Abstract
The vaginal microbiome is a well-defined compartment of the human microbiome. It has unique conditions, characterized by the dominance of one bacterial species, the Lactobacilli. This microbiota manifests itself by a low degree of diversity and by a strong dynamic of change in its composition under the influence of various exogenous and endogenous factors. The increase in diversity may paradoxically be associated with dysbiosis, such as bacterial vaginosis (BV). BV is the result of a disturbance in the vaginal ecosystem; i.e., a sudden replacement of Lactobacilli by anaerobic bacteria such as Gardnerella vaginalis, Atopobium vaginae, Ureaplasma urealyticum, Mycoplasma hominis, and others. It is the most common cause of vaginal discharge in women of childbearing age, approximately 30% of all causes. The etiology of this dysbiosis remains unknown, but its health consequences are significant, including obstetrical complications, increased risk of sexually transmitted infections and urogenital infections. Its diagnosis is based on Amsel’s clinical criteria and/or a gram stain based on the Nugent score. While both of these methods have been widely applied worldwide for approximately three decades, Nugent score are still considered the “gold standard” of BV diagnostic tools. Given the limitations of these tools, methods based on molecular biology have been developed as alternative rational strategies for the diagnosis of BV. The treatment of BV aims at restoring the balance of the vaginal flora to stop the proliferation of harmful microorganisms. Prescription of antibiotics such as metronidazole, clindamycin, etc. is recommended. Faced with the considerable uncertainty about the cause of BV, the high rate of recurrence, the unacceptable treatment options, and clinical management which is often insensitive and inconsistent, research on this topic is intensifying. Knowledge of its composition and its associated variations represents the key element in improving the therapeutic management of patients with the most suitable treatments possible.
Highlights
The vaginal microbial community is complex and dynamic, consisting of a group of bacteria typically characterized by abundant Lactobacilli that evolve during the life of the woman, depending on age, hormonal estrogen levels, sexual practices and the environment (Kumar et al, 2011; Bilardi et al, 2016b)
In 2011, a study by Ravel et al characterized the vaginal microbiota of asymptomatic North American women with pyrosequencing, showing that the vaginal flora of Asian and white American women was dominated by Lactobacilli, unlike Hispanic and AfricanAmerican women, of whom only 60% had a Lactobacillusdominated vaginal flora (Ravel et al, 2011)
The quantification of these bacteria makes it possible to establish a precise diagnosis of bacterial vaginosis (BV), with a sensitivity ranging from 90.5% to 96.7% and a specificity ranging from 85.8% to 95% compared to Amsel criteria and Nugent score (Coleman and Gaydos, 2018)
Summary
The vaginal microbial community is complex and dynamic, consisting of a group of bacteria typically characterized by abundant Lactobacilli that evolve during the life of the woman, depending on age, hormonal estrogen levels, sexual practices and the environment (Kumar et al, 2011; Bilardi et al, 2016b). BV is a dysbiosis of the vaginal microbiota characterized by a shift from Lactobacilli dominance to that of a mixture of various anaerobic bacteria (Mårdh, 1993; Hay, 2002). It is the most common vaginal disorder worldwide in women of childbearing age (Cristiano et al, 1996; Hogan et al, 2007; Trabert and Misra, 2007). Standard antibiotic therapy often fails, with an estimated relapse rate of 50% at six months follow-up (Bradshaw et al, 2006; Bretelle et al, 2015)
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