Probiotics in addition to metronidazole for treatment Trichomonas vaginalis in the presence of BV: a randomized, placebo-controlled, double-blind study

  • Andrey SgibnevEmail author
  • Elena Kremleva
Original Article


The purpose was to evaluate whether probiotics can increase the effectiveness of antimicrobial therapy. Ninety women with Trichomonas vaginalis (TV) in the presence BV were included in the study of regimens for therapy combination with metronidazole and vaginal probiotics. For 7 days, the probiotics group patients received metronidazole at 500 mg twice a day and 1 capsule of probiotic Gynophilus® vaginally twice a day; the placebo group patients in addition to metronidazole received a placebo instead of a probiotic. For the next 7 days, patients in both groups in order restore normal microflora were given the probiotics vaginally. Before the treatment, on the 4th, 8th, and 15th day of therapy complaints, pH and redox potential of the vaginal fluid were recorded, TV detection culturally, microflora of the vagina with the qPCR-RT and microscopically. Adding probiotics to traditional therapy of TV in the presence of BV increased the likelihood of cure from TV (88.6 and 42.9% in the probiotic and placebo groups, respectively) and from BV (63.6 and 11.9%, respectively). We have found that the addition of probiotics to antimicrobial therapy causes the decrease in the inflammatory response and significant changes in the vagina’s physicochemical parameters (decreased of the pH values, increased of the redox potential) already on the fourth day of the therapy. The changes in the metronidazole’s antimicrobial action implementation when a probiotic is added are the reason of increasing the TV therapy’s effectiveness in the BV presence.


Bacterial vaginosis Lactobacillus Metronidazole Probiotics Trichomonas vaginalis 



The authors wish to thank all gynecologists and volunteers who have participated in this study. The authors are sincerely grateful to Victoria Yansubaeva for her help in English language editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted according to Guidelines for Good Clinical Practice and was approved by the Human Research Ethics Committee at Orenburg State Medical University on March 10, 2017 (Orenburg, Russia, HRECOSMU-165/10/03/2017). Informed consent was provided prior to recruitment and participation.

Informed consent

Before inclusion in the study, the researcher provided the volunteer with all the information about the study. The volunteer gave written consent for the processing of her personal data implemented as part of this study and to an enabled research results analysis. When the volunteer gives her consent, she and the researcher signed and dated the consent form.


