From the Research
Enterococcus faecalis in the vagina typically represents colonization rather than infection in most cases, and treatment is only necessary if symptoms of vaginitis are present and E. faecalis is determined to be the causative pathogen. The presence of E. faecalis in the vagina can be associated with an increased risk of aerobic vaginitis, which is characterized by an imbalance of the vaginal flora and the presence of aerobic and intestinal pathogens with varying degrees of vaginal inflammation 1. According to a study published in 2022, the frequency of aerobic vaginitis varies from 12% to 23.7% in symptomatic women who are not pregnant, and E. faecalis is the most frequently isolated pathogen, accounting for approximately 31% of cases 1.
The study also suggests that the presence of E. faecalis in the vagina can be associated with an increased risk of cervical cancer, as it can reduce the protective effect of lactobacilli and increase the risk of HPV 16 infection 1. For symptomatic E. faecalis vaginal infections, a combination of therapy such as antibacterial, hormonal, non-steroidal anti-inflammatory, and/or probiotics may be effective, and treatment should be based on microscopic or microbiological findings. Local treatment with antibiotics, such as clindamycin vaginal cream 2% applied once daily for 7 days, may also be effective 1.
It is essential to note that E. faecalis is part of the normal gastrointestinal flora and can colonize the vagina without causing symptoms, and it becomes problematic when it overgrows and disrupts the normal vaginal microbiome, which is typically dominated by Lactobacillus species 1. Symptoms of infection include abnormal discharge, itching, burning, and discomfort, and proper diagnosis through vaginal cultures is crucial to distinguish between colonization and infection before initiating treatment 1.
In terms of treatment, there is no generally accepted clinical strategy for the treatment of aerobic vaginitis caused by E. faecalis, and most authors suggest that therapy should be based on microscopic or microbiological findings using a topical antibiotic for the infectious agent, a topical steroid to reduce inflammation, and estrogen to treat atrophy 1. The most recent and highest quality study recommends a combination of therapy, including antibacterial, hormonal, non-steroidal anti-inflammatory, and/or probiotics, which can be prescribed in the form of local or systemic therapy 1.