{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:56:57Z","timestamp":1789649817853,"version":"4.0.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian Government Research Training Program"},{"name":"Australian NHMRC Leadership Investigator","award":["GNT1173361 and GNT1172900"],"award-info":[{"award-number":["GNT1173361 and GNT1172900"]}]},{"name":"Australian NHMRC Leadership Investigator","award":["GNT1173361 and GNT1172900"],"award-info":[{"award-number":["GNT1173361 and GNT1172900"]}]},{"name":"NHMRC Senior Research Fellowship","award":["(GNT1117748) and NHMRC Project Grant (GNT1164982)"],"award-info":[{"award-number":["(GNT1117748) and NHMRC Project Grant (GNT1164982)"]}]},{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"crossref","award":["APP1138165"],"award-info":[{"award-number":["APP1138165"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Medical Research Future Fund","award":["MRFF75913"],"award-info":[{"award-number":["MRFF75913"]}]},{"name":"Medical Research Future Fund","award":["MRFF75913"],"award-info":[{"award-number":["MRFF75913"]}]},{"name":"Medical Research Future Fund","award":["MRFF75913"],"award-info":[{"award-number":["MRFF75913"]}]},{"name":"Medical Research Future Fund","award":["MRFF75913"],"award-info":[{"award-number":["MRFF75913"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The vaginal microbiota in bacterial vaginosis (BV) typically has low abundance of lactic acid producing lactobacilli. Lactic acid has properties that may make it effective for treating BV and\/or restoring an optimal lactobacillus-dominated vaginal microbiota. We conducted a systematic review to describe the effect of intravaginal lactic acid-containing products on BV cure, and their impact on vaginal microbiota composition (PROSPERO registration: CRD42018115982).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase and OVID were searched from inception to November 2019 to identify eligible studies. Included studies evaluated an intravaginal lactic acid-containing product and reported BV cure using established diagnostic methods, and\/or vaginal microbiota composition using molecular methods. Studies were independently screened and assessed, and the proportion of women cured post-treatment was calculated. Study results were described in a qualitative manner.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 1,883 articles and assessed 57 full-texts for eligibility. Seven different lactic acid-containing products were evaluated and differed with respect to excipients, lactic acid concentration and pH. Most studies had medium or high risk of bias. Three trials compared the efficacy of a lactic acid-containing product to metronidazole for BV cure. One study found lactic acid to be equivalent to metronidazole and two studies found lactic acid to be significantly inferior to metronidazole. Two studies included a control group receiving a placebo or no treatment. One reported lactic acid to be superior than no treatment and the other reported lactic acid to be equivalent to placebo. Lactic acid-containing products did not significantly impact the vaginal microbiota composition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is a lack of high-quality evidence to support the use of lactic acid-containing products for BV cure or vaginal microbiota modulation. However, adequately powered and rigorous randomised trials with accompanying vaginal microbiota data are needed to evaluate the efficacy of lactic acid as a BV treatment strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0246953","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T12:58:18Z","timestamp":1613134698000},"page":"e0246953","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":64,"title":["Lactic acid-containing products for bacterial vaginosis and their impact on the vaginal microbiota: A systematic review"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5710-2671","authenticated-orcid":true,"given":"Erica L.","family":"Plummer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catriona S.","family":"Bradshaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Doyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K.","family":"Fairley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3330-4433","authenticated-orcid":true,"given":"Gerald L.","family":"Murray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Bateson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindi","family":"Masson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Slifirski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilda","family":"Tachedjian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3679-9195","authenticated-orcid":true,"given":"Lenka A.","family":"Vodstrcil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"issue":"12","key":"pone.0246953.ref001","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1086\/657320","article-title":"Bacterial vaginosis assessed by Gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection","volume":"202","author":"RM Brotman","year":"2010","journal-title":"J Infect Dis"},{"issue":"Suppl 1","key":"pone.0246953.ref002","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/S0020-7292(99)00136-8","article-title":"A public health approach to adverse outcomes of pregnancy associated with bacterial vaginosis","volume":"67","author":"EH Koumans","year":"1999","journal-title":"Int J Gynaecol Obstet"},{"issue":"12","key":"pone.0246953.ref003","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S1473-3099(05)70298-X","article-title":"Intravaginal practices, bacterial vaginosis, and women\u2019s susceptibility to HIV infection: epidemiological evidence and biological mechanisms","volume":"5","author":"L Myer","year":"2005","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pone.0246953.ref004","doi-asserted-by":"crossref","first-page":"e1000416","DOI":"10.1371\/journal.pmed.1000416","article-title":"Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis","volume":"8","author":"N Low","year":"2011","journal-title":"PLoS Med"},{"issue":"6","key":"pone.0246953.ref005","doi-asserted-by":"crossref","first-page":"e1001251","DOI":"10.1371\/journal.pmed.1001251","article-title":"Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples","volume":"9","author":"CR Cohen","year":"2012","journal-title":"PLoS Med"},{"issue":"RR-03","key":"pone.0246953.ref006","first-page":"1","article-title":"Prevention. 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