title: Probiotic strategies for the treatment and prevention of bacterial vaginosis.
abstract: BACKGROUND
  Urogenital infections are on average the number-one reason for women to visit the doctor. Yet, treatment and preventive strategies have gone unchanged for close to 50 years. With prevalence rates for bacterial vaginosis at more than 29%, depending on the population, and similarly high incidences of vulvo-vaginal candidiasis and urinary tract infections, plus HIV, new therapies are urgently needed to improve the health of women around the world.
  
  
  METHODS
  This review discusses the vaginal microbiota, our improved understanding of its composition, and its role in health and disease. It also discusses the progress made in the past 10 years or so, with the development and testing of probiotic lactobacilli to improve vaginal health and better manage urogenital infection recurrences.
  
  
  RESULTS
  The reader will have an understanding of the clinical data obtained so far, and the potential mechanisms of action of probiotics. Despite the need for more clinical studies, the review illustrates a case for inclusion of probiotics as part of the approach to disease prevention, and as an adjunct to antimicrobial treatment. Challenges remain in optimizing clinical benefits, selecting new strains, preparing new products and having them tested in humans then approved with informative claims, and making products readily accessible to women in the developed and developing world.
  
  
  CONCLUSIONS
  The vaginal microbiota is a complex structure that can change quickly and dramatically, and significantly impact a woman's health. New health-maintenance and disease-treatment approaches are badly needed, and probiotics should be considered.
authors.affiliation: The University of Western Ontario, Department of Microbiology, London, Ontario, Canada.
authors.forename: Roderick A
authors.initials: RA
authors.lastname: MacPhee
authors.forename: Ruben
authors.initials: R
authors.lastname: Hummelen
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Bisanz
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Miller
authors.forename: Gregor
authors.initials: G
authors.lastname: Reid
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic / Q000379:methods; D005260:Female; D006801:Humans; D007778:Lactobacillus; D019936:Probiotics / Q000627:therapeutic use*; D012008:Recurrence; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control