The vaginal microbiome in bacterial vaginosis: Pathogenesis, reproductive impacts, and emerging therapies

Bacterial vaginosis (BV), the leading gynecological condition affecting women of reproductive age globally, is marked by a reduction in the dominant protective bacterial species Lactobacillus within the vaginal microbiome (VMB). This condition is triggered by an overgrowth of anaerobic bacteria and leads to many gynecological and reproductive repercussions, such as increased susceptibility to sexually transmitted infections and infertility. Moreover, BV's effects extend to pregnancy, contributing to adverse obstetric outcomes such as miscarriages, preterm delivery, and postpartum complications. While antibiotics remain the standard treatment for BV, their efficacy is compromised by high recurrence rates due to their inability to restore Lactobacillus and concerns about their negative impact on neonatal health during pregnancy. Recent research suggests probiotics as promising complementary or alternative therapies with their capacity to restore Lactobacillus in the VMB. In this review, we provide an in-depth examination of the impact of BV on gynecological health, pregnancy and fetal development and explore the latest advancements in BV treatments, including probiotics, vaginal microbiome transplantation (VMT), and biofilm disrupters, as preventative and therapeutic measures in addressing the multigenerational effects of this condition.