VAGINAL MICROBIOTA AND GYNECOLOGICAL HEALTH: NEW PERSPECTIVES IN UNDERSTANDING RECURRENT BACTERIAL VAGINOSIS

Abstract

Bacterial vaginosis (BV) is the most prevalent cause of vaginal discharge in women of reproductive age, characterized by dysbiosis of the vaginal ecosystem, with a reduction in Lactobacillus spp. and the proliferation of opportunistic anaerobes. The high rate of recurrence following conventional antibiotic therapy poses a significant clinical challenge, impairing quality of life and associating with obstetric and gynecological complications. The objective of this study was to analyze novel scientific perspectives regarding the vaginal microbiota and the key determinants of recurrent bacterial vaginosis. This integrative literature review was conducted using the PubMed, SciELO, and LILACS databases, covering publications from 2020 to 2026. The pathophysiology of recurrent BV involves the formation of complex polymicrobial biofilms, predominantly driven by Gardnerella vaginalis and Fannyhessea vaginae, which confer antimicrobial resistance and immune evasion. Factors such as strain genomic variability, vaginal pH alterations, and risk behaviors contribute to chronic persistence. Emerging therapeutic strategies, including species-specific Lactobacillus probiotics producing lactic acid and hydrogen peroxide, vaginal microbiota transplantation, and synthetic anti-biofilm agents combined with acidifying therapies, hold promise for achieving sustainable eubiosis. In conclusion, breaking the recurrence cycle of BV necessitates shifting from a strictly antimicrobial treatment model toward integrative strategies focused on restoring the vaginal microenvironment and eradicating pathogenic biofilms.