From the Guidelines
Bacterial vaginosis (BV) is not classified as a sexually transmitted infection (STI), although sexual activity can disrupt the vaginal bacterial balance and increase the risk of developing BV. BV occurs when there's an imbalance in the normal bacteria in the vagina, specifically an overgrowth of certain bacteria like Gardnerella vaginalis while beneficial lactobacilli decrease. According to the Centers for Disease Control and Prevention guidelines 1, BV is associated with having multiple sex partners, douching, and lack of vaginal lactobacilli; however, it is unclear whether BV results from acquisition of a sexually transmitted pathogen. Key points to consider include:
- BV is the most prevalent cause of vaginal discharge or malodor; however, up to 50% of women with BV may not report symptoms of BV 1.
- Women who have never been sexually active are rarely affected 1.
- Treatment of the male sex partner has not been beneficial in preventing the recurrence of BV 1. The condition is typically treated with antibiotics such as metronidazole (500mg orally twice daily for 7 days or 0.75% gel intravaginally once daily for 5 days) or clindamycin (300mg orally twice daily for 7 days or 2% cream intravaginally at bedtime for 7 days) 1. It's essential to complete the full course of antibiotics even if symptoms resolve earlier. During treatment, avoiding alcohol with metronidazole is necessary as it can cause severe nausea and vomiting. While BV itself isn't directly transmitted through sexual contact like traditional STIs, the disruption of vaginal flora that leads to BV can be influenced by sexual activity, which explains why some consider it sexually associated rather than sexually transmitted.
From the Research
Bacterial Vaginosis Transmission
- The provided studies do not directly address whether bacterial vaginosis (BV) is sexually transmitted 2, 3, 4, 5, 6.
- However, it is mentioned that BV affects many women and has a significant influence on their self-esteem, being associated with huge discomfort and changes in routines, especially sexual life 2.
- The studies primarily focus on the treatment of BV, comparing the efficacy of different antibiotics and treatment regimens 3, 4, 5, 6.
- There is no clear evidence in the provided studies to support the claim that BV is sexually transmitted, but it is known that BV can be associated with sexual activity and other factors 2.
Treatment and Recurrence
- The studies suggest that BV is associated with high rates of recurrence, and appropriate management of such recurrences can be challenging 3.
- The recurrence of BV may be linked to the persistence of Gardnerella vaginalis after treatment, but the clinical implications of this are not yet clear 3.
- Different treatment options, including oral metronidazole, tinidazole, and clindamycin, have been compared in terms of efficacy and tolerability 3, 4, 5, 6.