Background and aim: Antimicrobial resistance has increased in G. vaginalis. The aim was to determine the susceptibility patterns of isolates of G. vaginalis to antibiotics and investigated the genetic diversity of the isolates as well as linked the genetic data to patterns of antimicrobial resistance.

Methods: A cross sectional study where a total of n=150 pregnant women were enrolled. Vaginal swabs were used for cultivation of G. vaginalis and diagnosis of BV via Nugent scoring. Genetic diversity assessments were based on the genetic differences in the tuf gene using clade specific primers on a qPCR platform. The antimicrobial susceptibility profiles were generated using the Sensititre™ Anaerobe MIC Plate (Thermo Fischer Scientific, United States).

Results: 17 isolates of G.  vaginalis was isolated out of the 150 vaginal swabs. 5 were BV positive, 2 were BV negative and 9 were BV intermediate. All isolates were oxidase and catalase negative. The 16S rRNA gene was amplified in all isolates. 0% belonged to clade 3. The frequencies for clades were as follows; 100% for clade 1, 37.5% for clade 2 and 43.75% for clade 4. Multiple clades were found in 56.25% of the isolates. 15 isolates were successfully cultured and tested. 60% were susceptible to metronidazole and 40% were resistant to metronidazole. BV positive women (5), 20% showed metronidazole resistance. BV negative women (2), 50% showed metronidazole resistance. BV intermediate women (8), 50% showed metronidazole resistance. Highest prevalence of metronidazole resistance was in women with BV intermediate status. All women that were resistant to metronidazole experienced abnormal discharge. 100% of isolates with metronidazole resistance fell into clade 1. 16.66% of metronidazole resistant isolates fell into clades 1 and 4.

Conclusion: This study has shown a link between clade 1, BV intermediate women and metronidazole resistance. More research needs to focus on genotyping to understand the resistance patterns.

Abbreviations: BV- Bacterial vaginosis, G. vaginalis- Gardnerella vaginalis, MIC-Minimum inhibitory concentration, qPCR- Quantitative Polymerase Chain Reaction, RNA-Ribonucleic Acid