Abstract
Bacterial vaginosis (BV) is the most common vaginal infection worldwide. It is associated with an increased risk of acquisition of HIV and other sexually transmitted infections (STIs) as well as pelvic inflammatory disease and adverse birth outcomes. During BV, a polymicrobial biofilm forms on the surface of the vaginal mucosa. However, the exact etiology of BV remains controversial which has impeded significant advances in diagnosis, treatment, and prevention. Despite 30-day cure rates approaching 80% in BV-infected women treated with 7 days of oral metronidazole, recurrence within 12 months is common. This article provides a current review of the epidemiology, pathogenesis, diagnosis, and treatment of recurrent BV for practicing clinicians who commonly see women with this recurrent vaginal infection. Regarding management, we focus primarily on antimicrobial measures that may be effective. Future areas of research in this field are also discussed.
Acknowledgments
Christina A. Muzny, MD, MSPH is currently funded by the National Institute of Allergy and Infectious Diseases (grants R01AI146065-01A1 and R21AI167754-01).
Disclosure
CAM reports receiving grants to her institution from NIAID, Lupin, Abbott Molecular, and Gilead. She also reports honorarium and/or consulting fees from Scynexis, Cepheid, BioNTech, Visby Medical, Elsevier, UpToDate, Abbott Molecular, and Roche. In addition, CAM has a US Provisional Patent Application No: 63/355,887 pending for UAB, Minho University, and the Portuguese National Institute for Agricultural and Veterinary Research (UAB Ref No. U22-031/KT Ref No. 035979-1329130-217PV1). JDS has been a consultant to Scynexis Pharmaceuticals and Mycovia Pharmaceuticals and receives royalties from UpToDate.