Addressing the challenges with bacterial vaginosis pharmacotherapy

Abstract

[Excerpt] 1. Introduction: The healthy female vaginal environment is a dynamic ecosystem that is commonly colonized by several lactic acid-producing bacteria, most of the genus Lactobacillus [1]. It is believed that the normal human vaginal microbiota has an important role in maintaining health, with an impact on either baby delivery or increased risks in the acquisition of sexually transmitted infections [2]. The composition of the vaginal microbiota depends on ethnicity and can change over the menstrual cycle, during pregnancy, with age, and under external stresses, such as antimicrobial treatments [3]. For reasons not yet fully understood, the dominant healthy vagina lactic acid and hydrogen peroxide-producing lactobacilli can be replaced by a complex mixture of strictly and facultative anaerobic bacteria [4]. This significant shift in the composition of the vaginal microbiome is known as bacterial vaginosis (BV). Despite being the most common dysbiosis in women of childbearing age, BV etiology is not yet fully understood, with different controversial theories being raised over the years [3]. [...]