Probiotics for BV and VVC Treatment and Prevention: An Umbrella Review of Systematic Reviews and Meta-Analyses, with Inclusion of Recent Randomized Controlled Trials

Purpose of Review Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are the most common vaginal conditions globally and recur frequently despite standard antibiotic or antifungal therapy. Probiotics and live biotherapeutic products (LBPs) are increasingly marketed as adjunctive or preventive treatments. We conducted an umbrella review of systematic reviews and meta-analyses published since 2020, assessing overlap among included trials and incorporating recent randomized controlled trials not yet captured by reviews to evaluate current evidence for probiotic use in BV and VVC. Recent Findings For BV, adjunctive probiotic therapy following antibiotics appears to improve cure rates and reduce recurrence, although benefits vary by formulation and route of administration. The strongest evidence supports vaginal Lactobacillus crispatus products, particularly CTV-05, which reduces BV recurrence and reduces vaginal inflammation. New multi-strain L. crispatus LBPs have demonstrated successful colonisation after short treatment courses and present a promising next generation of microbiome-based therapeutics. In contrast, evidence for VVC remains less consistent. While some meta-analyses report short-term improvement when probiotics are used in combination with antifungal therapy, benefits beyond one month are uncertain and there is no convincing evidence supporting probiotic monotherapy. Summary Current evidence supports probiotics primarily as adjunctive, rather than replacement therapy for BV. Vaginal L. crispatus -based products show the most promise for prevention of recurrent BV, whereas evidence for VVC remains limited by heterogeneous study designs, low-certainty evidence, and inconsistent inclusion criteria across reviews. Future progress will require strain-specific trials, standardized clinical outcomes, and evaluation of regulated LBPs capable of durable vaginal colonization.