Recent Treatment Advances in Bacterial Vaginosis (BV) and Vaginal Candidiasis (VC): Herbal Medicine, Antibiotics, and Probiotics

Abstract

The vaginal microbiota is a dynamic ecosystem that changes throughout the menstrual cycle and the life course. Disruption of the healthy vaginal environment can lead to infection and inflammation, most notably bacterial vaginosis (BV) and vaginal candidiasis (VC), two common vaginal diseases affecting women of reproductive age worldwide. BV arises from an imbalance in the vaginal flora, characterized by reduced Lactobacillus abundance and the overgrowth of anaerobic bacteria such as Gardnerella and Mobiluncus. BV presents with symptoms such as abnormal discharge and an unpleasant odor; more importantly, it increases the risk of complications such as pelvic inflammatory disease (PID), adverse pregnancy outcomes, and sexually transmitted infections (STIs). Various factors, including hormonal fluctuations, sexual behavior, poor hygiene, and antibiotic use, influence the stability of the vaginal flora and susceptibility to BV. VC is mainly caused by Candida albicans, but it is increasingly associated with non albicans species and results in inflammation of the vulva and vagina. Its hallmark symptoms include itching, burning, redness, and thick, white discharge. Although VC is treatable with antifungal agents, recurrent or untreated infections can lead to cervicitis, PID, or infertility. Risk factors such as diabetes, pregnancy, immunosuppression, and excessive antibiotic use contribute to the high recurrence rates, negatively affecting women’s physical comfort and mental health. Both BV and VC are closely linked to disturbances in the vaginal microbiota. Understanding their microbial and immunological mechanisms is crucial for effective prevention and treatment. Current therapies include conventional antibiotics and antifungal agents, as well as emerging interventions such as probiotics and microbiota modulating strategies to restore balance. Herbal medicine approaches are also gaining attention for their potential to complement conventional treatments through herbal formulations and external applications. By integrating modern medical and traditional perspectives, researchers aim to develop more personalized and microbiome targeted treatments, thereby improving women’s reproductive and overall health.