Systematization of the evidence for the biofilm model of bacterial vaginosis and its practical significance: A literature review

Бактериалды вагиноздың биоқабықшалық моделінің дәлелдерін жүйелеу және оның практикалық маңызы: әдебиетке шолу
Систематизация доказательств биопленочной модели бактериального вагиноза и ее практическое значение: обзор литературы
Swidsinski A.V. Khamidullina Z.G. Myrzabekova A.Z. Tazhibayeva K.D. Nurgauasheva A.G.
30 December 2025 Kaz Med Print LLP

Reproductive Medicine (Central Asia)
2025 #2025 Issue 4

Relevance: Bacterial vaginosis (BV) is increasingly recognized not as simple “disbiosis” but as an organized polymicrobial biofilm scaffolded by Gardnerella spp., which accounts for adherence to transitional epithelium, local immune suppression, antimicrobial tolerance, and a relapse-prone course. The study aimed to systematize evidence on BV biofilms and critically appraise diagnostic and therapeutic approaches from the standpoint of recurrence prevention. Materials and Methods: We conducted a targeted literature search across PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for 2015-2025, in English or Russian, and reviewed relevant clinical guidelines. Priority was given to in situ visualization studies (ribosomal fluorescence in situ hybridization [FISH]/RiGinaM), ex vivo experiments, and publications addressing recurrence and partner management. Results: In situ data confirm the formation of an epithelial-attached polymicrobial film containing Gardnerella spp. Scaffold Lactobacillus crispatus persists within the consortium while adopting altered morphotypes. Clinical criteria and PCR/NGS are useful for initial identification but do not capture the spatial-functional architecture of communities; incorporating in situ methods improves risk assessment and guides management, including the need for partner-oriented care. Evidence indicates the limited effectiveness of empirical monotherapy— particularly nitroimidazoles—marked by interindividual variability in response, and the advantage of rational combination regimens targeting key biofilm functions (adhesion, matrix, metabolism). The probable role of sexual transmission and male coinfection strengthens the rationale for assessment and treatment of partners to prevent reinfection. Conclusion: BV should be regarded as a biofilm-mediated disease. An optimal strategy comprises a stepwise diagnostic pathway with in situ imaging for high-risk or recurrent cases, a shift from repeated empirical monotherapy to personalized combination regimens (ideally informed by functional ex vivo susceptibility testing within the consortium), and systematic partner-oriented management to reduce recurrence rates.

bacterial vaginosis , biofilm , clue cells , male coinfection , metronidazole resistance , ribosomal FISH , RiGinaM

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I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
The Humboldt University of Berlin, Berlin, Germany
Astana Medical University, Astana, Kazakhstan
Institute of Reproductive Medicine, Astana, Kazakhstan

I.M. Sechenov First Moscow State Medical University (Sechenov University)
The Humboldt University of Berlin
Astana Medical University
Institute of Reproductive Medicine

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