The Vaginal Microbiome: II. Vaginal Dysbiotic Conditions

Objective: This series of articles, titled The VaginalMicrobiome (VMB), written on behalf of the International Society for the Study of Vulvovaginal Disease, aims to summarize the recent findings and understanding of the vaginal bacterial microbiota, mainly regarding areas relevant to clinicians specializing in vulvovaginal disorders. Materials and Methods: A search of PubMed database was performed, using the search terms vaginal microbiome with dysbiosis, bacterial vaginosis, cytolytic vaginosis, desquamative inflammatory vaginitis, and aerobic vaginitis. Full article texts were reviewed. Reference lists were screened for additional articles. Results: The second article in this series focuses on vaginal dysbiotic conditions. Dysbiosis is a term describing imbalances in bacterial communities. Given that lactobacillus-dominatedmicrobiota are thought to be the most optimal, vaginal dysbiosis is usually considered as lactobacilli-depleted VMB. Bacterial vaginosis (BV), the most common vaginal dysbiotic condition, is a polymicrobial disorder, considered the leading cause for vaginal discharge in women worldwide. In addition, we review the VMB in other vaginal conditions associated with lactobacilli depletion: desquamative inflammatory vaginitis and aerobic vaginitis. We also discuss the controversial diagnosis of cytolytic vaginosis, related with lactobacilli overgrowth. Conclusions: Bacterial vaginosis displays complex microbiology. The heterogeneity and diversity within the genus Gardnerella may impact the progression of BV. Bacterial biofilms may contribute to the etiology and persistence of BV, and various bacteria may affect its clinical presentation and pathogenicity. Lack of lactobacilli is not always accompanied by an overgrowth of anaerobes.

Automated summary

This series of articles aims to summarize recent findings on the vaginal bacterial microbiota and its relevance to clinicians specializing in vulvovaginal disorders. The second article focuses on vaginal dysbiotic conditions, including bacterial vaginosis and other conditions associated with lactobacilli depletion. The heterogeneity and diversity within the genus Gardnerella may impact the progression of bacterial vaginosis.