Bacterial vaginosis in West Africa: prevalence, pathogenesis, diagnosis, and reproductive health implications

BACKGROUND: Bacterial vaginosis (BV) is a common vaginal dysbiosis characterized by loss of Lactobacillus -dominant communities and overgrowth of anaerobic bacteria. BV is highly prevalent in sub-Saharan Africa and is linked to adverse pregnancy outcomes and heightened susceptibility to sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV). OBJECTIVE: To synthesize current evidence on BV epidemiology in West Africa, microbiome-based mechanisms, risk factors, diagnostic approaches under resource constraints, clinical consequences, and management strategies including emerging microbiome-directed interventions. METHODS: This narrative review synthesized peer-reviewed literature and guideline documents on BV in West Africa. Comprehensive searches were conducted in PubMed, Scopus, and Google Scholar. Studies published between 2020–2024 were prioritized; earlier seminal works were retained to explain diagnostic criteria and pathogenesis. Studies were included if they reported human data from West African populations on BV prevalence, microbiome mechanisms, or clinical outcomes. RESULTS: BV pathogenesis is increasingly understood as a polymicrobial biofilm-associated dysbiosis in which Gardnerella spp. play a central structural role, supporting persistence and recurrence. Diagnostic reliance on syndromic management in many settings may lead to misclassification and inadequate follow-up. Standard nitroimidazole or clindamycin regimens offer good short-term response, yet recurrence remains common, motivating interest in adjunctive strategies such as probiotic Lactobacillus preparations and experimental vaginal microbiota transplantation (VMT). Evidence also supports the importance of considering sexual partnership dynamics in recurrence pathways. CONCLUSION: BV represents a major but under-addressed reproductive health challenge in West Africa. Strengthening microscopy-based diagnosis, integrating BV into antenatal and STI services, addressing intravaginal practices, and evaluating microbiome-restorative interventions in African populations are priorities for reducing BV-associated morbidity.