Bacterial Vaginosis

Bacterial Vaginosis is the most common vaginal condition with very high rate of recurrence. It is characterized by the presence of odorous vaginal discharge and is associated with increased risk of preterm birth and HIV transition. In spite of its high prevalence, very little is known about its cause and pathogenesis. Microbiologically, Bacterial Vaginosis is characterized by the excessive growth of anaerobic bacteria, germs associated with infection, and diminishing presence of Lactobacillus species, bacteria normally abundantly present in a healthy women’s vagina. Lactobacilli is a unique group of microorganism with multiple defensive mechanisms. Healthy Lactobacillus species produce lactic acid and bacteriocins, and some species produce hydrogen peroxide, all of which are believed to contribute to the healthy vaginal environment.

The treatments currently approved by FDA for Bacterial Vaginosis are antibiotics, metronidazole and clindamycin. Despite treatment with either treatment agent, approximately 10 to 15% of women fail therapy after 1 month. The proportion of women who relapse over a longer period of time is incredibly high: 25-30% at 3 months and 50-75% at 1 year following therapy. The reason for this high recurrence rate is not understood very too well but one possibility is that the available therapies do not sufficiently differentiate between killing the patogens (bad bacteria) and Lactobacilli, leading to elimination of good bacteria along with bad ones.