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BMC Women's Health
Published in: BMC Women's Health 1/2017

Open Access 01-12-2017 | Research article

Probiotics for vaginal health in South Africa: what is on retailers’ shelves?

Authors: Anna-Ursula Happel, Shameem Z. Jaumdally, Tanya Pidwell, Tracy Cornelius, Heather B. Jaspan, Remy Froissart, Shaun L. Barnabas, Jo-Ann S. Passmore

Published in: BMC Women's Health | Issue 1/2017

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Abstract

Background

Probiotics are widely used to improve gastrointestinal (GI) health, but they may also be useful to prevent or treat gynaecological disorders, including bacterial vaginosis (BV) and candidiasis. BV prevalence is high in South Africa and is associated with increased HIV risk and pregnancy complications. We aimed to assess the availability of probiotics for vaginal health in retail stores (pharmacies, supermarkets and health stores) in two major cities in South Africa.

Methods

A two-stage cluster sampling strategy was used in the Durban and Cape Town metropoles. Instructions for use, microbial composition, dose, storage and manufacturers’ details were recorded.

Results

A total of 104 unique probiotics were identified in Cape Town and Durban (66.4% manufactured locally). Cape Town had more products than Durban (94 versus 59 probiotics), although 47% were common between cities (49/104). Only four products were explicitly for vaginal health. The remainder were for GI health in adults (51.0%) or infants (17.3%). The predominant species seen overall included Lactobacillus acidophilus (53.5%), L. rhamnosus (37.6%), Bifidobacterium longum ssp. longum (35.6%) and B. animalis ssp. lactis (33.7%). Products for vaginal health contained only common GI probiotic species, with a combination of L. acidophilus/B. longum ssp. longum/B. bifidum, L. rhamnosus/L. reuteri or L. rhamnosus alone, despite L. crispatus, L. gasseri, and L. jensenii being the most common commensals found in the lower female reproductive tract.

