-clearance obtained in long-term treatment group has been interestingly high and encouraging. Obviously, larger and randomized studies are warranted to confirm these encouraging results, but we believe that eubiosis re-establishment is the key to tackle effectively even HPV-infection. TRIAL REGISTRATION: Retrospectively registered on PRS NCT03372395 (12/12/2017).
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Clinical trials have shown that the topical symbiotic approach is effective in decreasing recurrence rates.
“Clinical trials published in recent years have shown that this topical symbiotic approach is effective in decreasing the recurrence rates [47-65].”
From Vaginal microbiota and urinary tract infections in women: the protective role of vaginal lactobacilli in counteracting urinary tract infections occurrence and recurrence (2026) · cites this paper as [56]
The Results report that long-term vaginal probiotic administration reduced vaginal infection recurrences. The Methods describe vaginal Lactobacillus tablets alongside standard treatment, not a synbiotic combination of probiotics and prebiotics; the source therefore supports the recurrence finding but not the specified approach. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTopical application of Lactobacillus rhamnosus in the vagina restores the vaginal ecosystem by the seventh week after application.
“in the case of Lactobacillus rhamnosus , its topical application in the vagina allows this population to restore the vaginal ecosystem during the 7th weeks post application [51, 47-65].”
From Vaginal microbiota and urinary tract infections in women: the protective role of vaginal lactobacilli in counteracting urinary tract infections occurrence and recurrence (2026) · cites this paper as [56]
The Discussion says vaginally applied Lactobacillus rhamnosus BMX 54 can help restore a balanced vaginal ecosystem. But the Methods describe treatment lasting three or six months, and the Conclusions say treatment for at least six months may help re-establish vaginal microflora. The paper does not establish restoration by the seventh week. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA long-term course of vaginal lactobacilli application with a vaginal symbiotic is effective in bacterial vaginosis prevention, highlighting the central role of the combination of probiotics and prebiotic.
“As mentioned in several studies, the results obtained using 'a long-term course' of vaginal lactobacilli application in BV prevention with a vaginal symbiotic also highlight the central role of the combination of probiotics and prebiotic [47-65].”
From Vaginal microbiota and urinary tract infections in women: the protective role of vaginal lactobacilli in counteracting urinary tract infections occurrence and recurrence (2026) · cites this paper as [56]
The Methods (page not supplied) describe long-term vaginal Lactobacillus administration, and the Conclusions say it may help restore vaginal microflora. The Results report HPV outcomes, not prevention of bacterial vaginosis; the Methods describe probiotic tablets but no prebiotic or symbiotic combination. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLong-term addition of vaginal probiotics has a superior ability to reduce cytological abnormalities and improve HPV clearance compared with short-term administration of probiotics.
“Very interestingly, it has been shown that the long-term addition of vaginal probiotics has a superior ability to reduce cytological abnormalities and improve HPV clearance compared with the short-term administration of probiotics [177].”
From The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties (2024) · cites this paper as [177]
Long-term addition of vaginal probiotics has superior ability to reduce cytological anomalies (P=0.041) and enhance HPV clearance (P=0.044) compared to short-term probiotic administration.
“Interestingly, long-term addition of vaginal probiotics has been demonstrated to have a superior ability to reduce cytological anomalies (P=0.041) and enhance HPV clearance (P=0.044) compared to short-term probiotic administration (Palma et al., 2018).”
From Viral Infections, the Microbiome, and Probiotics (2021) · cites this paper as Palma et al., 2018
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The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties
Maftei, N.-M., Raileanu, C. R., Balta, A. A., Ambrose, L., Boev, M., Marin, D. B., & Lisa, E. L. (2024) · Microorganisms · doi:10.3390/microorganisms12020234 · Cited by 381 · see citing works
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- Authors
- Palma, E., Recine, N., Domenici, L., Giorgini, M., Pierangeli, A., & Panici, P. B.
- Affiliations
- Sapienza University of Rome (IT)
- Corresponding author
- Domenici, Lavinia
- Venue
- BMC Infectious Diseases
- Published
- 2018-01-05
- Volume
- 18
- Issue
- 1
- Pages
- 13-13
- ISSN
- 1471-2334 (ISSN-L)
- PMC
- PMC5756375
- OpenAlex
- W2782223764
- Cited by
- 132
- References
- 37
- Citations by year
- 2026: 17 · 2025: 22 · 2024: 19 · 2023: 23 · 2022: 19 · 2021: 13 · 2020: 10 · 2019: 7 · 2018: 2
- FWCI
- 6.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Keywords
- probiotics, HPV infection, bacterial vaginosis, vaginal infection, vaginal microbiota, eubiosis, HPV clearance, metronidazole, fluconazole, women's health
- MeSH terms
- Administration, Intravaginal, Adult, Female, Humans, Metronidazole, Vagina, Fluconazole, Vaginosis, Bacterial, Treatment Outcome, Probiotics, Papillomavirus Infections, Lacticaseibacillus rhamnosus, Microbiota
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