Probiotics: utility, benefits, and risks for gynecologic conditions.

Purpose of review: The vaginal microbiome plays an important role in protecting the vagina and bladder from infection. There is significant interest in understanding whether probiotics can normalize the vaginal microbiome and lead to decreased incidence of vulvovaginal-associated infections. Probiotics are an appealing treatment option as they are well tolerated, have a low risk profile, and potentially can reduce antibiotic usage.

Recent findings: Recent research suggests that probiotics may play a role in preventing recurrent bacterial vaginosis (BV) when administered with or after antibiotic treatment. Probiotics do not seem to be helpful for preventing recurrent vulvovaginal candidiasis. Probiotics prevent vaginal colonization with uropathogens from the gastrointestinal tract, and decrease recurrent urinary tract infections (UTIs) 76% when administered as part of a nonantibiotic recurrent UTI treatment bundle, which includes D-mannose, cranberry supplementation, and probiotics. Probiotics are a hopeful treatment for human papillomavirus (HPV), and evidence suggests that probiotic administration increases clearance of HPV and results in the resolution of abnormal papanicolaou test results.

Summary: Evidence shows that probiotics are useful treatments for BV, recurrent UTIs, and HPV. More research is necessary to recommend specific bacterial strains or products for each indication.