OPTIMIZATION OF TREATMENT OF BACTERIAL VAGINOSIS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.5733Keywords:
Bacterial Vaginosis, Antibiotic Treatment, Dysbiosis, Probiotics, BiofilmAbstract
Bacterial vaginosis (BV) is one of the most common dysbioses among sexually active women (prevalence between 23-29%). It is characterized by reduction in the natural microflora of Lactobacillus and overgrowth of anaerobic bacteria, such as Gardnerella vaginalis. BV is an important risk factor for reproductive health complications, including higher incidence of sexual transmitted infections (STIs), preterm birth, and infertility. Standard treatment is based on antibiotics like metronidazole, which is highly effective for alleviating acute symptoms but carries a high recurrence risk (up to 60% within 12 months) due to biofilm formation on the vaginal epithelium, which prevents penetration of medicines and leads to antibiotic resistance. The primary goal of BV treatment is to ensure stable long-term eubiosis through rapid, accurate diagnosis and effective treatment. This review identifies optimization approaches, including alternative antibiotics regimens, biofilm management, and supportive therapies.
References
Chen, X., Lu, Y., Chen, T., & Li, R. (2021). The female vaginal microbiome in health and bacterial vaginosis. Front Cell Infect Microbiol, 11, 631972. https://doi.org/10.3389/fcimb.2021.631972
Prabhurajeshwar, C., & Chandrakanth, R. K. (2017). Probiotic potential of lactobacilli with antagonistic activity against pathogenic strains: An in vitro validation for the production of inhibitory substances. Biomed J, 40(5), 270–283. https://doi.org/10.1016/j.bj.2017.06.008
Kwon, M. S., & Lee, H. K. (2022). Host and microbiome interplay shapes the vaginal microenvironment. Front Immunol, 13, 919728. https://doi.org/10.3389/fimmu.2022.919728
Peebles, K., Velloza, J., Balkus, J. E., McClelland, R. S., & Barnabas, R. V. (2019). High global burden and costs of bacterial vaginosis: A systematic review and meta-analysis. Sexually Transmitted Diseases, 46(5), 304–311. https://doi.org/10.1097/OLQ.0000000000000972
Smith, S. B., & Ravel, J. (2017). The vaginal microbiota, host defence and reproductive physiology. J Physiol, 595(2), 451–463. https://doi.org/10.1113/JP271694
Turovskiy, Y., Sutyak Noll, K., & Chikindas, M. L. (2011). The aetiology of bacterial vaginosis. J Appl Microbiol, 110(5), 1105–28. https://doi.org/10.1111/j.1365-2672.2011.04977.x
Hardy, L., Cerca, N., Jespers, V., Vaneechoutte, M., & Crucitti, T. (2017). Bacterial biofilms in the vagina. Res Microbiol, 168(9–10), 865–874. https://doi.org/10.1016/j.resmic.2017.02.001
Chee, W. J. Y., Chew, S. Y., & Than, L. T. L. (2020). Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microb Cell Fact, 19(1), 203. https://doi.org/10.1186/s12934-020-01464-4
Bradshaw, C. S., Morton, A. N., Hocking, J., Garland, S. M., Morris, M. B., Moss, L. M., Horvath, L. B., Kuzevska, I., & Fairley, C. K. (2006). High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis, 193(11), 1478–86. https://doi.org/10.1086/503780
Swidsinski, S., Moll, W. M., & Swidsinski, A. (2023). Bacterial vaginosis-vaginal polymicrobial biofilms and dysbiosis. Dtsch Arztebl Int, 120(20), 347–354. https://doi.org/10.3238/arztebl.m2023.0090
Sousa, L. G. V., Pereira, S. A., & Cerca, N. (2023). Fighting polymicrobial biofilms in bacterial vaginosis. Microb Biotechnol, 16(7), 1423–1437. https://doi.org/10.1111/1751-7915.14261
