I've been prone to UTIs since menopause (now in early 70s). My gyn years ago recommended a probiotic "in case" it might help stave them off. I randomly chose one on sale at Costco, and in the last decade, I have had about 2/year, less than before the probiotic. I realize there may be no connection whatever, but I thought, what the heck, keep using one a day because it won't hurt. Now, I'm wondering if I should keep taking the probiotic forever, or if I stop, will I be creating some (at least temporary) havoc in my vaginal microbiome?
Also, another question that actually came up on one of my mom chats, why do some of us experience horrible smelly large flatulence while breastfeeding especially early postpartum, and during a period?
"...instead of receiving the appropriate test to get an accurate diagnosis, all vaginal and vulvar mayhem is assumed to be yeast. "
I am reminded of the time (1990s) I saw a pt who'd been 'seen' elsewhere & handed a tube of Terazol. They obviously didn't examine her, as she had herpes AND chancroid...
In this study, all tested Lactobacillus and Bifidobacterium strains were susceptible toward ampicillin, gentamicin, erythromycin and tetracycline (Table 2). For most of the strains kanamycin, clindamycin, streptomycin and chloramphenicol were effective inhibitors. Only four lactobacilli could be considered resistant to one antibiotic (L. rhamnosus Lio 1 to streptomycin) or two antibiotics (L. acidophilus L-1 and L. brevis 1 to kanamycin and clindamycin, L. casei L-4 to clindamycin and chloramphenicol) with MICs higher than the breakpoints recently proposed by the FEEDAP Panel. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434095/
I used a review on the subject of antibiotic-induced vulvovaginal candidiasis written by Jack Sobel in 2019. As I am not a microbiologist, interpreting all of the lab data is not my direct expertise, although I know a lot. Here is a direct quote from Jack's paper in Current Infectious Diseases Reports:
"However, critical to this much-quoted dogma is lack of data confirming a critical reduction
of number or function of protective lactobacilli or other bacterial species following antibiotics. This is in spite of the plethora of publication using quantitative and qualitative
molecular technologies including next generation sequencing to evaluate vaginal microbiota but which lack of focus of the specific effects of antibiotics or the vaginal
microbiome. Previously all investigations of vaginal microbiota were limited to culture-based studies, entirely missing the many vaginal bacterial species potentially critical to understanding pathogenesis of VVC. It was widely assumed that antibiotic-induced VVC was the consequence of reduction of protective Lactobacillus species but studies lacked ability to
accurately perform quantitative cultures. This applies both to sporadic or recurrent VVC, whether or not related to antibiotic exposure. Non-quantitative studies performed in the past were unlikely to be of any value in determining the protective role of Lactobacillus spp."
Hi! I just read a review article of randomised controlled trials from Jan 2024 which seems to find benefits in probiotic supplements for some vaginal conditions. I am a bit confused as I am also a probiotic skeptic. The PMID of the article is 38216265. I was wondering if you had any thoughts on this? As we are getting new data, are we finding some benefits now?
I would love to know your thoughts on the new Seed vaginal probiotic. I have been struggling with BV for so long and nothing works. I have purchased it in the hopes that it can finally bring me relief but it is so expensive and I don't know if I can keep affording treatments that don't work.
I know you must be so busy, but if you are looking for post ideas I know a lot of people would be interested, I keep seeing it come up on Reddit. It would be really helpful if you did a post on the Seed probiotic, I can't tell if it's a drug, medical device or cosmetic product. Thank you so much I really appreciate your work
I didn’t understand the end of the article when you said to get tested if symptoms of a yeast infection occur after antibiotic use and then to use prevention with weekly diflucan or OTC. When to do this? Don’t you have to be treated now? Maybe I’m just not reading it correctly? Can you expound?
If you have symptoms that you think are a yeast infection, you should be a culture should you know if that is indeed what it is. This is important as 50% of people who think they have yeast do not. If the test is positive, then obviously treat it, but a future strategy could be to take fluconazole once a week while taking antibiotics to prevent a yeast infection.
The probiotics capsules or powders on the shelf are by definition (a) the bugs which are possible (and usually the ones which are easier) to grow in bulk commercially and (b) the ones which are shelf-stable. There is only a small overlap between that group of bacteria and the ones which currently appear to be best for human health.
Eat lots of fibre and polyphenols from a wide range of different vegetables and whole fruit every week - it's the best possible thing you can do for your microbiome, and general health (along with sleep and exercise). Save the money on probiotics and buy beans, lentils, cherries, prunes, flaxseed, broccoli, oranges ...
Would you be able to comment on the value of ordering specification on a vaginal yeast culture? This would be for someone who is diagnosed (by culture) with yeast. Also, when the culture identifies “sparse yeast” is it even worth treating as to further disrupt the delicate vaginal pH?
A yeast culture should identify the species without asking. It is the gold standard for testing. It is typically ordered as a "mycology culture" or a "fungal culture." The result will be Candida albicans or Candida glabrata etc. I have never seen a culture report that says yeast and doesn't identify it. A result like "sparse yeast" or "rare yeast" means there is a very small amount. If someone has symptoms that have not gone away with therapy, knowing what yeast it is would be helpful in management. Also, if that result is there despite therapy then getting sensitivity testing, meaning information about how best to treat the yeast, is usually helpful. People can have a lot of irritation with a tiny amount of yeast and some people have no no irritation with a lot, so typically, I don't get as hung up about the amount. Getting a yeast culture doesn't disturb the vaginal ecosystem in a meaningful way. Hope that helps!
I've been prone to UTIs since menopause (now in early 70s). My gyn years ago recommended a probiotic "in case" it might help stave them off. I randomly chose one on sale at Costco, and in the last decade, I have had about 2/year, less than before the probiotic. I realize there may be no connection whatever, but I thought, what the heck, keep using one a day because it won't hurt. Now, I'm wondering if I should keep taking the probiotic forever, or if I stop, will I be creating some (at least temporary) havoc in my vaginal microbiome?
