RECURRENT BACTERIAL VAGINOSIS: CURRENT CHALLENGES IN DIAGNOSIS, TREATMENT, AND RECURRENCE PREVENTION
Universitas Pelita Harapan
Universitas Pelita Harapan
Introduction. Bacterial vaginosis is the most common cause of abnormal vaginal discharge in women of reproductive age, affecting roughly one in four worldwide. Most relapse within a year of recommended therapy, facing repeated antibiotic courses and sustained risk of sexually transmitted infection and adverse reproductive outcomes. Method. We narratively reviewed guidelines, randomised trials, systematic reviews and mechanistic studies on recurrent bacterial vaginosis from PubMed, Scopus and Google Scholar, synthesising findings thematically. Result & Analysis. Recurrence reflects interacting mechanisms: a polymicrobial biofilm anchored by Gardnerella species, antimicrobial tolerance within it, failure to restore a Lactobacillus-dominant microbiome, and reinfection from untreated partners. The community regrowing after metronidazole is typically dominated by Lactobacillus iners rather than the protective Lactobacillus crispatus, so a Lactobacillus-dominant smear does not indicate protection. Positive Amsel result is reliable, whereas a negative one does not exclude disease. Suppressive metronidazole gel controls symptoms without curing the underlying dysbiosis. Live biotherapeutic products reduce recurrence only when antibiotic therapy has first achieved clinical cure, so sequence matters as much as product choice. Male-partner treatment substantially reduced recurrence in a trial stopped early for benefit, and is now endorsed in a practice update. Boric acid, probiotics and microbiota transplantation give variable results, and differing trial definitions of recurrence limit comparison. Discussion. Clinicians should reassess the diagnosis before repeating antibiotics, sequence microbiome restoration after antimicrobial cure, and consider partner treatment. Biofilm-targeted agents from antimalarial repurposing remain preclinical. Management is moving from uniform regimens toward microbiome-informed, individualised prevention, though validation in Southeast Asian populations is lacking.
Keywords: Bacterial Vaginosis Biofilm Partner Treatment Recurrance Vaginal Microbine
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