How to manage Lactobacillus iners-related vaginal dysbiosis?

Lactobacillus iners is a problematic member of the Lactobacillus family. Unlike other species that protect vaginal health, L. iners is often linked to various forms of vaginal dysbiosis, including BV (bacterial vaginosis), AV (aerobic vaginitis), and CV (cytolytic vaginosis).

If your lab test shows a dominance of BV-related bacteria and the presence of L. iners, you may have a specific type of L. iners-related BV. Similarly, if AV-related bacteria dominate along with L. iners, it suggests a specific type of L. iners-related AV. If L. iners alone or with other Lactobacillus species is dominant, it could indicate L. iners-related CV.

L. iners has a small genome of 1.3 Mbp and lacks the genes for complex metabolism, requiring it to collaborate with other bacteria for survival. This often results in its coexistence with BV, AV, or CV-related bacteria.

In addition to producing lactic acid like other Lactobacillus species, L. iners secretes a cytolytic toxin called inerolysin, which lyses vaginal skin cells, potentially leading to burning and discharge.

L. iners-associated dysbiosis presents a unique challenge, as common treatments for BV, AV, or CV often fail to eliminate L. iners. Being a facultative anaerobe, it can survive in the presence of oxygen, making L. iners-related dysbiosis a form of aerobic vaginitis (AV). Our new product for AV management, AV-NIL, has shown excellent effectiveness, possibly due to the bacterium's facultative nature.

For guidance on treating L. iners-related AV, refer to this article: "I have aerobic vaginitis (AV). Which product should I start?"

L. iners can also hide in the female bladder and male partner's urinary system, complicating treatment. Drinking plenty of water and avoiding sexual activity during treatment is recommended. If your partner does not experience painful urination, L. iners may not have infected him. Drinking water or cranberry juice may help clear it. However, if he has painful urination, indicating a urinary tract infection (UTI), seeing a urologist and taking antibiotics is advised.

During treatment, using non-latex condoms for protection is suggested if intimacy is desired. After completing three packs of AV-NIL, we recommend NeuEve Silver for maintenance and taking recommended probiotics to replace L. iners. For the best effect in clearing AV, refer to this article on probiotic timing: "To clear AV, when should I take probiotics to be most beneficial?"

We recommend at least three months of maintenance to prevent L. iners from returning. If you plan to do a microbiome test, wait at least one week after your last NeuEve suppository before taking the swab sample. This article shows you how: After my BV is cleared, when should I do a vaginal microbiome lab test?

Jul 2, 2024

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