title: Impact of vaginal ascorbic acid on abnormal vaginal microflora.
abstract: OBJECTIVE
  To evaluate the impact of vaginal ascorbic acid (vitamin C) as a treatment/maintenance regimen on increased vaginal pH and abnormal microflora on wet mounts in premenopausal women.
  
  
  METHODS
  A randomized study of 140 asymptomatic, low-risk pregnant and non-pregnant premenopausal women with vaginal pH ≥ 4.5 and a variety of partly/completely disrupted Lactobacillus microflora patterns on wet mounts in five outpatient clinics was carried out. Participants were randomized to the intervention group [250 mg vitamin C tablets vaginally at bedtime once a day for 6 days (treatment phase), followed by a one tablet per week, for 12 weeks (maintenance phase)] or the control group (no treatment). Outcomes were evaluated 4 months after randomizing, i.e., 2-3 weeks after the last vitamin C tablet insertion.
  
  
  RESULTS
  Normalization to normal flora was observed in 51.4 % of all ascorbic acid and in 24.3 % of control group patients (difference 27.1 %, 95 % CI 11.7-42.6, p < 0.05, ITT population). In the per protocol population, normalization was confirmed in 53.5 % of the intervention and 22.4 % of the control group (difference 31 %, 95 % CI 14.3-47.8, p < 0.05). Results of pregnant subgroup analysis showed better outcomes for the subgroup: difference of normalization rate between ascorbic acid and control group was 41.2 % (95 % CI 21.8-60.1, p < 0.05). Itching occurred in 19 %; 23 % of women reported irritation and 10 % stopped the treatment because of side effects.
  
  
  CONCLUSIONS
  Vaginal ascorbic acid improves abnormal vaginal pH and microflora, especially in pregnant women, but is not well tolerated by all women.
authors.affiliation: Department of Obstetrics and Gynecology, Riga Stradins University, Miera Street 45, Riga, 1013, Latvia, zodzika@inbox.lv.
authors.forename: Jana
authors.initials: J
authors.lastname: Zodzika
authors.forename: Dace
authors.initials: D
authors.lastname: Rezeberga
authors.forename: Gilbert
authors.initials: G
authors.lastname: Donders
authors.forename: Natalija
authors.initials: N
authors.lastname: Vedmedovska
authors.forename: Olga
authors.initials: O
authors.lastname: Vasina
authors.forename: Inara
authors.initials: I
authors.lastname: Pundure
authors.forename: Ruta
authors.initials: R
authors.lastname: Bite
authors.forename: Ingrida
authors.initials: I
authors.lastname: Silberga
authors.forename: Julija
authors.initials: J
authors.lastname: Socenova
authors.forename: Olita
authors.initials: O
authors.lastname: Melngaile
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D001205:Ascorbic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D007778:Lactobacillus / Q000187:drug effects*; D011247:Pregnancy; D017697:Premenopause; D014621:Vagina / Q000737:chemistry* / Q000382:microbiology*; D014815:Vitamins / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014815:Vitamins; D001205:Ascorbic Acid