Bacterial Vaginosis: Historical stigmas and diagnostic methods influence modern day perceptions

Abstract

For over a century research on the composition of the vaginal microbiome and its correlation to symptoms and disease has been of interest. Early studies have identified key Lactobacillus bacteria that are abundant in healthy women (Doderlein 1891), while other studies identified the possible pathogenic microbe, Gardnerella vaginalis, abundant in women with vaginal discomfort (Gardner 1957). The term used to describe the shift from the “healthy” bacteria to a different composition of bacteria in the vaginal microbiota is bacterial vaginosis (BV). This shift is seen as a dysbiosis that can cause vaginal discomfort. The method that is universally accepted for diagnosing BV scores vaginal bacterial compositions morphologically by the amount of Gram-positive Lactobacillus versus the amount of Gram-negative Gardnerella and other Gram-variable present in the canal (Nugent 1991). Recent studies have indicated there are multiple unique bacterial community compositions in women asymptomatic for BV (Ravel 2011). Some vaginal communities lack a dominating Lactobacillus species, and are then classified as having BV based on Nugent score criteria. Women who lack Lactobacillus species often are of different ethnic groups (Anukam 2006), leading researchers to question the reason and find correlations for this phenomenon. The present analysis highlights the skewed diagnosis techniques of BV that establish a social stigma against certain ethnic groups.