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Review
. 2025 Jun 19;11(1):43.
doi: 10.1038/s41572-025-00626-1.

Bacterial vaginosis

Catriona S Bradshaw  1   2   3 , Erica L Plummer  4   5 , Christina A Muzny  6 , Caroline M Mitchell  7 , David N Fredricks  8 , Melissa M Herbst-Kralovetz  9 , Lenka A Vodstrcil  10   11   12
Affiliations
Review

Bacterial vaginosis

Catriona S Bradshaw et al. Nat Rev Dis Primers. .

Abstract

Bacterial vaginosis (BV) is a vaginal microbiome disorder that is associated with preterm birth and spontaneous abortion, increased risk of HIV infection and sexually transmitted infections, and has negative effects on quality of life. BV affects one in four women globally, with the highest burden in resource-limited settings. Marked alterations in vaginal microbiome composition, in pro-inflammatory cytokines and chemokines, and in the proteome and metabolome characterize BV and contribute to adverse sequelae. Despite its prevalence, the exact aetiologic agent of BV is unknown and its pathophysiology is poorly understood. These knowledge gaps impede diagnostic and management approaches, with recommended treatment strategies resulting in recurrence that exceeds 50% over 3-6 months. New data on the sexual transmission of BV, including evidence that male-partner treatment improves cure, have improved our understanding of its aetiology and pathogenesis, and provide opportunities for developing optimal diagnostic, treatment and prevention strategies. Other factors probably also contribute to the low efficacy of current treatments, including biofilm and/or antimicrobial resistance, and failure to recolonize a favourable vaginal microbiome after treatment. The complex pathophysiology of BV highlights that individualized and multifaceted management approaches will be required to manage the refractory and adverse sequelae of BV.

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Conflict of interest statement

Competing interests: C.S.B. received research grant support to her institution from the Australian National Health and Medical Council and Australian Research Council. C.S.B. has been an adviser to Abbott Pty Ltd, serves on a number of technical advisory groups of The World Health Organisation and is a board member of the International Society for STD Research. M.M.H.-K. is on the scientific advisory board for Freya Biosciences. D.N.F. receives a royalty from BD for intellectual property (Institution: Fred Hutchinson Cancer Center. Inventors: David Fredricks and Tina Fiedler. US patent: US 7,625,704 B2. Status: issued. Aspect of patent related to manuscript: molecular methods for diagnosis of bacterial vaginosis). D.N.F. is also an officer in the MetaboliteDx corporation. C.A.M. received research grant support to her institution from NIH/NIAID, Lupin Pharmaceuticals, Gilead Sciences, Inc., BioNTech, and Abbott Molecular. C.A.M. also reports consulting fees from Abbott, BioNTech, bioMerieux and Cepheid; honoraria from Abbott, Roche, Elsevier and the Merck Manuals; and royalties from UpToDate. C.M.M. receives royalties from UpToDate and serves on the Scientific Advisory Boards of Concerto Bio, and Ancilia Biosciences. C.M.M. also has a financial interest in Ancilia Biosciences, a company developing a new class of Live Biotherapeutics and other bacterial products. C.M.M.’s interests were reviewed and are managed by Massachusetts General Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. L.A.V. and E.L.P. declare no competing interests.

References

    1. Schröder, R. Zur pathogenese und klinik des vaginalen fluors. Zentralbl. Gynäkol. 45, 1350–1361 (1921).
    1. Gardner, H. L. & Dukes, C. D. Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis. Am. J. Obstet. Gynecol. 69, 962–976 (1955). - PubMed - DOI
    1. Greenwood, J. R. & Pickett, M. J. Transfer of Haemophilus vaginalis Gardner and Dukes to a new genus, Gardnerella: G. vaginalis (Gardner and Dukes). Int. J. Syst. Bacteriol. 30, 170–178 (1980). - DOI
    1. Fredricks, D. N., Fiedler, T. L. & Marrazzo, J. M. Molecular identification of bacteria associated with bacterial vaginosis. N. Engl. J. Med. 353, 1899–1911 (2005). Early molecular study to characterize the bacterial composition of the vaginal microbiota using broad-range PCR, which highlighted bacterial diversity in bacterial vaginosis and identified newly recognized species, including three bacteria in the Clostridiales order that were highly specific for bacterial vaginosis. - PubMed - DOI
    1. Ravel, J. et al. Vaginal microbiome of reproductive-age women. Proc. Natl Acad. Sci. USA 108, 4680–4687 (2011). Early sequencing study that showed the vaginal microbiota of North American women clustered into five groups (community-state types), which have been subsequently widely used to describe the vaginal microbiota within and across populations. - PubMed - DOI

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