The Evolving Facets of Bacterial Vaginosis: Implications for HIV Transmission

Abstract

Bacterial vaginosis (BV) is a common yet poorly understood vaginal condition that has become a major focus of HIV transmission and immunology research. Varied terminologies are used by clinicians and researchers to describe microbial communities that reside in the female reproductive tract (FRT), which is driven, in part, by microbial genetic and metabolic complexity, evolving diagnostic and molecular techniques, and multidisciplinary perspectives of clinicians, epidemiologists, microbiologists, and immunologists who all appreciate the scientific importance of understanding mechanisms that underlie BV. This Perspectives article aims to clarify the varied terms used to describe the cervicovaginal microbiota and its “nonoptimal” state, under the overarching term of BV. The ultimate goal is to move toward language standardization in future literature that facilitates a better understanding of the impact of BV on FRT immunology and risk of sexually transmitted infections, including HIV.

Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy

“…Inflammation and ulcers can be expected to lower the barrier(s) to infection . Recent studies have tried to more precisely define the conditions that lead to HIV acquisition in women, with a focus on unique cytokine profiles and disturbance of vaginal microbiome with resultant “dysbiosis” (non‐optimal vaginal flora) . STIs can evoke an influx of receptive cells with expression of a greater number of CCR5 and CD4 receptors per cell .…”

The Role of the Cervicovaginal Microbiome on the Genesis and as a Biomarker of Premalignant Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer

“…That is, the entities that were referred to as BV after Amsel or Nugent diagnosis (Amsel or Nugent-BV) represent only a small fraction of the altered microbiome compositions detected by molecular methods (Molecular-BV). In this scenario, the molecular detection of BV is clinically relevant since it is associated with unfavorable outcomes such as increased HIV acquisition risk and is also informative for patients whose suboptimal bacterial flora could not be detected by Amsel criteria and/or Nugent score [122].…”

The vaginal metabolome and microbiota of cervical HPV‐positive and HPV‐negative women: a cross‐sectional analysis

“…CST IV is characterised by a paucity in Lactobacillus , high vaginal pH (>4.5), and high relative abundances of various anaerobic bacteria, including Gardnerella, Prevotella , and Atopobium spp . These microbial features are also characteristic of bacterial vaginosis (BV), which can be associated with a myriad of symptoms and adverse health outcomes, leading to the proposal of CST IV being termed ‘molecular‐BV’ …”