Speaker 1: The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered, a substitute for professional medical advice. Hello, this
is Karen Nickel, family nurse practitioner, and you are listening
to Itchy and Bitchy, a podcast supervised answers to your
many unanswered health questions. I recently received a message from
a woman named Katie on the I and B podcast
Facebook page. She says, Hi, Karen, I hope you're doing well.
I wanted to know if you may consider doing an
Itchy and Bitchy episode on vaginal biofilms and Katie, I'm
going to do just that right now. Katie goes on
to share her story at forty four. I've had recurring
infection in both BV that's bacterial vaginosis and yeast in
the past couple years, which is new for me. I've
treated them individually as they've come up, but it's been frustrating.
I had to switch OBG wayans because my last one
moved out of state in the middle of this process.
That adds another layer of complexity. My new doctor and
her nurses just kind of chalk this up to normal
at this age and are treating the infections as they
pop up. But I'm tired of bouncing back and forth
every one and a half to three months and want
to address the overall cause if possible. I've gotten ads
on my phone for companies that will send a home
swab test I can take looking for the presence of
a biofilm. Have you heard of this? Is it scammy
or could a biofilm cause recurring infections? I just saw
my GP and she's having me try a maintenance regimen
of sub for dial cream. That's an estrogen estra dial cream,
which I tried once, but I was in a persistent,
aggressive yeast infection cycle at that time, which thankfully I'm
not still dealing with. I wonder now that I'm not
actively in an infection if the Estra dial cream could
help to thicken my vaginal walls and make me less
susceptible to infections. But yeah, curious if you place any
stock in the biofilm theory. My GP had not heard
of it. Thanks and take care, Katie. I am always
very unhappy when I hear when a woman is being
dismissed by providers by being told that their symptoms are
purely part of the aging process. I've said it before.
The medical field, at least in the US, is very
tolerant of women's suffering, and it shouldn't be so. It's
twenty twenty six, for goodness sake, so to begin. Vaginal
biofilms are indeed a real thing. It's not a scam.
I will share some study information with you, as well
as the testing available to check for biofilms and some
treatment options that may work for you if you are
enduring this problem. What the heck is a vaginal biofilm?
This problem may be one you've never heard of. As
Katie mentioned, her GP has never heard of it either.
It's a sad statement considering the concept of biofilm growth
was officially described in nineteen seventy eight. Yes, nineteen seventy eight. Actually,
the concept was initially described by a Dutch microbiologist in
sixteen eighty three, and with the advent of sophisticated microscopic techniques,
it was confirmed in nineteen seventy eight. A vaginal biofilm
is a structured community bacteria primarily Gardinarella vaginellis or yeast
or both that adheres to the vaginal walls, often causing
recurrent infections like bacterial vaginosis BV or yeast vaginitis. This
coating of bacteria and or yeast acts as a shield
of sorts, making the community of microbes highly resistant to antibiotics, antifungals,
and immune responses. Because the biofilm protects bacteria or yeast,
standard treatments often fail, leading to high rates of relapse.
It's like a microbial teflon lining inside the vagina. You're
gonna love this next part. There are several stages in
the formation of a biofilm, and it happens quickly. First,
the bacteria or yeast cells land on the surface like
a vaginal lining, which is warm and moist. At first,
the they are weakly and temporarily adhered to the surface.
Then the bacteria produce a type of slime that allows
them to stick to the surface permanently. Oh it kiss better.
A matrix forms around the group of bacterial cells and
provides a physical architecture so the microbes can interact with
each other communicate with each other. They continue to divide
and multiply, and the community grows into a complex three
dimensional structure, often with water channels that distribute nutrients and
remove waste. You are hearing me correctly. Cells communicate through
a process that enables bacteria to monitor population density and
coordinate group behaviors. As this community grows, small or large
clumps of bacteria break off, spreading to new locations to
start the process elsewhere. Sounds like science fiction, doesn't it.
This is all taking place in the vagina. I will
give you a quick break to settle your reeling head,
and when I come back, I will talk about testing
and treatment. Welcome back. So is there hope in treating
this crazy bacterial or yeast community that has decided to
take up residents in your vagina? We know some of
the reasons that biofilms are resistant to treatment. A biofilm
can survive if there is slow or incomplete penetration of
antibiotics and cells into the community matrix. Also, the cells
change to improve their survivability. Additionally, there are cells called
persister cells, cells that persist that are able to survive
the concentrations of antibiotics or antifungals that would normally destroy
the cell, so they can hang on and help redevelop
the matrix if it has been partially destroyed per sistor cells.
On top of that, an antibiotic can be deactivated in
the upper layers of the biofilm using certain enzymes holy Cow.
