Vaginal Microbiome Testing and Personalized Care for Bacterial Vaginosis: Treatment Efficacy and Microbiome Optimization

Bacterial vaginosis (BV) affects approximately 30% of women annually, with recurrence rates of 50% within 3-6 months despite initial antibiotic treatment. This study evaluates outcomes from a metagenomic-based vaginal microbiome (VMB) test used to personalize BV treatment. A total of 1,159 patients diagnosed with BV received tailored treatment, including antibiotics and adjunctive therapies. Vaginal swabs and symptom data were collected before and after treatment (average 4.4 months). Patients were categorized as responders (symptom improvement) or non-responders (no change or worsening symptoms) based on post-treatment questionnaires. Personalized treatment resulted in a 75.5% response rate, with a recurrence rate of 29.7%. Responders showed a significant reduction in symptom scores (5.2 to 2.4, p< 0.0001). Both groups experienced increased Lactobacillus abundance (responders: 31.1% to 49.9%, p< 0.0001; non-responders: 38.5% to 44.0%, p< 0.05), and decreased BV-associated genera (responders: Gardnerella from 45.1% to 35.2%, p< 0.0001; non-responders: from 43.8% to 37.3%, p< 0.001). Treatment adherence was linked to positive outcomes, with mild adverse events. This study demonstrates that personalized, microbiome-informed therapy improves symptoms and restores vaginal microbiome balance in BV management.