Bradshaw, C. S., Morton, A. N., Hocking, J., Garland, S. M., Morris, M. B., Moss, L. M., Horvath, L. B., Kuzevska, I., & Fairley, C. K. (2006). High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis, 193(11), 1478–86. https://doi.org/10.1086/503780
Bilardi, J. E., Walker, S., Temple-Smith, M., McNair, R., Mooney-Somers, J., Bellhouse, C., Fairley, C. K., Chen, M. Y., & Bradshaw, C. (2013). The burden of bacterial vaginosis: Women's experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLoS One, 8(9), e74378. https://doi.org/10.1371/journal.pone.0074378
Kumar, N., Behera, B., Sagiri, S. S., Pal, K., Ray, S. S., & Roy, S. (2011). Bacterial vaginosis: Etiology and modalities of treatment-A brief note. J Pharm Bioallied Sci, 3(4), 496–503. https://doi.org/10.4103/0975-7406.90102
Dickey, L. J., Nailor, M. D., & Sobel, J. D. (2009). Guidelines for the treatment of bacterial vaginosis: Focus on tinidazole. Ther Clin Risk Manag, 5(3), 485–9. https://doi.org/10.2147/tcrm.s3777
Petrina, M. A. B., Cosentino, L. A., Rabe, L. K., & Hillier, S. L. (2017). Susceptibility of bacterial vaginosis (BV)-associated bacteria to secnidazole compared to metronidazole, tinidazole and clindamycin. Anaerobe, 47, 115–119. https://doi.org/10.1016/j.anaerobe.2017.05.005
Mauck, C., Hillier, S. L., Gendreau, J., Dart, C., Chavoustie, S., Sorkin-Wells, V., Nicholson-Uhl, C., Perez, B., Jacobs, M., Zack, N., & Friend, D. (2022). Single-dose, bioadhesive clindamycin 2% gel for bacterial vaginosis: A randomized controlled trial. Obstet Gynecol, 139(6), 1092–1102. https://doi.org/10.1097/AOG.0000000000004805
Armstrong-Buisseret, L., Brittain, C., Kai, J., David, M., Anstey Watkins, J., Ozolins, M., Jackson, L., Abdali, Z., Hepburn, T., Griffiths, F., Montgomery, A., Daniels, J., Manley, A., Dean, G., & Ross, J. D. (2022). Lactic acid gel versus metronidazole for recurrent bacterial vaginosis in women aged 16 years and over: The VITA RCT. Health Technol Assess, 26(2), 1–170. https://doi.org/10.3310/ZZKH4176
Heczko, P. B., Tomusiak, A., Adamski, P., Jakimiuk, A. J., Stefański, G., Mikołajczyk-Cichońska, A., Suda-Szczurek, M., & Strus, M. (2015). Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: A randomised, double-blind, placebo-controlled trial. BMC Womens Health, 15, 115. https://doi.org/10.1186/s12905-015-0246-6
Mtshali, A., San, J. E., Osman, F., Garrett, N., Balle, C., Giandhari, J., Onywera, H., Mngomezulu, K., Mzobe, G., de Oliveira, T., Rompalo, A., Mindel, A., Abdool Karim, S. S., Ravel, J., Passmore, J. S., Abdool Karim, Q., Jaspan, H. B., Liebenberg, L. J. P., & Ngcapu, S. (2021). Temporal changes in vaginal microbiota and genital tract cytokines among South African women treated for bacterial vaginosis. Front Immunol, 12, 730986. https://doi.org/10.3389/fimmu.2021.730986
Gottschick, C., Deng, Z. L., Vital, M., Masur, C., Abels, C., Pieper, D. H., Rohde, M., Mendling, W., & Wagner-Döbler, I. (2017). Treatment of biofilms in bacterial vaginosis by an amphoteric tenside pessary-clinical study and microbiota analysis. Microbiome, 5(1), 119. https://doi.org/10.1186/s40168-017-0326-y
Bitew, A., Mengist, A., Belew, H., Aschale, Y., & Reta, A. (2021). The prevalence, antibiotic resistance pattern, and associated factors of bacterial vaginosis among women of the reproductive age group from Felege Hiwot Referral Hospital, Ethiopia. Infect Drug Resist, 14, 2685–2696. https://doi.org/10.2147/IDR.S305329
Smart, S., Singal, A., & Mindel, A. (2004). Social and sexual risk factors for bacterial vaginosis. Sex Transm Infect, 80(1), 58–62. https://doi.org/10.1136/sti.2003.004978
