Bradshaw Catriona S, Sobel Jack D
Melbourne Sexual Health Centre Central Clinical School, Monash University, Clayton, Australia.
Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
J Infect Dis. 2016 Aug 15;214 Suppl 1(Suppl 1):S14-20. doi: 10.1093/infdis/jiw159.
Practitioners and patients alike widely recognize the limitations of current therapeutic approaches to the treatment of bacterial vaginosis (BV). Options remain extremely limited, and our inability to prevent the frequently, often relentless symptomatic recurrences of BV and to reduce serious sequelae such as preterm delivery, remains an acknowledged but unresolved shortcoming. Our incomplete understanding of the pathophysiology of this unique form of vaginal dysbiosis has been a significant impediment to developing optimal treatment and prevention approaches. New drugs have not been forthcoming and are not likely to be available in the immediate future; hence, reliance on the optimal use of available agents has become essential as improvised often unproven regimens are implemented. In this review, we will explore the limitations of currently recommended therapies, with a particular focus on the contribution of reinfection and pathogen persistence to BV recurrence, and the development of interventions that target these mechanisms. Ultimately, to achieve sustained cure and effectiveness against BV-associated sequelae, it is possible that we will need approaches that combine antimicrobials with biofilm-disrupting agents and partner treatments in those at risk of reinfection.
从业者和患者都普遍认识到当前治疗细菌性阴道病（BV）的方法存在局限性。治疗选择仍然极为有限，而且我们无法预防BV频繁且常常持续不断的症状复发，也无法减少诸如早产等严重后遗症，这仍是一个公认但尚未解决的缺点。我们对这种独特形式的阴道生态失调的病理生理学理解不完整，这一直是开发最佳治疗和预防方法的重大障碍。新药物尚未出现，近期也不太可能有；因此，在实施往往未经证实的临时方案时，依靠最佳使用现有药物变得至关重要。在这篇综述中，我们将探讨当前推荐疗法的局限性，特别关注再感染和病原体持续存在对BV复发的影响，以及针对这些机制的干预措施的发展。最终，为了实现对BV相关后遗症的持续治愈和疗效，我们可能需要将抗菌药物与生物膜破坏剂相结合的方法，并对有再感染风险的人群进行性伴侣治疗。
