Probiotics for vaginal health in South Africa: what is on retailers' shelves?

Abstract

Background: Probiotics are widely used to improve gastrointestinal (GI) health, but they may also be useful to prevent or treat gynaecological disorders, including bacterial vaginosis (BV) and candidiasis. BV prevalence is high in South Africa and is associated with increased HIV risk and pregnancy complications. We aimed to assess the availability of probiotics for vaginal health in retail stores (pharmacies, supermarkets and health stores) in two major cities in South Africa.

Methods: A two-stage cluster sampling strategy was used in the Durban and Cape Town metropoles. Instructions for use, microbial composition, dose, storage and manufacturers' details were recorded.

Results: A total of 104 unique probiotics were identified in Cape Town and Durban (66.4% manufactured locally). Cape Town had more products than Durban (94 versus 59 probiotics), although 47% were common between cities (49/104). Only four products were explicitly for vaginal health. The remainder were for GI health in adults (51.0%) or infants (17.3%). The predominant species seen overall included Lactobacillus acidophilus (53.5%), L. rhamnosus (37.6%), Bifidobacterium longum ssp. longum (35.6%) and B. animalis ssp. lactis (33.7%). Products for vaginal health contained only common GI probiotic species, with a combination of L. acidophilus/B. longum ssp. longum/B. bifidum, L. rhamnosus/L. reuteri or L. rhamnosus alone, despite L. crispatus, L. gasseri, and L. jensenii being the most common commensals found in the lower female reproductive tract.

Conclusion: This survey highlights the paucity of vaginal probiotics available in South Africa, where vaginal dysbiosis is common. Most vaginal products contained organisms other than female genital tract commensals.

Keywords: Lactobacillus spp.; Probiotics; Vaginal; Women.

Fig. 1

The South African probiotic market. Availability of probiotics by districts in the Cape Town (a) and Durban (b) metropoles. Cape Town consists of eight districts while Durban metropole is made up of seven districts. A colour scale was used to denote variation in the number of distinct probiotics available for each district. c Usage of probiotics. Each product was grouped into one of six categories according to their health claim; and the overall or city-specific distribution is depicted by the stacked bars. d Market share Cape Town vs. Durban. The area proportional Venn diagram represents the number of probiotics marketed exclusively in Cape Town (purple) or Durban (light blue) and those common to both cities (blue)

Fig. 2

Bacterial distribution in probiotics. a Constituting organisms. Bacterial species contained in probiotics belonged to the genera Lactobacillus with 15 species, Bifidobacterium with 8 species, Streptococcus thermophilus, Enterococcus mundtii and Propionibacterium shermanii. The yeast Saccharomyces was represented with two species. b Health claims and association with bacterial composition. Each product was grouped into one health category as described above and bacterial strains were listed. For the complete figure see Additional file 1: Figure S1.1 and Additional file 2: Figure S1.2