ORIGINAL ARTICLE
Open Access

Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study

Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsus, Chun-Hsi LiuORCID 1

1Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan.

DOI: https://doi.org/10.18081/ajbm/2025.3/252Crossmark logo

 Received 30 May 2025, Revised 18 June 2025, Accepted 19 July 2025, Available online 24 August 2025
© 2025 Liu, et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
CC BY 4.0

ABSTRACT

Background

Recurrent vulvovaginal candidiasis (RVVC) and pelvic inflammatory disease (PID) are two of the most common infectious disorders in women’s reproductive health, frequently resulting in chronic discomfort and infertility. Both conditions share underlying mechanisms of microbial dysbiosis and immune-mediated inflammation. This study aimed to evaluate the efficacy of probiotics in preventing RVVC recurrence and to explore the correlation between PID and tubal infertility (TFI), emphasizing the role of the genital tract microbiome in reproductive outcomes.

Methods

A prospective dual-center study was conducted between January 2021 and December 2023 at National Taiwan University Hospital and Chang Gung Memorial Hospital.
Two complementary components were designed:
1. A randomized, double-blind, placebo-controlled trial (n=200) assessing oral and intravaginal Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 as adjuncts to antifungal therapy in women with RVVC.
2. A case-control study (n=250; 125 TFI cases, 125 fertile controls) investigating prior PID history, Chlamydia trachomatis seropositivity, and microbial imbalance as predictors of tubal damage.
Clinical symptoms, vaginal pH, microbial load, and 16S rRNA microbiome composition were analyzed. Multivariate and correlation analyses identified risk factors for recurrence and infertility.

Results

In the RVVC trial, probiotic supplementation reduced recurrence rates (19% vs 44%; p<0.001) and prolonged recurrence-free survival. Vaginal Lactobacillus counts and Shannon diversity index significantly increased in the probiotic group. In the PID study, history of PID (aOR 3.62, 95% CI 1.84–7.10) and positive C. trachomatis IgG (aOR 3.34, 95% CI 1.52–7.32) were strongly associated with TFI. Microbiome analysis showed anaerobe-dominant flora and reduced Lactobacillus crispatus abundance in infertile women. The number of PID episodes correlated with tubal damage severity (r = 0.62, p<0.001). No major adverse events were reported.

Conclusion

Probiotic therapy effectively reduced recurrent vulvovaginal candidiasis and restored vaginal eubiosis, while prior PID—particularly chlamydial infection—was a significant determinant of tubal infertility. Findings highlight a continuum of genital tract dysbiosis linking lower tract infection with upper tract inflammation. Microbiome-centered interventions such as targeted probiotic therapy may represent a novel approach to both infection prevention and fertility preservation among reproductive-age women in Taiwan.

Keywords: Probiotics; recurrent vulvovaginal candidiasis; pelvic inflammatory disease; tubal infertility; vaginal microbiome; Lactobacillus rhamnosus; Chlamydia trachomatis; dysbiosis

Cite this article

Huang M, Lin Y, Chen P, Hsu W, Liu C. Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study. Advanced Journal of Biomedicine & Medicine. 2025;13(3):252-270. doi:10.18081/ajbm/2025.3/252

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Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsu, Chun-Hsi Liu (2025). Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study. American Journal of Biomedicine, 13(3), 252-270. https://doi.org/ 10. 10.18081/ajbm/2025.3/252
Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsu, Chun-Hsi Liu. "Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study." American Journal of Biomedicine, vol. 13, no. 3, 2025, pp. 252-270. DOI: 10. 10.18081/ajbm/2025.3/252.
Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsu, Chun-Hsi Liu. Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study. Am J Biomed. 2025;13(3):252-270. DOI: 10. 10.18081/ajbm/2025.3/252. PMID: .
Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsu, Chun-Hsi Liu 2025, "Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study", American Journal of Biomedicine, vol. 13, no. 3, pp. 252-270.
@article{mei-ling2025, title={Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study}, author={Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsu, Chun-Hsi Liu}, journal={American Journal of Biomedicine}, volume={13}, number={3}, pages={252-270}, year={2025}, doi={ 10. 10.18081/ajbm/2025.3/252} }
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%0 Journal Article %A Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsu, Chun-Hsi Liu %T Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study %J American Journal of Biomedicine %V 13 %N 3 %P 252-270 %D 2025 %R 10. 10.18081/ajbm/2025.3/252 %M
Mei-Ling Huang, Yi-Chun Lin, Pei-Ying Chen, Wei-Ting Hsu, Chun-Hsi Liu (2025). Role of Probiotics in Recurrent Vulvovaginal Candidiasis: A Randomized Controlled Trial Correlation between Pelvic Inflammatory Disease and Tubal Infertility: A Case-Control Study. American Journal of Biomedicine, 13(3), 252-270. https://doi.org/ 10. 10.18081/ajbm/2025.3/252

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