• Recent studies indicate that what is commonly known as a vaginal infection might actually be transmitted sexually.

  • Studies have shown that bacterial vaginosis (BV) can affect males as well, though it is typically considered a female condition.

  • The repeated occurrence of BV can be mitigated by treating the sexual partners of the affected individuals.

  • Research indicates that the chances of BV recurring are greatly reduced when both partners receive treatment.

Bacterial vaginosis (BV) is a prevalent vaginal infection that impacts roughly one-third of women globally and is known for its tendency to recur.

While traditionally, BV treatments have concentrated on women, new findings advocate for the treatment of sexual partners to manage what is now being recognized as a sexually transmitted infection (STI).

BV can develop after being exposed to a new sexual partner, especially in the absence of condoms or other protective barriers. The risk of getting reinfected increases when having intercourse with a regular partner after treatment.

The study uncovered that during sexual activities, microorganisms associated with BV can be transferred between partners.

Significant reductions in BV recurrence were noted when both female and male partners were treated. Women were treated with standard antimicrobial treatments, while men received a combination of oral and topical antimicrobials. This dual approach helped reduce the recurrence of BV in women within three months.

These insights have led researchers to suggest that including male partners in the treatment process could enhance the effectiveness of BV therapies and potentially lead to its eradication. The findings were published in The New England Journal of Medicine on March 5th.

“Previous attempts at partner treatment trials have been made by experts holding similar views, but these attempts did not decrease recurrence or improve the cure rate for BV in women,” explained Catriona Bradshaw, PhD, from the University of Melbourne’s School of Population and Global Health.

“These failures could partly be attributed to limitations in the trial designs, but we also believe it could be due to the exclusive use of oral antibiotics for men in those studies,” Bradshaw added during her interview with Healthline.

Reduction in BV Recurrence through Male Partner Treatment

Although BV is treatable and curable, about half of all women experience a recurrence within six months after receiving antibiotic treatment. This recurrence is associated with heightened risks of complications during pregnancy.

Having a regular sexual partner triples the likelihood of BV returning.

Experts have not traditionally classified BV as an STI due to the origin of the bacteria being internal rather than from sexual contact. However, the recent study challenges this view.

Prior investigations have found that men can harbor bacterial species associated with BV in their urethra and on their penile skin.

The researchers have compiled evidence over two decades to demonstrate that BV should be considered an STI.

The study involved 164 monogamous heterosexual couples where the female was diagnosed with BV. In the treatment group of 81 couples, women received first-line antimicrobial treatments, and men were given both oral and topical antimicrobials (metronidazole tablets and clindamycin cream) for seven days.

“Our approach was novel because we targeted the bacteria on the penile skin with a topical antibiotic as well as the bacteria inside the urethra with an oral antibiotic,” Bradshaw explained.

The control group consisted of 83 couples where only the females were treated, and males received no treatment. The study concluded at the 12-week follow-up because the female-only treatment proved less effective than the dual-partner treatment.

In the group where both partners were treated, the recurrence of BV in women was 35% compared to 63% in the control group.

Adverse effects in treated male partners were minor and included:

  • nausea

  • headache

  • a metallic taste

“This treatment strategy proved highly effective,” Bradshaw stated. “It clearly shows that men can reinfect women, which accounts for a significant portion of BV recurrences. The treatment is simple, well-tolerated, and only needs to be administered for a week.”

Advancements in Diagnosis and Treatment of Bacterial Vaginosis

Bradshaw emphasized that further research in a variety of populations and settings is essential to validate these results.

She is particularly interested in exploring the causes behind the high rates of treatment failure and recurrence of BV.

Bradshaw is also investigating why a small percentage of women continue to show signs of BV even after completing their antibiotic regimen and without resuming sexual activity.

These findings could potentially lead to improved treatment protocols that involve both partners.

“Our research is aimed at analyzing samples from couples to determine if specific bacterial strains in men are responsible for recurring BV in women. This could potentially lead to the development of more precise tests for BV, including tests for men, which has never been done before,” Bradshaw explained.

“We hope this trial will help doctors tailor BV treatments for their patients. This study is particularly relevant for women in a monogamous relationship with a male partner. For women without a current partner, the focus should be on their treatment and understanding that condoms can provide some protection against BV, just as they do against many STIs,” she added.

To increase awareness about treating BV as an STI, the researchers have created a website with resources for healthcare providers, patients, and their male partners.

Key Facts About Bacterial Vaginosis

​Bacterial vaginosis (BV) arises when there’s an imbalance in the vaginal bacterial environment, leading to an overgrowth of specific bacteria.

BV can cause several bothersome symptoms, including:

  • Unusual vaginal discharge that may be thin, gray, white, or green

  • A fishy odor, particularly after sex

  • Itching or irritation in the vaginal area

  • Burning during urination

It’s possible for some individuals with BV to not exhibit any symptoms, which underscores the importance of regular visits to a gynecologist for early detection.

Approaches to Treating BV

The primary treatments for bacterial vaginosis often involve antibiotics, administered either orally or through vaginal gels or suppositories. These treatments include:

  • Oral or vaginal antibiotics

  • Vaginal pessaries

  • Medicated vaginal gels

Strategies for Managing Recurrent BV

If BV persists after initial treatments, other strategies may be recommended, such as:

  • An extended course of antibiotics

  • Preventative measures like avoiding scented menstrual products, changing out of tight or damp clothing, and wearing breathable cotton underwear

  • Adjustments to sexual practices, including limiting the number of sexual partners and using latex condoms or other barrier methods during intercourse

When to Consult a Healthcare Provider

If you experience the following, it’s important to seek medical advice:

  • Unusual vaginal discharge with an odor

  • Persistent vaginal irritation or discomfort

  • Symptoms that recur after initial treatment

  • Concerns about a potential infection

Conclusions from the Study

Bacterial vaginosis (BV) has not been traditionally classified as a sexually transmitted infection, but recent research suggests this may change.

Studies have demonstrated that BV is present in males, and findings from the University of Melbourne indicate that treating both partners could significantly reduce the high rates of recurrence in women.

Further research with larger and more diverse groups is necessary to confirm these findings and to gain a deeper understanding of the reasons behind persistent BV despite treatment.