Potential for Phages in the Treatment of Bacterial Sexually Transmitted Infections Original paper

What was reviewed?

The review comprehensively examined bacteriophage therapy as a possible alternative to antibiotics for bacterial sexually transmitted infections. This review specifically explored the potential use of bacteriophages (phages) against various pathogens, including Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Mycoplasma genitalium, Ureaplasma parvum, Ureaplasma urealyticum, Haemophilus ducreyi, Calymmatobacterium granulomatis, and Shigella species. The paper provided detailed discussions on epidemiology, antibiotic resistance, bacterial characteristics, and current research challenges associated with each pathogen. The authors addressed both direct phage application and phage-derived enzyme therapy.

Who was reviewed?

The review synthesized available data from existing studies on various bacterial pathogens responsible for sexually transmitted infections. It included an analysis of laboratory studies, animal models, and limited clinical trials involving human subjects, focusing especially on pathogens with emerging antibiotic resistance. These pathogens included multidrug-resistant strains of N. gonorrhoeae and emerging antibiotic-resistant strains of other pathogens such as S. agalactiae, M. genitalium, Ureaplasma species, and Shigella.

What were the most important findings?

The review established that bacteriophage therapy represents a promising alternative or adjunct to antibiotic treatment due to its targeted action against specific bacteria, thus reducing off-target effects and antibiotic resistance pressures. For N. gonorrhoeae, phages identified include prophages within its genome; however, more research is required for practical application. Chlamydia trachomatis phages demonstrated activity in vitro, showing potential to disrupt bacterial replication. For S. agalactiae, isolated temperate phages and their derived enzymes demonstrated success in vitro and in vivo. The review emphasized enzymatic phage therapies (endolysins and depolymerases) as a promising avenue, highlighting their effectiveness particularly against Gram-positive bacteria like S. agalactiae. Additionally, the review underscored the significant challenges in phage therapy, including difficulties in isolating suitable phages for intracellular pathogens like Chlamydia and culturing fastidious organisms such as M. genitalium, Ureaplasma, and T. pallidum. It pointed out that genetically engineered phages and phage-derived enzymes could significantly overcome these obstacles, enhancing their applicability in clinical settings.

What are the greatest implications of this review?

The greatest implication of this review is that bacteriophage therapy could effectively address rising antibiotic resistance in bacterial sexually transmitted infections. Given the critical situation with multidrug-resistant pathogens, particularly N. gonorrhoeae, phage therapy might soon become necessary. The review calls for accelerated research to isolate and engineer bacteriophages with therapeutic potential, optimized delivery methods, and comprehensive clinical trials to validate safety and efficacy. Successful translation of phage therapy into clinical practice could revolutionize treatment approaches, preserving reproductive health, reducing antibiotic dependency, and preventing severe health complications associated with chronic and resistant BSTIs.