Dysbiotic bacterial vaginosis-associated vaginal microbiota (BV-associated microbiota)

The dysbiotic bacterial vaginosis-associated vaginal microbiota is a polymicrobial state characterized by the depletion of health-promoting Lactobacillus species and a massive overgrowth of diverse anaerobic bacteria, including Gardnerella vaginalis, Atopobium vaginae, and Prevotella species (Anahtar et al., 2018). This shift results in the loss of protective mechanisms such as lactic acid production, leading to an elevated vaginal pH and the formation of dense, antibiotic-resistant biofilms on the vaginal epithelium (Swidsinski et al., 2005). Clinically, this dysbiosis is the hallmark of bacterial vaginosis (BV), the most common vaginal condition in women of reproductive age, and is linked to severe outcomes including preterm birth and increased susceptibility to sexually transmitted infections (Kairys et al., 2023). Current treatments focus on eradicating anaerobes with antibiotics like metronidazole, though high recurrence rates remain a major challenge, prompting the investigation of microbiome-restoring therapies like live biotherapeutic products (Cohen et al., 2020).

Other names

Bacterial vaginosis microbiotaDysbiotic vaginal microbiomeBV-associated bacteriaVaginal dysbiosisPolymicrobial vaginal biofilm

Antibiotics like metronidazole and tinidazole target anaerobic bacteria by causing DNA strand breakage, while clindamycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit (Coudray & Madhivanan, 2020). Live biotherapeutic products (e.g., Lactobacillus crispatus) aim to restore the vaginal ecosystem by producing lactic acid to lower pH and hydrogen peroxide to inhibit the growth of dysbiotic anaerobes (Cohen et al., 2020). Boric acid acts as a mild antiseptic and helps disrupt the polymicrobial biofilms associated with recurrence (Kairys et al., 2023).