Bacterial Vaginosis: Understanding Symptoms and Treatment Options

Vaginal Microbiota and Causes of  Vaginal Dysbiosis

Vaginal microbiome is sometimes referred to as a vaginal microbiota which in turn is very crucial for overall health. The vaginal microbiome is the first line of defense against pathogens that can cause infections; altered vaginal microbiota can risk the likelihood of getting pregnant, miscarrying and also developing certain cancers.¹

The vagina  is occupied by almost 90–95% lactobacilli in a very balanced, healthy state amid the reproductive years. Glycogen is stored by vaginal epithelial cells, and when “friendly” lactobacilli digest the carbohydrate, lactic acid is created. This fermentation procedure lowers the pH of the vagina, inhibits the formation of potentially hazardous anaerobes, and prevents pathogens from adhering to the vaginal epithelium. Additionally, lactobacilli create antimicrobials such as bacteriocins and hydrogen peroxide that prevent biofilm formation and keep pathogenic anaerobes inactive. But when the bacterial balance of the vagina is  disturbed then it can cause bacterial dysbiosis which can lead to bacterial vaginosis.²

Vaginal Dysbiosis³

Dysbiosis is a condition where alteration of  the body’s microbial community diminishes  the  essential population of good bacteria and allows pathogenic (bad) bacteria that are normally present in low amounts, to flourish. The vaginal microbiome dysbiosis that affects women may lead to bacterial vaginosis (BV), which is sometimes silent, occasionally annoying and highly prevalent. Bacterial vaginosis accounts for 40%-50% of the cases of vaginal infections in which a cause is identified, vulvovaginal candidiasis (VVC) accounts for 20% to 25%, and trichomoniasis accounts for 15% to 20% of cases.

Causes of Bacterial Vaginosis

In bacterial vaginosis (BV), there is a significantly lesser Lactobacillus count and a complete overgrowth of other microbes, which upsets the natural balance of the vaginal microbiome which is very important for vaginal health. Common bacteria identified in bacterial vaginosis includes:

• Peptostreptococcus
• Gardnerella vaginalis
• Prevotella spp
• Mycoplasma hominis
• Mobiluncus spp 

Symptoms of Bacterial Vaginosis

 Following are the symptoms of Bacterial vaginosis:⁴

• Burning sensation when peeing
• A thin discharge from the vagina that is white or gray in color
• Burning sensation, pain, and itching in the vagina
• A fish like odor
• Itching around the outer vaginal area

The diagnosis of bacterial vaginosis can be carried out using the Nugent scoring system or the Amsel’s criteria. Amsel’s criteria for diagnosis of BV are met when 3 out of 4 of the following clinical signs are present:⁵

1. Epithelial cells on wet mount
2. Abnormal vaginal discharge
3. Vaginal pH > 4.5
4. Amine (fish-like) odor when the vaginal fluid is exposed to 10% potassium hydroxide (KOH).

The Nugent scoring system (NSS) can also be used to diagnose BV with a Gram stain, a microscope, and a (0–10) score on the basis of the amount of subsequent microorganisms observed per high-powered field.

• Gram variable rods (Garderella vaginalis morphotypes)
• Lactobacillus morphotypes
• Curved rods (Mobiluncus species morphotypes)

Traditional BV treatments include⁶

• Metronidazole
• Clindamycin
• Tinidazole
• Secnidazole

Following are the probiotics used for BV:⁷

• L. acidophilus LA14
• L. fermentum LF10 + L. plantarum LP02
• L. gasseri DSM 14869 + L. rhamnosus DSM 14870
• L. plantarum P17630
• L. crispatus LBV88+L. rhamnosus LBV96+L. jensenii LBV116+L. gasseri LBV150N

News:

A Major Advancement In The Treatment of Bacterial Vaginosis For The Well-being of Women

