Understanding and Preventing Recurring Bacterial Vaginosis: Important Considerations for Clinicians

Abstract

Bacterial vaginosis (BV) is the most common vaginal infection worldwide. It is associated with an increased risk of acquisition of HIV and other sexually transmitted infections (STIs) as well as pelvic inflammatory disease and adverse birth outcomes. During BV, a polymicrobial biofilm forms on the surface of the vaginal mucosa. However, the exact etiology of BV remains controversial which has impeded significant advances in diagnosis, treatment, and prevention. Despite 30-day cure rates approaching 80% in BV-infected women treated with 7 days of oral metronidazole, recurrence within 12 months is common. This article provides a current review of the epidemiology, pathogenesis, diagnosis, and treatment of recurrent BV for practicing clinicians who commonly see women with this recurrent vaginal infection. Regarding management, we focus primarily on antimicrobial measures that may be effective. Future areas of research in this field are also discussed.

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

“…However, there remains a contentious debate regarding the necessity of routine screening for these infections in asymptomatic women [11]. Although women with BV can present with symptoms, BV is predominantly characterized as a subclinical condition, frequently manifesting as an asymptomatic disease [33]. Hence, acquiring comprehensive data on bacterial vaginosis (BV) during pregnancy poses a challenge.…”

On the diagnosis and treatment of refractory and recurrent vaginosis and vaginitis in the practice of a gynecologist

“…[3]. До настоящего времени точная этиология БВ остается спорной, что препятствует значительному прогрессу в его диагностике, лечении и профилактике [4]. В отличие от БВ, вагинит -это острое воспаление слизистой влагалища, характеризующееся увеличением влагалищной секреции, при котором в большом количестве присутствуют лейкоциты, и отмечаются такие симптомы, как зуд и раздражение слизистой вульвы [5].…”

“…Несмотря на то что уровень излечения БВ в течение 30 дней приближается к 80% у женщин, принимавших метронидазол перорально в течение 7 дней, рецидив в течение 12 мес. является обычным явлением [4]. Причин рецидива несколько: устойчивость L. iners и некоторых штаммов G. vaginalis к имидазолам (либо резистентность, либо неэффективность антибиотиков по отношению к бактериальным биопленкам) и низкая чувствительность A. vaginae к имидазолам [32].…”

Achieving Effective Probiotic Therapy in Bacterial Vaginosis—Still an Unanswered Priority?

“…The second hypothesis emphasized by the LACTIN-V study is the relevance of post-antibiotic vaginal dysbiosis, indicative of persistent BVAB and antimicrobial resistance independent of biofilm formation. Such in vivo resistance has been poorly studied, largely fostered by the plethora of interrelated microbiota, involved in polymicrobial pathogenesis, with so many noncultivatable bacterial species disqualifying traditional in vitro susceptibility studies 23,24 . There is a growing literature documenting the ease of inducing G. vaginalis metronidazole resistance in vitro.…”

“…The resistance scenario invariably invites thoughts and the use of bacteriophage innovation. In the meantime, clinicians faced with an epidemic of RBV and the multiple complications thereof still struggle with innovative strategies to control but not cure or eradicate RBV 22–24 . Is the answer new LBP research and design, or shall this wait for further understanding, discovery, and answers to the complex polymicrobial pathogenesis of BV?…”