Microflora against vaginosis

Vaginosis was cured for the first time by transplantation of vaginal microbiota

Polina Loseva, N+1

Israeli doctors have reported on the successful results of the first clinical trial on vaginal microbiota transplantation. It was attended by three donors and five recipients with antibiotic-resistant bacterial vaginosis. In four out of five women, doctors managed to achieve remission of the disease, and they did not find any side effects. The study was published in the journal Nature Medicine (Lev-Sagie et al., Vaginal microbiome transplantation in women with intractable bacterial vaginosis).

Bacterial vaginosis occurs, according to various estimates, in every third or fourth woman of reproductive age. Its manifestations can be very different: from the complete absence of symptoms to an unpleasant smell and pain syndrome. In addition, bacterial vaginosis is a risk factor for more severe pathologies, such as pregnancy complications and vulnerability to sexually transmitted infections.

In severe cases, vaginosis often cannot be cured completely: despite treatment with antibiotics, the disease returns within a month in 30 percent of cases and within a year in 50-70 percent of patients. It is probably possible to cope with vaginosis with the help of a microbiota transplant from a healthy donor — by analogy with fecal transplants, which are already used to treat intestinal infections and are tested for many other diseases (for example, autism).

Ahinoam Lev-Sagie and his colleagues from the Hadassah Hebrew University Medical Center in Jerusalem conducted the first clinical trials of such a transplant. They selected three healthy donors who were ordered to abstain from sexual activity for a week before the transplant. As recipients, doctors found five patients with vaginosis who were not helped by antibiotic treatment, without other concomitant diseases.

On the seventh day of the menstrual cycle, vaginal fluid was taken from donors, diluted in sterile saline solution and injected into the vaginas of recipients. After that, the patients were examined every week for the first month, and then once a month to repeat the transplant if necessary.

The first two patients noted improvement immediately after transplantation. Doctors did not find any traces of vaginosis in them later: they remained healthy at the time of the last examination — 11.5 and 5.5 months after the transplant, respectively. 

The third patient stated that she feels well, but the doctors did not find any improvement in her. She had another transplant, after which she remained healthy for four months, and then the symptoms of vaginosis returned. The authors of the study decided to change the donor, and after the third transplant, the symptoms disappeared for at least 11 months. 

The fourth patient also needed three transplants to achieve remission — however, all from one donor. As for the fifth patient, a full recovery did not occur: despite two transplants, the microbiota of her vagina remained in a transitional state between the normal composition and the pathological characteristic of vaginosis.

The microbiome of the patient's vagina before and after transplantation. The black arrows indicate the cells of the vaginal wall, the white ones indicate the bacteria of the vaginal fluid. A drawing from an article in Nature Medicine.

The authors of the trials did not find any side symptoms from the treatment in their patients. However, they note that the procedure may carry certain risks.

First, it is necessary to check the microbiome of donors for the absence of antibiotic-resistant strains, so that the story of fecal transplantation, which recently led to the death of a patient with suppressed immunity, to whom, among other microbes, one resistant was transplanted, does not repeat itself.

Secondly, it is important to ensure that there are no spermatozoa in the vaginal fluid to avoid unwanted pregnancy. In addition, doctors note that other complications of the procedure are possible, which they did not detect due to a small sample.

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