Women’s health campaigners have maintained for years that much more research on women’s bodies and health is required. There hasn’t been an animal model for studying bacterial vaginosis since 1982. The bacterial community in the human vagina is unique among species. The development of a vaginal chip was inspired by studies on environmental enteric dysfunction, a juvenile illness most prevalent in low-resource countries and the second leading cause of death in children under the age of five. This research was supported by the Gates Foundation. At that point, Ingber realized how significantly the child’s microbiota affected this illness.¹¹

The scientists seeded the top channel of a polymer chip with human vaginal epithelial cells using the Wyss Institute’s microfluidic Organ Chip platform, which was later licenced to Emulate. Human uterine fibroblast cells were then put to the other side of the permeable membrane that separated the top and bottom channels. This three-dimensional design resembled the structure of the human vaginal wall.The Vagina Chip has grown numerous unique layers of differentiated cells that resembled those found in human vaginal tissue after five days. Three distinct consortia were placed into the chip, each containing numerous strains of L. crispatus, and all three effectively colonized the chips after three days. The consortium also started creating lactic acid, which helps to keep the vagina’s pH low and inhibits the growth of other microorganisms. Chips containing bacterial consortia produced decreased levels of numerous inflammation-causing cytokine molecules, which aids in the control of inflammation in healthy human vaginas.¹⁰ The vaginal chip will advance knowledge of fundamental female reproductive biology and hasten the process of creating novel women’s health treatments.¹¹

1. The vaginal microbiome regulates vaginal health and disease and has a significant influence on prenatal health.¹⁰
2. Bacterial vaginosis (BV) is caused by changes in the vaginal microbiome, and it affects roughly 30% of reproductive-aged women worldwide.¹⁰
3. The human Vagina Chip provides an appealing method for studying host-microbiome interactions and expediting the development of novel probiotic therapies.¹⁰
4. The chip may aid researchers in developing new therapies for endometriosis, chlamydia, and vaginal yeast infections in addition to bacterial vaginosis.¹¹
5. This model can be used to evaluate various microbe combinations in order to find the best probiotic therapy for BV and other illnesses.¹⁰

Reference: 

1. https://www.metagenicsinstitute.com/blogs/bacterial-vaginosis-symptoms/
2. Chen X, Lu Y, Chen T, Li R. The Female Vaginal Microbiome in Health and Bacterial Vaginosis. Front Cell Infect Microbiol. 2021 Apr 7;11:631972. doi: 10.3389/fcimb.2021.631972. PMID: 33898328; PMCID: PMC8058480.
3. Saraf VS, Sheikh SA, Ahmad A, Gillevet PM, Bokhari H, Javed S. Vaginal microbiome: normalcy vs dysbiosis. Arch Microbiol. 2021 Sep;203(7):3793-3802. doi: 10.1007/s00203-021-02414-3. Epub 2021 Jun 13. PMID: 34120200.
4. Amsel R et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiological associations. Am J Med. 1983;74:14-22.
5. https://www.metagenicsinstitute.com/blogs/bacterial-vaginosis-symptoms/
6. https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285
7. van de Wijgert J, Verwijs MC. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG. 2020 Jan;127(2):287-299. doi: 10.1111/1471-0528.15870. Epub 2019 Aug 8. PMID: 31299136.
8. https://www.news-medical.net/news/20230417/Lactobacillus-probiotics-improve-vaginal-health-in-asymptomatic-women.aspx
9. Ansari, AbuZar, et al. “Lactobacillus Probiotics Improve Vaginal Dysbiosis in Asymptomatic Women.” Nutrients, vol. 15, no. 8, 2023, p. 1862, https://doi.org/10.3390/nu15081862, https://www.mdpi.com/2072-6643/15/8/1862
10. https://wyss.harvard.edu/news/a-breakthrough-in-bacterial-vaginosis-treatment-for-womens-health/
11. https://www.webmd.com/infertility-and-reproduction/news/20230209/scientists-create-vagina-on-chip-what-to-know