Muzny, C. A., & Kardas, P. (2020). A narrative review of current challenges in the diagnosis and management of bacterial vaginosis. Sex Transm Dis, 47(7), 441–446. https://doi.org/10.1097/OLQ.0000000000001178
Simoes, J. A., Bahamondes, L. G., Camargo, R. P., Alves, V. M., Zaneveld, L. J., Waller, D. P., Schwartz, J., Callahan, M. M., & Mauck, C. K. (2006). A pilot clinical trial comparing an acid-buffering formulation (ACIDFORM gel) with metronidazole gel for the treatment of symptomatic bacterial vaginosis. Br J Clin Pharmacol, 61(2), 211–7. https://doi.org/10.1111/j.1365-2125.2005.02550.x
Surapaneni, S., Akins, R., & Sobel, J. D. (2021). Recurrent bacterial vaginosis: An unmet therapeutic challenge. Experience with a combination pharmacotherapy long-term suppressive regimen. Sex Transm Dis, 48(10), 761–765. https://doi.org/10.1097/OLQ.0000000000001420
Powell, A., Ghanem, K. G., Rogers, L., Zinalabedini, A., Brotman, R. M., Zenilman, J., & Tuddenham, S. (2019). Clinicians' use of intravaginal boric acid maintenance therapy for recurrent vulvovaginal candidiasis and bacterial vaginosis. Sex Transm Dis, 46(12), 810–812. https://doi.org/10.1097/OLQ.0000000000001063
Caliskan, M., Karadeniz, O., Goksu, M., & Cetin, A. (2025). Intravaginal boric acid treatment for recurrent bacterial vaginosis: Short-term effects on vaginal health parameters and patient satisfaction. BMC Womens Health, 25(1), 536. https://doi.org/10.1186/s12905-025-04084-5
Gaspar, C., Rolo, J., Cerca, N., Palmeira-de-Oliveira, R., Martinez-de-Oliveira, J., & Palmeira-de-Oliveira, A. (2021). Dequalinium chloride effectively disrupts bacterial vaginosis (BV) Gardnerella spp. Biofilms. Pathogens, 10(3), 261. https://doi.org/10.3390/pathogens10030261
Haydock, R., Hepburn, T., Ross, J., Daniels, J., Brittain, C., Jackson, L., Ozolins, M., & Wilson, J. (2022). The DEVA trial: Protocol for a randomised controlled trial of dequalinium chloride versus usual care antibiotics for the treatment of bacterial vaginosis. Trials, 23(1), 1040. https://doi.org/10.1186/s13063-022-06954-x
Hay, P. (2017). Bacterial vaginosis. F1000Res, 6, 1761. https://doi.org/10.12688/f1000research.11417.1
Rezazadeh, M. B., Zanganeh, M., Jarahi, L., & Fatehi, Z. (2024). Comparative efficacy of oral and vaginal probiotics in reducing the recurrence of bacterial vaginosis: A double-blind clinical trial. BMC Womens Health, 24(1), 575. https://doi.org/10.1186/s12905-024-03418-z
Chen, R., Li, R., Qing, W., Zhang, Y., Zhou, Z., Hou, Y., Shi, Y., Zhou, H., & Chen, M. (2022). Probiotics are a good choice for the treatment of bacterial vaginosis: A meta-analysis of randomized controlled trial. Reprod Health, 19(1), 137. https://doi.org/10.1186/s12978-022-01449-z
Hemmerling, A., Wierzbicki, M. R., Armstrong, E., & Cohen, C. R. (2024). Response to antibiotic treatment of bacterial vaginosis predicts the effectiveness of LACTIN-V (Lactobacillus crispatus CTV-05) in the prevention of recurrent disease. Sex Transm Dis, 51(6), 437–440. https://doi.org/10.1097/OLQ.0000000000001962
Pagar, R., Deshkar, S., Mahore, J., Patole, V., Deshpande, H., Gandham, N., Mirza, S., Junnarkar, M., & Nawani, N. (2024). The microbial revolution: Unveiling the benefits of vaginal probiotics and prebiotics. Microbiol Res, 286, 127787. https://doi.org/10.1016/j.micres.2024.127787
Abbe, C., & Mitchell, C. M. (2023). Bacterial vaginosis: A review of approaches to treatment and prevention. Front Reprod Health, 5, 1100029. https://doi.org/10.3389/frph.2023.1100029
