Finding a Balance in the Vaginal Microbiome: How Do We Treat and Prevent the Occurrence of Bacterial Vaginosis?

Abstract

Bacterial vaginosis (BV) has been reported in one-third of women worldwide at different life stages, due to the complex balance in the ecology of the vaginal microbiota. It is a common cause of abnormal vaginal discharge and is associated with other health issues. Since the first description of anaerobic microbes associated with BV like Gardnerella vaginalis in the 1950s, researchers have stepped up the game by incorporating advanced molecular tools to monitor and evaluate the extent of dysbiosis within the vaginal microbiome, particularly on how specific microbial population changes compared to a healthy state. Moreover, treatment failure and BV recurrence rate remain high despite the standard antibiotic treatment. Consequently, researchers have been probing into alternative or adjunct treatments, including probiotics or even vaginal microbiota transplants, to ensure successful treatment outcomes and reduce the colonization by pathogenic microbes of the female reproductive tract. The current review summarizes the latest findings in probiotics use for BV and explores the potential of vaginal microbiota transplants in restoring vaginal health.

Microorganisms in the reproductive system and probiotic's regulatory effects on reproductive health

“…Bacterial vaginosis is caused by imbalance in the ecology of the vaginal microbiota, and approximately one-third of women worldwide have suffered to BV at different times in their lives [101] . Probiotics are considered an effective treatment to increase the Lactobacillus colonization rate and restore the normal flora in the vagina, thus helping to alleviate vaginal inflammation.…”

Probiotics, Their Extracellular Vesicles and Infectious Diseases

“…It is important to note that many clinical trials examine the use of probiotics as a supplementation to conventional therapy against infectious diseases, such as antibiotic and antifungal agents ( Shi et al, 2019 ; Joseph et al, 2021 ). In general terms, probiotics have shown effectiveness in preventing infectious diseases in different organ systems, from the respiratory and gastrointestinal tracts to the female urogenital system, among others.…”

Molecular Regulatory Mechanisms Drive Emergent Pathogenetic Properties of Neisseria gonorrhoeae

“…Clinical symptoms of BV include (1) vaginal pH > 4.5, (2) grayish-white vaginal discharge with a (3) distinct fishy odor due to the presence of polyamines, and (4) detection of clue cells (epithelial cells covered with Gram-negative rod cells) in the vaginal smears examined under the microscope. Limited studies have examined the mechanistic details of how N. gonorrhoeae responds to the healthy and dysbiotic vaginal ecology and how this could potentially impact treatment and vaccine development [ 129 , 130 , 131 ]. In vitro studies have shown that N. gonorrhoeae responds to acidic conditions by modulating the expression of surface-expressed proteins including Rmp, an important determinant of gonococcal vaccine efficacy, and stress response proteins Hsp63 [ 132 , 133 , 134 ].…”