Bacterial vaginosis biofilms: a target for therapeutic innovation

Abstract

Bacterial vaginosis (BV) is one of the most common variants of vaginal microbiome disorders worldwide. Bacterial vaginosis is a risk factor for the development of various complications in obstetric and gynecologic practice. Despite many years of study of this syndrome, existing and dynamically improving clinical, laboratory and instrumental diagnostic methods, progressive development of science in general, the etiology and pathogenesis of BV are still poorly understood. This is evidenced by the high frequency of chronic and/or recurrent course. There are standard therapeutic approaches aimed at eradication of the etiologic agent, but the level of efficacy remains questionable due to recurrent episodes, which requires further study of this problem. At present, it is reliably established that G. vaginalis forms polymicrobial biofilms on the mucosa of the urogenital tract. Biofilm is a cooperation of microorganisms that are attached to the surface of the epithelium and bound together by a polymeric matrix. Biofilm influences the properties of microorganisms included in its structure, provides conditions for their interaction. This leads not only to the strengthening of already existing pathogenic properties of bacteria associated with bacterial vaginosis, but also to the formation of new characteristics, due to which microorganisms become less susceptible to previously effective antibacterial drugs and aggressive environments, which contributes to recurrence. In most cases, treatment of BV is carried out by a direct mechanism of action on microorganisms, but in patients with verified “biofilm” bacterial vaginosis such strategy is not effective, which leads to recurrences. Thus, diagnostics of the causes of recurrent BV, development and introduction into clinical practice of antibiofilm agents aimed at destruction of the biofilm matrix and release of bacteria from its structure, which will increase the effectiveness of treatment, remain topical today.