Biotics Fight Vaginal Fungal Biofilms

“Over the past decade,” said corresponding author Leslie Thian Lung Than, PhD, “fungal biofilms have been implicated in the development of vulvovaginal candidiasis (VVC).” He is an Associate Professor in the Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM) in Serdang, Malaysia.1

Normally, candidiasis The species are opportunistic fungal pathogens present in healthy vaginal microflora and pose no threat to the host. However, conditions such as changes in pH, immunosuppression, and poor hygiene can shift the bacterial balance away from a healthy predominance of lactobacilli, leading to fungal overgrowth and invasion.

Vaginal fungal biofilms could form on the vaginal epithelium (biotic biofilms) and on implantable polymeric devices such as vaginal rings (abiotic biofilms). Contemporary OB/GYN®. “Because fungal biofilms are generally less responsive to the current antifungal arsenal, persistent recalcitrant cells in biofilms often survive, which can impact recurrent CVVs and persistent infections.” The inability of antifungals to penetrate fungal biofilms could lead to the development of antifungal resistance, he added, which prevents complete eradication of fungal biofilms, resulting in a vicious cycle.

Other causes of antimicrobial resistance include overuse of over-the-counter agents. Although these products can effectively treat simple VVCs,2 he says, easy access leads to unsupervised self-medication, which doctors should discourage in patients with suspected CVD.

“With respect to complicated CVV, including recurrent CVV, CVV associated with fungal biofilm, and non-Candida albicans VVC,” said Than, “it is important to identify candidiasis species via vaginal culture or PCR. Because some non-C. albicans candidiasis species (for example, Candida hairless) are inherently resistant to azoles, he said, providers could perform antifungal susceptibility testing before prescribing antifungals.

For CVVs that are resistant to standard antifungal therapy, the authors recommended combining antifungals with adjuvants such as biotics, boric acid, allicin, and tea tree oil. “Combining existing antifungals with adjuvant therapy using the family of biotics could be a promising treatment regimen for better management of complicated vaginal fungal infections,” said lead author Shu Yih Chew, PhD. He is a postdoctoral researcher, Department of Medical Microbiology, UPM.

Administered orally or vaginally, Lactobacillus and Bifidobacterium represent the most commonly used lactic acid bacteria (LAB) for vaginal probiotics. “The ability of probiotics to colonize and replenish the vaginal ecosystem creates an environment conducive to the long-term restoration of the host’s native LAB, thereby decreasing the risk of recurrent attacks,” Chew said. Probiotics also avoid the side effects of conventional antifungals, reducing the chances of developing drug-resistant mutations.

Prebiotics such as oligosaccharides enhance the growth and viability of probiotics. Synbiotics combine both probiotics and prebiotics in a form of synergy.

Postbiotics is a broad term to describe bioactive compounds and metabolites secreted by probiotics during fermentation that are potentially as effective as the probiotics themselves, Chew said. “Postbiotic components, including bacteriocin, biosurfactants, LAB cell-free supernatant, and organic acids, also represent prospective strategies for the treatment of vaginal fungal infections.”3-6


1. Boahen A, Than LTL, Loke YL, Chew SY. The role of the antibiotic family of biotics in vaginal mycoses. Microbiol before. 2022 May 26;13:787119. doi: 10.3389/fmicb.2022.787119. PMID: 35694318; PMC ID: PMC9179178

2. Chew SY, than LT. Vulvovaginal candidiasis: contemporary issues and future of prophylactic and therapeutic approaches. Fungal infections. 2016;59(5):262-273. doi:10.1111/myc.12455

3. Umar Meleh H, Choo S, Mohd Desa MN, et al. Isolation and safety characterization of lactobacilli strains with antimicrobial properties as potential probiotics for human use. LWT. 2020;131:109796. doi:10.1016/j.lwt.2020.109796

4 De Gregorio PR, Parolin C, Abruzzo A, et al. Vaginal biosurfactant Lactobacillus crispatus BC1 as a promising agent to interfere with candidiasis membership. Fact about microbial cells. 2020; 19:133. doi:10.1186/s12934-020-01390-5

5. Hefzy EM, Khalil MAF, Amin AAI, Ashour HM, Abdelaliem YF. Bacteriocin-like inhibitory substances from probiotics as therapeutic agents for candidiasis vulvovaginitis. Antibiotics. 2021; 10(3):306. doi:10.3390/antibiotics10030306

6. Parolin C, Abruzzo A, Giordani B, et al. Anti-candidiasis the activity of hyaluronic acid associated with Lactobacillus crispatus Freeze-dried supernatant: a new antifungal strategy. Antibiotics. 2021;10(6):628. doi:10.3390/antibiotics10060628

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