Sex Transm Infect 81:100-102 doi:10.1136/sti.2003.007161
  • Review

Life in the littoral zone: lactobacilli losing the plot

  1. P Hay
  1. Correspondence to:
 Dr Phillip Hay
 Courtyard Clinic, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK;
  • Accepted 5 August 2004


Recurrent bacterial vaginosis is a challenge for those affected by it, and their physicians. Our inability to prevent relapse after treatment, may be because of the flawed approach of using antibiotics to treat a condition that is an imbalance rather than an infection. The maintenance of a healthy lactobacillus population offers an approach to preventing relapse: the problem is how best to do this. Physiological approaches such as the use of hydrogen peroxide, lactic acid, and exogenous lactobacilli need to be explored further. The role of bacterial vaginosis as a risk factor for acquisition of HIV and other STIs is a further impetus to attempting to prevent bacterial vaginosis from recurring.


  • Conflict of interest statement: The author has received payment for lectures and consultancy from Osmetech, which is developing a diagnostic test for bacterial vaginosis; 3M, which manufacturers 0.75% metronidazole vaginal gel; and Pharmacia and Upjohn, which manufacture 2% clindamycin vaginal cream and clindamycin capsules. He has conducted clinical trials for which his unit has received reimbursement from Osmetech; 3M; Pharmacia and Upjohn, and he has received financial support to attend conferences from these companies.