Clinical Application of Lactobacillus rhamnosus In Treating Vaginal Infections: Symptom Control and Infection Clearance

Lactobacillus rhamnosus GG (LGG), known under the reference number ATCC 53103, was first isolated by Sherwood Gorbach and Barry Goldwin from the stool samples of a healthy adult individual, with its designation “GG” derived from the initials of the researchers [1]. Upon discovery, LGG was immediately recognized as a potential probiotic strain due to its resistance to acid and bile, as well as its favorable growth characteristics. Numerous studies have confirmed that LGG can be detected in the stool of adults for at least seven days after oral administration, while in neonates, it persists longer and at higher concentrations, indicating a better colonization capacity during early life, attributed to the less developed gut microbiota in newborns [2]. LGG exerts its beneficial effects through several key mechanisms, including the inhibition of pathogenic microorganisms either directly or by influencing the gut microbiota, enhancement of epithelial barrier function via regulation of signaling pathways such as NF-kB, Akt, and MAPK, contributing to increased mucus production and improved tight junction integrity, and immunomodulation through the regulation of local and systemic immune responses, mediated by microbe-associated molecular patterns (MAMPs) recognized by receptors such as Toll-like receptors (TLRs) [3]. The combination of resistance to gastrointestinal stressors, adherence capacity to epithelial cells, and immunomodulatory properties makes LGG an exceptionally valuable probiotic strain, with extensively studied effects in clinical research. In the context of vaginal health, Lactobacillus rhamnosus plays a pivotal role in maintaining the balance of the vaginal microbiota, where healthy microbiota are dominated by lactobacilli that produce lactic acid, creating an acidic environment (pH 3.8–4.5) hostile to the growth of pathogenic bacteria and fungi [4,5]. This probiotic produces lactic acid, hydrogen peroxide, and bacteriocins—natural substances that inhibit the growth of microorganisms such as Candida albicans and Gardnerella vaginalis, the main culprits of vaginal infections [6]. Its ability to adhere to the epithelial cells of the vaginal mucosa allows it to compete with pathogens for binding sites, preventing their colonization and biofilm formation [7]. Studies have shown that regular use of products containing Lactobacillus rhamnosus can reduce the frequency of recurrent vaginal infections, such as bacterial vaginosis and vaginal candidiasis. Moreover, its immunomodulatory effects further enhance local immune responses by stimulating the secretion of immunoglobulin A (IgA) and regulating pro-inflammatory cytokines, thereby contributing to the protection of the vaginal ecosystem [8]. This probiotic is recommended not only for women suffering from vaginal infections but also for those seeking to maintain urogenital health, especially during periods of increased risk of dysbiosis, such as pregnancy, menopause, antibiotic use, or stress. Its safety and proven efficacy make it an ideal choice for supporting health and preventing infections.

The study, conducted to evaluate the effect of oral administration of a probiotic supplement containing Lactobacillus rhamnosus on vaginal flora, included 30 women aged 20–45 years and was strictly anonymous. Participants were healthy women without active infections, pregnancy, chronic illnesses, or recent use of antibiotics or antifungal medications within the last 90 days. The participants consumed one probiotic capsule daily (containing at least 108CFU per capsule) for 30 days. Vaginal swabs were collected before and after the intervention by trained medical personnel under sterile conditions and analyzed using standard microbiological techniques, including Gram staining and bacterial species identification. In addition to microbiological analyses, symptoms of vaginal discomfort (itching, burning, increased discharge, dryness) were assessed through a standardized questionnaire administered both before and after the treatment, ensuring that all data were collected and processed with full participant anonymity. Qualitative and quantitative data were statistically analyzed to evaluate the probiotic’s effects on changes in vaginal microbiota and symptom alleviation. The study was designed as a prospective investigation with pre- and post-treatment assessments.

In Table 1. presents the mean values and standard deviations for the presence of the fungus Candida albicans and the bacterium Gardnerella vaginalis in the study participants (30 women). The participants were grouped by age, ranging from 25 to 45 years. Among the participants aged 25–30 years, Candida albicans was the most dominant, with an average concentration of (5.2 x 103 ± 1.0 x 103). However, the values in other age groups did not deviate significantly. This pattern was not observed with Gardnerella vaginalis, which exhibited substantially higher concentrations overall. For Gardnerella vaginalis, the concentrations ranged from 7.5 do 8.2 x 103 characterizing it as a highly colonizing strain. The highest concentration was observed in participants aged 30–35 years 8.2. x103± 2.6 x103 closely followed by participants aged 40–45 years (8.1 x103± 2.7 x103) the latter group also showing the highest standard deviation.

