Title: Impact of (Recurrent) Bacterial Vaginosis on Quality of Life and the Need for Accessible
Alternative Treatments
Version: 1 Date: 21 Nov 2022
Reviewer:  António Machado
Reviewer's report:
Reviewer – Manuscript ID c6ffaffd-78a8-453c-b695-96efd25942ce
Congratulations to the authors for the present study. I believe that it is important to evaluate the
BV treatment outcomes.
General comments
However, before I recommended for publication, some issues must be mandatorily solved, more
exactly:
Please check the scientific names of the bacteria names cited in the present study and some
minor English Editing is advised.
References must be reviewed by the authors.
Also, a better description of the results and revision of Table 2 could be realized in the Results
section by the authors.
The Discussion section of the manuscript needs to be improved by the authors, discussing more
treatments (see my minor comments).
Minor comments
Keywords
Line 10- Please replace “lactobacillus” with “Lactobacillus” or “lactobacilli”.
Running title
Line 13- The running title is missing.
Abstract
Line 42- Please replace “vaginal conditions” with “vaginal dysbiosis”.
Line 55 and 57- Please rectify “lactobacillus sp.” and “lactobacillus crispatus. Lactobacillus …”
with “Lactobacillus sp.” and “Lactobacillus crispatus”, respectively.  I deduce that it is well-
known by the authors that the first name of a bacteria genus begins with a capital letter, and it
must be in italics. I will no longer mention this type of error and I ask the authors to check this
type of error in the remaining manuscript.
Introduction
Lines 99-104-  “Previous studies have shown that women have BV recurrence rates of 15-30%
within 3 months of treatment.8 High rates of recurrences underscore that current treatments such
as metronidazole do not directly restore the normal vaginal microflora. Alternative approaches to
therapy such as Lactobacillus crispatus (LACTIN-V) vaginal inserts have shown some success
in preventing recurrence of BV.9” The reference for BV treatment is too old (from 1992), and
the authors are only citing an alternative approach of 2020. This part must be improved by more
recent references and by citing more alternative approaches for BV treatment. I recommended
the following reference:
Muñoz-Barreno, A.; Cabezas-Mera, F.; Tejera, E.; Machado, A. Comparative Effectiveness
of Treatments for Bacterial Vaginosis: A Network Meta-Analysis. Antibiotics 2021, 10, 978.
https://doi.org/10.3390/antibiotics10080978
Lines 106 and 109- Please check the text of your manuscript. Replace “Gardeneralla vaginalis”
with “Gardnerella vaginalis” and “Lactobacilli” should not be in italics nor with the first letter
as a capital letter.
Methods
Lines 123-125- “We obtained Investigational Review Board approval from UC San Diego
and online informed consent prior to administration and completion of this anonymous online
survey.” Please add the approval number of the Review Board and the link to the anonymous
online survey information in the sentence.
Line 160- Please add the version and reference of the SPSS 27 statistical software package.
Line 165- Please replace “two-sided p<.05” with “two-sided p# 0.05”.
Results
Tables 1 and 2- Please complete the title of Table 1. “Table 1. Demographics” is not a proper
title for a scientific paper. Also, table titles should not be included in the tables.
Lines 181-182- Please rectify the following sentence: “Of these, 80% (20/25) had vaginal
candidiasis, 12% (3/25) had trichomonas, 4% (1/25) had herpes, 16% (4/25) had HPV and 4%
(1/25) had gonorrhea.”. There is no need for repeating “had” and if the authors started the
percentage values with decimals, they should continue with this format during all results.
Lines 197-200- The percentage values do not match the report in Table 2; therefore, a better
explanation should be done by the authors to avoid misunderstandings by the Readers or rectify
Table 2 by adding the calculated percentage values cited in the text.
Line 208- Please replace “sexual health (p=0.008).” with “sexual health (p=0.009).” accordingly
with the provided Table 2.
Discussion
Lines 208-214- “Even with successful antibiotic treatment, reported rates of relapses are
frequent, with more than 50% relapsing within 3-6 months.16 Using metronidazole as the first
line of treatment as a monotherapy may be insufficient for treatment of recurrent BV as its
restoration of healthy vaginal flora is likely only temporary. In a previous study that analyzed
the microbiome of 63 women (17 patients with recurrent BV compared to 46 healthy controls),
Lactobacilli was less abundant in women with recurrent BV.17”  I recommended the authors
update and add more available information of the following reference:
Muñoz-Barreno, A.; Cabezas-Mera, F.; Tejera, E.; Machado, A. Comparative Effectiveness
of Treatments for Bacterial Vaginosis: A Network Meta-Analysis. Antibiotics 2021, 10, 978.
https://doi.org/10.3390/antibiotics10080978
Lines 216-218- “This study aims to evaluate which treatment options were the most effective
and participants’ preferences for clinical management of (recurrent) BV.” Please rephrase the
sentence stating which of the two treatment options was more effective and selected by the
participants.
Line 231- “Limitations of this study include the relatively small sample size (n=63) …” In line
168 of the Methods section and Table 1 stated 62 participants. Please rectify the sentence.
References
The manuscript could be improved with more elaborate Introduction and Discussion sections,
showing only 18 references.
Congratulations on the present study. However, the manuscript needs to be improved in order
to be published. The Introduction, Results, and Discussion sections of the manuscript need to
be improved by the authors.