Bacterial vaginosis: the role of microbiota and prospects

Bacterial vaginosis (BV) is a widespread disease among women of reproductive age worldwide and is associated with unfavorable gynecological and obstetric outcomes. The polymicrobial nature of the disease, the high recurrence rate (up to 80%) and asymptomatic course (up to 50%), the formation of an extensive layer of bacterial biofilms resistant to traditional therapy necessitate the search for new approaches to diagnosis and treatment options. The purpose of this review is to summarize research on the role of individual representatives of the female reproductive tract microbiota in the development of bacterial vaginosis, to consider the inter-bacterial interaction of BV-associated microorganisms using biofilm as an example, and to review approaches to the diagnosis and treatment of the disease. The vaginal microbiota is a complex and dynamic ecosystem, subject to constant fluctuations throughout a woman’s life, and the genus Lactobacillus plays an important role in maintaining the state of the vaginal microbiome. Excessive growth of bacteria such as Gardnerella spp., Fannyhessea vaginae, Prevotella bivia, Mobiluncus spp., Peptostreptococcus anaerobius, Megasphaera spp., etc. It mediates the development of bacterial vaginosis, and therefore it is necessary to study modern concepts of microorganisms involved in the development of BV, in terms of both their individual characteristics and pathogenicity factors, as well as their ability to associate with each other, including through the formation of biofilms.