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News|Articles|July 13, 2026

Kate McLean, MD, MPH, on how bacterial vaginosis subtypes may validate symptoms, guide treatment

Key Takeaways

  • Newly defined BV microbial subtypes may help validate patients whose symptoms fall outside the classic presentation.
  • McLean hypothesizes subtype-specific approaches, such as boric acid before antibiotics for biofilm BV and L. crispatus probiotics for typical BV, though these remain to be confirmed.
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Kate McLean, MD, describes how newly defined bacterial vaginosis subtypes could validate patient symptoms and inform treatment.

Newly defined microbial subtypes of bacterial vaginosis (BV) may help validate patients' symptoms and eventually guide more tailored treatment, according to Kate McLean, MD, MPH, FACOG, ob-gyn, Chief Medical Officer, Evvy. In a continued conversation with Contemporary OB/GYN, McLean discussed how added nuance in classifying BV could reshape both the clinical encounter and treatment strategy.1

The discussion builds on Evvy's February announcement, which identified 6 distinct microbial subtypes — typical, transitional, lacto-dominant, biofilm, mixed, and atypical BV — from sequencing of more than 100,000 vaginal microbiome samples.2

Validating the patient experience

McLean framed the first benefit of subtyping as helping patients whose symptoms fall outside the classic BV presentation feel understood.

“I think patients whose symptoms do not classically fit BV have been told, ‘Well, maybe you do not actually have BV. Are these symptoms just in your head?’” she said. “And so I think adding more nuance helps patients feel understood and included. And then I think on the flip side, it helps us understand the science even better.”

She noted that matching symptoms to microbial signatures could be affirming for patients who have struggled to get answers.

“If we can say to somebody, it actually makes sense that you are experiencing burning because we see these particular microbial signatures, somebody is going to be like, ‘Wow, it just feels validating to know that there are other patients just like me, that this is a known pattern, and that this burning is not in my head because I went to five other doctors before this and they told me I was crazy,’” McLean said.

Could subtypes inform treatment?

McLean offered several hypotheses about how subtypes might inform treatment, while emphasizing these remain to be tested against the data.

“For the biofilm-producing BV, I would expect to see in our data that patients perhaps who tried boric acid prior to doing a vaginal antibiotic course might have a better outcome,” she said, describing boric acid as a means of breaking up biofilm before introducing an antibiotic. For typical BV, she hypothesized that patients using vaginal probiotics containing Lactobacillus crispatus after antibiotic treatment would fare better by boosting healthy bacteria.

The subtypes remain an early framework, and McLean noted that correlating them with symptoms and treatment outcomes is the next phase of research.

References:

  1. Fitch J. Kate McLean, MD, MPH, explains microbial subtypes within bacterial vaginosis. Contemporary OB/GYN. Published July 2026. Accessed July 13, 2026. https://www.contemporaryobgyn.net/view/kate-mclean-md-mph-facog-better-understanding-bacterial-vaginosis
  2. Evvy Unveils Data-Driven Subtypes of Bacterial Vaginosis. Evvy. Press release. Published February 26, 2026. Accessed July 13, 2026. https://www.businesswire.com/news/home/20260226236249/en/Evvy-Unveils-Data-Driven-Subtypes-of-Bacterial-Vaginosis

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