Supporting women's intimate health with QUATREFLORA™

Worldwide, it is 75% of women that will know a vaginal infection (vulvovaginal candidiasis or bacterial vaginosis), usually from 14 to 55 years old. It is considered that vaginal infections account for more than 10 million doctors’ visits per year, and that 70% of episodes of vaginitis in premenopausal women are caused by bacterial vaginosis (BV) or vulvovaginal candidiasis (VVC). In fact, 56% of women with menopausal symptoms have abnormal vaginal flora.

Although standard antimicrobials as Fluconazole, metronidazole, and clindamycin have generally been used as antimicrobials in the treatment of BV and VVC and remain the primary strategy for prevention and treatment of vaginal infections, VVC and BV are difficult to treat because of high rates of resistance and recurrence.

VVC affects women of childbearing age and is caused by fungi of the genus Candida. Of the Candida species, C. albicans accounts for nearly 80-90% of all VVC cases. It is a dimorphic fungus that can exist as a yeast and a mold. In the yeast form, Candida can colonize the vaginal mucosa asymptomatically. However, in some cases, the yeast cells develop into hyphae, which can damage and breach the mucosal surfaces, leading to acute vulvovaginal infections.

In addition, Candida albicans is a major causative agent of a severe chronic infection called recurrent VVC. Although VVC occurs in more than 50% of women, approximately 5-8% of these women experience recurrence.

Several host and behavioral risk factors may contribute to VVC, including pregnancy, hyperglycemia, immunosuppression, antibiotic or glucocorticoid treatment, oral contraceptive use, intrauterine devices, and genetic susceptibility.

However, despite the increasing number of well-known risk factors, the role of the host response to the microbe in the development of Candida vaginitis and recurrent episodes remains to be elucidated.

Bacterial vaginosis is considered the most common form of vaginitis affecting fertile, premenopausal, and pregnant women. BV is often grouped together with trichomoniasis, a sexually transmitted infection caused by the parasite Trichomonas vaginalis.

BV is not a true infection, but it is considered a complex imbalance in the physiological vaginal flora, where the normal population levels of Lactobacillus spp. are reduced and replaced by some of the less dominant and potentially pathogenic microorganisms, such as Gardnerella vaginalis, Atopobium vaginae or Mobiluncus spp.

Microbiologically, BV is characterized by a depletion of hydrogen peroxide (H2O2)-producing lactobacilli and a proliferation of anaerobic bacteria.  There is general consensus that BV is characterized by the presence of a multi-microbial anaerobic biofilm composed primarily of Gardnerella vaginalis.

Important features associated with the pathogenesis of this disease are:

• The ability of Gardnerella to strongly adhere to vaginal epithelium forming a robust biofilm ;
• The capacity to produce sialidase, an enzyme known to facilitate the destruction of the protective mucus on the vaginal epithelium ;
• The ability to trigger exfoliation of vaginal epithelial cells, which facilitates the spread of the pathogen to the underlying tissues.

Luconazole, metronidazole, and clindamycin have been commonly used as antibiotics to treat vaginal infections such as VVC and BV. Although these antibiotics inhibit the activation of intravaginal and anaerobic bacteria that cause vaginal infections, their use is problematic because of antibiotic resistance, side effects, and recurrence. Initial cure rates for BV with metronidazole or clindamycin are poor, ranging from 10% to 15%, with recurrence rates of BV as high as 80% in patients with an initial response.

Therefore, Lactobacillus probiotics have recently been gradually replacing antibiotic therapy for the treatment and prevention of vaginal infections such as BV and VVC.

With respect to vaginal health, probiotics improve the therapeutic outcome in women with vaginal infections by maintaining the normal vaginal microbiota of lactobacilli. They produce lactic acid and lower the intravaginal pH from 3.5 to 4.5, thus playing a key role in maintaining a more protective vaginal environment against harmful microorganisms. Probiotics indirectly contribute to the treatment of BV and CVV by preventing the recurrence and spread of infections.

Quatreflora™ is a probiotic approach to women's intimate health issues. Made from the patented Saccharomyces cerevisiae CNCM I-3856 strain, Quatreflora™ is a yeast probiotic that balances and optimizes the vaginal flora, preventing bacterial and yeast vaginosis

There are several published pre-clinical and clinical studies have demonstrated the efficacy and beneficial effects of Quatreflora™.

Quatreflora™ has a multitude of beneficial properties:

• Helps manage vaginal infections specifically due to C. albicans and G. vaginalis ;
• Prevents recurrence of vaginal infections ;
• Adheresand protectsthe vaginal epithelium by forming a barrier ;
• Limits the proliferation of the pathogen by inhibiting virulence factors ;
• Coaggregation with C.albicans and inhibition of hypha formation (pathogenic form) & virulence factors ;
• Displacement of G. vaginalis from the vaginal epitheliumand inhibition of virulence factors.