Recurrent vulvovaginal infections (RVVI) has not only become an epidemiological and clinical problem but also include large social and psychological consequences. Understanding the mechanisms of both commensalism and pathogenesis are necessary for the development of efficient diagnosis and treatment strategies for these enigmatic vaginal infections. Through this review, an attempt has been made to analyze vaginal microbiota (VMB) from scratch and to provide an update on its current understanding in relation to health and common RVVI i.e. bacterial vaginosis, vulvovaginal candidiaisis and Trichomoniasis, making the present review first of its kind. For this, potentially relevant studies were retrieved from data sources and critical analysis of the literature was made. Though, culture-independent methods have greatly unfolded the mystery regarding vaginal bacterial microbiome, there are only a few studies regarding the composition and diversity of vaginal mycobiome and different Trichomonas vaginalis strains. This scenario suggests a need of further studies based on comparative genomics of RVVI pathogens to improve our perceptive of RVVI pathogenesis that is still not clear (Fig. 5). Besides this, the review details the rationale for Lactobacilli dominance and changes that occur in healthy VMB throughout a women's life. Moreover, the list of possible agents continues to expand and new species recognised in both health and VVI are updated in this review. The review concludes with the controversies challenging the widely accepted dogma i.e. "VMB dominated with Lactobacilli is healthier than a diverse VMB". These controversies, over the past decade, have complicated the definition of vaginal health and vaginal infections with no definite conclusion. Thus, further studies on newly recognised microbial agents may reveal answers to these controversies. Conversely, VMB of women could be an answer but it is not enough to just look at the microbiology. We have to look at the woman itself, as VMB which is fine for one woman may be troublesome for others. These differences in women's response to the same VMB may be determined by a permutation of behavioural, cultural, genetic and various other anonymous factors, exploration of which may lead to proper definition of vaginal health and disease.

中文翻译：

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阴道健康中的微生物群和复发性外阴阴道感染的发病机制：批判性回顾。


复发性外阴阴道感染（RVVI）不仅已成为流行病学和临床问题，而且还带来巨大的社会和心理后果。了解共生现象和发病机制对于制定针对这些神秘阴道感染的有效诊断和治疗策略是必要的。通过本次综述，我们尝试从头开始分析阴道微生物群 (VMB)，并提供其当前对健康和常见 RVVI（即细菌性阴道病、外阴阴道念珠菌病和滴虫病）相关认识的更新，使本综述成为其首次综述。种类。为此，从数据源中检索了潜在的相关研究，并对文献进行了批判性分析。尽管不依赖培养的方法极大地解开了阴道细菌微生物组的谜团，但关于阴道真菌组和不同阴道毛滴虫菌株的组成和多样性的研究却很少。这种情况表明需要基于 RVVI 病原体的比较基因组学进行进一步研究，以提高我们对尚不清楚的 RVVI 发病机制的认识（图 5）。除此之外，该综述还详细介绍了乳酸菌占主导地位的基本原理以及女性一生中健康 VMB 发生的变化。此外，可能的药物清单继续扩大，并且在健康和 VVI 方面认可的新物种也在本次审查中得到更新。该评论的结论是，争议挑战了广泛接受的教条，即“以乳酸菌为主的 VMB 比多样化的 VMB 更健康”。过去十年来，这些争议使阴道健康和阴道感染的定义变得复杂，目前还没有明确的结论。 因此，对新认识的微生物制剂的进一步研究可能会揭示这些争议的答案。相反，女性的 VMB 可能是一个答案，但仅关注微生物学是不够的。我们必须看看女人本身，因为VMB对一个女人来说很好，但对其他人来说可能会很麻烦。女性对同一 VMB 的反应差异可能是由行为、文化、遗传和各种其他匿名因素的排列决定的，对其进行探索可能会导致对阴道健康和疾病的正确定义。