VAGINAL MICROBIOTA: CLINICAL SIGNIFICANCE AND MANAGEMENT STRATEGIES IN WOMEN WITH INTERMEDIATE NUGENT PROFILES (4–6)

Abstract

Introduction. A Nugent score of 4–6 is not diagnostic for bacterial vaginosis (BV) but reflects vaginal microbiota instability and may indicate an unfavorable prognosis. Molecular studies show that BV-related microbial patterns occur even at intermediate morphotypes, highlighting the need for careful evaluation. Aim. To summarise current data on the vaginal microbiome at Nugent scores 4–6, determine the clinical significance of this intermediate range, and outline possible management algorithms for patients with a borderline microbiological profile. Materials and methods. This review is based on a structured analysis of 78 publications retrieved from PubMed, Scopus, Web of Science, and Google Scholar (2000–2025), including clinical studies, molecular microbiome analyses, and meta-analyses focused on women with intermediate Nugent scores (4–6). A systematic search strategy with explicit inclusion and exclusion criteria was applied. Included studies: peer-reviewed clinical, molecular, or microbiome analyses with reported Nugent 4–6 data. Excluded: non-peer-reviewed sources, conference abstracts, studies without Nugent stratification. Results. Intermediate scores are linked to reduced Lactobacillus crispatus and L. jensenii, predominance of L. iners, and moderate presence of anaerobes such as Gardnerella vaginalis and Atopobium vaginae. This pattern corresponds to community state type IV (CST- IV), associated with higher risks of BV, recurrent infections, and adverse reproductive outcomes. Symptoms, elevated pH, pregnancy, or immunosuppression justify treatment, while asymptomatic women with normal pH may be observed. Conclusions. These conclusions are based on a synthesis of peer-reviewed scientific literature covering clinical, molecular and microbiome studies published between 2000 and 2025. Data from Gram staining, qPCR, 16S rRNA sequencing, and CST classification support molecular diagnostics and differentiated therapy. Combined regimens using probiotics, antimicrobials, or integrated strategies help stabilise the microbiota and prevent dysbiosis. An intermediate Nugent score should be regarded as a marker of microbial imbalance requiring individualised management and further research toward personalised, biomarker-based care.