Recurrent Bacterial Vaginosis Following Metronidazole Treatment is Associated with Microbiota Richness at Diagnosis Original paper
Researched by:
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Divine Aleru
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Divine Aleru
I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
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Women’s Health
Women’s Health
Women’s health, a vital aspect of medical science, encompasses various conditions unique to women’s physiological makeup. Historically, women were often excluded from clinical research, leading to a gap in understanding the intricacies of women’s health needs. However, recent advancements have highlighted the significant role that the microbiome plays in these conditions, offering new insights and potential therapies. MicrobiomeSignatures.com is at the forefront of exploring the microbiome signature of each of these conditions to unravel the etiology of these diseases and develop targeted microbiome therapies.
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Bacterial Vaginosis
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.
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Divine Aleru
Researched by:
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Divine Aleru
ID
Divine Aleru
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What was Studied?
This study investigated the association between pre-treatment vaginal microbiota composition and the likelihood of recurrent bacterial vaginosis (BV) following metronidazole treatment. The researchers analyzed cervicovaginal lavage samples from women diagnosed with BV using 16S rRNA gene sequencing to identify microbial signatures linked to treatment failure or success. The study aimed to determine whether specific microbiota characteristics at diagnosis could predict treatment outcomes, including transient clearance, sustained clearance, or recurrence of BV.
Who was Studied?
The study included 28 women diagnosed with symptomatic BV, confirmed by Nugent scoring, who were enrolled in a clinical trial. Participants were non-pregnant, free of other reproductive tract infections, and had not used antibiotics in the 14 days before enrollment. Samples were collected at baseline (pre-treatment), 7–10 days post-treatment, and 28–32 days post-treatment to assess microbial and immune changes.
What were the most Important Findings?
The study revealed that women who failed to clear BV or experienced recurrence had significantly higher pre-treatment microbial richness and evenness than those with sustained clearance. Significant microbial associations (MMA) included polymicrobial anaerobic taxa such as Gardnerella vaginalis, Prevotella, Sneathia, and Atopobium, which were dominant at baseline. Notably, Lactobacillus iners (CT2) dominance post-treatment was associated with improved mucosal immune markers, including elevated SLPI and reduced ICAM-1, but these benefits were transient in cases of recurrence. The persistence of diverse, low-abundance taxa and biofilm-forming bacteria like Atopobium and Sneathia post-treatment suggested their role in treatment resistance. Importantly, no participants achieved Lactobacillus crispatus (CT1) dominance, highlighting a gap in current therapeutic efficacy.
What are the Implications of this Study?
The findings underscore the limitations of metronidazole in treating BV, particularly in cases with high pre-treatment microbial diversity. The study suggests that microbiome profiling could help identify women at risk of treatment failure, paving the way for personalized therapies. Future research should explore adjunct treatments, such as Lactobacillus crispatus biotherapeutics or biofilm disruptors, to improve outcomes. Additionally, the transient immune improvements observed with Lactobacillus dominance emphasize the need for sustained microbiome modulation to prevent recurrence and associated complications like STI susceptibility.
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.
Nugent Score
The Nugent Score is a standardized Gram stain-based scoring system used to diagnose bacterial vaginosis (BV) by assessing key bacterial morphotypes in vaginal samples. With its high specificity, it remains a gold standard in microbiome research, though its complexity and need for trained personnel make it less common in routine clinical practice.