Conclusion

This survey highlights the paucity of vaginal probiotics available in South Africa, where vaginal dysbiosis is common. Most vaginal products contained organisms other than female genital tract commensals.
Appendix
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Literature
1.
Mittu B, Kaur B, Balgir PP. Bacterial vaginosis. Clin Microbiol. 2015;4:3.
2.
3.
Murphy K, Mitchell CM, Hospital MG, Hospital MG. The interplay of host immunity and environment on risk of bacterial vaginosisand associated reproductive health outcomes. J Infect Dis. 2016;214 Suppl 1:S29–35.CrossRefPubMed
4.
Borgdorff H, Tsivtsivadze E, Verhelst R, Marzorati M, Jurriaans S, Ndayisaba GF, et al. Lactobacillus-dominated cervicovaginal microbiota associated with reduced HIV/STI prevalence and genital HIV viral load in African women. ISME J. 2014;8:9. Nature Publishing Group.CrossRef
5.
Kyongo JK, Crucitti T, Menten J, Hardy L, Cools P, Michiels J, et al. Cross-sectional analysis of selected genital tract immunological markers and molecular vaginal microbiota in sub-Saharan African women, with relevance to HIV risk and prevention. Clin Vaccine Immunol. 2015;22:5.CrossRef
6.
Buve A, Jespers V, Crucitti T, Fichorova RN. The vaginal microbiota and susceptibility to HIV. AIDS. 2014;28:16.CrossRef
7.
Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res. 2016;3:4.CrossRefPubMedPubMedCentral
8.
Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SSK, McCulle SL, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci. 2011;108(Suppl 1):4680–7.CrossRefPubMed
9.
Gajer P, Brotman RM, Bai G, Sakamoto J, Schütte UME, Zhong X, et al. Temporal dynamics of the human vaginal microbiota. Sci Transl Med. 2012;4:132ra52.CrossRefPubMedPubMedCentral
10.
Petrova MI, van den Broek M, Balzarini J, Vanderleyden J, Lebeer S. Vaginal microbiota and its role in HIV transmission and infection. FEMS Microbiol Rev. 2013;37:5.CrossRef
11.
Boskey ER, Cone RA, Whaley KJ, Moench TR. Origins of vaginal acidity: high D/L lactate ratio is consistent with bacteria being the primary source. Hum Reprod. 2001;16:9.CrossRef
12.
Fayol-messaoudi D, Berger CN, Moal VL, Alain L. Acid-dependent activities of probiotic lactobacilli against salmonella enterica serovar typhimurium pH-, lactic acid-, and non-lactic acid-dependent activities of probiotic lactobacilli against salmonella enterica serovar typhimurium Vanessa Lie. Appl Env Microbiol. 2005;71:10.CrossRef
13.
Kaewsrichan J, Peeyananjarassri K, Kongprasertkit J. Selection and identification of anaerobic lactobacilli producing inhibitory compounds against vaginal pathogens. FEMS Immunol Med Microbiol. 2006;48:1.CrossRef
14.
Ling Z, Liu X, Chen W, Luo Y, Yuan L, Xia Y, et al. The restoration of the vaginal microbiota after treatment for bacterial vaginosis with metronidazole or probiotics. Microb Ecol. 2013;65:3.
15.
Anahtar MN, Byrne EH, Doherty KE, Bowman BA, Yamamoto S, Soumillon M, et al. Inflammatory responses in the female genital tract. Immunity. 2016;42:5.
16.
Zhou X, Brown CJ, Abdo Z, Davis CC, Hansmann MA, Joyce P, et al. Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women. ISME J. 2007;112:10.
17.
Macklaim JM, Fernandes AD, Di Bella JM, Hammond J-A, Reid G, Gloor GB. Comparative meta-RNA-seq of the vaginal microbiota and differential expression by Lactobacillus iners in health and dysbiosis. Microbiome. 2013;1:12.CrossRefPubMedPubMedCentral
18.
Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M. The epidemiology of bacterial vaginosis in relation to sexual behaviour. BMC Infect Dis. 2010;10:81.CrossRefPubMedPubMedCentral
19.
Clark P, Kurtzer T, Duff P. Role of bacterial vaginosis in peripartum infections. Infect Dis Obstet Gynecol. 1994;2:4.CrossRef
20.
Haggerty CL, Totten PA, Tang G, Astete SG, Ferris MJ, Norori J, et al. Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sex Transm Infect. 2016;0:1.
21.
Nelson DB, Hanlon A, Nachamkin I, Haggerty C, Mastrogiannis DS, Liu C, et al. Early pregnancy changes in bacterial vaginosis-associated bacteria and preterm delivery. Paediatr Perinat Epidemiol. 2014;28:2.CrossRef
22.
Brotman RM, Klebanoff MA, Nansel TR, Yu KF, Andrews WW, Zhang J, et al. Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J Infect Dis. 2010;202:12.CrossRef
23.
Guo Y-L, You K, Qiao J, Zhao Y, Geng L. Bacterial vaginosis is conducive to the persistence of HPV infection. Int J STD AIDS. 2012;23:8.CrossRef
24.
Holzman C, Leventhal JM, Qiu H, Jones NM, Wang J. Factors linked to bacterial vaginosis in nonpregnant women. Am J Public Health. 2001;91:10.CrossRef
25.
Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol. 2013;209:6. Elsevier Inc.CrossRef
