Treatment strategies in different phenotypic forms of bacterial vaginosis

BACKGROUND: Bacterial vaginosis represents the most prevalent non-inflammatory syndrome affecting the lower genital tract in women. It is associated with significant complications in obstetric and gynecological practice. At present, the only recommended treatment regimens for bacterial vaginosis include antibiotics (metronidazole and clindamycin), which have been observed to have only short-term effects. Recurrence of bacterial vaginosis occurs in 50–80% of cases within a year of completing treatment. This may be attributed to the distinctive characteristics of the vaginal microbiome and the fact that following antibiotic treatment, beneficial strains of Lactobacillus spp., such as L. crispatus, are unable to recolonize the vagina. In the absence of an efficacious and long-term treatment, clinicians and scientists are investigating alternative approaches to the management and prevention of this syndrome. This has led to a rapid evolution in the understanding of the etiology of bacterial vaginosis and of the best patient care. Current research in this field is focused on the use of antiseptics, probiotics, prebiotics, transplantation of the vaginal microbiome, pH modulation and biofilm disruption as potential treatments for bacterial vaginosis. AIM: The objective is to identify the species of vaginal Lactobacillus and the genotypes of Gardnerella vaginalis in women before treatment of bacterial vaginosis and after administration of a one-step antibacterial regimen in comparison to a two-step therapy with suppositories containing at least 10⁷ live Lactobacillus acidophilus or a lactic acid-glycogen complex. MATERIAL AND METHODS: A prospective, comparative, randomized study was conducted in 90 women aged 18 to 45 years old diagnosed with bacterial vaginosis based on the molecular genetic characteristics of the vaginal microbiota. The patients were randomized to one of three groups, with 30 subjects in each. Group 1 received only antibiotic therapy, Group 2 received antibiotic therapy concomitantly with a suppository containing ≥107 live Lactobacillus acidophilus, and Group 3 received antibiotic therapy concomitantly with lactic acid and glycogen. Clinical and laboratory efficacy of the treatment was assessed at the end of Week 4. RESULTS: The results showed that four weeks after treatment, all study groups experienced favorable changes in the symptoms and signs, normalization of vaginal pH, and improvements in molecular genetic testing. These effects were more pronounced in Group 2 patients. CONCLUSION: The combination of antibiotic therapy with lactic acid and glycogen demonstrated high clinical efficacy and good tolerability. However, further studies are needed to assess the long-term results of this treatment approach.