Use of Probiotic for the

Prevention of re-occurrence
vaginal candidiasis in Pregnant
women
ANG XIN YEE P-IM0011/20(R)
Registration date: October 2020
Prof. Dr. Liong Min Tze
 Table of Contents

01 Introduction 02 Objectives 03 Methodology

04 Expected
Outcomes 05 Gantt Chart 06 References
 01
Introduction
 Probiotic
 Vaginal Yeast Infection
 STP4
PROBIOTIC
Benefits of probiotics
Bowel Atopic
Movements Eczema

Stress-
Lactose Related
Intolerance Psychiatric
Disorders

Oral Anti-Fungal
Diseases Pharmaceutical
Agent
Vaginal Yeast
Infection
 Vaginal Yeast Infection

Inflammation of the Candida albicans /

vaginal vulva C. glabrata

Pregnant women more

Symtoms
Vaginal scrathing, redness
Consist: discharged
likely to get 5-50%
different study
populations across major
continents
 Tendency of vaginal yeast infection
For pregnancy-related factors:

changes in Hormone imbalance/

immune system fluctations
Increase the release of oestrogen, upset
the vagina's chemical balance
Several risk factors:

Unhealthy lifestyle antibiotic used immune-suppressing

Poor diet, lack of sleep • Tetracycline diseases
• demeclocycline Diabetes, HIV infection
•
STP4
manufactured under a HACCP and ISO 22000 certified
manufacturing plant (Synbio Tech Inc., Taiwan)
• HALAL certification by Taiwan Halal Integrity
Development Association (THIDA), Taiwan as
recognized by JAKIM, Malaysia
• Patented in Taiwan in 2013 (I412371) and China In
2018 (CN103409334B) for use of lactobacilli to inhibit
vaginitis pathogens
• The strains are:
 Lactobacillus plantarum LP115,
 Lactobacillus helveticus LA25,
 Lactobacillus rhamnosus LRH10,
 Lactobacillus paracasei LPC12,
 Lactobacillus fermentum LF26,
 Lactobacillus delbrueckii subsp. lactis LDL114
 Administration of STP4
• 2 capsules/day of STP4 / placebo for 8-
weeks
• One capsule : 9.5 log CFU of
lactobacillus.
 Paper reviewed
• Treatment with antibiotics or anti-fungal medication in combination with
EcoVag® capsules - clinical study from Norway and Sweden found that
provide long-term cure against BV and R-VVC as compared to previous
reports (Pendhakar et al., 2015).
• Treatment of skim milk contain with Lactobacilus rhamnosus GR-1 and
Lactobacillus fermentum RC-14 suspended in skim milk and given twice daily
for 14 days -10 women with a history of recurrent yeast vaginitis, bacterial
vaginosis (BV) and urinary tract infections, strains, were recovered from the
vagina(Reid et al., 2001).
• Treatment of vulvovaginal candidiasis with fluconazole plus probiotic
Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14- A study
conducted in Brazil by Martinez et al., (2008), on seen an improved. At 4
weeks, probiotic treated group significant less vaginal discharge associated
symptoms (Martinez et al., 2008).
02
OBJECTIVES
Objectives
1. To evaluate the effects and efficiency of oral administration of STP4 for 8 weeks to against vaginal
yeast infection in pregnant women

Specific objective:
1. To evaluate microbiota profiles, concentrations of proteins and gene expressions of vaginal and
cervical swab, cervico vaginal lavages fluid (CVL), and fecal samples of pregnant women with yeast
infection
2. To assess mental stress due to infection and/or gastrointestinal discomfort in pregnant women with
yeast infection
3. To determine health profiles of women and infants post-delivery, from women with yeast infection
4. To assess clinical symptoms in pregnant women with yeast infection
 03
Methodology
 Subjects
78 Pregnant women
Week: 14-32 (2nd -3rd trimester)
Most episodes of symptomatic
vulvovaginal candidiasis (VVC)
occur during the 2nd and 3rd
trimesters
Groups:
-39 Probiotic;
-39Placebo
Inclusion
- Pregnant women subjects (14 to
32 weeks pregnancy)
- Confirmed with yeast infection by
HUSM’s O & G Specialist
- Positive yeast culture as
determined by HUSM
Microbiology Laboratory
- Willing to commit throughout the
experiment
Exclusion
- HIV positive patients
- Type-1 diabetes
- Long term medication
- Glucose-6-phosphate
dehydrogenase (G6PD)
deficiency
 Sampling

