Polymicrobial infections and bacterial vaginosis: past, present and future

Swidsinski A.V., Swidsinski S.V., Apolikhina I.A., Baranov I.I., Bashmakova N.V., Borovkova L.V., Gribova E.P., Gomberg M.A., Gushchin A.E., Dzhibladze T.A., Dobrokhotova Yu.E., Zarochentseva N.V., Zuev V.M., Kim D.G., Kostina E.A., Kukarskaya I.I., Lazareva G.A., Ledina A.V., Mingaleva N.V., Minkina G.N., Priputnevich T.V., Savicheva A.M., Semenova M.V., Swidsinski N.V., Sinchikhin S.P., Storozheva K.V., Sukhikh G.T., Tapilskaya N.I., Tarnaeva L.A., Tikhomirov A.L., Trifonova N.S., Fatkullin I.F., Fatkullina L.S., Khryanin A.A., Chernova N.I.

1) I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia; 2) Humboldt University of Berlin, Berlin, Germany; 3) Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 4) Ural Research Institute for the Protection of Maternity and Infancy, Ministry of Health of Russia, Yekaterinburg, Russia; 5) Privolzhsky Research Medical University, Ministry of Health of Russia, Nizhny Novgorod, Russia; 6) Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; 7) N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia; 8) Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia; 9) V.F. Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia; 10) Tyumen State Medical University, Ministry of Health of Russia, Tyumen, Russia; 11) Perinatal Medical Center, Tyumen, Russia; 12) Kursk State Medical University, Ministry of Health of Russia, Kursk, Russia; 13) Lapino Clinical Hospital of Mother and Child Group, Moscow Region, Russia; 14) Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia; 15) Russian University of Medicine, Ministry of Health of Russia, Moscow, Russia; 16) D.O. Ott Research Institute of Obstetrics, Gynecology and Reproduction, St. Petersburg, Russia; 17) St. Petersburg State Pediatric Medical University, Ministry of Health of Russia, St. Petersburg, Russia; 18) Izhevsk State Medical Academy, Ministry of Health of Russia, Izhevsk, Russia; 19) Astrakhan State Medical University, Ministry of Health of Russia, Astrakhan, Russia; 20) Kazan State Medical University, Ministry of Health of Russia, Kazan, Russia; 21) Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia

The studies of the spatial relationships of microorganisms using ribosomal fluorescence in situ hybridization (FISH) suggest that there are many infections caused by groups of functionally cooperating pathogens that only become infectious when transported and grown together. 
The research into the interspecies relationships of the vaginal microbiome shows that bacterial vaginosis (BV) is not a single disease, but a complex syndrome involving completely different infectious processes with similar symptoms.
The most common cause of BV syndrome is polymicrobial biofilms (namely biofilm-associated gardnerellosis) followed by cohesive vaginosis mainly caused by Lactobacillus iners. The BV syndrome also includes different types of dysbiosis that have not yet been clearly characterized in terms of composition and causes. It is also possible that they will subsequently break down into specific nosological units depending on the communities (polymicrobial consortia) that cause or prevent their development.
Gardnerella spp. form the bulk of vaginal biofilms in BV, they cooperate with other microorganisms embedded 
in the biofilm and significantly expand its capacity. Due to interspecies cooperation, biofilm shows high resistance 
to immunity, antibiotics and hygiene products. Since the combined qualities of polymicrobial communities are absent in the individual species that make up the biofilm, their isolated spread from a sick person to a healthy person 
is unable to lead to biofilm formation in a new location and cause a disease.
Currently, pathogenic consortia can only be detected using the ribosomal FISH method. Although multiplex PCR or sequencing methods are extremely sensitive, none of them can be useful as they focus only on the detection 
of individual bacterial species and not on the elucidation of their interspecies relationships. Since stable interspecies interactions depend on specific genes required for the cohesion of the microorganisms involved, the identification 
of these genes and their use in clinical diagnosis and therapy is a matter of time and challenge for infectious disease specialists.
Conclusion: This review critically examines the contradictions and weaknesses of modern infectious disease studies that aim to identify a single pathogen; it also suggests ways to overcome previous impasses. Many of the problems presented in this article are in the initial stages of development and have yet to be specified, evolved and implemented. Therefore, the above is not a complete doctrine, but rather the collective opinion of obstetricians and gynecologists who are experts in the field and have co-authored and signed a series of tasks for initial implementation in the near future.

