Utility of Next-generation sequencing in Managing Bacterial Vaginosis: Examples from Clinical Practice

Abstract

There is an unacceptably high recurrence rate for bacterial vaginosis and vaginitis owing to multiple causes, including misdiagnosis and empirical under-treatment and over-treatment. A diagnostic test that provided complete knowledge of the vaginal microbiome in patients with bacterial vaginosis (BV) would fill an important void. In initial evaluations of Next-generation Sequencing (NGS), this new test offers great promise.As a clinical diagnostic for primary or recurrent bacterial vaginosis, NGS by simple vaginal swab offers heightened sensitivity and specificity compared to culture or limited three-organism genetic tests. NGS holds valuable potential in multiple BV quandary situations, including: (a) Recurrent BV in a patient that failed initial therapy, (b) Symptoms of BV in a patient with false-positive Amsel criteria, (c) Gardnerellavaginalis-negative BV with mixed infection. Multiplex next-generation sequencing (NGS) provides a complete and accurate description of the composition of the complex polymicrobial vaginal microbiome and associated antimicrobial resistance-determining genes, facilitating personalized diagnosis and therapy for patients with bacterial vaginosis, STIs and vaginitis.