Utility of Next-generation sequencing in Managing Bacterial Vaginosis: Examples from Clinical Practice

Bostwick GD, Hunt CA, Parke

Abstract

There is an unacceptably high recurrence rate for bacterial vaginosis and vaginitis owing to multiple causes, including misdiagnosis and empirical under-treatment and over-treatment. A diagnostic test that provided complete knowledge of the vaginal microbiome in patients with bacterial vaginosis (BV) would fill an important void. In initial evaluations of Next-generation Sequencing (NGS), this new test offers great promise.As a clinical diagnostic for primary or recurrent bacterial vaginosis, NGS by simple vaginal swab offers heightened sensitivity and specificity compared to culture or limited three-organism genetic tests. NGS holds valuable potential in multiple BV quandary situations, including: (a) Recurrent BV in a patient that failed initial therapy, (b) Symptoms of BV in a patient with false-positive Amsel criteria, (c) Gardnerellavaginalis-negative BV with mixed infection. Multiplex next-generation sequencing (NGS) provides a complete and accurate description of the composition of the complex polymicrobial vaginal microbiome and associated antimicrobial resistance-determining genes, facilitating personalized diagnosis and therapy for patients with bacterial vaginosis, STIs and vaginitis.