From Relapse to Restoration: Insights into the Immunopathology of Bacterial Vaginosis (BV) in Women of Reproductive Age

Bacterial vaginosis (BV) has been a subject of study for decades, yet its complex pathogenesis remains poorly understood. BV affects most women of reproductive age, with significant associations to gynecological and obstetric complications. A deeper understanding of the complicated host-microbiota dynamic is crucial for advancing treatment options, as BV continues to pose challenges in effective management. This review aims to explore the current research on vaginal microbiota as well as potential mechanisms of BV-associated bacteria (BVAB) and their interaction with the host immune system, altogether sheds light on the complex interplay within the human reproductive tract. While Lactobacillus-dominant communities support vaginal mucosal health and reduce inflammation, BVAB promote pro-inflammatory cytokines production and contribute to the degradation of epithelial integrity that further complicate the host defense mechanism. In light of frequent BV relapse, this review also explores emerging therapeutic strategies and research directions focused on targeting persistent BVAB and restoring vaginal microbiota to enhance treatment effectiveness and support long-term management.