title: Probiotics for vaginal health in South Africa: what is on retailers' shelves?
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa.|UMR 5290 MIVEGEC, CNRS IRD Université Montpellier, Montpellier, France.
authors.forename: Anna-Ursula
authors.identifier: 0000-0003-3658-8638
authors.initials: AU
authors.lastname: Happel
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa.|CAPRISA DST-NRF Centre of Excellence in HIV Prevention, Cape Town, South Africa.
authors.forename: Shameem Z
authors.initials: SZ
authors.lastname: Jaumdally
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa.|Desmond Tutu HIV Foundation, Cape Town, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Pidwell
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa.
authors.forename: Tracy
authors.initials: T
authors.lastname: Cornelius
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa.|Seattle Children's Research Institute, University of Washington, Seattle, WA, USA.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Jaspan
authors.affiliation: UMR 5290 MIVEGEC, CNRS IRD Université Montpellier, Montpellier, France.
authors.forename: Remy
authors.initials: R
authors.lastname: Froissart
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa.|Desmond Tutu HIV Foundation, Cape Town, South Africa.
authors.forename: Shaun L
authors.initials: SL
authors.lastname: Barnabas
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa. Jo-ann.Passmore@uct.ac.za.|CAPRISA DST-NRF Centre of Excellence in HIV Prevention, Cape Town, South Africa. Jo-ann.Passmore@uct.ac.za.|National Health Laboratory Service, Cape Town, South Africa. Jo-ann.Passmore@uct.ac.za.
authors.forename: Jo-Ann S
authors.initials: JS
authors.lastname: Passmore
mesh_terms: D000069982:Bifidobacterium animalis / Q000378:metabolism; D000069978:Bifidobacterium longum / Q000378:metabolism; D002177:Candidiasis / Q000178:diet therapy / Q000517:prevention & control; D003132:Commerce / Q000379:methods; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007779:Lactobacillus acidophilus / Q000378:metabolism; D052201:Lacticaseibacillus rhamnosus / Q000378:metabolism; D019936:Probiotics / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use; D013019:South Africa; D011795:Surveys and Questionnaires; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000178:diet therapy / Q000517:prevention & control
keywords: Lactobacillus spp.; Probiotics; Vaginal; Women