Could targeting neighboring bacterial populations help combat bacterial vaginosis?

Abstract

[Excerpt] Bacterial vaginosis (BV), the most common vaginal disorder in women of reproductive age, remains one of the most intriguing and controversial challenges in modern day clinical microbiology. High prevalence and relapse rates make this infection of paramount global importance [1]. Yet, despite its impact on women’s health, its etiology is still unknown [2]. In the early years, researchers and physicians attributed Gardnerella vaginalis as the sole causative agent of BV [3] but this concept was replaced by the polymicrobial theory, which proposed that BV was caused by a complex microbial community, where G. vaginalis was present, but not sufficient to cause BV [4]. A few years later, inconsistencies with the polymicrobial theory arose from epidemiological data, suggesting that BV was a sexually transmitteddisease(STD),whichwouldrequireasoleetiologicalagent [5].TheSTDtheoryalsohaditspitfallswith some inconsistencies noted [6]. Furthermore, it has been suggested that BV is perhaps not a typical STD, but that sexual activity does enhance its occurrence [7], although no experimental data pursued this line of thought. Other theories have explored the inherent genetic background of women as a possible direction for the cause of BV [8]. However, once again, genotyping studies did not always agree with epidemiological data [9]. A recent hallmark in this research field was the realization that BV is associated with bacterial biofilms [10]. This puts all previous BV research into perspective. [...]