Effect of Ozonated Water on Normal Vaginal Microecology and Lactobacillus
The female vagina is a complex microecology system, typically dominated by H2O2-producing Lactobacillus species in healthy women. These bacteria decompose glycogen in vaginal epithelial cells into lactic acid, maintaining the vagina’s normal acidic environment. The dominance of Lactobacillus is crucial for vaginal health, as any disruption can lead to various vaginal infections. Conventional treatments for vaginitis primarily involve antibiotics to eliminate pathogenic microorganisms. However, Lactobacillus is sensitive to many antibiotics, including cephalosporins, penicillin, and clindamycin, which can inadvertently harm these beneficial bacteria.
Ozone, a reactive oxygen species consisting of three oxygen atoms, is produced by ultraviolet light and high-pressure diatomic oxygen. It is recognized as a potent oxidative antimicrobial agent. Ozone therapy has gained increasing attention in recent years for its effectiveness in treating infections, reperfusion injury, cancer, and dental caries. In the context of vaginitis, ozone therapy is a relatively new concept. The medical integrated ozone therapeutic apparatus generates a specific concentration of ozone, which is then mixed with filtered tap water to form ozonated water. This ozonated water, containing ozone and active molecules in a liquid state, is used for vaginal lavage to achieve sterilization.
Despite the growing use of ozonated water in the clinical treatment of vaginitis, its impact on the dominant position of Lactobacillus and the overall balance of vaginal microecology post-treatment remains unclear. This study aimed to evaluate the effects of ozonated water lavage on vaginal microecology and Lactobacillus by analyzing various indicators in vaginal secretions.
The study recruited 30 female volunteers without vaginal infections, including aerobic vaginitis (AV), bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomonas vaginitis (TV). These volunteers were recruited from the gynecological clinic of Beijing Tsinghua Changgung Hospital between April 2016 and October 2016. Inclusion criteria included non-pregnancy, non-lactation, and non-menstruation fertility women aged 18–50 years without vaginal infection, no abnormal vaginal bleeding, at least three days of asexual life before enrollment, and no systemic or vaginal antibiotics for nearly two weeks.
All volunteers received ozonated water from the Medical Integrated Oxygen Therapy Instrument (XYK-6000D type; produced by Zhuhai Xinyike Medical Technology Co., Ltd., Zhuhai, China) for vaginal lavage. The lavage was performed for 5 minutes per day during non-menstrual periods for three consecutive days, using an ozone concentration of 80 mg/L and 3.0 L of ozone solution per lavage. Vaginal secretions were collected using two swabs before the first vaginal ozonated water lavage and at the first, second, and third weeks after the last lavage. One swab was used to prepare a dry slide for Gram staining, which was then examined under 400-fold magnification to test for AV, BV, VVC, and TV. The other swab was used to extract the total DNA of vaginal flora, and the V1-V2 variable region of the 16S rDNA genes was sequenced using the Illumina MiSeq platform.
The study evaluated several indicators related to vaginal microecology, including AV scores, Nugent scores, microbial density, microbial diversity, dominant flora, Lactobacillary grades, hypha, leukocytes, and vaginal microbial community diversity and abundance. Microbial density and diversity were assessed on a scale of +, ++, +++, and ++++. Lactobacillary grades were categorized as I, IIa, IIb, and III, while leukocytes were assessed based on their count per high power field (HPF) and per epithelial cell.
Of the 30 volunteers, 29 completed all three follow-up visits, with one lost at the third week. The results showed no significant changes in the contents of vaginal microecology, including AV score, Nugent score, microbial density, microbial diversity, dominant flora, Lactobacillary grades, hypha, and leukocytes, at the four time points (before the first lavage and at the first, second, and third weeks after the last lavage). The absolute values of the correlation coefficients for these indicators were all less than 0.2, indicating no significant correlation.
The top three bacteria at all four time points were Lactobacillus iners, Lactobacillus crispatus, and Lactobacillus jensenii. The type and abundance of Lactobacillus showed no significant changes before and after the ozonated water lavage. This indicates that ozonated water lavage does not adversely affect the dominant position of Lactobacillus or the overall balance of vaginal microecology.
The study concluded that ozonated water lavage has no obvious side effects on intravaginal microecology and Lactobacillus. This is significant as it provides evidence that ozonated water can be used to treat vaginitis without disrupting the beneficial Lactobacillus population or the vaginal microecology. Ozonated water not only kills pathogens but also protects Lactobacillus and maintains the balance of vaginal microecology. This is particularly important in cases of severe vaginal discharge accompanied by odor, where a large number of inflammatory secretions can cause discomfort. Ozonated water can help reduce the concentration of local vaginal pathogens and aid in the recovery of the dominant vaginal bacteria.
As a relatively new treatment concept, ozone therapy has been widely used in various industries, but its application in the treatment of vaginitis still lacks extensive clinical evidence. More in vivo and in vitro studies are needed to provide a theoretical basis for the widespread use of ozonated water in the treatment of vaginitis. The findings of this study are crucial in advancing the understanding of ozone therapy’s role in maintaining vaginal health and treating infections without disrupting the beneficial microbial balance.
doi.org/10.1097/CM9.0000000000000216
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