The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment

Purpose of review Recent evidence supports the view that bacterial vaginosis presents as a polymicrobial biofilm infection. This has far-reaching implications for the pathogenesis, epidemiology, diagnosis and treatment of bacterial vaginosis. Recent findings Gardnerella vaginalis is presumably the first species to adhere to the vaginal epithelium and then becomes the scaffolding to which other species adhere. Not all G. vaginalis strains do form biofilms: G. vaginalis can be present in the vagina in a planktonic or in a biofilm mode of growth. The presence of planktonic (dispersed) or biofilm-associated (cohesive) G. vaginalis can be reliably shown in urine sediments in both women and men, and there is an absolute concordance in the carriage of biofilm-associated (cohesive) G. vaginalis between women with bacterial vaginosis and their partners. In-vitro data suggest that selected probiotic lactobacilli might be an effective means to conquer the biofilm. Summary Future epidemiological research may benefit from biofilm-based urine diagnosis of bacterial vaginosis to a significant extent. The search for novel therapeutic agents can now be more directed towards the biofilm-breaking agents, but is at present hampered by the lack of a proper in-vitro model of the bacterial vaginosis biofilm.