Evaluation of the vaginal microbiome in clinical diagnosis and management of vaginal infectious diseases

When patients attend with medical complaints such as abnormal leucorrhea, the clinician should consider the possibility of an infection in the lower genital tract, such as vulvovaginal candidiasis (VVC). At that point, it is appropriate to then further assess the typical clinical manifestation, diagnosis, and routine management of the infection. However, sometimes, it is not possible to detect any pathogen at all through standard diagnostic techniques. In such a scenario, what happens to these patients? It has been suggested that the human microbiome may be thought of as the “second human genome,” and recent data published in the field have revealed that the urogenital site contributes approximately 9% of the entire human microbiome. This compares with the gastrointestinal tract, which comprises 29%.[1] The vaginal microbiome is an intricate and dynamic system of bacteria flora where various microbial communities exhibit considerable diversity and density. Any imbalance in the naturally occurring bacterial flora may result in infections such as VVC, bacterial vaginitis (BV), or aerobic vaginitis (AV).[2,3] In order to navigate and explore this exciting microecosystem and its inhabitants, we need a valid roadmap. Changes to several microecological indicators of the vaginal microbiome providing a unique “signature” for lower genital tract infections are usually identified by clinical microbiology laboratories through vaginal swab cultures and microscopic examinations. A multicenter epidemiological study used the Vaginal Microecology Evaluation System (VMES) as a tool to analyze the vaginal microbiomes in most areas of China.[4] The aim of this article is to introduce knowledge on changes to the vaginal microecological environment and inform users of the VMES in diagnosing and managing the broad range of vaginal infections that can occur.