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Re: The vaginal microbiome, vaginal anti‐microbial defence mechanisms and the clinical challenge of reducing infection‐related preterm birth

We read with great interest the most engaging and erudite review article by Professor Witkin. The concept of treating vaginal dysbiosis with lactic acid is a most attractive concept to supplant the current over-use of antibiotics for what is essentially a nonlife-threatening maternal condition. However, high concentrations of hydrogen peroxide produced in vitro by lactobacilli are bactericidal to the actual source of the hydrogen peroxide, i.e. the same lactobacilli. This selfregulatory mechanism is designed to keep in check the growth of lactobacilli. Could the exogenous administration of lactic acid potentiate the vicious cycle of lactobacilli deficiency and thus in the longer term prove to be of no benefit to the patient. We would be most interested in Professor Witkin’s thoughts on this matter.&