From the Guidelines
Bacterial vaginosis (BV) is not considered a sexually transmitted infection (STI), although it is associated with sexual activity and can increase the risk of developing BV. The condition occurs when there's an overgrowth of certain bacteria naturally found in the vagina, particularly Gardnerella vaginalis, which outnumbers beneficial lactobacilli 1. While BV can develop in women who aren't sexually active, having new or multiple sexual partners can increase risk.
Key Points
- BV is the most prevalent cause of vaginal discharge or malodor, but up to 50% of women with BV may not report symptoms 1.
- The cause of the microbial alteration is not fully understood, but it is associated with having multiple sex partners, douching, and lack of vaginal lactobacilli 1.
- Treatment of the male sex partner has not been beneficial in preventing the recurrence of BV 1.
- Treatment typically involves antibiotics such as metronidazole (500mg twice daily for 7 days) or clindamycin (300mg twice daily for 7 days), available as oral tablets or vaginal creams/gels 1.
Recommendations
- It is essential to complete the full course of antibiotics even if symptoms improve quickly.
- Sexual partners generally don't need treatment, but using condoms may help reduce recurrence.
- BV can cause complications including increased susceptibility to STIs and pregnancy complications if left untreated, so seeking medical care for symptoms like unusual discharge or fishy odor is recommended.
From the Research
Bacterial Vaginosis (BV) and Sexual Transmission
- The question of whether Bacterial Vaginosis (BV) is sexually transmitted is a topic of ongoing debate in the medical community 2, 3, 4, 5, 6.
- Studies have shown that women are more likely to report BV if they have had a higher number of lifetime sexual partners, are unmarried, have engaged in their first intercourse at a younger age, have engaged in commercial sex work, and practice regular douching 3.
- A study found that women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence, with the top 3 factors attributed to both BV onset and recurrence being unprotected sex, sex with a new male partner, and sex in general 2.
- However, another study suggests that BV may be considered a sexually enhanced disease (SED) rather than a sexually transmitted infection (STI), with frequency of intercourse being a critical factor 6.
Evidence for and Against Sexual Transmission
- Some studies have found that BV is associated with an increased risk of other STIs, such as Chlamydia trachomatis and Neisseria gonorrhoeae 3, 5.
- A systematic review of randomized trials found that treatment of male sexual partners did not have a uniformly beneficial effect on reducing BV recurrence in women, which is incongruous with epidemiologic and microbiologic data suggesting a sexually transmissible component of BV 4.
- Another study found that periodic presumptive treatment for vaginal infections, including BV, may reduce the incidence of sexually transmitted bacterial infections 5.
Mechanisms of BV Pathogenesis
- The exact mechanisms of BV pathogenesis are not fully understood, but it is thought to involve a shift from lactobacilli-dominated microflora to a BV-like type of microflora, which may be enhanced by sexual activity 6.
- Mechanical transfer of perineal enteric bacteria during coitus may also play a role in the development of BV 6.