Bacterial vaginosis: novel aspects of etiology, pathogenesis, and selection of therapeutic strategy

Abstract

G.B. Dikke F.I. Inozemtsev Academy of Medical Education, St. Petersburg, Russian Federation The article discusses novel data on vaginal microbiome composition, risk factors, occurrence, pathogenesis, diagnosis, modification of therapeutic approaches, and prevention of recurrences of bacterial vaginosis. Recent published data demonstrate that epidemiological profile of bacterial vaginosis is similar to that of sexually transmitted infections. Moreover, women with bacterial vaginosis have 2.7-fold higher relative risk of sexually transmitted infections. According to the conceptual pathogenic model, the major causative agent of bacterial vaginosis is Gardnerella vaginalis. However, its virulent properties manifest in the presence of other microbes. Immune-mediated mechanisms of bacterial vaginosis and inflammatory response were identified. It was demonstrated that Amsel criteria and culturing are not diagnostically relevant any more. Currently, vaginal smear microscopy and Nugent’s score are of primary importance. Treatment approaches to bacterial vaginosis (regarding recent studies on antimicrobial efficacy) should include broad-spectrum agents (considering polymicrobial etiology of bacterial vaginosis) which contain high dosages of active ingredients (due to the potential antimicrobial resistance, in particular, in recurrent bacterial vaginosis) and with minimal inhibitory effect on lactobacilli. Keywords: bacterial vaginosis, vaginal discharge, Gardnerella vaginalis, metronidazole, clindamycin, Metromicon-Neo. For citation: Dikke G.B. Bacterial vaginosis: novel aspects of etiology, pathogenesis, and selection of therapeutic strategy. Russian Journal of Woman and Child Health. 2019;2(4):307–313.