From the Guidelines
No, Enterococcus faecalis does not cause bacterial vaginosis (BV). Bacterial vaginosis is primarily caused by an overgrowth of anaerobic bacteria such as Gardnerella vaginalis, Prevotella species, Mobiluncus species, and other anaerobes, which disrupt the normal vaginal flora dominated by Lactobacillus species [ 1 ]. Enterococcus faecalis is a gram-positive bacterium that is part of the normal gut flora and can sometimes be found in the vagina, but it is not a causative agent of bacterial vaginosis. While E. faecalis can cause various infections including urinary tract infections, endocarditis, and wound infections, it is not associated with the specific microbial imbalance that characterizes BV.
The evidence from the Centers for Disease Control and Prevention [ 1 ] and other studies [ 1, 1 ] supports the fact that BV is a clinical syndrome resulting from replacement of the normal H2O2-producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria, and not by Enterococcus faecalis. If E. faecalis is found in significant numbers in vaginal cultures, it may represent a different type of infection or colonization, but not bacterial vaginosis. The distinction is important because treatment approaches differ based on the specific pathogen involved.
Key points to consider:
- Bacterial vaginosis is caused by an overgrowth of anaerobic bacteria [ 1 ]
- Enterococcus faecalis is not a causative agent of bacterial vaginosis [ 1 ]
- Treatment approaches differ based on the specific pathogen involved [ 1, 1 ]
- The evidence supports the fact that BV is a clinical syndrome resulting from replacement of the normal H2O2-producing Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria [ 1 ]
From the Research
Bacterial Vaginosis and Enterococcus faecalis
- Enterococcus faecalis is not typically considered a primary cause of bacterial vaginosis (BV) 2
- However, E. faecalis has been isolated from women with BV, suggesting it may play a role in the infection 2
- Aerobic vaginitis, which can be caused by E. faecalis, is a distinct condition from BV, characterized by an imbalance of the vaginal flora and the presence of aerobic and intestinal pathogens 3
Treatment of Bacterial Vaginosis
- The preferred treatment for BV is oral metronidazole (500 mg twice daily for 7 days) 4
- Other effective treatment regimens include single-dose metronidazole, 2% clindamycin vaginal cream, 0.75% metronidazole vaginal gel, and oral clindamycin 4
- Tinidazole has also been shown to be effective in treating BV, with similar efficacy and safety to metronidazole 5
Role of Enterococcus faecalis in Aerobic Vaginitis
- E. faecalis is a common causative agent of aerobic vaginitis, accounting for approximately 31% of cases 3
- The presence of E. faecalis in the vaginal flora can lead to an increase in pH, reducing the defense ability of the vagina and favoring the development of bacterial inflammation 3
- Treatment of aerobic vaginitis caused by E. faecalis typically involves a combination of antibacterial, hormonal, non-steroidal anti-inflammatory, and/or probiotic therapies 3