BACTERIAL VAGINOSIS: CURRENT THERAPEUTIC STRATEGIES AND CLINICAL CHALLENGES

Abstract

This review article addresses Bacterial vaginosis (BV), the most common cause of vaginal discharge in women of reproductive age, characterized by profound dysbiosis of the vaginal microbiota. The introduction establishes the clinical relevance of BV, which goes beyond the symptoms of discharge, associating it with an increased risk of acquiring Sexually Transmitted Infections (STIs), gynecological complications such as Pelvic Inflammatory Disease (PID), and adverse obstetric outcomes such as preterm birth. The main objective of the study is to review current therapeutic strategies, diagnostic methods, and, most importantly, the clinical challenges posed by the extremely high recurrence rates of the condition. The methodology employed was a narrative review of the literature, with searches conducted in the PubMed database for publications from the last five years, using descriptors such as 'Vaginosis, bacterial,' 'Diagnosis,' and 'Treatment.' In the results and discussion, the paper details diagnostic approaches, from the Amsel clinical criteria, widely used in practice, to the Nugent score (Gram stain), considered the gold standard in research. It also highlights the emergence of molecular methods (qPCR) as more sensitive, but costly, tools. The treatment section confirms that antibiotics (metronidazole and clindamycin) are the first-line treatment and achieve high initial cure rates (70-80%). However, the crucial point of the discussion is the challenge of recurrence, which affects more than 50% of women within 12 months. The causes are multifactorial, including the persistence of biofilm-forming bacteria, failure to reestablish the lactobacilli flora, and possible reinfection by sexual partners. The study concludes by exploring emerging therapies that aim to overcome this limitation, such as the use of probiotics, boric acid, and the innovative, still under investigation, Vaginal Microbiota Transplantation (VMT).