## 5 Conclusions  
Our data demonstrated that four GMNL _Lactobacillus_ strains (GMNL-74, -185, -680, and -682) inhibited the adherence of pathogenic bacteria on the surface of HeLa cells. A randomized, double-blind trial of oral consumptions of two formula of GMNL _Lactobacillus_ strains of VGA-1 (GMNL-74 and GMNL-185) or VGA-2 (GMNL-680 and GMNL-682) displayed improvement effects on BV patients but VGA-1 displayed a better efficacy in the reductions in color/odor of vaginal discharges and vaginal secretions/itching. The prolonged time to relapse was also observed in both VGA-1 or VGA-2 consumption groups, and the beneficial effects were correlated with an increased abundance of _Lactobacillus_ species and decreased IL-6 expression in vaginal swabs. We believe that the oral consumption of VGA-1 or VGA-2 can serve as a safe intervention for intermediate BV patients, with improvement of clinical symptoms, reduction of recurrence, and a prolonged relapse period, as presented in Figure 8, but it requires a placebo controlled trial involving more subjects for further validation. It also suggests that the combination of VGA-1 or VGA-2 with the currently used antibiotics indicates that BV patients can be considered in the future. **Supplementary Materials:** The following are available online at [[https://www.mdpi.com/2076-3417/11/3/902/s1](https://www.mdpi.com/2076-3417/11/3/902/s1)]([https://www.mdpi.com/2076-3417/11/3/902/s1](https://www.mdpi.com/2076-3417/11/3/902/s1)). Figure S1: Scheme of experimental procedure for the _Lactobacillus_ strains on the adherence of pathogens to HeLa cervical epithelial cells. Figure S2: Effects of _Lactobacillus_ strains on the adherence of _Gardnerlla vaginalis_ to HeLa cervical epithelial cells. Figure S3: Effects of _Lactobacillus_ strains on _Streptococcus agalacliae_ adherence to cervical epithelial cells. Figure S4: Inhibition of _Lactobacillus_ strains on pathogenic bacteria-induced inflammation. Figure S5: Immune responses of human peripheral blood mononuclear cells to _Lactobacillus_ strains. Figure S6: Correlations between Nugent score and vaginal flora. Figure S7: Effects of _Lactobacillus_ strains on the adherence of _Candida albicans_ to HeLa cervical epithelial cells. Table S1: Pretesting results of two vaginal swab specimens before starting the trial. Table S2: qRT-PCR primer sequence for inflammatory cytokines. Table S3: Species-specific primer sequence for PCR. Table S4: Arbitrary primer sequence for RAPD-PCR. Table S5: Growth inhibitory activity of _Lactobacillus_ _Hummous_ GR-1 and _Lactobacillus_ _reuteri_ RC-14 against bacterial pathogens. Table S6: Characteristics of subjects during follow-up. Table S7: Interval time of bacterial vaginosis of subjects with BV history before and after probiotic intervention. Table S8: _Lactobacillus_ contents of vaginal specimens isolated from BV patients S017 and S025 who received VGA-1 probiotics, at week 2 and week 4. Supplementary protocol: The study protocol of this randomized, double-blinded trial. Table S9. The number of BV subjects with decreased Nugent scores after VGA-1 or VGA-2 intervention. **Author Contributions:** Conceptualization, I-L.H., W-H.T., and T-C.L. ; formal analysis, I-L.H. and W.-H.T. ; clinical investigation and data curation, T-C.L., Y-C.C., L.-C.K., and M.-S.H. ; in vitro experiments, W-L.Y. and S.-J.H. ; trial monitoring, Y-H.C.; writing--original draft preparation, I-L.H., W-H.T., and W.-W.C.; writing--review and editing, I-L.H., W.-H.T., W-W.C., and T-C.L. ; project administration, I-L.H., W-H.T., and T-C.L. ; funding acquisition, W-H.T. All authors have read and agreed to the published version of the manuscript. **Funding:** This research was funded by GenMont Biotech Incorporation (Tainan, Taiwan). Figure 8: The main findings of this study. Four GMNL-_Lactobacillus_ strains were selected by their activity to prevent the in vitro growth and adhesion to cervical epithelial cells of BV pathogenic bacteria.