Bacterial Vaginosis: Current Diagnostic Avenues and Future Opportunities

Abstract

A healthy female genital tract harbors a microbiome dominated by lactic acid and hydrogen peroxide producing bacteria, which provide protection against infections by maintaining a low pH. Changes in the bacterial compositions of the vaginal microbiome can lead to bacterial vaginosis (BV), which is often associated with vaginal inflammation. Bacterial vaginosis increases the risk of acquiring sexually transmitted infections (STIs) like human immunodeficiency virus (HIV) and affects women's reproductive health negatively. In pregnant women, BV can lead to chorioamnionitis and adverse pregnancy outcomes, including preterm premature rupture of the membranes and preterm birth. In order to manage BV effectively, good diagnostic procedures are required. Traditionally clinical and microscopic methods have been used to diagnose BV; however, these methods require skilled staff and time and suffer from reduced sensitivity and specificity. New diagnostics, including highly sensitive and specific point-of-care (POC) tests, treatment modalities and vaccines can be developed based on the identification of biomarkers from the growing pool of vaginal microbiome and vaginal metabolome data. In this review the current and future diagnostic avenues will be discussed.

Keywords: bacterial vaginosis; diagnostics; female genital tract; vaginal inflammation; vaginal metabolome; vaginal microbiome.

Figure 1

Current diagnostics and future possibilities for BV detection and/or BV pathogenesis characterization. Figure annotations in acronym or abbreviated form are: DESI-MS, desorption electrospray ionization-mass spectrometry; GP, genetic programming; IFN, interferon; IL, interleukin; LR, logistic regression; NMR, nuclear magnetic resonance; PCR, polymerase chain reaction; PNA-FISH, peptide nucleic acid fluorescence in situ hybridization; RF, random forest; TLR, toll-like receptor; VGTest-IMS, VGTest-ion mobility spectrometry.