Samantaray, S. R., Parida, S., & Mohapatra, I. (2024). Connecting the dots: Exploring the relationship between menstrual hygiene and bacterial vaginosis in eastern India. J Family Med Prim Care, 13(10), 4451–4456. https://doi.org/10.4103/jfmpc.jfmpc_431_24
Vodstrcil, L. A., Muzny, C. A., Plummer, E. L., Sobel, J. D., & Bradshaw, C. S. (2021). Bacterial vaginosis: Drivers of recurrence and challenges and opportunities in partner treatment. BMC Med, 19(1), 194. https://doi.org/10.1186/s12916-021-02077-3
Tuniyazi, M., & Zhang, N. (2023). Possible therapeutic mechanisms and future perspectives of vaginal microbiota transplantation. Microorganisms, 11(6), 1427. https://doi.org/10.3390/microorganisms11061427
Haahr, T., Ersbøll, A. S., Karlsen, M. A., Svare, J., Sneider, K., Hee, L., Weile, L. K., Ziobrowska-Bech, A., Østergaard, C., Jensen, J. S., Helmig, R. B., & Uldbjerg, N. (2016). Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery - a clinical recommendation. Acta Obstet Gynecol Scand, 95(8), 850–60. https://doi.org/10.1111/aogs.12933
Yang, S., Reid, G., Challis, J. R. G., Gloor, G. B., Asztalos, E., Money, D., Seney, S., & Bocking, A. D. (2020). Effect of oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillusreuteri RC-14 on the vaginal microbiota, cytokines and chemokines in pregnant women. Nutrients, 12(2), 368. https://doi.org/10.3390/nu12020368
Skafte-Holm, A., Humaidan, P., Bernabeu, A., Lledo, B., Jensen, J. S., & Haahr, T. (2021). The association between vaginal dysbiosis and reproductive outcomes in sub-fertile women undergoing IVF-treatment: A systematic PRISMA review and meta-analysis. Pathogens, 10(3), 295. https://doi.org/10.3390/pathogens10030295
Haahr, T., Elbaek, H. O., Laursen, R. J., Alsbjerg, B., Jensen, J. S., & Humaidan, P. (2017). Treatment of abnormal vaginal microbiota before frozen embryo transfer: Case-report and minireview to discuss the longitudinal treatment efficacy of oral clindamycin. Front Physiol, 8, 415. https://doi.org/10.3389/fphys.2017.00415
Cauci, S., Driussi, S., De Santo, D., Penacchioni, P., Iannicelli, T., Lanzafame, P., De Seta, F., Quadrifoglio, F., de Aloysio, D., & Guaschino, S. (2002). Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women. J Clin Microbiol, 40(6), 2147–52. https://doi.org/10.1128/JCM.40.6.2147-2152.2002
Yoshikata, R., Yamaguchi, M., Mase, Y., Tatsuyuki, A., Myint, K. Z. Y., & Ohta, H. (2022). Evaluation of the efficacy of Lactobacillus-containing feminine hygiene products on vaginal microbiome and genitourinary symptoms in pre- and postmenopausal women: A pilot randomized controlled trial. PLoS One, 17(12), e0270242. https://doi.org/10.1371/journal.pone.0270242
Redelinghuys, M. J., Geldenhuys, J., Jung, H., & Kock, M. M. (2020). Bacterial vaginosis: Current diagnostic avenues and future opportunities. Front Cell Infect Microbiol, 10, 354. https://doi.org/10.3389/fcimb.2020.00354
Savicheva, A. M., Krysanova, A. A., Budilovskaya, O. V., Spasibova, E. V., Khusnutdinova, T. A., Shalepo, K. V., Beliaeva, N. R., Safarian, G. K., Sapozhnikov, K. V., Tapilskaya, N. I., & Kogan, I. Y. (2023). Vaginal microbiota molecular profiling in women with bacterial vaginosis: A novel diagnostic tool. Int J Mol Sci, 24(21), 15880. https://doi.org/10.3390/ijms242115880
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Copyright (c) 2026 Patrycja Gągałka, Zuzanna Guzowicz, Bartosz Niemiec, Bruno Olesiński, Szymon Piosik, Łukasz Piasecki, Natalia Dudziak, Zuzanna Drozd, Monika Kamińska

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