Reviewer ’s report  
 
Title: PROBIOTICS AND VAGINAL MICROECOLOGY: FACT OR FANCY?  
 
Version: 0 Date: 26 May 2018  
 
Reviewer: Francesco De Seta  
 
Reviewer's report:  
1) the authos ignored to differentiate oral and vaginal route in the introduction   
 
2) In the Cochrane Database Syst Rev. 2017 (Probiotics for vulvovaginal candidiasis in non -
pregnant women. Probiotics for vulvovaginal candidiasis in non -pregnant women) the data 
show the benefi cial effects of probiotics in short term follow up not confirmed in long term 
cure, but we know that also with traditional/conventional treatment (azoles) the recurrences 
represent a sort of not solved issue.  
 
3) Regarding BV and probiotics  the authors con sidered only data from Tan H, Fu Y, Yang C, 
Ma J. and they completely neither cited nor mentioned other trial or cochrane with results not 
completely negative  
 
( Effects of probiotics for the treatment of bacterial vaginosis in adult women: a meta -analysis of 
randomized clinical trials. Huang H, Song L, Zhao W The effects of antimicrobial therapy on 
bacterial vaginosis in non -pregnant women. Oduyebo OO, Anorlu RI, Ogunsola FT. Cochrane 
Database Syst Rev. 2009)  
 
4) The authors dont differentiate between acute and recurrent form of infections (candidiasis or 
vaginosis) and relative therapeutic implications. In fact in complicated forms (recurrent 
infections) all  treatments (also antymicotic or antibiotic) are not supportive, until today ,of 
long term beneficial  results  
 
5) In the obstetric population data showed in the paper are only related to the negative studies, 
instead other data reported beneficial effects in case of pPROM (Daskalakis et al) . Also the 
norvegian protocol showed beneficial effects when admi nistrating in the early gestational 
age. At the end we know how far we are to having significant results in Ob patients but the 
sensation is that the authors have considered only a negative data of the literature to stress the 
incocnclusive effects of prob iotics  
 
6) In the text there is a big confusion related to the endpoints considered in obstetic patients  : 
prematurity? pPROM? Metabolic outcomes? Preeclampsia ?   
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors . 
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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