Phage therapy for treatment of bacterial vaginosis.

A common vaginal dysbiosis, bacterial vaginosis (BV), has serious consequences for reproductive health, including an elevated risk of infertility and pelvic inflammatory disease. Its distinctive feature is a robust polymicrobial biofilm, mainly composed of Gardnerella species (spp.), which protects infections against antibiotic therapy and promotes high rates of recurrence. Concurrently, Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection globally, with over 130 million new cases annually. A primary cause of tubal factor infertility, CT infection promotes adnexal adhesions and fallopian tube obstruction through inflammatory damage. This article reviewed two critical agents: CT, an intracellular bacterium that causes inflammatory tubal damage, and BV, caused by biofilm-forming pathogens such as Gardnerella. The growth of antimicrobial resistance underscores the critical need for targeted alternatives to broad-spectrum antibiotics. Endolysins, enzymes that break down bacterial cell walls, are produced by bacteriophages (phages) and represent a potential new treatment approach. This paper summarizes evidence that modified endolysins, such as PM-477, can specifically break down Gardnerella biofilms in vitro and ex vivo while preserving beneficial vaginal lactobacilli. We examine how this precise mechanism addresses the fundamental shortcomings of existing BV treatment. Then, to transform phage-derived techniques from an intriguing preclinical concept into a workable therapeutic intervention for recurrent BV, we critically assess the key translational obstacles that must be addressed, including pharmacokinetics, formulation, and the need for clinical trials.