A Comparative Analysis of Vaginal Flora in Women with and Without Bacterial Vaginosis

Bacterial vaginosis (BV), the most prevalent vaginal dysbiosis, is typified by a transition from a Lactobacillus-dominant community to a polymicrobial anaerobic community. This study aimed to characterize and compare the vaginal microbial profile of BV-positive and BV-negative women and assess the antibiotic susceptibility profiles of primary bacterial isolates. Samples were collected between September 2024 and April 2025 from 200 symptomatic women between 18 and 45 years. The participants were categorized into BV-positive (n=75) and BV-negative (n=125) based on Nugent scoring. Vaginal swabs were subjected to Gram stain, culture on appropriate media, and microbial identification by routine biochemical tests. Antibiotic susceptibility testing was performed for key bacterial pathogens. The prevalence of BV was 37.5%. Relative to BV-negative women (16.8%), polymicrobial growth was significantly more common among BV-positive women (72.0%). The most common isolates from BV-positive women were Gardnerella vaginalis (42.7%), Prevotella spp. (25.3%), and Atopobium vaginae (18.7%). BV-negative women were mainly colonized by Lactobacillus spp. (58.4%) and Candida spp. (44.0%). Among the 200 samples collected, positive microbial growth occurred in 148 samples (74.0%). The most frequent isolates in the entire cohort were Candida spp. (28.0%), Staphylococcus aureus (22.0%), Escherichia coli (20.0%), and Streptococcus agalactiae (12.0%). Antibiotic sensitivity testing revealed that ciprofloxacin inhibited S. aureus and S. agalactiae, and norfloxacin inhibited 88% of the E. coli isolates. This study confirms the high prevalence of BV and its distinct polymicrobial nature in our population, underscoring the necessity for accurate diagnosis to guide effective, targeted antimicrobial therapy.