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Background  To reduce acquisition and relapse of bacterial vaginosis (BV), lactobacilli must be maintained in the vaginal microbiome. Probiotic lactobacilli may aid this purpose. We investigated whether vaginal probiotics (containing  Lactobacillus rhamnosus  DSM 14870 and  Lactobacillus gasseri  DSM 14869) would result in vaginal colonisation with lactobacilli in women with and without BV.    Methods  This prospective, partially randomised, exploratory pilot study was conducted in Soweto, South Africa. Thirty-nine sexually-active, HIV negative women were enrolled from October 2014 to May 2016 into three arms. Women who did not have BV (Group 1,  n  = 13) self-administered probiotic capsules vaginally once daily for 30 days, then once a week until Day 190. Women diagnosed with BV were randomized into Group 2 ( n  = 12) or Group 3 ( n  = 14) and treated with the triple oral antibiotic combination for vaginal discharge syndrome per South African guidelines (cefixime 400 mg stat, doxycycline 100 mg BD for 7 days and metronidazole 2 g stat). Immediately after antibiotic treatment, women in Group 2 self-administered probiotic capsules vaginally once daily for 30 days then vaginally once a week until Day 190. Women in Group 3 were not given lactobacilli.    Results  During the study,  L. rhamnosus  DSM 14870 or  L. gasseri  DSM 14869, were isolated in 5/13 (38.5%) women in Group 1 compared to 10/12 (83.3%) women in Group 2 ( p  = 0.041). The 1-month and 6-month BV cure rates were similar ( P  >  0.05) between Group 2 (42 and 25%) compared to Group 3 (36 and 25%). In Group 2, no correlation was observed between the frequency of isolation of the two  Lactobacillus  strains and the 1-month or 6-month cure rate.    Conclusions  Supplementation with vaginal probiotic capsules resulted in colonisation of the vagina by the  Lactobacillus  strains ( L. rhamnosus  DSM 14870 and  L. gasseri  DSM 14869) contained in the capsules. We observed low initial cure rates of BV after a stat dose of metronidazole and that the probiotic did not improve BV cure rates or alleviate recurrence which could be due to treatment failure or very limited power of the study.    Trial registration  Registered at the Pan African Clinical Trial Registry ( www.pactr.org ) on April 13, 2018 (retrospectively registered). Trial identification number: PACTR201804003327269.    Electronic supplementary material  The online version of this article (10.1186/s12879-019-4425-1) contains supplementary material, which is available to authorized users.

bmc infectious diseases

An exploratory pilot study evaluating the supplementation of standard antibiotic therapy with probiotic lactobacilli in south African women with bacterial vaginosis