  1. 1.
    Levy SB, Marshall B (2004) Antibacterial resistance worldwide: causes, challenges and responses. Nat Med 10(12 Suppl):S122–S129. CrossRefPubMedGoogle Scholar
  2. 2.
    Macklaim JM, Clemente JC, Knight R, Gloor GB, Reid G (2015) Changes in vaginal microbiota following antimicrobial and probiotic therapy. Microb Ecol Health Dis 26:27799. CrossRefPubMedGoogle Scholar
  3. 3.
    Sgibnev A, Kremleva E (2017) Influence of hydrogen peroxide, lactic acid, and surfactants from vaginal lactobacilli on the antibiotic sensitivity of opportunistic bacteria. Probiotics Antimicrob Protein 9(2):131–141. CrossRefGoogle Scholar
  4. 4.
    Heller DS, Maslyak S, Skurnick J (2006) Is the presence of Trichomonas on a Pap smear associated with an increased incidence of bacterial vaginosis? J Low Genit Tract Dis 10(3):137–139. CrossRefPubMedGoogle Scholar
  5. 5.
    Torok MR, Miller WC, Hobbs MM, Macdonald PD, Leone PA, Schwebke JR, Sena AC (2007) The association between Trichomonas vaginalis infection and level of vaginal lactobacilli, in nonpregnant women. J Infect Dis 196(7):1102–1107. CrossRefPubMedGoogle Scholar
  6. 6.
    Brotman RM, Bradford LL, Conrad M, Gajer P, Ault K, Peralta L, Forney LJ, Carlton JM, Abdo Z, Ravel J (2012) Association between Trichomonas vaginalis and vaginal bacterial community composition among reproductive-age women. Sex Transm Dis 39(10):807–812. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Gatski M, Martin DH, Levison J, Mena L, Clark RA, Murphy M, Henderson H, Schmidt N, Kissinger P (2011) The influence of bacterial vaginosis on the response to Trichomonas vaginalis treatment among HIV-infected women. Sex Transm Infect 87(3):205–208. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bouchemal K, Bories C, Loiseau PM (2017) Strategies for prevention and treatment of Trichomonas vaginalis infections. Clin Microbiol Rev 30(3):811–825. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Coudeyras S, Jugie G, Vermerie M, Forestier C (2008) Adhesion of human probiotic Lactobacillus rhamnosus to cervical and vaginal cells and interaction with vaginosis-associated pathogens. Infect Dis Obstet Gynecol 2008:549640. CrossRefPubMedGoogle Scholar
  10. 10.
    Petricevic L, Witt A (2008) The role of Lactobacillus caseirhamnosus Lcr35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis. BJOG 115(11):1369–1374. CrossRefPubMedGoogle Scholar
  11. 11.
    Menezes CB, Mello Mdos S, Tasca T (2016) Comparison of permanent staining methods for the laboratory diagnosis of Trichomoniasis. Rev Inst Med Trop Sao Paulo 58:5. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Holmes KK, Chen KC, Lipinski CM, Eschenbach DA (1985) Vaginal redox potential in bacterial vaginosis (nonspecific vaginitis). J Infect Dis 152(2):379–382. CrossRefPubMedGoogle Scholar
  13. 13.
    Khatoon R, Jahan N, Ahmad S, Khan HM, Rabbani T (2015) Comparison of four diagnostic techniques for detection of Trichomonas vaginalis infection in females attending tertiary care hospital of North India. Indian J Pathol Microbiol 58(1):36–39. CrossRefPubMedGoogle Scholar
  14. 14.
    Nugent RP, Krohn MA, Hillier SL (1991) Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29(2):297–301PubMedPubMedCentralGoogle Scholar
  15. 15.
    Menard JP, Fenollar F, Raoult D, Boubli L, Bretelle F (2012) Self-collected vaginal swabs for the quantitative real-time polymerase chain reaction assay of Atopobiumvaginae and Gardnerella vaginalis and the diagnosis of bacterial vaginosis. Eur J Clin Microbiol Infect Dis 31(4):513–518. CrossRefPubMedGoogle Scholar
  16. 16.
    Hilbert DW, Smith WL, Chadwick SG, Toner G, Mordechai E, Adelson ME, Aguin TJ, Sobel JD, Gygax SE (2016) Development and validation of a highly accurate quantitative real-time PCR assay for diagnosis of bacterial vaginosis. J Clin Microbiol 54(4):1017–1024. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gilbey P, Livshits L, Sharabi-Nov A, Avraham Y, Miron D (2015) Probiotics in addition to antibiotics for the treatment of acute tonsillitis: a randomized, placebo-controlled study. Eur J Clin Microbiol Infect Dis 34(5):1011–1015. CrossRefPubMedGoogle Scholar
  18. 18.
    Nader-Macias ME, Juarez Tomas MS (2015) Profiles and technological requirements of urogenital probiotics. Adv Drug Deliv Rev 92:84–104. CrossRefPubMedGoogle Scholar
  19. 19.
    Bermudez-Humaran LG, Langella P (2017) Use of traditional and genetically modified probiotics in human health: what does the future hold? Microbiol Spectr 5(5).
  20. 20.
    Figueroa-Angulo EE, Rendon-Gandarilla FJ, Puente-Rivera J, Calla-Choque JS, Cardenas-Guerra RE, Ortega-Lopez J, Quintas-Granados LI, Alvarez-Sanchez ME, Arroyo R (2012) The effects of environmental factors on the virulence of Trichomonas vaginalis. Microbes Infect 14(15):1411–1427. CrossRefPubMedGoogle Scholar
  21. 21.
    Jung HS, Ehlers MM, Lombaard H, Redelinghuys MJ, Kock MM (2017) Etiology of bacterial vaginosis and polymicrobial biofilm formation. Crit Rev Microbiol 43(6):651–667. CrossRefPubMedGoogle Scholar
  22. 22.
    Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE (2004) Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis. Clin Microbiol Rev 17(4):783–793, table of contents. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    lwakil HS, Tawfik RA, Alam-Eldin YH, Nassar DA (2017) The effect of iron on metronidazole activity against Trichomonas vaginalis in vitro. Exp Parasitol 182:34–36. CrossRefGoogle Scholar
  24. 24.
    Memar MY, Ghotaslou R, Samiei M, Adibkia K (2018) Antimicrobial use of reactive oxygen therapy: current insights. Infect Drug Resist 11:567–576. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of the Study of the Mechanisms of Formation Microbial Biocenosis of HumansInstitute of Cellular and Intracellular SymbiosisOrenburgRussian Federation
  2. 2.Department of BiochemistryOrenburg State Medical UniversityOrenburgRussian Federation
  3. 3.Department of Obstetrics and GynecologyOrenburg State Medical UniversityOrenburgRussian Federation

Personalised recommendations