26.
Cohen CR, Lingappa JR, Baeten JM, Ngayo MO, Spiegel CA, Hong T, et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Med. 2012;9:6.
27.
Masson L, Arnold KB, Little F, Mlisana K, Lewis DA, Mkhize N, et al. In flammatory cytokine biomarkers to identify women with asymptomatic sexually transmitted infections and bacterial vaginosis who are at high risk of HIV infection. Sex Trans Infect. 2015;92:186–93.CrossRef
28.
Mlisana K, Naicker N, Werner L, Roberts L, Van Loggerenberg F, Baxter C, et al. Symptomatic vaginal discharge is a poor predictor of sexually transmitted infections and genital tract inflammation in high-risk women in South Africa. J Infect Dis. 2012;206:1.CrossRef
29.
Barrons R, Tassone D. Use of lactobacillus probiotics for bacterial genitourinary infections in women: a review. Clin Ther. 2008;30:3.CrossRef
30.
Homayouni A, Bastani P, Ziyadi S, Mohammad-Alizadeh-Charandabi S, Ghalibaf M, Mortazavian AM, et al. Effects of probiotics on the recurrence of bacterial vaginosis: a review. J Low Genit Tract Dis. 2014;18:1.CrossRef
31.
Mastromarino P, Vitali B, Mosca L. Bacterial vaginosis: a review on clinical trials with probiotics. New Microbiol. 2013;36:229–38.PubMed
32.
33.
Figueroa-González I, Quijano G, Ramírez G, Cruz-Guerrero A. Probiotics and prebiotics-perspectives and challenges. J Sci Food Agric. 2011;91:8.CrossRef
34.
Ouwehand AC, Salminen S, Isolauri E. 19 - Probiotics. an overview of beneficial effects. Antonie Van Leeuwenhoek. 2002;82:279–89.CrossRefPubMed
35.
Thibault H, Aubert-Jacquin C, Goulet O. Effects of long-term consumption of a fermented infant formula (with Bifidobacterium breve c50 and Streptococcus thermophilus 065) on acute diarrhea in healthy infants. J Pediatr Gastroenterol Nutr. 2004;39:2.CrossRef
36.
McLean NW, Rostenstein IJ. Characterization and selection of a lactobacillus species to re-colonize the vagina of women with recurrent bacterial vaginosis. J Med Microbiol. 2000;49:543–52.CrossRefPubMed
37.
Reid G, Beuerman D, Heinemann C, Bruce AW. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunol Med Microbiol. 2001;32:1.CrossRef
38.
Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B. Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol. 2001;30:1.CrossRef
39.
Morelli L, Zonenenschain D, Del Piano M, Cognein P. Utilization of the intestinal tract as a delivery system for urogenital probiotics. J Clin Gastroenterol. 2004;38 Suppl 2:107–10.CrossRef
40.
Reid G, Charbonneau D, Erb J, Kochanowski B, Beuerman D, Poehner R, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol. 2003;35:2.CrossRef
41.
Cribby S, Taylor M, Reid G. Vaginal microbiota and the use of probiotics. Interdiscip Perspect Infect Dis. 2008;2008:256490.PubMed
42.
Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995;125:6.
43.
Rastall RA, Maitin V. Prebiotics and synbiotics: towards the next generation. Curr Opin Biotechnol. 2002;13:5.CrossRef
44.
Rossi M, Amaretti A, Raimondi S. Folate production by probiotic bacteria. Nutrients. 2011;3:1.CrossRef
45.
Tataru A, Boca AN. Vitamins and nutritional supplements. In: Katsambas DA, Lotti MT, Dessinioti C, D’Erme MA, editors. Eur. Handb. Dermatological treat. Berlin: Springer; 2015.
46.
Goh YJ, Klaenhammer TR. Genetic mechanisms of prebiotic oligosaccharide metabolism in probiotic microbes. Annu Rev Food Sci Technol. 2015;6:1.CrossRef
47.
Peltzer K. Utilization and practice of traditional/complementary/alternative medicine (TM/CAM) in South Africa. Afr J Tradit Complement Altern Med. 2009;6:2.
48.
Turroni F, Duranti S, Bottacini F, Guglielmetti S, Van Sinderen D, Ventura M. Bifidobacterium bifidum as an example of a specialized human gut commensal. Front Microbiol. 2014;5:437.CrossRefPubMedPubMedCentral
49.
Walter J. Ecological role of lactobacilli in the gastrointestinal tract: implications for fundamental and biomedical research. Appl Environ Microbiol. 2008;74:16.CrossRef
50.
Azcarate-peril MA, Altermann E, Rebecca L, Cano RJ, Klaenhammer TR, Hoover-fitzula RL. Identification and inactivation of genetic loci involved with lactobacillus acidophilus acid tolerance identification and inactivation of genetic loci involved with lactobacillus acidophilus acid tolerance. Appl Environ Microbiol. 2004;70:9.CrossRef
51.
Buck BL, Altermann E, Svingerud T, Klaenhammer TR. Functional analysis of putative adhesion factors in lactobacillus acidophilus NCFM functional analysis of putative adhesion factors in lactobacillus acidophilus NCFM. Appl Environ Microbiol. 2005;71:12.CrossRef
52.
