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A Journal on Obstetrics and Gynecology

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Minerva Ginecologica 2014 October;66(5):497-512

language: Italian

Recurrent cystitis and vaginitis: role of biofilms and persister cells. From pathophysiology to new therapeutic strategies

Graziottin A. 1, Zanello P. P. 2, D’Errico G. 3

1 Centro di Ginecologia e Sessuologia Medica, Ospedale San Raffaele Resnati, Milano, Italia;
2 Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, Unità di Microbiologia e Virologia, Università degli Studi di Parma, Parma, Italia;
3 Divisione di Ostetricia e Ginecologia, Ospedale Civile Di Vigevano, Pavia, Italia


Recurrent vaginitis and cystitis are a daily challenge for the woman and the physician. The recurrence worsens the symptoms’ severity, increases comorbidities, both pelvic (provoked vestibulodynia, bladder pain syndrome, levator ani hyperactivity, introital dyspareunia, obstructive constipation, chronic pelvic pain) and cerebral (neuroinflammation and depression), increases health costs, worsens the quality of life. Antibiotics increase the risk of bacterial resistences and devastate the ecosystems: intestinal, vaginal and mucocutaneous. Pathogenic biofilms are the (still) neglected etiology of recurrences. Biofilms are structured communities of bacteria and yeasts, protected by a self-produced polymeric matrix adherent to a living or inert structures, such as medical devices. Biofims can be intra or extracellular. Pathogens live in a resting state in the deep biofilm layers as “persister cells”, resistant to antibiotics and host defences and ready to re-attack the host. The paper updates the evidence on biofilms and introduces new non-antibiotic strategies of preventing and modulating recurrent vaginitis and cystitis.

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