A common condition affecting hundreds of millions of women has been reclassified as a sexually transmitted infection after doctors discovered sex is a major driver.
Bacterial vaginosis (BV) is an overgrowth of bad bacteria in the vagina that causes excess gray or white discharge, a fishy odor and vaginal itching and burning.
The condition can cause infertility, premature births and newborn deaths and a third of women worldwide – up to 1.3billion – are estimated to have had it.
Only women can get it but now that doctors have reclassified the infection as an STI, they hope it can ‘pave the way for a revolution in how it is treated’ by including male partners in treatment plans.
BV was previously not classified as an STI but it was known to be more common in women who were sexually active, as sex exposes the vagina to more bacteria.
BV is unlike other STIs in that it isn’t contagious like chlamydia or syphilis and isn’t spread by bodily fluids. Instead, a woman develops BV when something disrupts the balance of healthy vaginal bacteria.
It can also be caused by pregnancy, smoking and certain hygienic products – anything that affects hormones or throws off the balance of good and bad bacteria in the vagina and disrupts its healthy microbiome.
Bacterial vaginosis (BV) is estimated to affect about one-third of women globally, or about 1.3billion people
The standard treatment – a week-long round of oral antibiotics or antibiotic vaginal suppositories – approaches the infection as solely an imbalance of vaginal bacteria – but more than 50 percent of women have a relapse of symptoms within three months.
And while BV only infects women, researchers found that approaching it as an STI and including male sexual partners in the treatment plan achieves ‘significantly higher cure rates than treating women alone.’
This, they hope, will drastically reduce recurrence rates.
Co author of the study Professor Catriona Bradshaw, a researcher at the Melbourne Sexual Health Centre, said: ‘Our trial has shown that reinfection from partners is causing a lot of the BV recurrence women experience, and provides evidence that BV is in fact an STI.’
Researchers at Monash University and Melbourne Sexual Health Centre studied the infection in 164 couples.
For the trial, which returned such strong results it was ended early, all the women with BV received oral antibiotics.
Their male partners were randomly assigned to receive both an oral antibiotic and a topical medicated cream or receive no treatment.
Couples took the medications for one week and were followed up for 12 weeks to determine any recurrence.
They found BV recurrence in the partner-treated group was half of that in the women-only treated group.
The researchers didn’t posit why recurrence was lower, but previous studies, they said, have shown men harbor bacteria associated with BV on the penis and inside the penis.
Therefore, treating men for the infection could be eliminating that bacteria.
This would prevent men from introducing the bacteria into the vagina and upsetting the vaginal microbiome.
Professor Bradshaw added: ‘This successful intervention is relatively cheap and short and has the potential for the first time to not only improve BV cure for women, but opens up exciting new opportunities for BV prevention, and prevention of the serious complications associated with BV.’
Estimates of the number of cases of BV vary widely, but one study found 29 percent of American women – 21million – between 14 and 49 years old have had BV. In the UK, it is 15 to 30 percent.
But just 16 percent exhibited any symptoms in the US study.
The lack of signs or symptoms raises concerns because untreated BV can lead to reproductive health issues.
The infection can cause pelvic inflammatory disease (PID), which can damage the fallopian tubes and cause infertility.
Additionally, BV makes the body more susceptible to bacterial uterine infections, which double the risk of preterm birth and increase the risk of low birth weight.
Historically, BV has been difficult to establish as an STI because doctors still don’t know the exact bacteria behind the infection, but ‘advances in genomic sequencing are helping us close in on that mystery.’
Co-author Dr Lenka Vodstrcil, also a researcher at the Melbourne Sexual Health Centre, added that having BV was already known to increase the risk of other STIs.
She said: ‘We’ve suspected for a long time that it’s a sexually transmitted infection because it has a similar incubation period [after sex] to most STIs and is associated with the same risk factors as STIs like chlamydia, such as change in sexual partner and not using condoms.’
Based on their new study, the Melbourne Sexual Health Centre has already updated its treatment plan to treat couples together.
Additionally, new resources are being establishing to provide this updated information to providers and consumers.
Professor Bradshaw added: ‘This information has been co-designed with consumers and participants in the trial and health professionals to make it accessible to all.
‘Changes in national and international treatment guidelines always take time, so we felt an obligation to provide accurate online and downloadable information at the time that the results of the trial are published.’