Clinic assessment symptoms by O&G Specialist

Sample Sample collected at (week)
Cervico Vaginal Lavages fluid (CVL) 0, 4, 8
High vaginal swab (HVS) 0, 4, 8
Low vaginal swab (LVS) 0, 4, 8
0, 4, 8, after delivery (mother
Fecal sample
& baby)
Questionnaires 0, 4, 8, after delivery
 Analysis
Sample Analysis

Swab: CVL, HVS & LVS DNA & RNA, ELISA

Fecal sample DNA, pyrosequencing

 Analysis
DNA Relative abundance (C. albicans, C. glabrata, C. krusei,
Of several microbial C. tropicalis, C. parakasei, S. aureus,
By qPCR G. vaginalis, E. coli, L. gensenni,
L. crispatus)

Swab RNA cDNA Gene expression: Anti-inflammatory: IL-4, IL-10,

By RT-qPCR Pro-inflammatory: IFNɣ, TNFα

Protein Concentration: ELISA (IL-4, TNFα, IFNɣ, IL-10)

Fecal Freeze dried DNA pyrosequencing

 Expected outcome
• The microbiota profiles, concentrations of proteins and gene expressions of
vaginal and cervical swab, cervico vaginal lavages fluid (CVL), and fecal
samples of pregnant women with yeast infection can be known.
• Mental stress due to infection and/or gastrointestinal discomfort in pregnant women
with yeast infection can be known.
• Effects of Health profiles of women and infants post-delivery, from women with
yeast infection can be known.
• Effects of Clinical symptoms in pregnant women with yeast infection can be
known.
• Effects of STP4 to against vaginal yeast infection in pregnant women can be
known.
 Gantt Chart
Semester
Activity
1 2 3 4
Literature Review
Methodology Review
Material Preparation
JEPeM application & approval
Screening of subjects
Collection of consent form
Double blind randomization
Sample collection from W0, W4, W8 and after
delivery
Collection of Questionnaires
Analysis
Thesis manusrcipt writing
 References
1. Bermudez-Brito, M., Plaza-Díaz, J., Muñoz-Quezada, S., Gómez-Llorente, C., & Gil, A. (2012).
Probiotic Mechanisms of Action. Annals of Nutrition and Metabolism, 61(2), 160–174.
https://doi.org/10.1159/000342079
2. Fijan, S. (2014a). Microorganisms with Claimed Probiotic Properties: An Overview of Recent
Literature. International Journal of Environmental Research and Public Health, 11(5), 4745–4767.
https://doi.org/10.3390/ijerph110504745
3. Fijan, S. (2014b). Microorganisms with Claimed Probiotic Properties: An Overview of Recent
Literature. International Journal of Environmental Research and Public Health, 11(5), 4745–4767.
https://doi.org/10.3390/ijerph110504745
4. Hammes, W. P., & Vogel, R. F. (1995). The genus Lactobacillus. In B. J. B. Wood & W. H. Holzapfel
(Eds.), The Genera of Lactic Acid Bacteria (pp. 19–54). Springer US. https://doi.org/10.1007/978-1-
4615-5817-0_3
5. Jang, S.-E., Jeong, J.-J., Choi, S.-Y., Kim, H., Han, M. J., & Kim, D.-H. (2017). Lactobacillus rhamnosus
HN001 and Lactobacillus acidophilus La-14 Attenuate Gardnerella vaginalis-Infected Bacterial
Vaginosis in Mice. Nutrients, 9(6). https://doi.org/10.3390/nu9060531
6. Jeanmonod, R., & Jeanmonod, D. (2020). Vaginal Candidiasis (Vulvovaginal Candidiasis). In
StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK459317/
7. Kalia, N., Singh, J., & Kaur, M. (2019). Immunopathology of Recurrent Vulvovaginal Infections: New
Aspects and Research Directions. Frontiers in Immunology, 10.
https://doi.org/10.3389/fimmu.2019.02034
Thank you