An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole

• DOI: 10.1016/j.ajog.2007.06.039
• Publication Date: 2007-11-27T20:39:15Z
• Authors: Alexander Swidsinski; Werner Mendling; Vera Loening-Baucke; Sonja Swidsinski; Yvonne Dörffel; Jürgen Scholze; Herbert Lochs; Hans Verstraelen
• Keywords: Gardnerella vaginalis

The purpose of this study was to determine the efficacy of standard treatment with oral metronidazole in the eradication of the bacterial vaginosis biofilm.We conducted an interventional follow-up study in which 18 patients with bacterial vaginosis were treated with oral metronidazole during 1 week and subsequently had a single random follow-up assessment at 1-week intervals, up to 5 weeks, with 3 patients representing each point in time. Follow-up assessment included conventional scoring of the vaginal microflora and determination of bacterial biofilm characteristics on a vaginal biopsy through bacterial 16/23S recombinant DNA-based fluorescence in-situ hybridization.Although all patients recovered, we consistently observed the resurgence with treatment cessation of a dense and active bacterial biofilm on the vaginal mucosa, primarily consisting of Gardnerella vaginalis and Atopobium vaginae.A large reservoir of the core bacteria to bacterial vaginosis persists as a biofilm after metronidazole treatment.