Urogenital infections are non-sexually transmitted infections, including urinary tract infections (UTI) and yeast vaginitis. There is an association between abnormal vaginal flora and the risk of UTIs. Only about 50 microbial species may inhabit the vagina (compared to 800 in the gut).
The flora of premenopausal women are dominated by Lactobacillus species. Hormonal changes, pH and glycogen alter the species in the vagina. Lactobacillus iners is the most common species found in white females. Only about 25% of menopausal women still have Lactobacilli present. Estrogen therapy raises this from 60 to 100% of women. Women with recurrent UTIs have low lactobacilli counts.
Probiotics have been shown to reduce diarrhea when used with antibiotics, and may be able to prevent and treat tonsillitis, caries, renal stones and respiratory infections. Fermented dairy products include Lactobacillus and Bifidobacteria species.
Risk factors for UTIs in women include sex with multiple partners and the use of spermicides. The later increase the pH of the vagina and loss of Lactobacilli. Increased pH causes growth of pathologic gram-negative bacteria and UTIs. Risk factors for UTIs in menopausal women are prior urogenital surgery, altered bladder function and loss of estrogen.
The most common bacteria for UTI are Escherichia coli, Staphylococcus saprophyticus, and Enterococci. Postmenopausal women have high rates of asymptomatic bacteria in the urine. Of pregnant women with asymptomatic bacteria in the urine, 13 to 27% will develop acute pyelonephritis.
Yeast vaginitis can be treated topically. However yeasts are becoming resistant to these agents.
The replacement of Lactobacilli in the vagina may take weeks or months for recolonization, and may overcome some pathologic species. An oral dose of 10 billion live bacteria once or twice a week may be sufficient therapy. A daily oral intake of L. rhamnosus and L. fermentum may alter the vaginal flora. This may be good long-term therapy for pregnant women and those with recurrent UTI. Placing a daily capsule of probiotics in the vagina may restore the normal flora.
CONCLUSION: Probiotics promise to be an important option for improved urogenital health.
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