Dr. Kim Capone, Lead SHWI Educator, and Chief Science Officer for Vaginal Biome Science.
March 2024
Did you know that antimicrobial resistance is currently one of the greatest global health threats, with resistance detected to all antibiotics currently in clinical use? This fact is of particular concern in women’s health because of the increased risk of recurrent and chronic infections that women face, especially during pregnancy and childbirth. More importantly, antibiotics remain the first-line therapy for bacterial vaginosis (BV), which is the most common vaginal condition, affecting nearly 30% of reproductive age women (21.2 million women annually). Despite available antibiotic treatments, the recurrence rate of BV after therapy is alarmingly high, often exceeding 60%. The recurrence rate not only poses health risks but also leads to significant emotional and economic burdens for affected individuals and requires the repeated use of antibiotics.
The persistence and recurrence of BV have been partly attributed to the formation of a multi-species biofilm by BV-associated bacteria (BVAB) and antimicrobial resistance (AMR) within these bacterial communities. AMR poses a significant challenge to eradicating drug-resistant vaginal microbiota, necessitating a reevaluation of current treatment modalities and the exploration of new therapeutic strategies.
A recent article by Christina A. Muzny and Jack D. Sobel (The Role of Antimicrobial Resistance in Refractory and Recurrent Bacterial Vaginosis and Current Recommendations for Treatment) delves into both in vitro and in vivo studies highlighting the issue of AMR in BVAB. It underscores the variability in resistance patterns among these bacteria, with some strains showing resistance to traditional antibiotics like metronidazole while remaining susceptible to others like clindamycin, and vice versa. This evidence points towards the need for BV diagnostics and alternative or combination antimicrobial regimens that could more effectively target the specific bacterial populations within the BV biofilm. Furthermore, in vivo studies reinforce the presence of AMR genes within the vaginal microbiome, even after treatment, hinting at the complex nature of achieving a sustained therapeutic response in BV with antibiotics.
To combat the challenges posed by AMR, the authors recommend employing a combination of therapeutic approaches, including the use of probiotics and vaginal fluid transfer, alongside conventional antimicrobials. These strategies aim not only to restore the dominance of Lactobacillus in the vaginal microbiota but also to help eradicate the resistant bacterial populations. Specifically, for refractory BV, the article suggests switching between antimicrobial classes or adjusting the duration and dosage of the current treatment regimen. For recurrent BV, it emphasizes eliminating predisposing factors, switching antimicrobial classes, and initiating maintenance prophylactic regimens to prevent relapse.
The persistent issue of recurrent and refractory BV, exacerbated by AMR, underlines a critical need for a deeper understanding of the vaginal microbiome's dynamics and the mechanisms of resistance. The limited success of current treatment strategies against BV signals an urgent call for antibiotic stewardship among clinicians.
Clinicians play a pivotal role in antibiotic stewardship by making informed decisions about antibiotic prescribing, considering alternative and combination therapies, and staying abreast of the latest research findings on AMR and effective treatment protocols for BV. Furthermore, there's a pressing need for longitudinal research to track changes in the vaginal microbiota post-treatment and identify genetic markers of AMR. Such studies will provide valuable insights into the development of novel therapeutic agents or regimens capable of overcoming the limitations posed by current treatments.
Vaginal Biome Science is committed to partnering with clinicians to conduct vaginal microbiome research to uncover meaningful insights into current vaginal healthcare models as well as alternative and combination therapies. If you are interested in learning more about our clinical trial to map the vaginal microbiome across multiple vaginal health and disease states, please let us know. This study will lay the groundwork for developing novel solutions for vaginal health issues impacted by imbalances in the vaginal microbiome.