Current and emerging pharmacotherapy for recurrent bacterial vaginosis

ABSTRACT

Introduction

Given the frequency of recurrent bacterial vaginosis (RBV), enhancing treatment and preventing recurrence have become the central target of pharmacotherapy today. Antimicrobial failure is occurring at a time when knowledge of pathogenesis of bacterial vaginosis (BV) and RBV is incomplete, limiting rational treatment modification.

Areas Covered

The current manuscript reviews pathogenesis of RBV and the performance of available antimicrobials as well as attempts employed to enhance activity and pharmacologic strategies to reduce BV recurrence and refractory vaginal disease. The authors also provide their expert perspectives on the subject area, including their outlook for the future.

Expert opinion

In the face of an empty pipeline of new antibiotics, strategies have emerged to enhance existing antibiotic efficacy, which include modifying drug dose, treatment duration, long-term prophylactic regimens, and use of biofilm disrupting agents. It is likely that future effective therapy will include several simultaneous and consecutive treatment components, including combinations of antibiotics, antibiofilm agents, and probiotics. Measures to prevent sexual transmission and reinfection are also essential.

KEYWORDS:

• Recurrent bacterial vaginosis
• vaginal microbiota
• anti-anaerobic antibiotics
• biofilm
• probiotics

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article Highlights

• Recurrent Bacterial Vaginosis (RBV) has emerged as a major previously unrecognized complication of BV defying current antimicrobial agents used.

• Pathogenesis of RBV is complex including sexual transmission or reinfection as well as frequent relapse due to persistent or recurrent vaginal dysbiosis

• Molecular advances have facilitated diagnosis, but in spite of recognition of new potential uncultivatable pathogens has not revealed its relevant microbiota details responsible for recurrence

• Probiotics have contributed little to date in preventive RBV although, a new non-commercially available preparation is encouraging

• The role of acquired antibiotic resistance is largely unstudied although, the recently identified BV-biofilm may contribute to resistance

• In the absence of new antibiotics for BV, new strategies have emerged in an attempt to reduce BV recurrence

This box summarizes key points contained in the article.

Additional information

Funding

This manuscript was not funded.