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Bacterial Vaginosis - prevalence, alternative treatments and associated resistance patterns.

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eMediNexus    15 December 2018

A new article published in Microbial Pathogenesis discussed that bacterial vaginosis (BV) is a complex polymicrobial infection of the vagina that shifts the predominant vaginal microflora from lactobacilli to opportunistic pathogens. BV is categorized by a greyish white discharge and pH greater than 4.5. It results in the preterm labor, abortion, pelvic inflammatory disorders, and post-cesarean infections. The authors further stated that BV is associated with Sexually Transmitted Diseases (STDs) or immune deficiency disorders like Human Immunodeficiency Virus (HIV), Human Papilloma Virus (HPV), Herpes Simplex Virus (HSV) 1 and 2, and Neisseria gonorrhoeae. It was reported that the prevalence rate of BV is approximately 29.2%, worldwide. BV is treated with the current recommended antibiotic therapy including metronidazole and clindamycin. However, the recurrence rate is 76%, which may occur within six months of treatment due to antibiotic resistance against pathogenic bacteria and their biofilms. Meanwhile, antibiotic resistance is a global health issue; this demands the exploration of other treatment modalities. One of these, targets treating sex partners in order to prevent recurrences in females. However, this method has failed to provide appreciable results. Probiotic therapy has exhibited promising results, but its benefits in controlling the recurrence rates has been refuted in certain studies. Newer therapeutic options are under trial and are yet to be clinically or commercially available. The authors reported that thermoplastic polyurethane (TPU) intravaginal rings containing lactic acid and metronidazole has shown promising results in trials of BV treatment. Vaginal acidifiers are used as an alternative method for maintaining the vaginal pH but the process of douching is a major limitation. While activated charcoal, used to treat BV patients in clinical trials, can render a decrease in the pH with only 3.1% loss of lactobacilli. Phage therapy is a reemerging field to overcome the bacterial resistance. They are host specific and easier to handle. They can be used naturally and synthetically; phage cocktails and phage-antibiotics combination can be used. Phages have shown better results as compared to antibiotics since they also treat biofilms and have minimal side effects. Phage therapy can be used in pharmaceuticals according to Food and Drug Administration (FDA) guidelines. In inference it was stated that further investigation in bacteriophages is warranted for their use against BV pathogenesis.

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