The current drug of choice for BV is metronitazol, either
oral or vaginal, but there is a high recurrence rate
when treating with this medication alone. Multiple studies show that
using this med along with other agents such as probiotics,
boric acid, vitamin C, and estrogen, all administered vaginally, decreases
the recurrence rate significantly. There are some effective treatments with
low recurrence rates that are not in the category of
either antibiotics or antifungals. For example, compared with conventional antifungal medications,
one of the more effective therapies for recurrent vaginal yeast
infections is intravaginal boric acid. This therapy has been shown
to be effective in treating recurrent BV as well. Boric
acid seems to specifically impact the biofilm and can enhance
the antibacterial effect of conventional antimicrobial therapy. Boric Acid vaginal
suppositories are readily available over the counter and can be
purchased at your regular pharmacy. Zetaria multiflora, a plant also
known as wild marjoram, has proven to be highly effective
in addressing recurrent BV. Zataria multiflora. Point one percent vaginal
cream using a five gram dose intravationally for seven days
has a ninety two point nine percent curate in a
study that included seventy women. This product is not readily
available in the US. Its commercial name is lukorx l
e U c R e X. This specific herbal formulation
is often distributed from Iran, where the plant is native.
I found one website that sells this product Erboca dot
com h e R Boca dot com, but I cannot
vouch for the product or the website. Also, it is
produced and distributed in Iran, and at the time of
this airing, the US has initiated a war against Iran,
so I am not sure what the availability of the
product will be now or in the future. In a
small study of twenty five women, the probiotic Lactobacillis crispitis
had a high curate of ninety six percent at thirty
days after starting treatment. The dosing in the study was
one cap intravaginally for seven days. I found only one
intravaginal probiotic cream that contains L. Crispitis, but I did
not do an exhaustive search. The product I found is
Vagi Biome Vaginal Health Suppositories. The manufacturers recommended dosing for
recurrent vaginal infections is to use one Veggie Biome suppository
per day for three consecutive days, followed by one suppository
per week for two months to restore Lactobacillis flora. Using
over the counter treatments like boric acid and or vaginal
probiotics in conjunction with an RX med that is given
to you life metronitisol could help you break the cycle
of recurrent BV or yeas vaginitis. Regarding Katie's specific question
about whether or not using vaginal estradial cream will help
with infection prevention, this simple answer to that is yes.
Using the estra dial or estriol vaginal cream as directed,
usually twice weekly, will help improve the vaginal tissues and
help create a healthier microbiome, so that treatment is definitely
a good addition. As I mentioned earlier, it may require
a combination of treatments to break this cycle. For instance,
a combination of vaginal estrogen along with a vaginal probiotic
and possibly vaginal boric acid. I know that means a
lot of things going into the vagina, but you wouldn't
insert them all on the same day. Is there hope
for the future. Well, there are some treatments on the
horizon that could be useful, but studies using these ingredients
would need to be done before they become available. Di
amino acids can trigger biofilm disassembly by causing the release
of fibers that link the biofilm cells together, so hopefully
that treatment option is something that will be available to
women in the future. Quorum sensing inhibitors qsis have recently
been identified as anti biofilm agents for a number of
bacterial species. Some natural qsies include cinnamon, garlic, clove, rhisveratrol,
and citrus flavonoids. There are some medications in this category
of inhibitors that include azythromyacin, erreithromyacin, syprofloxosin, and moloxicam. Now,
I'm not recommending that you crack out your spices and
start inserting them into your vagina. Studies need to be
done to determine effective and safe doses of these substs.
And what form of distribution is going to be used,
such as a cream. Self testing is available if you
feel you're not getting answers or aren't being tested at
all by your providers. The company evy Evvy has a
vaginal microbiome swab that tests for over seven hundred vaginal
bacteria and fungi. You collect the sample at home with
a vaginal swab and send it back to the company.
You get results in seven to ten days, along with
a detailed report and a personalized plan. In some states,
you can also choose to receive prescription treatment online from
an heavy provider. The cost is one hundred and fifty
nine dollars for a single test, or if you become
a member, you get four tests a year for one
hundred and twenty nine dollars each. Microgen Dx has an
at home test called Women's Key that identifies over sixty
thousand types of bacteria and fungi that can affect the
urinary and reproductive systems with ninety nine point two percent accuracy,
which is independently verified by the College of American Pathology.
Women's Key also tests for antibacterial and anti fungal resistance.
Having this information helps tailor treatment options to effectively combat
drug resistant microbes. The test kit is sent to your
home and you do the collecting of your urine and
vaginal swab samples in the privacy of your home and
send them back using a prepaid shipping label. Results come
to you in twenty four hours after the sample is
received by the lab. It is recommended that you take
the results to your provider to review and implement treatment.
The cost is two hundred and eighty nine dollars. I
do want to make it clear that these tests are
checking for bacteria and yeast. They don't actually determine if
there is a biofilm matrix present. However, if you are
having chronic symptoms and this test reveals bacteria and or yeast,
it is highly likely that a biofilm has developed. Although
our understanding of pathogenic vaginal biofilms, particularly with regards to BV,
has advanced, additional research and development in the area of
vaginal biofilm infections is definitely needed if we want to
have more and better treatment options and improve treatment outcomes.
Since the studies needed involve women and their vaginas, I
will be interested to see if anyone invests dollars into
this research. Katie, thank you for sharing your story and
asking the terrific question about vaginal biofilm. I hope this
gives you and our listeners some direction on how to
approach recurrent vaginitis any Thanks to all of you for listening.
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Thank you to Forrestwinsl, my son, our producer and composer
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the behind the scenes work to make this podcast possible.
Thank you. Forest Forest continues to thrive at Peabody Music
Conservatory and is finishing up yes his final semester of
the Master's Program. If you want to listen to what
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Remember that your health is in your hands. She retarst