Sexual health delivery in general practice.

Lactobacillus and thrush prevention A randomised controlled trial1 has dashed the hope that eating, or putting preparations of lactobacillus into the vagina, prevents thrush. The aim of the study published in the British Medical Journal was to test whether oral or vaginal lactobacillus could prevent postantibiotic vulvovaginitis. The study recruited women aged 18–50 years with nongynaecological infections who started shortterm treatment with oral antibiotics within 48 h of enrollment. Fifty general practices and 16 pharmacies collaborated. Women were excluded if they had vaginal symptoms, had used vaginal antifungal agents within the past fortnight or other antibiotics within the past month, were pregnant or immunocompromised. The trial used a 2 x 2 factorial design to test: (a) an oral powder, Lactobac® (containing Lactobacillus rhamnosus and Bifidobacterium longum) against placebo (maltodextrin powder) and (b) a vaginal pessary, Femilac® (containing L. rhamnosus, L. delbrueckii, L. acidophilus and Streptococcus thermophilus) against placebo (maltodextrin). Active treatments and placebos were identical in appearance. The trial used self-collection of vaginal specimens by patients (which is a convenient and validated method for the diagnosis of vaginal thrush) at 14 days. The analysis was on the basis of intention to treat. The results showed no protection for either the vaginal or oral administration of lactobacillus. The authors point out that it seems unlikely that oral administration of lactobacillus could be helpful in the short term. The lactobacillus would have to survive gastric acid and competition from other gut bacteria and, in this case, the antibiotic taken as well. Also, lactobacilli exhibit host specificity and colonisation potential, so that not all lactobacilli can colonise the gut or the vagina. Lactobacillus pessaries are also affected by antibiotics. So the advice has to be that patients susceptible to thrush after taking antibiotics should use conventional antifungal medication, not yogurt or other probiotics containing lactobacilli.