
US doctors are hoping to start offering women vaginal fluid transplants - Tomte
https://www.bbc.com/news/health-49646907
======
tcj_phx
Some years ago I did some searching on scholar.google.com about bacterial
vaginosis.

While douching is generally discouraged as non-helpful at best or counter-
productive at worst, I remember reading a study that found washing the vagina
with iodine mostly eliminates all bacteria - desirable and undesirable - but
that the beneficial lacto-bacteria are the first to repopulate the cavity.

Quotes and links to two studies about this approach are below.

I recall that when I was looking into the matter, I noticed that Walmart's
store brand of iodine wash has that chemical in spermicide that some women are
sensitive to. The adjacent bottle of brand-name iodine (Betadine?) doesn't
have that chemical. Searching now, it must've been Nonoxynol-9 -
[https://en.wikipedia.org/wiki/Nonoxynol-9](https://en.wikipedia.org/wiki/Nonoxynol-9)
/ [https://en.wikipedia.org/wiki/Povidone-
iodine](https://en.wikipedia.org/wiki/Povidone-iodine)

I'll look at my pictures... (EDIT: maybe it's been reformulated: "Active
Ingredient: Povidone-iodine, 10%; Inactive ingredients: C12-13, PARETH-9,
citric acid, disodium phosphate, glycerin, sodium hydroxide, water" \-
[https://www.walmart.com/ip/Equate-First-Aid-
Antiseptic-8-fl-...](https://www.walmart.com/ip/Equate-First-Aid-
Antiseptic-8-fl-oz/236247392)

This one has Nonoxynol-9: [https://www.walmart.com/ip/Betadine-skin-
cleanser/46068801](https://www.walmart.com/ip/Betadine-skin-cleanser/46068801)

Betadine without Nonoxynol-9: Active Ingredients: Povidone-Iodine (10%) (1%
Available Iodine). Purpose: First Aid Antiseptic. Inactive Ingredients: Pareth
25-8, Purified Water, Sodium Hydroxide. -
[https://www.walmart.com/ip/Betadine-Solution-8-fl-
oz/1732500...](https://www.walmart.com/ip/Betadine-Solution-8-fl-oz/17325005)
/EDIT)

tl/dr: use iodine to wipe out all bacteria, so the lactic-acid producing
bacteria can repopulate the area.

Two studies that seem to support using iodine washes to take out all the
bacteria:

" [...] Contrary to that the lactobacilli counts from patients treated with
povidone iodine suppositories decreased after the first week but increased in
the second one. Potentially pathogenic germs, e.g. Gardnerella, Bacteroides
and Enterobacteria were reduced in a higher extent and with a longer lasting
effect after treatment with povidone iodine suppositories than with capsules
containing lactobacilli. The results of this study show that native
lactobacilli rapidly re-colonize after the antiseptic treatment with povidone
iodine. Therefore, there is no need to use lactobacilli in addition." \-
_Efficacy of Povidone-Iodine Vaginal Suppositories in the Treatment of
Bacterial Vaginosis_ \-
[https://www.karger.com/Article/Abstract/57731](https://www.karger.com/Article/Abstract/57731)

"Repeated vaginal washings with 3% H2O2, 15% NaCl and 10% providone iodine
were initiated. At the end of each washing, vaginal walls were thoroughly
cleaned up with a small gauze. After 10 days of treatment the odor and the
vaginal discharge had ceased and 12 months later no relapse had occurred" \-
_Recurrent Bacterial Vaginosis in a Virgin Adolescent: A New Method of
Treatment_ \-
[https://link.springer.com/article/10.1007/s15010-002-2001-9](https://link.springer.com/article/10.1007/s15010-002-2001-9)

~~~
daed
Was this something you actually did and had success with? If so, did you have
chronic BV or just acute BV?

Things we’ve tried: \- boric acid suppositories (this helps but the BV always
comes back) \- hydrogen peroxide douche (no results) \- a couple essential oil
mixtures (no results) \- antibiotics (BV comes back)

Through research it seems the problem may be biofilms. You kill all the
bacteria except those hiding in the biofilms and so they just repopulate.

A cursory google shows iodine may bust biofilms, so this May be worth a try.

~~~
kaitai
There are some probiotic blends that focus on lactobacillus that some have
found helpful. These can be used externally or internally. See papers like
[https://www.sciencedirect.com/science/article/pii/S1198743X1...](https://www.sciencedirect.com/science/article/pii/S1198743X14606017)
and
[https://www.ncbi.nlm.nih.gov/pubmed/24299970](https://www.ncbi.nlm.nih.gov/pubmed/24299970)
for instance. If interested in this, check out the particular types of
lactobacillus mentioned in these articles and make sure the product you're
purchasing has those, rather than a general lacto blend. It appears that
antibiotics should be a short course and probiotics a long course: killing is
fast, growing is slower.

The science isn't conclusive but there are ~ zero negative side effects, so
it's a good expected value.

~~~
daed
Yeah I’d neglected to mention that we’d tried some of that as well... but the
only available probiotics matching the “correct” lactobacilli strains were in
Europe... so we tried a few weeks of them but between their cost and not being
certain they’d even survive the long journey to California we didn’t get many
doses and as mentioned weren’t confident they’d be active on arrival.

------
dang
All: comments are welcome as always, but please check that you're not posting
because you find the topic activating. That always makes threads less
interesting. Ditto for flagging; some users flagged this, but it's obviously a
legit topic for HN, so we turned the flags off. Intellectual curiosity is the
spirit:
[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html).

Edit: I switched to what looks like a better article instead of
[https://arstechnica.com/science/2019/09/transplanting-
poop-c...](https://arstechnica.com/science/2019/09/transplanting-poop-c...).
Hopefully the BBC is a little more sobering.

