Vaginal Lactobacillosis: Symptoms & Treatment

Vaginal lactobacillosis (VL) is characterised by an overabundance of much-longer-than-normal lactobacilli-related bacterial species, Leptothrix vaginalis¹.

Lactobacilli are normally 5-15 µm long. In VL or lactobacillosis, the bacteria appear in segmented chains 40-75 µm long².

But, it’s still not clear what sort of bacteria this is. Identification has not properly been undertaken, no DNA sequence has been taken, and cultivation is difficult.

It is believed by some researchers³ that about 15 per cent of those who complain of abundant vaginal discharge have lactobacillosis.

It has been suggested⁴ that some symptoms of bacterial vaginosis may in fact be lactobacillosis caused by L. vaginalis.

Other microbial findings with L. vaginalis

In one study¹, the prevalence of L. vaginalis on pap smears was four per cent (18 samples out of 445). With L. vaginalis came:

Inflammatory changes (16 of 18)
Fungi (6 of 18)
Atypical squamous cells of undetermined significance (4 of 18)
Other cell observations
Other studies have found a connection of L. vaginalis with Trichomonas vaginalis (‘spaghetti and meatballs’)⁵

Symptoms of lactobacillosis

Profuse white discharge
Thick, creamy, possibly curdy discharge
Feeling ‘wet’ all the time (in underwear)
Possible vulvar itching
Possible burning sensation of the vaginal entrance (introitus) after urinating
Cleaning up vulvar and perianal area required regularly
Symptoms most apparent in the second half of the menstrual cycle (post-ovulation), especially right before the menstrual period begins
Symptoms are often cyclical
No unusual odour
pH is within the normal range
No other clinical findings upon vaginal and cervical examination
Possibly previously treated for yeast or other microflora imbalances unsuccessfully

How is lactobacillosis different from cytolytic vaginosis?

Cytolytic vaginosis (CV) is different because the lactobacilli in CV are regular-sized, and there are other signs such as debris from epithelial cells. CV also presents with numerous intermediate epithelial cells⁶.

Lactobacillosis and vulvodynia

Researchers⁷ have suggested that as lactobacillosis comes with increased production of lactic acid and hydrogen peroxide, it could cause or contribute to epithelial cell and nerve damage, possibly being a risk factor for vulvodynia.

Lactobacillosis and diabetes

Other researchers found a correlation between type II diabetes mellitus since women with high serum glucose have more lactobacilli.

Treatment of vaginal lactobacillosis

Medical treatments include oral amoxicillin-clavulanate or doxycycline.

500mg amoxicillin clavulanate orally every eight hours for seven days
100mg doxycycline every 12 hours for 10 days
Vaginal nifuratel
Clavulanate potassium

References

1.
Meštrović T, Profozić Z. Clinical and microbiological importance ofLeptothrix vaginalison Pap smear reports. Diagn Cytopathol. October 2015:68-69. doi:10.1002/dc.23385
2.
Horowitz BJ, Mårdh P-A, Nagy E, Rank EL. Vaginal lactobacillosis. American Journal of Obstetrics and Gynecology. March 1994:857-861. doi:10.1016/s0002-9378(94)70298-5
3.
Ventolini. Vaginal Lactobacillosis. J Clin Gynecol Obstet. 2014. doi:10.14740/jcgo278e
4.
Fitzhugh VA, Heller DS. Significance of a Diagnosis of Microorganisms on Pap Smear. Journal of Lower Genital Tract Disease. January 2008:40-51. doi:10.1097/lgt.0b013e31813e07ff
5.
von M. [Leptothrix vaginalis. Morphological studies]. Fortschr Med. 1976;94(16):295-298. https://www.ncbi.nlm.nih.gov/pubmed/1261954.
6.
Korenek P, Britt R, Hawkins C. Differentiation of the vaginoses-bacterial vaginosis, lactobacillosis, and cytolytic vaginosis. ispub.com. https://print.ispub.com/api/0/ispub-article/12743.
7.
Ricci P, Troncoso JL. Lactobacillosis and Chronic Vulvar Pain: Looking for High-Risk Factors as Precursors in Women Who Developed Vulvodynia. Journal of Minimally Invasive Gynecology. November 2013:S163-S164. doi:10.1016/j.jmig.2013.08.550