Transplants of vaginal fluid may ‘cure’ women of severe bacterial vaginosis

• Bacterial vaginosis recurs within three months in more than half of patients 
• The method involves transferring a sample of fluid from a healthy donor
• In a study, it treated four patients with severe BV within five to 21 months 

Transplants of vaginal fluid could treat women of severe and persistent bacterial vaginosis (BV), scientists have shown.

Doctors gave the experimental treatment to five patients whose lives were being ruined by the condition.

Results of the trial showed the transplant successfully treated four of the women, leaving them in remission for up to 21 months. 

The other woman given the vaginal microbiota transplant (VMT) only had partial remission, according to researchers from Israel.  

VMT involves taking discharge samples from the vagina of a healthy woman, and later transferring it to the vagina of women with BV. 

The aim of VMT is to replenish the number of ‘good’ bacteria that have been wiped out and push out the overgrowth of ‘bad’ bacteria. 

Vaginal fluid transplants’ could cure women of severe and persistent bacterial vaginosis

BV is caused by an imbalance in the bacteria inside the vagina, which can lead to grey-coloured discharge with a fishy smell. 

The vagina should normally be dominated by the Lactobacillus species, which protects the host against infection.

But in patients with BV, its overtaken by an overgrowth of an organism called Gardnerella vaginalis and anaerobic bacteria. ‘Anaerobic’ means the bacteria doesn’t need any oxygen to survive or grow.  

This disrupts the balance of natural chemicals in the vagina, which may not be obvious is symptoms don’t appear.

The condition is very common. Figures suggest it affects up to one in three women at some point in their life.  

WHAT IS BACTERIAL VAGINOSIS?

Bacterial vaginosis (BV) is a common cause of unusual vaginal discharge.

It affects around one in three women at some point in their lives. 

Although it is not an STI, it does increase a woman’s risk of catching a sexually-transmitted infection.

BV is caused by a change to the delicate bacterial balance in a woman’s vagina. 

The most common symptom is a fishy-smelling discharge, particularly after sex.

There may also be a change to the discharge’s colour or texture, such as it becoming grey or watery.

But half of women with BV experience no symptoms.

If a woman suspects she has BV, she should go to her GP or sexual-health clinic to confirm it is not an STI. 

Once diagnosed – via a cotton bud ‘smear’ – BV is usually treated via prescribed antibiotic tablets, or gels or creams.

BV often returns within three months.

Those who get it more than twice in six months will need treatment for up to half-a-year. 

BV can be prevented by using just water to wash the genital area and opting for showers over baths.

Perfumed soaps, vaginal deodorants, douches, strong detergents and even smoking raise a woman’s risk of the condition. 

BV is more common in those who are sexually active, have recently changed their partner or have ‘the coil’. 

If ‘caught’ during pregnancy, BV can lead to a premature birth or miscarriage.

Worried pregnant women should speak to their GP or midwife.

Source: NHS Choices 

Treating bacterial vaginosis can become a vicious cycle. Antibiotics can kill off vital bacteria, or cause resistance. 

The condition also often comes back, leaving affected women on a continuous cycle of antibiotics to try and keep the symptoms under control. 

More than half of women successfully treated with BV find their symptoms return, usually within three months.  

Hadassah-Hebrew University Medical Center experts recruited five women, aged 27 to 47. All had suffered from BV four or more times in the past year.

They had attempted to rid their symptoms with a range of antibiotics for prolonged periods of time, according to the findings published in the journal Nature. 

All patients, who were only named as A, B, C, D and E, revealed BV had a significant negative impact on their life.

They spoke of how it had ‘devastating consequences’ to their relationships, sex lives and self-esteem.  

Three donor women were recruited, aged between 35 and 48, who had not been affected by BV in the five years before the study.   

During the procedure, vaginal fluid was collected using a spatula. 

The collected discharge was evaluated to make sure the pH was in balance before being stored in below freezing temperatures (-80°C/-112°F).

The BV patients were treated with a weeks-worth of antibiotics prior to the transfer. 

Then the donor’s sample was placed above the cervix – the neck of the womb – in a procedure taking less than an hour.

A few rules were in place to ensure maximum success, such as no sex for a month and no douching for a week, as both can disrupt the vagina pH.  

VMTs were repeated if symptoms came back, as the BV patients were followed up weekly and then monthly.

Four patients had long lasting improvements. Two patients received one VMT and saw improvements one week after transfer. They stayed in remission for 5.5 and 11.5 months. 

The other two patients needed three VMTs, with long-term remission lasting four 11 months in one patient and 21 one months in another. 

The fifth patient only had partial remission. The authors noted that she needed to take antibiotics for pharyngitis four weeks after VMT, at which point BV flared up again. 

Remission was measured as having a Lactobacillus-dominated microbiome, disappearance of symptoms, and a lower Amsel score.

The Amsel score includes four criteria – the presence of a grey, watery discharge, pH of the vagina being more than 4.5, a fishy odour before or after the addition of hydroxide – called the whiff test – and the presence of clue cells under the microscope.

According to Amsel, if three of four criteria are positive, the patient has BV. 

The authors said VMT is feasible to a long-term treatment, especially as there were not side effects reported. 

They added that there needs to be further trials which use a placebo for comparison.  

Doctors at John Hopkins University in Baltimore have been given the go-ahead to do such a trial by the Food and Drug Administration. 

US DOCTORS TO TEST VAGINAL FLUID TRANSPLANTS IN A STUDY

US doctors have been given the go ahead to test ‘vaginal bacteria transplants’ in women with bacterial vaginosis (BV).

Researchers at John Hopkins University in Baltimore plan to take vaginal fluid from healthy donors and put it into a tampon-like device.

It will be tested in a trial of around 40 BV sufferers, with some having the vaginal microbiota transplant (VMT) and others a placebo.

The US Food and Drug Administration approved the trial after the doctors took vaginal fluid from 20 volunteers in a pilot study.

The medics claim ‘unfit’ donors could be easily ‘screened out’, with further tests then determining their ‘bacterial quality’. 

It is unclear when the trial will begin. The doctors said they would ‘start right away’ if they had the necessary funding.

Although it may sound nauseating, the procedure has been shown to be successful in up to 92 per cent of recurrent infections that do not respond to antibiotics. 

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