~~~
joering2
Thanks for always looking up for HN site to keep its sanity. Could you
reactivate my voting right please?

------
gervase
If you want to go direct to the publication:

"Conceptual Design of a Universal Donor Screening Approach for Vaginal
Microbiota Transplant",

[https://www.frontiersin.org/articles/10.3389/fcimb.2019.0030...](https://www.frontiersin.org/articles/10.3389/fcimb.2019.00306/full)

------
gizmo686
I have nothing to add on this procedure, but fecal transplant turned out to be
remarkably successful, so it makes sense that researchers would want to try
again here.

According to Wikipedia, fecal transplant was used as far back as 4th century
China, with the modern treatment dating back to 1958. A 2013 study on the
procedure was stopped early due to the high effectivness (81% cured after 1
procedure, 90% cured after 2).

[https://en.wikipedia.org/wiki/Fecal_bacteriotherapy#History](https://en.wikipedia.org/wiki/Fecal_bacteriotherapy#History)

[https://www.hopkinsmedicine.org/gastroenterology_hepatology/...](https://www.hopkinsmedicine.org/gastroenterology_hepatology/clinical_services/advanced_endoscopy/fecal_transplantation.html)

------
jelliclesfarm
Alkaline vaginas are more susceptible to BV. As are multiple partners.
Sometimes even menstruation.

A healthy vagina is mildly acidic and lactic acid suppositories were often
used but it’s benefits were iffy. If you went back to sex without condoms or
multiple partners(male or female) BV will return. It flares in the absence of
sufficient acidity in the vaginal environment..as it were..

BV is caused by a cocktail of bacteria and we have masses of bacterial
colonies..good and bad..in our bodies.

The imbalance occurs due to moving them around. Abstaining from sex will often
rebalance or getting rid of all bacteria and repopulating with good bacteria
will work.

Many times, prevention is better than cure. This isn’t a STD or a terminal
condition. BV just needs education and good sexual hygiene. I remain
unimpressed by science’s efforts to moderate female sexual organs.

~~~
kaitai
Your first paragraph is not quite accurate. The high iron levels that occur
during menstruation tend to retard growth of some of the problematic flora
(although this is more true of yeast infections).

~~~
jelliclesfarm
Sperm and blood can make BV worse as they are alkaline in the vagina’s
environment.

That iron retards problematic flora needs some citation.

Bacteria will likely flourish more in an iron rich environment. But BV is
different kinds of bacteria. At the end of the day, it’s a ratio. If the
lactic acid strains become fewer than the pH changes to more alkaline. Sperm
and blood increase the alkaline levels by diluting the acid environment of the
vagina.

------
scarejunba
I suppose the whole thing makes sense if you see humans as just a composite
organism with colonies of functionality. I wonder if we'll get mouth bacteria
transplants for tooth health next!

~~~
watersb
"Ear, Nose, Throat" is a clinical medicine specialty in the US. Don't know
about the rest of the world.

But yeah: every interface between inside and outside of the human body is a
great place to look for microbiome etiology.

~~~
overkalix
Of course it is a specialty. In romance languages (at least Catalan, Spanish,
French and Portuguese) we call them otorhinolaringologists - otorrino/otorhino
for short. I have to say, the ENT doctor thing has always seemed very silly to
me.

~~~
maxerickson
English too:

[https://en.wikipedia.org/wiki/Otorhinolaryngology](https://en.wikipedia.org/wiki/Otorhinolaryngology)

------
abtinf
It seems like we are constantly learning more about human microbiomes, but
it’s an area I found highly unintuitive. “Poop pill” transplants, food with
special bacteria to help digestion, now this. Are there any frontiers still
left in this area, like armpits, feet, ears, or other internal systems?

~~~
watersb
Of course there are frontiers. It's a paradigm shift for mainstream science
and [Western?] medical practice: we are not feeding a single organism, not
applying drugs to a single creature. The human body is an ecological niche for
an array of critters we know we little about.

------
trhway
the recently discussed C-section vs. natural birth wrt. priming of the
neonatal gut microbiome comes to mind. One can wonder whether the BV results
in adverse consequences here.

~~~
kaitai
Before you get to neonatal biomes, you have the problem that BV can result in
premature birth.... which has its own side effects.

------
adrr
I wonder if microbiome transplantation ends up like sperm donation. You can
pick your donor for the transplant and there will be a financial incentive for
healthy people to donate.

~~~
newnewpdro
Is there really a financial incentive for _healthy_ people to donate? Where
are these sperm banks paying top dollar for better sperm?

Based on what I've read in the news about artificial insemination outcomes
using sperm sourced from banks, there's just enough financial incentive for
_poor_ people to donate, and they lie in the poorly vetted paperwork about
their health, education, background, etc.

------
basicplus2
I wonder if like intestinal bacteria, vaginal bacteria is in a large part
controlled by what is eaten?

------
sabujp
are frequent uti's sign of bv?

~~~
sjg007
possibly.

------
wjnc
The articles tone is like the Register but on vaginas. It's hardly serious and
full of innuendo. For serious discussion, link to the scientific article?

~~~
bloopernova
"In the afterglow of successful fecal transplants, researchers are now
sniffing around vaginal fluids for the next possible bodily product to improve
health—and they’re roused by the possibilities."

Were the article authors attempting to be funny, or were they seriously going
for the worst-sounding opening paragraph to an article on fecal and vaginal
microbiota transplants?

~~~
dang
It's dumb, but please don't make this thread dumber by turning that into the
topic.

~~~
shantly
I don't think it's commenters' fault if the article's... you know, like this,
and they comment on how it's like this. Topic's fine but if commenting on the
article's not OK then it should be different article.

~~~
dang
There are two problems: annoying articles, and comments that rush to complain
about the annoyance. Both are at fault.

