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A THIRD OF WOMEN GET THIS INFECTION. THE FIX: TREAT THEIR MALE
PARTNERS.
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Alisha Haridasani Gupta
March 5, 2025
New York Times
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_ Bacterial vaginosis is most likely a sexually transmitted
infection, according to a new study. _
, Getty Images
Bacterial vaginosis is a poorly understood infection that affects one
in three women and can bring with it uncomfortable symptoms and,
sometimes, long-term health complications. Treatment is often
unsuccessful, with 60 percent of B.V. cases recurring within a year,
keeping women stuck in a disruptive cycle of going on and off
antibiotics.
A study
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shows the results of a novel treatment regimen so effective that an
independent safety-monitoring group advised halting the trial early so
that all participants could access it.
The key? Treating the women’s male partners.
The findings are “pretty significant for women’s health,” said
Dr. Christina Muzny, professor of obstetrics and gynecology at the
University of Alabama at Birmingham. She was not involved in the study
but coauthored an editorial
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findings in the New England Journal of Medicine. Not only do the study
results change how B.V. could be treated going forward, she said, but
they also seem to confirm a long-held suspicion among scientists that
the condition is actually a sexually transmitted infection.
“Patients and providers are going to need renewed education on
B.V.,” Dr. Muzny said.
The Centers for Disease Control and Prevention describe B.V. as a
condition
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occurs when there is an imbalance of vaginal bacteria, but “we
don’t know if it’s one bacteria or a group of bacteria” or what
throws off the balance, Dr. Muzny said.
Many women don’t have symptoms; those who do may experience
increased discharge, a fishy odor and burning or itching in the
vaginal area. Infected patients, whether or not they are symptomatic,
are at greater risk of developing other sexually transmitted
infections, such as chlamydia or H.I.V., as well as pelvic
inflammatory disease. B.V. in pregnant women is also associated with
an increased risk of preterm birth.
The standard treatment for B.V. is a weeklong course of antibiotics
taken either orally or vaginally, said Dr. Paul Nyirjesy, co-director
of the Jefferson Vulvovaginal Health Center in Philadelphia, PA. But
its high recurrence rate means patients have to get “treated over
and over and over — five, six, 10 times,” which can impact their
quality of life and their sex lives. Some patients are put on
prolonged regimens of six or seven months to suppress the bacteria, he
said, but once they stop treatment, the infection often comes back.
In the study, which was conducted at multiple sexual health and family
planning centers in Australia, researchers gave 83 monogamous couples
the standard treatment of a seven-day course of antibiotics for the
female partner. Meanwhile, 81 other monogamous couples received
treatment for the male partner too, which included a seven-day course
of oral antibiotics and a topical antibiotic that was applied to the
penis. After 12 weeks, 35 percent of women in the partner treatment
group had B.V. again compared to 63 percent in the standard treatment
group. A majority of men experienced no side effects with the
treatment but some reported nausea, headaches or a metallic taste.
Potential risk factors for B.V. recurrence include having an
intrauterine device or having sex with an uncircumcised partner. This
study found that even among patients with those risk factors, treating
both partners reduced recurrence, said Dr. Catriona Bradshaw, the lead
author of the study and a clinician at the Melbourne Sexual Health
Centre at Monash University.
For decades, reproductive health experts have suspected that B.V. was
sexually transmitted. While doing research in central and east Africa
over 20 years ago, Dr. Bradshaw found that “recurrence was double or
triple in women who had an ongoing sex partner,” she said. It was
also more common in people who didn’t use condoms — both signs
that suggested the infection was an S.T.I.
[[link removed]] Several other studies
published over the years bolstered that theory, including more recent
findings that bacteria in infected women tended to match
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penises [[link removed]].
But, in the 1980s and early 1990s, a handful of trials in which men
were given antibiotics as a way to reduce B.V. rates failed to reduce
recurrence. The results of those studies “were actually taken as
evidence that B.V. was not an S.T.I.,” Dr. Bradshaw said. “It was
really the nail in the coffin.”
Since then, however, researchers have concluded that those failed
studies had significant flaws
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said Dr. Nyirjesy. Key among them was that participants only used an
oral antibiotic without addressing the bacteria that lived on the
penis skin. To date, the new study is the only one that used both oral
and topical treatments.
The findings of this study represent a paradigm shift that may even
lead to medical bodies, like the C.D.C., changing their treatment
guidelines, Dr. Muzny said.
She added: “It’s time for men to take shared responsibility for
treating this infection.”
_Alisha Haridasani Gupta
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reporter covering women’s health and health inequities. More about
Alisha Haridasani Gupta
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* Science
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* Medicine
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* sexually transmitted infections
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* bacteria
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* health inequities
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