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Speaker 1: The content of this podcast is provided for general informational

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purposes only and is not intended as nor should it

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be considered, a substitute for professional medical advice. Hello, this

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is Karen Nickel, family nurse practitioner, and you are listening

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to Itchy and Bitchy, a podcast supervised answers to your

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many unanswered health questions. I recently received a message from

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a woman named Katie on the I and B podcast

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Facebook page. She says, Hi, Karen, I hope you're doing well.

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I wanted to know if you may consider doing an

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Itchy and Bitchy episode on vaginal biofilms and Katie, I'm

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going to do just that right now. Katie goes on

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to share her story at forty four. I've had recurring

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infection in both BV that's bacterial vaginosis and yeast in

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the past couple years, which is new for me. I've

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treated them individually as they've come up, but it's been frustrating.

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I had to switch OBG wayans because my last one

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moved out of state in the middle of this process.

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That adds another layer of complexity. My new doctor and

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her nurses just kind of chalk this up to normal

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at this age and are treating the infections as they

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pop up. But I'm tired of bouncing back and forth

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every one and a half to three months and want

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to address the overall cause if possible. I've gotten ads

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on my phone for companies that will send a home

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swab test I can take looking for the presence of

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a biofilm. Have you heard of this? Is it scammy

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or could a biofilm cause recurring infections? I just saw

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my GP and she's having me try a maintenance regimen

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of sub for dial cream. That's an estrogen estra dial cream,

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which I tried once, but I was in a persistent,

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aggressive yeast infection cycle at that time, which thankfully I'm

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not still dealing with. I wonder now that I'm not

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actively in an infection if the Estra dial cream could

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help to thicken my vaginal walls and make me less

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susceptible to infections. But yeah, curious if you place any

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stock in the biofilm theory. My GP had not heard

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of it. Thanks and take care, Katie. I am always

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very unhappy when I hear when a woman is being

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dismissed by providers by being told that their symptoms are

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purely part of the aging process. I've said it before.

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The medical field, at least in the US, is very

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tolerant of women's suffering, and it shouldn't be so. It's

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twenty twenty six, for goodness sake, so to begin. Vaginal

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biofilms are indeed a real thing. It's not a scam.

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I will share some study information with you, as well

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as the testing available to check for biofilms and some

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treatment options that may work for you if you are

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enduring this problem. What the heck is a vaginal biofilm?

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This problem may be one you've never heard of. As

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Katie mentioned, her GP has never heard of it either.

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It's a sad statement considering the concept of biofilm growth

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was officially described in nineteen seventy eight. Yes, nineteen seventy eight. Actually,

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the concept was initially described by a Dutch microbiologist in

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sixteen eighty three, and with the advent of sophisticated microscopic techniques,

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it was confirmed in nineteen seventy eight. A vaginal biofilm

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is a structured community bacteria primarily Gardinarella vaginellis or yeast

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or both that adheres to the vaginal walls, often causing

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recurrent infections like bacterial vaginosis BV or yeast vaginitis. This

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coating of bacteria and or yeast acts as a shield

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of sorts, making the community of microbes highly resistant to antibiotics, antifungals,

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and immune responses. Because the biofilm protects bacteria or yeast,

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standard treatments often fail, leading to high rates of relapse.

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It's like a microbial teflon lining inside the vagina. You're

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gonna love this next part. There are several stages in

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the formation of a biofilm, and it happens quickly. First,

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the bacteria or yeast cells land on the surface like

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a vaginal lining, which is warm and moist. At first,

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the they are weakly and temporarily adhered to the surface.

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Then the bacteria produce a type of slime that allows

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them to stick to the surface permanently. Oh it kiss better.

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A matrix forms around the group of bacterial cells and

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provides a physical architecture so the microbes can interact with

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each other communicate with each other. They continue to divide

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and multiply, and the community grows into a complex three

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dimensional structure, often with water channels that distribute nutrients and

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remove waste. You are hearing me correctly. Cells communicate through

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a process that enables bacteria to monitor population density and

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coordinate group behaviors. As this community grows, small or large

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clumps of bacteria break off, spreading to new locations to

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start the process elsewhere. Sounds like science fiction, doesn't it.

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This is all taking place in the vagina. I will

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give you a quick break to settle your reeling head,

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and when I come back, I will talk about testing

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and treatment. Welcome back. So is there hope in treating

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this crazy bacterial or yeast community that has decided to

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take up residents in your vagina? We know some of

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the reasons that biofilms are resistant to treatment. A biofilm

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can survive if there is slow or incomplete penetration of

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antibiotics and cells into the community matrix. Also, the cells

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change to improve their survivability. Additionally, there are cells called

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persister cells, cells that persist that are able to survive

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the concentrations of antibiotics or antifungals that would normally destroy

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the cell, so they can hang on and help redevelop

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the matrix if it has been partially destroyed per sistor cells.

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On top of that, an antibiotic can be deactivated in

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the upper layers of the biofilm using certain enzymes holy Cow.

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The current drug of choice for BV is metronitazol, either

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oral or vaginal, but there is a high recurrence rate

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when treating with this medication alone. Multiple studies show that

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using this med along with other agents such as probiotics,

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boric acid, vitamin C, and estrogen, all administered vaginally, decreases

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the recurrence rate significantly. There are some effective treatments with

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low recurrence rates that are not in the category of

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either antibiotics or antifungals. For example, compared with conventional antifungal medications,

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one of the more effective therapies for recurrent vaginal yeast

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infections is intravaginal boric acid. This therapy has been shown

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to be effective in treating recurrent BV as well. Boric

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acid seems to specifically impact the biofilm and can enhance

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the antibacterial effect of conventional antimicrobial therapy. Boric Acid vaginal

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suppositories are readily available over the counter and can be

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purchased at your regular pharmacy. Zetaria multiflora, a plant also

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known as wild marjoram, has proven to be highly effective

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in addressing recurrent BV. Zataria multiflora. Point one percent vaginal

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cream using a five gram dose intravationally for seven days

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has a ninety two point nine percent curate in a

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study that included seventy women. This product is not readily

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available in the US. Its commercial name is lukorx l

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e U c R e X. This specific herbal formulation

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is often distributed from Iran, where the plant is native.

