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Bacterial Vaginosis

By Yvonne GattungEchinacea purpurea plant

As medical herbalists, we are well versed on how intestinal dysbiosis affects many gastrointestinal conditions, however the vaginal ecosystem is often over looked.

Bacterial vaginosis (BV) is the most common vaginal infection found in women of childbearing age and pregnant women.  BV is not considered a STD but it does seem to be linked to sexual activity, although it is possible to get BV with no current sexual activity and in women who are virgins.  It can also occur in women who have sex with women so the infection is not thought to occur via the penis but rather transmitted on fingers or sex toys.

The bacterial infection can be caused by a variety of different bacteria and although a discharge is common, sometimes there are no symptoms.

Pathophysiology of Bacterial Vaginosis
The normal vaginal environment is characterized by a dynamic interrelationship between Lactobacillus acidophilus and other endogenus flora, oestrogen, glycogen, vaginal pH and metabolic by-products of flora and pathogens. L. acidophilus produces hydrogen peroxide, which is toxic to pathogens and keeps the vaginal pH healthy and between 3.8 and 4.2.

BV occurs when the vaginal flora has become altered by the introduction of pathogens or due to changes in the vaginal environment that allows pathogens to proliferate. These changes can occur due to antibiotics, contraceptives, pregnancy, sexual intercourse, douching, stress or hormonal influences.

As the L. acidophilus organism decreases, this allows the proliferation of normally suppressed organisms and it is these organisms which produce metabolic by-products such as amines which are thought to be responsible for the malodorous discharge in BV.

There are many unanswered questions about this condition, its causes, transmission and the possible role of sexual activity as women do not get BV from toilet seats, bedding or swimming pools.

How is Bacterial Vaginosis diagnosed?
A vaginal swab is the usual diagnosis for BV.

What are the complications of Bacterial Vaginosis?
BV can increase a woman’s susceptibility to STD’s such as Herpes, Chlamydia and Gonorrhoea.  Having BV increases the chances that an HIV-infected woman can pass HIV to her sexual partner.  BV has been associated with an increase in the development of an infection following surgical procedures such as a hysterectomy or an abortion and can sometimes lead to Pelvic inflammatory disease.

BV during pregnancy has been linked to serious complications including the premature rupture of the membranes surrounding the baby, pre-term labour, premature birth, low weight babies, and infection of the uterus after delivery.  Although routine testing during pregnancy is not currently recommended, there is some evidence to support testing in women at high risk for preterm delivery. There are no known direct effects of BV on the new born.

Medical Treatment for Bacterial Vaginosis:
The usual medical treatment is antibiotics either or both orally and intravaginal, BV can reoccur after treatment.

Herbal and other Treatment for Bacterial Vaginosis

  • Probiotics

Probiotics are live microorganisms and are similar to the microorganism that are found in the human digestive system.  Probiotic organisms are found in yoghurt, fermented foods such as miso, tempeh or can be taken as a supplement.

There have been many studies supporting the use of Probiotics especially Lactobacilli acidophilus administered both orally and intravaginally in the treatment of BV.  Despite issues with heterogeneity of products, trial methodologies, dose and outcome measures most studies have been in favour of using probiotics in the prevention and treatment for BV, and no adverse effects have been reported.

The Natural Standard database indicates a level of Good Scientific evidence (Grade B) for the use of Lactobacillus acidophilus in the treatment of BV.  But a grade of C- unclear or conflicting scientific evidence for the use of probiotics during pregnancy.

Probiotics improve immunity, decrease allergies and food intolerances, normalise bowel function, reduce intestinal inflammation and decrease intestinal permeability. All of which will have a positive effect on general health.

  • Prebiotics

Prebiotics are nondigestible ingredients in food that have a beneficial effect on stimulating the growth and activity of beneficial bacteria in the digestive system.

Prebiotics, principally oligosaccharides of which there are various types including oligofrutose, inulins, siomalto-oligosaccharides, lactosucrose, lactulose, inulin and more.  Prebiotics are fermented by micoflora in the proximal colon resulting in the production of short-chain fatty acids and gas.  As a result the growth of Bacteroides spp is reduced and the Lactobacilli and Bifidobacteria are increased.  As prebiotics stimulate the growth of these beneficial bacteria the use of prebiotics may have a role in the treatment of BV.

Probiotics help recolonize the intestine and prebiotics are used as fuel by the helpful bacteria to stimulate their growth hence both improve health of digestive and vaginal ecosystems.

  • Echincaea angustifolia/purpurea

Evidence for the immune modulating, anti microbial, vulnerary and lymphatic actions of the alkylamides in Echinacea are very strong.  This powerful herb is widely used for all manner of infections including infections of the reproductive tract.

  • Allium sativum (Garlic)

Allium sativum has been used as both food and medicine since time began.  Sanskrit records document the use of Allium sativum 5000 years ago.  One of the first scientist to confirm Allium sativum had antimicrobial properties was Louis Pasteur.  In terms of our topic of BV, Allium sativum not only acts on an extremely broad range of bacteria, it also has prebiotic properties which will complement the probiotics as mentioned above.

