Evvy, the vaginal microbiome testing company, has published data showing that bacterial vaginosis (BV) encompasses six distinct microbial subtypes rather than the single, broadly defined condition it’s traditionally been treated as. The findings are drawn from shotgun metagenomic sequencing of more than 100,000 real-world vaginal microbiome samples – what Evvy says is the largest dataset of its kind.
BV affects more than 30% of reproductive-age women in the U.S. annually and is a leading reason people visit the gynecologist, yet it’s still broadly defined as an “overgrowth of bacteria” with limited nuance in how it’s diagnosed or treated. Evvy’s data suggests patients with the same clinical diagnosis can have fundamentally different underlying microbiomes – which may help explain why recurrence rates are so high and why standard treatments don’t work for everyone.
The six subtypes Evvy identified range from the classic BV presentation (dominated by Gardnerella and Prevotella with low Lactobacillus) to more nuanced patterns including a “biofilm BV” characterized by bacteria that form protective structures making them harder to treat, a “transitional BV” dominated by L. iners that may be progressing toward or recovering from BV, and a “lacto-dominant BV” where protective lactobacilli are actually present alongside BV-associated bacteria at lower levels.
“BV has historically been defined in very broad terms, despite advances in sequencing technology,” said Dr. Kate McLean, OB-GYN and Chief Medical Advisor at Evvy. “By applying high-resolution microbiome analysis across a large and diverse population, Evvy can identify reproducible microbial patterns that add important biological context to a BV diagnosis. This is how precision medicine begins to take shape in women’s health.”
The subtypes are now integrated into the Evvy product experience – patients diagnosed with BV through the platform will see their specific microbial subtype alongside clinician-designed care pathways. Evvy says it has shared the methodology and initial findings with plans to publish larger papers contributing to the clinical conversation around BV heterogeneity and recurrence.
“For too long, patients with BV have been treated as if a simple diagnosis tells the whole story,” said co-founder and CEO Priyanka Jain. “By investing in uncovering deeper biological context, we’re helping clinicians and patients better understand what’s actually happening beneath the surface.”
