A groundbreaking study from researchers at Monash University and Alfred Health has revolutionized the understanding of bacterial vaginosis (BV), a condition affecting nearly a third of women globally and linked to infertility, premature birth, and newborn deaths. Published today in the New England Journal of Medicine, the study reveals that BV is, in fact, a sexually transmitted infection (STI), which could dramatically change how it is treated moving forward.
Professor Catriona Bradshaw and Dr. Lenka Vodstrcil, leading researchers from the Melbourne Sexual Health Centre, emphasized the importance of their findings, which suggest that the standard approach to treating BV—as a microbial imbalance in the vaginal flora—has not been effective in preventing recurrence. Over 50% of women experience a relapse within three months after receiving standard treatment with a one-week course of oral antibiotics.
In a randomized trial of 164 couples with BV in monogamous relationships, the researchers found that treating both sexual partners simultaneously led to significantly higher cure rates compared to the current practice of treating women alone. The trial was so successful that it was halted early when it became clear that BV recurrence rates were halved in couples who received treatment for both partners.
Professor Bradshaw called the new approach “relatively cheap, short, and transformative,” saying it could significantly improve BV cure rates for women while opening up new opportunities for prevention and addressing the serious complications that stem from the condition.
The study’s design included a multicenter, randomized trial where women were treated with first-line recommended antibiotics. Their male partners were either treated with both oral antibiotics and a topical antibiotic cream for one week or assigned to a control group, which received no partner treatment. Couples were followed for 12 weeks to assess the effectiveness of this combined treatment approach.
Dr. Vodstrcil noted that BV had long been suspected of being an STI due to its association with risk factors common to other STIs, such as multiple sexual partners and inconsistent condom use. “We’ve suspected for a long time that BV might be sexually transmitted because it has similar characteristics to other STIs, including a comparable incubation period after sex,” she said.
Previously, studies suggested that while men could harbor bacteria associated with BV on the penile skin and inside the penis, treating male partners did not result in improved BV outcomes for women. However, these earlier studies had significant design flaws, including not using a combination of oral and topical antibiotics to effectively treat bacterial presence in men.
“This study provides strong evidence that reinfection from male partners is a significant cause of BV recurrence in women, and firmly establishes that BV is indeed an STI,” Professor Bradshaw stated.
The findings are further supported by advances in genomic sequencing, which are shedding light on the specific bacterial species responsible for BV. With this new evidence, the Melbourne Sexual Health Centre has already begun changing its clinical practice to treat both partners in BV cases. A new online platform has been launched, offering health professionals and the public easy access to guidelines for prescribing and administering partner treatment.
Assistant Minister for Health Ged Kearney highlighted the implications of the study for women’s health, especially in preventing the serious consequences of BV, including premature labor and pregnancy loss. “Bacterial vaginosis is a common condition with severe consequences, and this study shows how a simple shift in treatment can make a significant difference for women’s health.”
While changes to national and international treatment guidelines may take time, Professor Bradshaw and her team are committed to ensuring that healthcare providers and consumers have access to the latest, evidence-based information immediately.
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