  • Melaleuca alternifolia (Tea tree)

In laboratory studies, Melaleuca alternifolia oil has been shown to kill yeast and certain bacteriaHowever, the Natural standards data base reports that at this time there is not enough information available from human studies to make recommendations for or against the use of Melaleuca alternifolia oil for vaginal infections.  A case report indicated a 5-day course of 200 mg Melaleuca alternifolia oil in a vegetable oil base inserted into the vagina was successful in the eradication of bacterial vaginosis after one month.

  • Leptospermum scoparium. (Manuka)

Also known as the New Zealand Tea tree

Leptospermum scoparium has powerful antibacterial and antifungal actions, which have been well investigated in a laboratory setting.  It has been shown to be effective against some 20 different types of bacteria, including the notorious methicillin-resistant Staphylococcus aureus (MRSA).

  • Hydrastis Canadensis and Berberis Spp (Golden Seal)

Hydrastis canadensis and Berberis Spp are potent herbs with antimicrobial, bitter, anti-inflammatory, vulnerary and chloretic actions.  They are commonly used for all manner of bacterial, fungal and parasitic infections.  Contraindicated during pregnancy, these herbs are to be respected and in the case of Hydrastis canadensis used cautiously due to over harvesting in the wild and only cultivated sources should be considered.

  • Calendula officinalis

Calendula officinalis is one of my favourite herbs which I use frequently internally and externally for BV.  Calendula officinalis looks at us with her lovely orange flowers, growing everywhere and asking to be used.  The colour associated with the sacral chakra is orange and this chakra is associated with sexual vitality, physical power and fertility.

Calendula officinalis has antimicrobial, anti inflammatory, vulnerary, antioxidant actions and is considered helpful for many different conditions affecting the reproductive tract including infections, cervical dysplasia, vaginal thrush, and leucorrhoea.

  • Tabebuia avellanedae (Pau de arco)

Tabebuia avellanedae has a wide antibacterial action including penicillin G-resistant Staphylococcus aureus, Methicillin-resistant S. aureus (MRSA), Streptoccus spp, Brucella spp, Helicobacter pylori and Clostridum paraputifactum while the intestinal flora Bifidobactreium spp and Lactobacillus spp are not adversely affected.  Being anti microbial it is also has antifungal, antiviral and antiparasitic properties.

  • Phyllocladus trichomanoides (Tanekaha)

Phyllocladus tricomanoides was used medicinally as an astringent and antimicrobial agent by Maori people and early European settlers.  Decoctions of the inner bark were used in the treatment of diarrhoea, dysentery and internal haemorrhage.  Externally, it was used as a healing remedy for burns as well as for boils, abscesses and septic infections.  The anti-microbial action of tannic acid has been well documented, and it has been shown to be effective against a range of bacteria, yeasts and viruses.

  • Vaccinium myrtillus (Blueberry)

Traditionally Vaccinium myrtillus has been used to reduce vaginal discharge.  Mechanism for this is not explained, but maybe Vaccinium myrtillus’s antimicrobial along with its many and varied therapeutic properties contribute.

  • Salvia officinalis (Sage)

The natural standard data base gave Salvia officinalis a C grade (Unclear or conflicting scientific evidence) sighting the successful use topically of an extract of Salvia officinalis (preparation not well described) which was applied 1-2 x day for four weeks.  Salvia officinalis’ antimicrobial, antiseptic and astringent therapeutic actions could be helpful.

Low Vitamin D Levels Linked to Bacterial Vaginosis
Research suggests that having low levels of vitamin D during pregnancy may increase the risk of bacterial vaginosis.

Researchers measured the vitamin D levels of 469 pregnant women and monitored them for the development of bacterial vagniosis.  They found that 41 percent of the women developed bacterial vaginosis, and of those, 93 percent were vitamin D deficient.  Additionally, higher levels of vitamin D were associated with a decreased risk of bacterial vaginosis.

According to the authors, vitamin D may play a role in the condition by regulating the production and function of antimicrobial molecules, which in turn may help the immune system prevent and control the infection.  However, additional research is needed to determine exactly how, if at all, vitamin D affects the risk of bacterial vaginosis.

CASE STUDY:
A 21 year old woman came to see me at 28 weeks into her second pregnancy with a diagnosis of bacterial vaginosis.  I had treated her in the past but was not currently treating her.

She was fit and well and other than the BV, there had been no other issues with the pregnancy.

The client had taken two different types of antibiotics which had made no difference to the discharge and she did not want to start another round of antibiotics.

She had self prescribed barley grass, folic acid, vitamin C and fish oil which she was taking and also had made no difference.

Treatment consisted of:
a) Increasing garlic in her diet
b) Taking capsule providing 12.5 billion organisms of Lactobacillus acidophilus and 12.5 billion organisms of Bifidobacterium animalis ssp Lactis per capsule, dose
of 1 capsule twice a day with large glass of water on empty stomach.
c) Tablets providing equi. dry Echinacea angustifolia root 600 mg and Echinacea purpurea root 675 mg per tablet. Two tablets per day
d) Cream to apply topically twice a day.

After two weeks taking these herbs, she was symptom free, had a follow up vaginal swab which confirmed the elimination of the BV and she proceeded to have a healthy full-term baby girl.

There was no re-occurrence.

References – available on request

 

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