title: Current Treatment of Bacterial Vaginosis-Limitations and Need for Innovation.
abstract: Practitioners and patients alike widely recognize the limitations of current therapeutic approaches to the treatment of bacterial vaginosis (BV). Options remain extremely limited, and our inability to prevent the frequently, often relentless symptomatic recurrences of BV and to reduce serious sequelae such as preterm delivery, remains an acknowledged but unresolved shortcoming. Our incomplete understanding of the pathophysiology of this unique form of vaginal dysbiosis has been a significant impediment to developing optimal treatment and prevention approaches. New drugs have not been forthcoming and are not likely to be available in the immediate future; hence, reliance on the optimal use of available agents has become essential as improvised often unproven regimens are implemented. In this review, we will explore the limitations of currently recommended therapies, with a particular focus on the contribution of reinfection and pathogen persistence to BV recurrence, and the development of interventions that target these mechanisms. Ultimately, to achieve sustained cure and effectiveness against BV-associated sequelae, it is possible that we will need approaches that combine antimicrobials with biofilm-disrupting agents and partner treatments in those at risk of reinfection.
authors.affiliation: Melbourne Sexual Health Centre Central Clinical School, Monash University, Clayton, Australia.
authors.forename: Catriona S
authors.initials: CS
authors.lastname: Bradshaw
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects*; D064806:Dysbiosis / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006194:Gardnerella vaginalis / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D010413:Penis / Q000382:microbiology; D012008:Recurrence; D015231:Sexually Transmitted Diseases, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D014621:Vagina / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission
chemical_list: D000890:Anti-Infective Agents
keywords: bacterial vaginosis; recurrence; treatment approaches