Recent Advances in the Role of Bacteriophages in the Aetiology and Therapy of Vaginal Dysbiosis in the Form of Bacterial Vaginosis and the Prevention of Preterm Birth

Abstract

Bacterial vaginosis is more than a mild inconvenience for women and has been shown to be an important cause of morbidity and mortality in women through sexually transmitted infections, and in babies due to late miscarriage and preterm birth. The aetiology of bacterial vaginosis remains unclear but there is increasing evidence to support sexual transmission as a cause. Preterm birth is a major cause of neonatal and perinatal mortality and morbidity worldwide and a huge cost on healthcare. The earlier bacterial vaginosis is detected in pregnancy, the greater the risk of an adverse outcome like preterm birth. Bacteriophages influence the vaginal microbiome, resulting in a eubiotic or dysbiotic state that may have implications on the prediction and prevention of preterm birth. We have provided the evidence to link vaginal dysbiosis in the form of bacterial vaginosis with the prediction and prevention of preterm birth. We have also explored the role of bacteriophages in bacterial vaginosis and the possibility of therapeutic interventions. Bacteriophages play an important role in the aetiology of vaginal dysbiosis and novel therapeutic interventions may help in the prediction and prevention of preterm birth through achieving vaginal eubiosis.

Keywords: aetiology; bacterial vaginosis; biochemistry; birth; dysbiosis; microbiology; phage virus; prediction; preterm; prevention; probiotics; sexual transmission; treatment; vagina; virome.

Figure 1

The proposed interaction among the mechanisms, aetiology, predisposing factors, and phenotypic outcomes in obstetrics and gynaecology of the bacterial vaginosis syndrome (with permission from RF Lamont) [12]. GYN, gynaecological; Misc, miscarriage; OB, obstetric; PET, pre-eclampsia/toxaemia; PID, pelvic inflammatory disease; PPROM, preterm prelabour rupture of the membranes; PTL, preterm labour; STI, sexually transmitted infection; UTI, urinary tract infection. ↓: decreased and ↑: increased.