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Australian researchers found that recurrent bacterial vaginosis occurs through two distinct pathways: persistence of infection despite antibiotics and re-infection from partners. The study involved 188 couples and was published in The Lancet Obstetrics, Gynaecology & Women's Health.
Australian scientists have identified two distinct contributors to recurrent bacterial vaginosis, a common sexual health condition affecting about one in four women globally. The research, published in The Lancet Obstetrics, Gynaecology & Women's Health, involved 188 couples and revealed two separate pathways to recurring BV: persistence of the condition despite a weeklong course of antibiotics, and re-infection.
The condition, commonly called BV, is characterised by an imbalance of naturally occurring bacteria in the vagina, involving a reduction of good bacteria and an overgrowth of other mixed bacteria. BV can be asymptomatic or can cause vaginal itching, burning and discomfort. Treatment is essential as the condition can increase susceptibility to other infections and is linked to complications in pregnancy and childbirth.
Partner Treatment and BV Recurrence
Previous research by the same group found that concurrently treating women with the condition and their male sexual partners with antibiotics reduced BV recurrence rates by more than 60%. In this new research, the scientists set out to understand why about 20% of women treated concurrently with their partners were not cured of BV. The study involved 188 couples: the women were given a weeklong course of oral antibiotics, while the men were treated with both oral and topical antimicrobials.
The study identified two distinct pathways to recurring BV: persistence of the condition despite a weeklong course of antibiotics, and re-infection. A researcher from the Melbourne Sexual Health Centre said: For about two-thirds of women, the day after they finish treatment, they return to an optimal vaginal microbiome, which is characterised by an abundance of healthy bacteria.
The other third of women had microbiomes suggesting they may not have cleared their BV before couples resumed sex after treatment, and were nearly three times more likely to get the condition again within four weeks. A better understanding of persistence of infection helps us develop new strategies to cure more women from BV, Vodstrcil said.
Two Pathways to Recurring BV
The study, which the researchers believe is the largest to date involving heterosexual couples receiving concurrent BV treatment, found that persistence and reinfection from partners were distinct, but not mutually exclusive, pathways. Of the female participants, 30% used an intrauterine device, which the study found could enhance the persistence of bacterial vaginosis following treatment in some women but noted that further research was needed. The scientists now plan to trial longer treatment lengths and combinations of multiple antibiotics.
Our aim is to stop women from having two, three, four courses of antibiotics throughout the year, which was happening previously, Vodstrcil said. Study senior author Prof Catriona Bradshaw, head of research translation and mentorship at Monash University and the Melbourne Sexual Health Centre, said: Using partner-treatment to mitigate re-infection and more intensive strategies that target persistence of BV-bacteria, we hope to create more effective treatment approaches that can be tailored to an individual and achieve higher levels of cure.
Though the ethnicities of participants were representative of urban Australia, the study noted that its results might not be generalisable to other global populations, including those in low-income and middle-income countries and in other settings with a high burden of bacterial vaginosis.
Recurrent BV Antibiotic Treatment Partner Treatment Vaginal Microbiome
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