Authors’ contributions: Apolikhina I.A., Baranov I.I., Bashmakova N.V., Borovkova L.V., Gribova E.P., Gomberg M.A., Gushchin A.E., Dzhibladze T.A., Dobrokhotova Yu.E., Zarochentseva N.V., Zuev V.M., Kim D.G., Kostina E.A., Kukarskaya I.I., Lazareva G.A., Ledina A.V., Mingaleva N.V., Minkina G.N., Priputnevich T.V., Savicheva A.M., Semenova M.V., Swidsinski N.V., Sinchikhin S.P., Storozheva K.V., Sukhikh G.T., Tapilskaya N.I., Tarnaeva L.A., Tikhomirov A.L., Trifonova N.S., Fatkullin I.F., Fatkullina L.S., Khryanin A.A., Chernova N.I. – participation in the conceptual development of the theory of polymicrobial infections presented 
in the work; Swidsinski A.V., Swidsinski S.V. – writing the text, editing.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Swidsinski A.V., Swidsinski S.V., Apolikhina I.A., Baranov I.I., Bashmakova N.V., Borovkova L.V., 
Gribova E.P., Gomberg M.A., Gushchin A.E., Dzhibladze T.A., Dobrokhotova Yu.E., Zarochentseva N.V., 
Zuev V.M., Kim D.G., Kostina E.A., Kukarskaya I.I., Lazareva G.A., Ledina A.V., Mingaleva N.V., Minkina G.N., 
Priputnevich T.V., Savicheva A.M., Semenova M.V., Swidsinski N.V., Sinchikhin S.P., Storozheva K.V., Sukhikh G.T., Tapilskaya N.I., Tarnaeva L.A., Tikhomirov A.L., Trifonova N.S., Fatkullin I.F., Fatkullina L.S., Khryanin A.A., 
Chernova N.I. Polymicrobial infections and bacterial vaginosis: past, present and future.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (6): 63-73 (in Russian)
https://dx.doi.org/10.18565/aig.2025.105

