Key to bacterial vaginosis treatment unlocked

A groundbreaking Australian study is ‘paving the way for a revolution’ in bacterial vaginosis treatment, after discovering the condition is sexually transmitted.
 
Bacterial vaginosis currently affects almost a third of reproductive-age women, with ‘stubborn and distressing’ recurrence rates impacting patients’ lives.
 
But landmark new research from the Melbourne Sexual Health Centre, published on Thursday, has declared the condition a sexually transmitted infection (STI), and therefore transmitted between partners.
 
According to researchers, the standard practice of treating bacterial vaginosis as an imbalance to the vaginal microbiome has led to more than half of women being diagnosed again within three months after a standard week-long treatment of an oral antibiotic.
 
In a bid to change this, researchers studied 164 couples with bacterial vaginosis in monogamous heterosexual relationships.
 
‘In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment – metronidazole 400 mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for seven days,’ the study said.
 
‘In the control group, the woman received first-line treatment, and the male partner received no treatment – standard care.’
 
Ultimately, they discovered that when treating both sexual partners simultaneously, bacterial vaginosis recurrence was halved in the partner treatment group compared to treating women alone.
 
‘The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care,’ the study concluded.
 
Chair of RACGP Specific Interests Sexual Health Medicine Dr Sara Whitburn welcomed the study’s findings and described the condition as having a severe impact on patients’ quality of life and self-esteem.
 
‘This study is quite groundbreaking in that it shows us that if we treat it in a monogamous, heterosexual population, that actually we can drop the risk of recurrence, so we can give people more disease-free time or even help them be disease-free,’ she told newsGP.
 
‘Calling it an STI is probably confirming what we’ve suspected clinically, but it will also impact how we discuss it with people who are positive. So that is actually going to probably be a clinical challenge.
 
‘STIs come with stigma, and so one of the things health practitioners are going to have to think about is, how do we talk to people about this as an STI.’
 
However, Dr Whitburn said ‘we just need to be clear on what population was studied’, saying further research is needed into other populations to continue to treat STIs and other sexually related conditions that impact on patients.
 
Study co-author Professor Catriona Bradshaw said earlier studies found men may carry bacterial species associated with bacterial vaginosis on the penile skin and inside the penis, however trials that included male partners did not show improved cure rates in their female partners.
 
‘This was interpreted as evidence against sexual transmission,’ she said.
 
‘However, these studies had design limitations, and none used a combination of oral and topical antibiotics to adequately clear bacterial vaginosis bacteria in men, especially from the penile-skin site.

‘Our trial has shown that reinfection from partners is causing a lot of the bacterial vaginosis recurrence women experience and provides evidence that bacterial vaginosis is in fact an STI.’
 
Professor Bradshaw added that researchers still do not know exactly which bacteria are the cause, but advances in genomic sequencing are ‘helping us close in on that mystery’.
 
The study’s results have already led to the Melbourne Sexual Health Centre changing its clinical practice to treat couples.
 
The centre has launched a new information source for healthcare professionals, which offers a practical prescribing guide for GPs in light of the study’s findings.
 
‘This information has been co-designed with consumers and participants in the trial and health professionals to make it accessible to all,’ Professor Bradshaw said.
 
‘Changes in national and international treatment guidelines always take time, so we felt an obligation to provide accurate online and downloadable information at the time that the results of the trial are published.’
 
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bacterial vaginosis sexual health sexually transmitted disease STI women’s health