Bacterial Vaginosis: Discover Why Researchers Now Classify It as an STI and What It Means for Your Health

Bacterial vaginosis (BV) has long been recognized as a prevalent vaginal condition affecting women, but new research suggests that it may also be classified as a sexually transmitted infection (STI). This recent study published in The New England Journal of Medicine highlights the importance of understanding the treatment landscape of BV and its potential transmission between sexual partners.

Bacterial vaginosis affects approximately 30% of reproductive-aged women in the United States. It arises from an imbalance of “good” and “bad” bacteria within the vagina. This imbalance can lead to significant health complications, including an elevated risk of acquiring other STIs and developing pelvic inflammatory disease.

Traditionally, treatment for BV has involved a week-long course of antibiotics for women only. However, the reinfection rate is notably high, with up to 80% of women experiencing a recurrence within nine months post-treatment. In light of these statistics, researchers explored a new approach: treating both female and male partners simultaneously. Their findings revealed substantially improved cure rates compared to the standard practice of treating only the woman.

As researchers Lenka Vodstrcil and Catriona Bradshaw, from Monash University and Melbourne Sexual Health Centre, noted, “We, and others, have accumulated a body of evidence to show that BV, and BV-associated bacteria, is sexually transmitted.” This revelation brings BV into a new light and could significantly influence treatment protocols.

Understanding Bacterial Vaginosis

Bacterial vaginosis is defined by the Centers for Disease Control and Prevention (CDC) as a condition where there’s an imbalance of bacteria in the vagina. Under normal circumstances, the vagina hosts a variety of bacteria that help maintain its health. However, with BV, harmful bacteria outnumber the beneficial ones.

Many women with bacterial vaginosis remain asymptomatic, but those who do experience symptoms may face:

• A thin white or gray vaginal discharge
• Pain, itching, or burning sensations in the vagina
• A strong fish-like odor, particularly after sexual intercourse
• Burning during urination
• Itching around the vaginal opening

Why Bacterial Vaginosis Isn’t Classified as an STI

Despite growing evidence suggesting that BV can be sexually transmitted, the American College of Obstetricians and Gynecologists (ACOG) does not currently classify it as an STI. This classification is essential, as it shapes how the condition is treated across various medical settings.

Some reasons for the current classification include:

• Bacterial vaginosis can occur in individuals who have never been sexually active, although this is uncommon.
• Men typically do not exhibit symptoms associated with BV.
• Previous studies from the 1980s and 1990s suggested that treating both partners did not prevent reinfection.

However, limitations in those prior studies — specifically treating men with oral antibiotics instead of topical creams — raise questions about their conclusions. Lenka Vodstrcil and Catriona Bradshaw argue that, “The body of evidence suggesting BV was sexually transmitted was overwhelming, so we decided we had to revisit partner treatment.”

Examining a New Treatment Paradigm

The new study involved 164 monogamous heterosexual couples, all of whom had a female partner diagnosed with BV. Participants were divided into two groups: one received treatment solely focused on the women, while the other included both the women and their male partners receiving antibiotics and topical ointments.

After a 12-week follow-up, the study concluded prematurely due to the overwhelming success of treating both partners. In the female-only treatment group, 63% of women experienced reinfection. Conversely, only 35% of women in the partner treatment group faced a resurgence of BV.

Researchers state, “Our trial found that reinfection from an ongoing sexual partner is a significant driver of BV recurrence.” This emphasizes the importance of treating both partners to effectively combat BV.

The Future of BV Classification and Treatment

Although these findings are promising, medical expert Aparna Sridhar cautions against prematurely classifying BV as an STI. “At this time, the study provides valuable evidence suggesting that treating male partners in heterosexual relationships may help reduce BV recurrence,” she stated, emphasizing that this does not yet constitute a definitive classification of BV as an STI.

Despite this, there is an increasing acknowledgment of the need to address BV through a shared responsibility between partners. Gale Burstein, MD, noted, “Significantly reducing the prevalence of BV recurrence by treating the male sexual partner provides robust evidence that BV-associated bacteria are sexually transmitted.”

In conclusion, researchers Vodstrcil and Bradshaw highlight the necessity for evolving treatment approaches in BV management, recommending that healthcare providers consider the treatment of both partners to minimize reinfection risks. They have even created a dedicated website aimed at spreading awareness and providing resources regarding their findings. “We recognize that for men who don’t have symptoms, taking medication can be confusing,” they said. By fostering a cooperative approach, understanding, and open dialogue, the stigma surrounding BV can be alleviated while ensuring effective treatment for those affected.