US doctors are hoping to start offering women vaginal fluid transplants | Hacker News Reader

US doctors are hoping to start offering women vaginal fluid transplants

bbc.com

107 pointsTomte57 comments

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/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-...

This one has Nonoxynol-9: 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... /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

"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

good researching. thanks for sharing . it's cool that the good ones are the first to establish in the fresh neighborhood. i think this should be common knowledge, and i think you've just helped that become a reality.

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.

I’d gotten my partner’s microbes... After some searching I decided it was the male equivalent of BV. I’ve used various kinds of iodine on myself successfully, but I don’t have a vagina to experiment on. I’d like to experiment on my current partner, but she’s not interested in the experiment, and her condition is very minor in comparison to the partner who motivated my searches.

Another factor to look at is the person’s body temperature. People who are a few degrees below normal supposedly have different intestinal bacteria than people who have a normal body temperature.

There are unique carbohydrates in medicinal mushrooms (uhm... “polysaccharides, glycoproteins and proteoglycans“) and cranberries (D-Mannose) that might be useful to you too...

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... and 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.

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.

I grow medicinal herbs. I have found that with Ayurveda there are herbal washes that help with restoring vaginal pH towards slight acidity.

I don’t grow them as I am not in the right zone, but I have read that there are many herbs that does this function. Plus..Ayurveda takes a whole systems approach and includes dietary changes and lifestyle tips. Most of it was targeted towards menopausal and perimenopausal women who go through the changes and will affect whole body pH. The kind of herbs depends on the individual’s constitution.

I am pretty sure TCM has similar protocols for women’s health but the names were not familiar to me and I didn’t feel confident enough to enquire in a language that I wasn’t fluent in..

Unfortunately Ayurveda and TCM has little to scientific backing, at least as far as I know.

Define ‘scientific backing’. Please.

I'm assuming they're using backing and validation interchangeably.

The type of research that goes into normal medical treatments before they become approved treatments. Studies that show safety and efficacy.

Do you know where in the timeline of human history did ‘science’ appear?

Is boric acid protocol for BV transplanted vaginal microbiome be considered ‘science’?

(Nice. The downvoting begins. And I haven’t even started. What’s the point? You guys please continue to enjoy talking amongst yourselves about scientific ways to deal with vaginal pH.)

Around the time of the enlightenment I'd say.

Please note that I'm not saying that Ayurveda or TMC doesn't contain things that work. I'm just saying that a lot of those things haven't seen any proper testing done, so we don't know whether they work better than a placebo, or even whether they are safe, and of the things we did test, few worked particularly well.

Boric acid for example has been studied and found to work okay: https://www.ncbi.nlm.nih.gov/pubmed/21774671

I'm a bit late to this thread but have you looked into RepHresh Gel?[1] It's a vaginal suppository that supposedly encourages lactobacillus growth. It's approved in the EU for the treatment of BV[2] but sold in the US for "odor elimination." It's definitely a bit pricey - $16 for about a week's worth on Amazon and from what I understand the EU guidelines suggest using it somewhat long-term to treat BV (something like 12 IIRC) so it's far from a quick fix.

[1] http://www.rephresh.com/RepHresh-Products/RepHresh-Vaginal-G...

[2] https://www.onmedica.com/NewsArticle.aspx?id=f7138438-b72c-4...

Yeah we’ve tried that and unfortunately it didn’t work... but we definitely didn’t do 12 weeks of it. Thank you for that info!

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.

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

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

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...

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://www.hopkinsmedicine.org/gastroenterology_hepatology/...

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.

For those not reading the article:

BV = bacterial vaginosis

And now I am thankful I don’t have a vagina to maintain. I hope this isn’t a black and white issue for women; I.e. if you have a lot of sex without condoms you will get BV eventually (even with only one partner).

Well..BV comes from a mixture of different flora. If you have sex with someone, you are certainly co mingling their bacteria with your own. All healthy girls from the onset of puberty ..due to estrogen..have vaginal discharge(about 1/2-1 tsp of discharge/day) and the vaginal environment is slightly acidic due to lactic acid.

The discharge makes our vagina a self cleaning tube. It is a flexible elastic tube. The walls are made of mucous membrane. Only part of it is visible genitalia. If we don’t have discharge, we can’t flush out harmful bacteria and other ickies. The discharge is also a lubricant.

Every time there is intercourse and co mingling of body fluids, there is a chance of BV. It’s not a sexually transmitted disease but more partners = more chance for BV. Or disruption of vaginal Ph. It is less likely to have BV if you have never had sex or you are abstaining. Altho’ it is possible. (Diff topic)

You can pick up BV even with condoms. Anything that alters the vaginal Ph has an effect on chances of BV flares.

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).

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.

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!

Actually, parents pass the germ that causes cavities to their babies.

http://www.nbcnews.com/id/35989527/ns/health-oral_health/t/m...

"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.

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.

English too:

https://en.wikipedia.org/wiki/Otorhinolaryngology

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?

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.

Check out probiotic deoderants! I think "mother dirt" probiotic skin spray is the first one I learned of.

Oral microbiomes and susceptibility to cavities and periodontal disease is another big topic.

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.

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

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.

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.

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

are frequent uti's sign of bv?

possibly.

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?

"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?

Reminds me of Gweneth Paltrow's egg thing

https://www.health.com/sexual-health/jade-egg-goop

Pretty sure it was supposed to be humorous.

No, it seems to be on purpose and the puns just keep going south.

> "If they work as researchers hypothesize, they could rub out many common problems at once. And based on what we know of vaginas, they could be far less messy than transplants involving poop."

OK, thank you :)

I was confused throughout, doubting my own sense of humour rather than think that someone writing for Ars could swing and miss so much!

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

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.

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

I'll keep that in mind for future comments. Removing mine now would probably be counter productive?

But you're right, I completely slipped into Reddit snark mode rather than constructive HN mode.

It also contains useful information. I don't think it's too much to ask HN users to respond to the useful information and filter out the innuendo. Think of it as a community test.

Edit: I found what looks like a better article, so have changed the URL from https://arstechnica.com/science/2019/09/transplanting-poop-c.... Hopefully the BBC is a little more sobering.

Yes please. The piece gave the impression that it was written by a 12 year old with an English major. It’s incredibly annoying to read such childishness on such a serious topic.

You're not wrong, but one of the skills we're here to build is containing annoyance, rather than venting it into the commons. I think this is an interesting occasion to practice that.

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