Optimization of Treatment of Bacterial Vaginosis

Bacterial vaginosis (BV) is one of the most common dysbioses among sexually active women (prevalence between 23-29%). It is characterized by reduction in the natural microflora of Lactobacillus and overgrowth of anaerobic bacteria, such as Gardnerella vaginalis. BV is an important risk factor for reproductive health complications, including higher incidence of sexual transmitted infections (STIs), preterm birth, and infertility. Standard treatment is based on antibiotics like metronidazole, which is highly effective for alleviating acute symptoms but carries a high recurrence risk (up to 60% within 12 months) due to biofilm formation on the vaginal epithelium, which prevents penetration of medicines and leads to antibiotic resistance. The primary goal of BV treatment is to ensure stable long-term eubiosis through rapid, accurate diagnosis and effective treatment. This review identifies optimization approaches, including alternative antibiotics regimens, biofilm management, and supportive therapies.