TITLE:
A Multi-Target Symbiotic Formulation Reduces Recurrence in Recurrent Bacterial Vaginosis and Vulvovaginal Candidiasis: A Pilot Clinical Study
AUTHORS:
Filippo Murina, Cecilia Fochesato, Dario Recalcati
KEYWORDS:
Recurrent Vaginitis, Bacterial Vaginosis, Vulvovaginal Candidiasis, Symbiotic, Probiotics, Vaginal Microbiome
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.16 No.4,
March
31,
2026
ABSTRACT: Background: Recurrent bacterial vaginosis (BV) and recurrent vulvovaginal candidiasis (RVVC) are highly prevalent conditions associated with substantial recurrence rates despite appropriate antimicrobial therapy. Dysbiosis of the vaginal microbiota is central to both disorders. Symbiotic formulations combining probiotics and prebiotics may enhance microbial restoration and reduce relapse. Objective: To evaluate recurrence rates, tolerability, and microbiome modifications in women with recurrent BV or RVVC treated with a novel oral symbiotic-based food supplement as adjunctive and prophylactic therapy. Methods: This was an interventional, uncontrolled pilot clinical trial enrolling reproductive-age women with recurrent BV or RVVC. After standard induction therapy (fluconazole or metronidazole), participants received a symbiotic supplement containing Bifidobacterium breve BR03, Lactobacillus rhamnosus LR04, N-acetylcysteine (NAC), fructooligosaccharides (FOS), pomegranate extract, zinc gluconate, and myrrh extract. The protocol included induction (10 days), prophylactic phase I (30 days), prophylactic phase II (60 days), and a 2-month follow-up. The primary outcome was recurrence rate. Secondary outcomes included Patients’ Global Impression of Change (PGIC). Results: Twenty women were enrolled (11 with recurrent VVC and 9 with recurrent BV; mean age 37.7 years ± 11.0 years). During prophylaxis and follow-up, recurrence occurred in 6 patients (25%). Overall, 70% were classified as responders, 20% as partial responders, and 10% as non-responders. According to the PGIC scale, 70% of participants reported being “much improved” or “very much improved”, and 65% expressed willingness to continue the supplement. The formulation was well tolerated; mild gastrointestinal discomfort occurred in 20% of patients and resolved spontaneously. Conclusion: The tested symbiotic formulation showed potential in reducing recurrence of BV and RVVC and was well tolerated. Larger randomized controlled trials are warranted.