When it comes to gynaecological symptoms we don’t feel comfortable talking about openly, the strong fishy smell associated with bacterial vaginosis is definitely up there. Bacterial vaginosis – or BV – is the most common vaginal infection, with symptoms including a greyish-white, watery discharge and unpleasant fishy odour. It’s not sexually transmitted and half of those affected don’t have any symptoms, but it can cause complications in pregnancy. And despite the fact that as many as one in three of us will get BV at some point in our lives, it’s still badly understood and notoriously difficult to treat.
Research published last week could be a game-changer though. Scientists at Johns Hopkins University in the US have taken the first step towards using vaginal fluid transplants as a potential new treatment option for BV. Inspired by the successful use of faecal microbiota transplants (FMT – or poo transplants, to you and me) to treat gut problems, the idea behind vaginal microbiota transplants (VMT) is effectively to ‘reset’ the balance of bacteria inside the vagina, using ‘good’ bacteria from donors’ vaginal fluid (or mucus).
Balancing vaginal bacteria
What exactly is the scientific explanation behind this? “The vaginal microbiome is fascinating. Bacteria reside within the mucus that’s secreted by the vaginal tract and, in the healthy state, you essentially have a monoculture of [protective] lactobacillus bacteria,” explains researcher Dr Laura Ensign, who is also co-author of the paper. “That’s completely unique compared to [the microbiomes of] your gut and your skin, where the community of bacteria is very diverse. In the vagina, the dominance of these lactobacillus bacteria keeps the vaginal pH acidic, and that’s how you keep other [bad] bacteria out.” Bacterial vaginosis, she explains, is a blanket term for that vaginal microbiome being out of whack – instead of being dominated by ‘good’ lactobacillus bacteria, it’s made up of any other combination of bacteria.
Currently BV is treated using antibiotics – either taken orally or applied to the vagina in a gel or cream. The problem, as the Johns Hopkins researchers point out, is that existing BV treatment isn’t “curative or restorative” – while antibiotics may treat the harmful bacteria, they don’t create a protective environment to prevent them from coming back. As a result, Dr Ensign says, up to 70% of women experience a recurrence of BV. Oh, and the antibiotics used to treat BV can also cause thrush, just in case that recurrent cycle of infection wasn’t frustrating enough already.