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Abstract
Bacterial Vaginosis (BV) is a complex polymicrobial infection of vagina that shifts
the paradigms of vaginal flora from lactobacilli to opportunistic pathogens. BV is
catagorized by greyish white discharge, pH greater than 4.5. It results in the preterm
labor, abortion, pelvic inflammatory disorders, post cesarean infections. BV is associated
with Sexually Transmitted Diseases (STDs) or immune deficiency disorders like Human
Immunodeficiency Virus, Human Papilloma Virus, Herpes Simplex Virus 1 and 2, and Neisseria
gonorrhoeae. The prevalence rate is about 21.2 million (29.2%) worldwide. BV is more
frequent in black females as compared to white females, independent of geographical
distribution. Globally, BV is treated with the current recommended antibiotic therapy
including Metronidazole and Clindamycin. The recurrence rates are 76% and occur within
06 months of treatment due to antibiotic resistance against pathogenic bacteria and
their biofilms. The antibiotic resistance is a global health issue which directs the
attentions towards other treatments. One of these is the treatment of sex partners,
thus helping to stop the recurrence rates in females. However, this method does not
show any positive results. Probiotic therapy is an incorporation of Lactobacilli orally
or intravaginally for the recolonization of healthy microbes. This therapy has exhibited
promising results but some studies revealed that Probiotic therapy does not control
the recurrence rate. The other methods are in trials period and none of them are used
clinically or commercially available for the treatment. The thermoplastic polyurethane
(TPU) intravaginal rings contain lactic acid and metronidazole showed promising results
in trials of BV treatment. The vaginal acidifiers are used as an alternative method
to maintain the vaginal pH but the process of douching is a major limitation. The
activated charcoal is used to treat BV patients in clinical trials showed decrease
in the pH with only 3.1% loss of lactobacilli. Phage therapy is a reemerging field
to overcome the bacterial resistance. They are host specific and easier to handle.
They can be used naturally, synthetically; phage cocktails and phage-antibiotics combination
can be used. Phages show auspicious results for the treatment of bacterial infections
as compared to antibiotics as they also treat biofilms. This is one of the promising
therapy in future to treat infections with no side effects. Phage therapy can be used
in pharmaceuticals according to Food and Drug Administration (FDA) guidelines. Taken
together, it is suggested that large funding is required by pharmaceutical sector
or government for further investigation of bacteriophages to be used against BV pathogenesis.