Bacterial vaginosis: a review of approaches to treatment and prevention

Abstract

Bacterial vaginosis (BV) is a common cause of vaginitis worldwide and is associated with serious reproductive health outcomes, including increased risk of preterm birth, sexually transmitted infections, and pelvic inflammatory disease. The current and only FDA-approved treatment regimens for BV are antibiotics, such as metronidazole and clindamycin. Antibiotics provide a short-term cure for bacterial vaginosis; however, fail to provide a consistent long-term cure for many women. Fifty to eighty percent of women experience a BV recurrence within a year of completing antibiotic treatment. This may be because after antibiotic treatment, beneficial strains of Lactobacillus, such as L. crispatus, do not recolonize the vagina. In the absence of an effective long-term cure, patients, providers, and researchers are exploring different approaches to treatment and prevention, resulting in a rapid evolution of perspectives on BV pathogenesis and approaches to management. Current areas of investigation for BV management include probiotics, vaginal microbiome transplantation, pH modulation, and biofilm disruption. Behavioral modifications that may help include smoking cessation, condom use and hormonal contraception. Additional strategies considered by many people include dietary modification, non-medical vaginally applied products, choice of lubricant, and treatments from medical practices outside of allopathic medicine. This review aims to provide a comprehensive and up to date outline of the landscape of ongoing and potential treatment and prevention strategies for BV.

Effect of bacterial vaginosis on induced labour in the third trimester of pregnancy: A retrospective cohort study

“…Previous research has brought attention to the limited predictive value of the Bishop score in determining the success of induction and the potential for adverse outcomes in multiparous women. Additionally, these studies have suggested that regardless of their initial Bishop scores, multiparous women can undergo induction safely and have successful outcomes [32]. Our research successfully gathered comprehensive data on bacterial vaginosis (BV) in women who underwent induced labour during the third trimester of pregnancy.…”

Genetic predictors for bacterial vaginosis in women living with and at risk for HIV infection

“…Given the high frequency of BV recurrence, alternatives to antibiotics are currently being studied for BV treatment, including interventions targeting vaginal pH, biofilms and restoration of a Lactobacillus dominant vaginal microbiome. Lower, acidic vaginal pH limits growth of BV‐associated anaerobes, therefore, lactic acid‐based interventions have been investigated though thus far they have not been shown to reliably treat BV in small studies compared to standard antibiotic treatment 6,53 . Two biofilm disruptors have shown promising results in small studies though neither is currently available in the US.…”

“…Moreover, in women living with HIV, vaginal dysbiosis and mucosal inflammation have been linked to genital HIV shedding, which may increase HIV transmission risk 4,5 . Effective treatments for BV are lacking, 6 therefore, understanding factors that influence BV risk is critical 7 …”

Inflammatory mediators in bacterial vaginosis: The role of cytokines

“…The vaginal microbiome, in a physiologically normative context, manifests as an intricate and equilibrium-maintained ecological construct. Lactobacillus species predominantly characterize the healthy vaginal microbiome and are recognized for their role in safeguarding the vaginal ecosystem via the secretion of antimicrobial agents, including lactic acid, hydrogen peroxide, and bacteriocin-like compounds [14]. The production of lactic acid contributes to the acidic vaginal milieu (pH 3.5-4.5), facilitating the proliferation of Lactobacillus and inhibiting the colonization of pathogenic microorganisms [15].…”