Pfeiler EA, Klaenhammer TR. Role of transporter proteins in bile tolerance of Lactobacillus acidophilus. Appl Environ Microbiol. 2009;75:18.CrossRef
53.
Khaleghi M, Kermanshahi RK, Yaghoobi MM, Zarkesh-Esfahani SH, Baghizadeh A. Assessment of bile salt effects on S-layer production, slp gene expression, and some physicochemical properties of Lactobacillus acidophilus ATCC 4356. J Microbiol Biotechnol. 2010;20:4.
54.
Bull M, Plummer S, Marchesi J, Mahenthiralingam E. The life history of lactobacillus acidophilus as a probiotic: a tale of revisionary taxonomy, misidentification and commercial success. FEMS Microbiol Lett. 2013;349:2.CrossRef
55.
Jungersen M, Wind A, Johansen E, Christensen J, Stuer-Lauridsen B, Eskesen D. The science behind the probiotic strain bifidobacterium animalis subsp. Lactis BB-12®. Microorganisms. 2014;2:2.CrossRef
56.
Millette M, Ruiz MT, Millette M, Ruiz MT, Character- ML. Characterization of probiotic properties of Lactobacillus strains. Dairy Sci. Technol. 2008;88:6.
57.
Toscano M, De Vecchi E, Gabrieli A, Zuccotti GV, Drago L. Probiotic characteristics and in vitro compatibility of a combination of Bifidobacterium breve M-16 V, Bifidobacterium longum subsp. infantis M-63 and Bifidobacterium longum subsp. longum BB536. Ann Microbiol. 2015;65:2.CrossRef
58.
Picard C, Fioramonti J, Francois A, Robinson T, Neant F, Matuchansky C. Review article: Bifidobacteria as probiotic agents - Physiological effects and clinical benefits. Aliment Pharmacol Ther. 2005;22:6.CrossRef
59.
Redondo-lopez V, Cook RL, Sobel JD. Emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora. Rev Infect Dis. 1990;12:5.CrossRef
60.
Buts JP. Twenty-five years of research on saccharomyces boulardii trophic effects: updates and perspectives. Dig Dis Sci. 2009;54:1.CrossRef
61.
Chen X, Kokkotou EG, Mustafa N, Bhaskar KR, Sougioultzis S, O’Brien M, et al. Saccharomyces boulardii inhibits ERK1/2 mitogen-activated protein kinase activation both in vitro and in vivo and protects against Clostridium difficile toxin A-induced enteritis. J Biol Chem. 2006;281:34.
62.
Mumy KL, Chen X, Kelly CP, McCormick BA. Saccharomyces boulardii interferes with Shigella pathogenesis by postinvasion signaling events. Am J Physiol Gastrointest Liver Physiol. 2008;294:3.CrossRef
63.
Wu X, Vallance BA, Boyer L, Bergstrom KSB, Walker J, Madsen K, et al. Saccharomyces boulardii ameliorates Citrobacter rodentium-induced colitis through actions on bacterial virulence factors. Am J Physiol Gastrointest Liver Physiol. 2008;294:1.CrossRef
64.
Machado Caetano JA, Parames MT, Babo MJ, Santos A, Bandeira Ferreira A, Freitas AA, et al. Immunopharmacological effects of Saccharomyces boulardii in healthy human volunteers. Int J Immunopharmacol. 1986;8:3.CrossRef
65.
Dalmasso G, Cottrez F, Imbert V, Lagadec P, Peyron JF, Rampal P, et al. Saccharomyces boulardii inhibits inflammatory bowel disease by trapping T cells in mesenteric lymph nodes. Gastroenterology. 2006;131:6.CrossRef
66.
Zanello G, Meurens F, Berri M, Salmon H. Saccharomyces boulardii effects on gastrointestinal diseases. Curr Issues Mol Biol. 2009;11:33.
67.
Kelesidis T, Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Ther Adv Gastroenterol. 2011;5:2.
68.
Higashide T, Takahashi M, Kobayashi A, Ohkubo S, Sakurai M, Shirao Y, et al. Endophthalmitis caused by Enterococcus mundtii. J Clin Microbiol. 2005;43:3.CrossRef
69.
Repizo GD, Espariz M, Blancato VS, Suárez CA, Esteban L, Magni C. Genomic comparative analysis of the environmental Enterococcus mundtii against enterococcal representative species. BMC Genomics. 2014;15:1.CrossRef
70.
Turner RE, Degnan FH, Archer DL. Label claims for foods and supplements: a review of the regulations. Nutr Clin Pract. 2005;20:1.CrossRef
71.
U.S. Department of Health and Human Services. Guidance for industry on complementary and alternative medicine products and their regulation by the food and drug administration. 2006. p. 17.
72.
Heimbach JT. Health‐benefit claims for probiotic products. Clin Infect Dis. 2008;46 Suppl 2:S122–4.CrossRefPubMed
73.
Elliott E, Teversham E. An evaluation of nine probiotics avaliable in South Africa. SAMJ. 2004;94:2.
74.
Weese JS. Evaluation of defiencies in labeling of commercial probiotics. Can Vet J. 2003;44:12.
Metadata
Title
Probiotics for vaginal health in South Africa: what is on retailers’ shelves?
Authors
Anna-Ursula Happel
Shameem Z. Jaumdally
Tanya Pidwell
Tracy Cornelius
Heather B. Jaspan
Remy Froissart
Shaun L. Barnabas
Jo-Ann S. Passmore
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2017
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-017-0362-6

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