title: Infection through structured polymicrobial Gardnerella biofilms (StPM-GB).
abstract: We analysed data on bacterial vaginosis (BV) contradicting the paradigm of mono-infection.
  
  
  
  Tissues and epithelial cells of vagina, uterus, fallopian tubes and perianal region were investigated using fluorescence in situ hybridization (FISH) in women with BV and controls.
  
  
  
  Healthy vagina was free of biofilms. Prolific structured polymicrobial (StPM) Gardnerella-dominated biofilm characterised BV. The intact StPM-Gardnerella-biofilm enveloped desquamated vaginal/prepuce epithelial cells and was secreted with urine and sperma. The disease involved both genders and occurred in pairs. Children born to women with BV were negative. Monotherapy with metronidazole, moxifloxacin or local antiseptics suppressed but often did not eradicate StPM-Gardnerella-biofilms. There was no BV without Gardnerella, but Gardnerella was not BV. Outside of StPM-biofilm, Gardnerella was also found in a subset of children and healthy adults, but was dispersed, temporal and did not transform into StPM-Gardnerella-biofilm.
  
  
  
  StPM-Gardnerella-biofilm is an infectious subject. The assembly of single players to StPM-Gardnerella-biofilm is a not trivial every day process, but probably an evolutionary event with a long history of growth, propagation and selection for viability and ability to reshape the environment. The evolutionary memory is cemented in the structural differentiation of StPM-Gardnerella-biofilms and imparts them to resist previous and emerging challenges.
authors: Charité Hospital, CCM, Laboratory for Molecular Genetics, Polymicrobial Infections and Bacterial Biofilms and Department of Medicine, Gastroenterology, Universitätsmedizin Berlin, Germany. alexander.swidsinski@charite.de.
authors: Alexander
authors: A
authors: Swidsinski
authors: Charité Hospital, CCM, Laboratory for Molecular Genetics, Polymicrobial Infections and Bacterial Biofilms and Department of Medicine, Gastroenterology, Universitätsmedizin Berlin.
authors: Vera
authors: V
authors: Loening-Baucke
authors: Vivantes Kliniken für Gynaekologie und Geburtshilfe, Am Urban and im Friedrichshain, Berlin, Germany.
authors: Werner
authors: W
authors: Mendling
authors: Outpatient Clinic, Charité Universitätsmedizin Berlin, CCM, Berlin, Germany.
authors: Yvonne
authors: Y
authors: Dörffel
authors: Charité Hospital, CCM, Laboratory for Molecular Genetics, Polymicrobial Infections and Bacterial Biofilms and Department of Medicine, Gastroenterology, Universitätsmedizin Berlin.
authors: Johannes
authors: J
authors: Schilling
authors: DRK Kliniken Berlin Westend, Klinik für Gynaekologie und Geburtshilfe, Berlin.
authors: Zaher
authors: Z
authors: Halwani
authors: Department of Obstetrics and Gynecology, the first affiliated hospital of Jinan University, Guangzhou, China.
authors: Xue-feng
authors: XF
authors: Jiang
authors: Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
authors: Hans
authors: H
authors: Verstraelen
authors: Labor Berlin, Department of Microbiology, Berlin, Germany.
authors: Sonja
authors: S
authors: Swidsinski
mesh_terms: D018441:Biofilms / Q000187:drug effects / Q000254:growth & development*; D002181:Candidiasis, Vulvovaginal / Q000382:microbiology; D016022:Case-Control Studies; D005260:Female; D016975:Gardnerella / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D011247:Pregnancy; D014621:Vagina / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000188:drug therapy / Q000382:microbiology*