Bacterial Vaginosis: An Update on Diagnosis and Treatment

Hans Verstraelen; Rita Verhelst


Expert Rev Anti Infect Ther. 2009;7(9):1109-1124. 

In This Article

Expert Commentary & Five-year View

Diagnosis of BV in the nearby future will definitely continue to rely on standardized clinical criteria that can be assessed rapidly as a point-of-care test by the attending physician. It is even commendable that this approach would be uniformly implemented, as vaginitis is too often treated empirically. Diagnosis is ideally confirmed by analysis of a Gram-stained vaginal smear, although there is a defined need to standardize the procedures and criteria involved. Computer-based cell morphotype recognition is being developed and may help tremendously in the scoring of Gram-stained vaginal smears. Furthermore, following the recent surge of molecular analysis of the vaginal bacterial biota, molecular diagnosis of BV is now pending. Species-specific QRT-PCR techniques are being patented and may become commercially available as diagnostic assays. In addition, highly sensitive high- throughput analysis through deep pyrosequencing will further enlighten our knowledge of bacterial diversity with BV. This in turn may lead to the recognition of distinct microflora patterns representing specific subtypes of BV that may be associated with specific health outcomes. Finally, molecular diagnosis will also document that part of what is now categorized as intermediate microflora actually involves BV biota. As for the treatment of BV, there are very few perspectives, if any, for shotgun therapy and singular treatment courses. Therefore, the focus will shift to long-term treatment regimens aiming at restoring and maintaining a normal vaginal microflora, thereby in itself preventing the recurrence of BV. Further research may explore the potential of disinfectants and vaginal acidifying and buffering agents; however, the expectations of the scientific community are primarily directed to the development of prebiotics, probiotics and synbiotics. Results obtained thus far with the administration of probiotic bacilli following an antibiotic course have not proven unequivocally successful, but at least we have a proof-of-concept for this approach through a couple of randomized clinical trials. Probiotic preparations will be sophisticated further by adding prebiotics and other substances that enhance the colonization and growth of the lactobacilli administered. Finally, therapeutic research in this particular area will be guided by our recently acquired knowledge of BV as a biofilm condition.


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