The Human Vaginal Virome: Composition, Microbiome Interactions, and Implications for Bacterial Vaginosis, HPV Persistence, and Preterm Birth.

Important gaps remain in our understanding of the vaginal virome. Its composition, interactions with the bacterial microbiome and host immune system, and implications for vaginal homeostasis, human papillomavirus (HPV) persistence, and obstetric outcomes remain incompletely defined. The vaginal virome is a dynamic component of the female genital ecosystem. It includes viruses that infect human cells, bacteriophages, and endogenous viral elements. Observational studies have associated altered viral composition or diversity with vaginal dysbiosis, persistent HPV detection, and adverse pregnancy outcomes, including preterm birth. These relationships remain correlative, and causality has not been established. Bacteriophage-based therapies and recombinant endolysins may selectively target bacterial biofilms associated with bacterial vaginosis. However, most applications remain preclinical or in early clinical development. Better characterization of the interactions among viruses, bacteria, epithelial cells, and mucosal immunity may support future diagnostic biomarkers and precision therapeutic strategies in women's health.