Also, another question that actually came up on one of my mom chats, why do some of us experience horrible smelly large flatulence while breastfeeding especially early postpartum, and during a period?
"...instead of receiving the appropriate test to get an accurate diagnosis, all vaginal and vulvar mayhem is assumed to be yeast. "
I am reminded of the time (1990s) I saw a pt who'd been 'seen' elsewhere & handed a tube of Terazol. They obviously didn't examine her, as she had herpes AND chancroid...
In this study, all tested Lactobacillus and Bifidobacterium strains were susceptible toward ampicillin, gentamicin, erythromycin and tetracycline (Table 2). For most of the strains kanamycin, clindamycin, streptomycin and chloramphenicol were effective inhibitors. Only four lactobacilli could be considered resistant to one antibiotic (L. rhamnosus Lio 1 to streptomycin) or two antibiotics (L. acidophilus L-1 and L. brevis 1 to kanamycin and clindamycin, L. casei L-4 to clindamycin and chloramphenicol) with MICs higher than the breakpoints recently proposed by the FEEDAP Panel. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434095/
I used a review on the subject of antibiotic-induced vulvovaginal candidiasis written by Jack Sobel in 2019. As I am not a microbiologist, interpreting all of the lab data is not my direct expertise, although I know a lot. Here is a direct quote from Jack's paper in Current Infectious Diseases Reports:
"However, critical to this much-quoted dogma is lack of data confirming a critical reduction
of number or function of protective lactobacilli or other bacterial species following antibiotics. This is in spite of the plethora of publication using quantitative and qualitative
molecular technologies including next generation sequencing to evaluate vaginal microbiota but which lack of focus of the specific effects of antibiotics or the vaginal
microbiome. Previously all investigations of vaginal microbiota were limited to culture-based studies, entirely missing the many vaginal bacterial species potentially critical to understanding pathogenesis of VVC. It was widely assumed that antibiotic-induced VVC was the consequence of reduction of protective Lactobacillus species but studies lacked ability to
accurately perform quantitative cultures. This applies both to sporadic or recurrent VVC, whether or not related to antibiotic exposure. Non-quantitative studies performed in the past were unlikely to be of any value in determining the protective role of Lactobacillus spp."
Hi! I just read a review article of randomised controlled trials from Jan 2024 which seems to find benefits in probiotic supplements for some vaginal conditions. I am a bit confused as I am also a probiotic skeptic. The PMID of the article is 38216265. I was wondering if you had any thoughts on this? As we are getting new data, are we finding some benefits now?
I would love to know your thoughts on the new Seed vaginal probiotic. I have been struggling with BV for so long and nothing works. I have purchased it in the hopes that it can finally bring me relief but it is so expensive and I don't know if I can keep affording treatments that don't work.
I know you must be so busy, but if you are looking for post ideas I know a lot of people would be interested, I keep seeing it come up on Reddit. It would be really helpful if you did a post on the Seed probiotic, I can't tell if it's a drug, medical device or cosmetic product. Thank you so much I really appreciate your work
Hi Dr Gunter,
What are your thoughts on Clairvee?
I didn’t understand the end of the article when you said to get tested if symptoms of a yeast infection occur after antibiotic use and then to use prevention with weekly diflucan or OTC. When to do this? Don’t you have to be treated now? Maybe I’m just not reading it correctly? Can you expound?
If you have symptoms that you think are a yeast infection, you should be a culture should you know if that is indeed what it is. This is important as 50% of people who think they have yeast do not. If the test is positive, then obviously treat it, but a future strategy could be to take fluconazole once a week while taking antibiotics to prevent a yeast infection.
I know we're all about the vjjs here but wondering if you have any thoughts about probiotics after antibiotics (or just in general) for gut health?
I wrote about that here https://vajenda.substack.com/p/can-probiotics-prevent-osteoporosis
It seems that probiotics actually delay the return of normal gut flora...
The probiotics capsules or powders on the shelf are by definition (a) the bugs which are possible (and usually the ones which are easier) to grow in bulk commercially and (b) the ones which are shelf-stable. There is only a small overlap between that group of bacteria and the ones which currently appear to be best for human health.
Eat lots of fibre and polyphenols from a wide range of different vegetables and whole fruit every week - it's the best possible thing you can do for your microbiome, and general health (along with sleep and exercise). Save the money on probiotics and buy beans, lentils, cherries, prunes, flaxseed, broccoli, oranges ...
agree 100%
There is also no vidence that probiotics after antibiotics regenerate gut micro biome better than our own bodies…
Hello from Cape Cod!
Would you be able to comment on the value of ordering specification on a vaginal yeast culture? This would be for someone who is diagnosed (by culture) with yeast. Also, when the culture identifies “sparse yeast” is it even worth treating as to further disrupt the delicate vaginal pH?
Thank-you!
Jenny
A yeast culture should identify the species without asking. It is the gold standard for testing. It is typically ordered as a "mycology culture" or a "fungal culture." The result will be Candida albicans or Candida glabrata etc. I have never seen a culture report that says yeast and doesn't identify it. A result like "sparse yeast" or "rare yeast" means there is a very small amount. If someone has symptoms that have not gone away with therapy, knowing what yeast it is would be helpful in management. Also, if that result is there despite therapy then getting sensitivity testing, meaning information about how best to treat the yeast, is usually helpful. People can have a lot of irritation with a tiny amount of yeast and some people have no no irritation with a lot, so typically, I don't get as hung up about the amount. Getting a yeast culture doesn't disturb the vaginal ecosystem in a meaningful way. Hope that helps!