Bacterial Vaginosis Biofilms: Challenges to Current Therapies and Emerging Solutions

Abstract

Bacterial vaginosis (BV) is the most common genital tract infection in women during their reproductive years and it has been associated with serious health complications, such as preterm delivery and acquisition or transmission of several sexually transmitted agents. BV is characterized by a reduction of beneficial lactobacilli and a significant increase in number of anaerobic bacteria, including Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp., Bacteroides spp. and Prevotella spp.. Being polymicrobial in nature, BV etiology remains unclear. However, it is certain that BV involves the presence of a thick vaginal multi-species biofilm, where G. vaginalis is the predominant species. Similar to what happens in many other biofilm-related infections, standard antibiotics, like metronidazole, are unable to fully eradicate the vaginal biofilm, which can explain the high recurrence rates of BV. Furthermore, antibiotic therapy can also cause a negative impact on the healthy vaginal microflora. These issues sparked the interest in developing alternative therapeutic strategies. This review provides a quick synopsis of the currently approved and available antibiotics for BV treatment while presenting an overview of novel strategies that are being explored for the treatment of this disorder, with special focus on natural compounds that are able to overcome biofilm-associated antibiotic resistance.

Bacterial vaginosis: a critical analysis of current knowledge

“…Vaginolysin, a toxin released by G. vaginalis , has been shown to promote the adherence of this bacterium to the vaginal epithelium . This facilitates development of a biofilm that aids in bacterial persistence by enhancing resistance to host defence mechanisms and to antibiotics …”

Metatranscriptome analysis of the vaginal microbiota reveals potential mechanisms for protection against metronidazole in bacterial vaginosis

“…It has been hypothesized that patches of surviving bacterial biofilm may be one of 77 the reasons for recurrence [11]. The predominant species of this multi-species biofilm is G. 78 vaginalis [13]. G. vaginalis is frequently found in biofilms during BV but it is also a member 79 of the healthy VMB [14].…”

Clinical Evaluation of the Efficacy and Safety of a Medical Vaginal Device Containing Rigenase® for the Treatment of Vaginosis: A Randomized Study

“…For this reason, therapeutic alternatives have been proposed, including non-steroidal anti-inflammatory drugs [16], Medical Vaginal Device Treating Vaginosis J Clin Gynecol Obstet. 2017;6(1):6-11 plant extracts [17] and agents active on the bacterial biofilm [18]. In this study, the ability of the studied medical device (cream, ovules, solution, gel, and foam) to restore the state of well-being in patients with inflammatory-dystrophic vaginal disorders was evaluated.…”