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About the Authors

Alexander V. Svidsinski, Chief Physician of the Gastroenterological Outpatient Clinic, Head of the Molecular Genetic Laboratory, Humboldt University of Berlin, Berlin, Germany; Professor, Department of General Hygiene, Institute of Public Health named after F.F. Erisman, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of Russia, Moscow, Russia, alexander.swidsinski@charite.de
Sonja V. Svidsinski, Professor, Department of General Hygiene, Institute of Public Health named after F.F. Erisman, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia, alexander.swidsinski@charite.de
Inna A. Apolikhina, Dr. Med. Sci., Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, Professor at the Department of Obstetrics and Gynecology, Department of Vocational Education, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor, Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
Igor I. Baranov, Dr. Med. Sci., Professor, Head of the Department of Scientific and Educational Programs, Academician V.I. Kulakov National Medical Research Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; Vice President of RSOG.
Nadezhda V. Bashmakova, Dr. Med. Sci., Honored Doctor of the Russian Federation, Professor, Chief Obstetrician-Gynecologist of the Ural Federal District, Chief Researcher and Head of the Department of Assisted Reproductive Technologies, Urals Scientific Research Institute for Maternal and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia.
Lyudmila V. Borovkova, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Volga Research Medical University, Ministry of Health of Russia, Nizhny Novgorod, Russia; Chairman of the Nizhny Novgorod branch of the RSOG.
Emma P. Gribova, PhD, Chief Physician, Sechenov Center for Motherhood and Childhood, Clinical Center, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of Russia, Moscow, Russia, gribova_e_p@staff.sechenov.ru
Mikhail A. Gomberg, Dr. Med. Sci., Professor, Chief Researcher, Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology, Moscow City Health Department, Moscow, Russia; Member of the Royal College of Physicians (RCP), Member of the American Academy of Dermatology (AAD), Member of the European Academy of Dermatovenereology (EADV), Senior Advisor to the International Union for Sexually Transmitted Infections (IUSTI).
Alexander E. Gushchin, PhD (Bio), Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow City Health Department, Moscow, Russia, alegus65@mail.ru
Tea A. Dzhibladze, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
Yulia E. Dobrokhotova, Dr. Med. Sci., Professor, Honored Doctor of the Russian Federation, Honored Scientist of the Russian Federation, Laureate of the Prize of the Government of the Russian Federation, Head of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University,
Ministry of Health of Russia, Moscow, Russia.
Nina V. Zarochentseva, Dr. Med. Sci., Professor of the Russian Academy of Sciences, Deputy Director for Research, Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology; Professor, Department of Obstetrics and Gynecology, V.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia.
Vladimir M. Zuev, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
Dmitry G. Kim, PhD, Dermatovenerologist, Head of the Competence Center for Viral Skin Diseases, Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology, Moscow City Health Department, Moscow, Russia.
Ekaterina A. Kostina, Laboratory for the Diagnosis of Polymicrobial Infections and Bacterial Biofilms, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
Irina I. Kukarskaya, Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Perinatology of the Institute of Motherhood and Childhood, Tyumen State Medical University, Ministry of Health of Russia; Chief Obstetrician-Gynecologist of the Tyumen Region Health Department; Chief Physician, Regional Perinatal Center, Tyumen, Russia.
Galina A. Lazareva, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Institute of Continuing Education, Kursk State Medical University, Ministry of Health of Russia, Kursk, Russia.
Antonina V. Ledina, Dr. Med. Sci., co-director of the All-Russian educational project «ZhenProSvet – AGO»; Doctor, Lapino Clinical Hospital of Mother and Child Group, Moscow Region, Russia.
Natalia V. Mingaleva, Dr. Med. Sci., Professor, Department of Obstetrics, Gynecology and Perinatology No. 2, Institute of Continuing Education, Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia.
Galina N. Minkina, Dr. Med. Sci., Professor, Department of Obstetrics, Gynecology and Reproductive Medicine, Russian University of Medicine, Ministry of Health of Russia, Moscow, Russia.
Tatyana V. Priputnevich, Corresponding Member of RAS, Dr. Med. Sci., Associate Professor, Director of the Institute of Microbiology, Antimicrobial Therapy and Epidemiology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor, Department of Microbiology and Virology, Faculty of Pediatrics, Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.
Alevtina M. Savicheva, Dr. Med. Sci., Professor, Honored Scientist of the Russian Federation, Head of the Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology; Head of the Department of Medical Microbiology and Clinical Laboratory Diagnostics, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia, St. Petersburg, Russia.
Margarita V. Semenova, PhD, Associate Professor, Head of the Department of Obstetrics and Gynecology, Izhevsk State Medical Academy, Ministry of Health of Russia, Izhevsk, Russia.
Nadezhda V. Svidsinski, Laboratory for the Diagnosis of Polymicrobial Infections and Bacterial Biofilms, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of Russia, Moscow, Russia.
Sergey P. Sinchikhin, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Faculty of Medicine, Astrakhan State Medical University,
Ministry of Health of Russia, Astrakhan, Russia.
Ksenia V. Storozheva, Obstetrician-Gynecologist, PhD Student at the Department of Reproductology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, St. Petersburg, Russia.
Gennady T. Sukhikh, Academician of the RAS, Professor, Dr. Med. Sci., Director, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia.
Natalya I. Tapilskaya, Dr. Med. Sci., Professor, Head of the Department of Reproductology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology; Professor, Department of Obstetrics and Gynecology, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia, St. Petersburg, Russia.
Liana A. Tarnaeva, Obstetrician-Gynecologist, PhD Student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, Moscow, Russia.
Alexander L. Tikhomirov, Dr. Med. Sci., Honored Doctor of the Russian Federation, Laureate of the Prize of the Government of the Russian Federation, Professor at the Department of Obstetrics and Gynecology, Russian University of Medicine, Ministry of Health of Russia, Moscow, Russia.
Natalya S. Trifonova, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology No. 1 of the N.V. Sklifosovsky ICM, obstetrician-gynecologist at the Sechenov Center for Motherhood and Childhood of the Clinical Center, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia, trifonova.nataly@mail.ru
Ildar F. Fatkullin, Dr. Med. Sci., Professor, Professor at the Department of Obstetrics and Gynecology, Kazan State Medical University, Ministry of Health of Russia; Chief Freelance Specialist in Obstetrics and Gynecology of the Ministry of Health of Russia in the Volga Federal District, Kazan, Russia.
Larisa S. Fatkullina, PhD, Associate Professor at the Department of Obstetrics and Gynecology named after Prof. V.S. Gruzdev, Kazan State Medical University, Ministry
of Health of Russia; Chief Freelance Obstetrician-Gynecologist of the Kazan Health Department of the Ministry of Health of the Republic of Tatarstan, Kazan, Russia.
Alexey A. Khryanin, Dr. Med. Sci., Professor, Department of Dermatovenereology and Cosmetology, Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia.
Nadezhda I. Chernova, Dr. Med. Sci., Professor, Head of the Department of Anogenital Dermatoses and Sexually Transmitted Infections, Dermatovenerologist, Moscow Scientific and Practical Center for Dermatovenerology and Cosmetology, Moscow City Health Department, Moscow, Russia.

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