Table 1: Mean values and standard deviations of microbiological samples.

In Table 2. the results of the microbiological sample after 30 days of Lactobacillus rhamnosus (10^8 CFU/ml) administration in 30 participants are presented. The results indicate that the effect was more than satisfactory, with a drastic reduction in infection.

The fungus Candida albicans showed a decrease to 2.1 x 103 in participants aged 25–30 years, who had the most dominant ratio. Overall, the concentration of Candida albicans after Lactobacillus rhamnosus (10^8 CFU/ml) administration ranged from 1.0 do 2.1 x 103 . Asimilar trend was observed with the bacterium Gardnerella vaginalis, which also showed a reduction in infection. In the group with the highest concentration, participants aged 30–35 years recorded 1.8 x103 . The concentration ratio for Gardnerella vaginalis ranged from 1.6 do 1.4 x 103 , leading to the conclusion that Lactobacillus rhamnosus significantly contributes to women’s health and the resolution of infections caused by various bacterial strains, including Gardnerella vaginalis and Candida albicans in our study.

Table 2:Presentation of microbiological samples after 30 days of Lactobacillus rhamnosus administration.

In Table 3. the results of the survey questionnaire administered to 30 participants before and after the application of Lactobacillus rhamnosus are presented. The questionnaire included symptoms such as itching, burning, increased discharge, and dryness. Participants aged 25 to 45 reported the presence of all symptoms, with some experiencing them less intensely and others more prominently. Participants aged 40 to 45 had a high prevalence of each accompanying symptom: itching and burning at 83%, increased discharge at 92% and dryness at 100%. However, after the application of Lactobacillus rhamnosus, to 40, increased discharge (25%) and dryness (25%) were present. In the 40 to 45-year age group, in addition to burning and increased discharge (both 8%), dryness was also reported in 25% of cases.

Table 3:Presentation of symptoms before and after Lactobacillus rhamnosus use.

Based on the results, it is evident that the participants aged 40 to 45 experienced the most severe infections and symptoms, with high rates of itching, burning, increased discharge, and dryness before the treatment. This age group demonstrated the most pronounced infection severity and symptom intensity, indicating stronger underlying inflammatory processes. In contrast, all other age groups showed a significant reduction in both infections and symptoms after the application of Lactobacillus rhamnosus, reflecting a positive therapeutic effect. However, a slight persistence of symptoms was observed in the 40 to 45-year-old group, which may be attributed to their generally weaker basal metabolism and immune response, as well as the potential influence of the perimenopausal phase. These factors likely contribute to a slower recovery and a more persistent symptomatology compared to younger age groups.

The results of our study show significant changes in symptoms and infections after the application of Lactobacillus rhamnosus in participants from different age groups. Although women aged 40-45 years had pronounced symptomatology and more severe infections before treatment, after 30 days of probiotic application, a significant reduction in symptoms was observed in all groups, except for women in this age group. These women retained certain symptoms, which can be attributed to their specific health condition commonly seen during the perimenopausal period. According to some studies, older women have reduced immune system functionality, which may cause a slower response to infections and prolonged symptom duration. Additionally, changes in hormonal status, such as a decline in estrogen levels during menopause, can affect the vaginal microbiome by reducing the number of beneficial bacteria like Lactobacillus spp., increasing susceptibility to infections caused by Candida albicans and Gardnerella vaginalis [9]. These factors may explain the weaker response to treatment in women during perimenopause and menopause. In our study, women in younger age groups (20-35 years) showed a significant reduction in symptoms such as itching, burning, increased discharge, and dryness, which can be attributed to the effective influence of Lactobacillus rhamnosus on the vaginal microbiome balance. Probiotics like Lactobacillus have the ability to restore healthy microbiota, lower pH levels, and stimulate immune responses, which leads to a reduction in infections and inflammatory processes in the vagina [10]. It is important to note that although symptoms were significantly reduced in all participants, including those in the older age group, complete recovery was not always achieved, especially in women aged 40-45 years. This may indicate the need for additional therapeutic approaches, such as hormone therapy or more specific probiotics for older women, which could be more effective in reducing symptoms and preventing recurrent infections. In conclusion, our results support the importance of applying probiotics in the treatment of vaginal infections, with an emphasis on the specific challenges in older age groups, where additional factors such as hormonal changes may play a significant role in treatment success. Further research is needed to better understand the mechanisms behind these differences in response to treatment and to develop personalized approaches for different age groups.

The author thanks to Prof. Darshana Choubisa, Department of Prosthodontics and Crown & Bridge, Geetanjali Dental and Research Institute, Udaipur, Rajasthan 313002, India for help.

The author has no conflict of interest.

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