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I found one website that sells this product Erboca dot

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com h e R Boca dot com, but I cannot

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vouch for the product or the website. Also, it is

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produced and distributed in Iran, and at the time of

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this airing, the US has initiated a war against Iran,

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so I am not sure what the availability of the

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product will be now or in the future. In a

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small study of twenty five women, the probiotic Lactobacillis crispitis

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had a high curate of ninety six percent at thirty

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days after starting treatment. The dosing in the study was

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one cap intravaginally for seven days. I found only one

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intravaginal probiotic cream that contains L. Crispitis, but I did

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not do an exhaustive search. The product I found is

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Vagi Biome Vaginal Health Suppositories. The manufacturers recommended dosing for

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recurrent vaginal infections is to use one Veggie Biome suppository

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per day for three consecutive days, followed by one suppository

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per week for two months to restore Lactobacillis flora. Using

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over the counter treatments like boric acid and or vaginal

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probiotics in conjunction with an RX med that is given

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to you life metronitisol could help you break the cycle

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of recurrent BV or yeas vaginitis. Regarding Katie's specific question

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about whether or not using vaginal estradial cream will help

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with infection prevention, this simple answer to that is yes.

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Using the estra dial or estriol vaginal cream as directed,

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usually twice weekly, will help improve the vaginal tissues and

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help create a healthier microbiome, so that treatment is definitely

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a good addition. As I mentioned earlier, it may require

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a combination of treatments to break this cycle. For instance,

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a combination of vaginal estrogen along with a vaginal probiotic

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and possibly vaginal boric acid. I know that means a

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lot of things going into the vagina, but you wouldn't

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insert them all on the same day. Is there hope

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for the future. Well, there are some treatments on the

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horizon that could be useful, but studies using these ingredients

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would need to be done before they become available. Di

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amino acids can trigger biofilm disassembly by causing the release

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of fibers that link the biofilm cells together, so hopefully

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that treatment option is something that will be available to

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women in the future. Quorum sensing inhibitors qsis have recently

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been identified as anti biofilm agents for a number of

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bacterial species. Some natural qsies include cinnamon, garlic, clove, rhisveratrol,

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and citrus flavonoids. There are some medications in this category

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of inhibitors that include azythromyacin, erreithromyacin, syprofloxosin, and moloxicam. Now,

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I'm not recommending that you crack out your spices and

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start inserting them into your vagina. Studies need to be

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done to determine effective and safe doses of these substs.

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And what form of distribution is going to be used,

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such as a cream. Self testing is available if you

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feel you're not getting answers or aren't being tested at

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all by your providers. The company evy Evvy has a

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vaginal microbiome swab that tests for over seven hundred vaginal

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bacteria and fungi. You collect the sample at home with

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a vaginal swab and send it back to the company.

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You get results in seven to ten days, along with

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a detailed report and a personalized plan. In some states,

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you can also choose to receive prescription treatment online from

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an heavy provider. The cost is one hundred and fifty

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nine dollars for a single test, or if you become

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a member, you get four tests a year for one

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hundred and twenty nine dollars each. Microgen Dx has an

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at home test called Women's Key that identifies over sixty

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thousand types of bacteria and fungi that can affect the

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urinary and reproductive systems with ninety nine point two percent accuracy,

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which is independently verified by the College of American Pathology.

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Women's Key also tests for antibacterial and anti fungal resistance.

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Having this information helps tailor treatment options to effectively combat

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drug resistant microbes. The test kit is sent to your

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home and you do the collecting of your urine and

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vaginal swab samples in the privacy of your home and

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send them back using a prepaid shipping label. Results come

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to you in twenty four hours after the sample is

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received by the lab. It is recommended that you take

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the results to your provider to review and implement treatment.

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The cost is two hundred and eighty nine dollars. I

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do want to make it clear that these tests are

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checking for bacteria and yeast. They don't actually determine if

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there is a biofilm matrix present. However, if you are

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having chronic symptoms and this test reveals bacteria and or yeast,

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it is highly likely that a biofilm has developed. Although

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our understanding of pathogenic vaginal biofilms, particularly with regards to BV,

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has advanced, additional research and development in the area of

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vaginal biofilm infections is definitely needed if we want to

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have more and better treatment options and improve treatment outcomes.

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Since the studies needed involve women and their vaginas, I

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will be interested to see if anyone invests dollars into

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this research. Katie, thank you for sharing your story and

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asking the terrific question about vaginal biofilm. I hope this

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gives you and our listeners some direction on how to

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approach recurrent vaginitis any Thanks to all of you for listening.

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Wherever you listen to this podcast, please leave a review

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Our website is itchymbitchi dot com, where there are blogs

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with some of our subjects available for you to read.

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Thank you to Forrestwinsl, my son, our producer and composer

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of our theme music and the person who does all

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the behind the scenes work to make this podcast possible.

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Thank you. Forest Forest continues to thrive at Peabody Music

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Conservatory and is finishing up yes his final semester of

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the Master's Program. If you want to listen to what

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he's creating, you can go to his website Forrestwinsl dot com.

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Remember that your health is in your hands. She retarst