Researchers pursue lasting cure for recurrent BV

Melbourne researchers and clinicians are trialling new female-focused treatments in the hope of finding a lasting cure for recurrent bacterial vaginosis (BV).
 
The team from Monash University and Bayside Health’s Melbourne Sexual Health Centre is trialling treatments, including longer duration and new combinations of antibiotics designed to eradicate persistent BV-causing bacteria.
 
The results, published in The Lancet Obstetrics, Gynaecology & Women’s Health, identified two pathways to repeat infection: re-infection and persistence of BV bacteria.
 
To improve cure rates, the study suggests women with persistent BV, after treatment and before the resumption of sex, might benefit from intensive female-directed interventions.
 
BV is the most common vaginal condition among women of reproductive age, affecting around one in four people worldwide.
 
More than 50% of women treated for BV have recurrence within 3–6 months after treatment. For women with an ongoing regular partner, this increases to 60–80%.
 
The latest research from the Monash and Bayside Health team follows their landmark 2025 study, which revealed BV to be sexually transmissible, challenging the long-held belief that it is caused by a bacterial imbalance.
 
Further, it showed that concurrent male-partner treatment (MPT) reduces BV recurrence in women by more than 60%.
 
Lead author of both studies, Dr Lenka Vodstrcil, said the latest research builds on the 2025 findings, enabling them to explore tailored treatments that they hope will improve cure rates for millions of women worldwide.
 
‘While partner treatment improves cure for most women in a monogamous relationship, there are some women who have persistent BV bacteria that survive initial therapy before couples resume sex after treatment,’ she said.
 
‘By identifying this early, we can intervene with more intensive female-focused treatments before the infection takes hold again.’
 
Researchers said such a strategy ‘would prevent clinicians from simply recommending re-treatment of women (and their partners) with the same regimen and, importantly, would create an opportunity to generate an evidence base for optimal management of persistent bacterial vaginosis’.
 
‘More intensive management approaches … could entail extended duration regimens, combination antimicrobial regimens, or both, and adjunct strategies such as novel agents to disrupt bacterial vaginosis biofilms or live biotherapeutics (or prebiotics) that promote optimal growth and recolonisation of lactobacilli.’
 
Dr Sara Whitburn, Chair of RACGP Specific Interests Sexual Health Medicine, told newsGP BV is an ‘often very distressing’ condition for people.
 
‘It can really impact their self-esteem, it impacts their sexual life, their relationship life,’ she said.
 
The reasons for why BV remains persistent for more than half of women are not yet fully understood, she said, although having an IUD is associated with a higher risk of recurrent BV.
 
‘It may be about how people’s biomes respond to both the bacteria, but also treatment in general with antibiotics,’ she said.
 
‘We do see people, especially with a copper IUD, are represented in populations that have recurrent BV, but I still want to support [long-acting reversible contraception] choice for people who need an IUD, but there is a little bit of an association there.
 
‘We want to be able to support people to have IUDs but have options to support them if BV occurs, so there is still a lot of research that needs to be done, but the more we know, the more we can target treatment.’
 
Dr Whitburn said there is always some risk in optimising antibiotic use, in regard to antimicrobial resistance and the effect on the biome, but it is about finding a balance against the impacts of BV.
 
‘We know that use of broad-spectrum antibiotics can put people at risk of things like thrush, but you’re really trying to balance this against the psychological and physical impacts of bacterial vaginosis, and in some ways, trying to target antibiotic treatment so that it is used at the right time for the right amount to balance that antimicrobial stewardship,’ she said.
 
Dr Whitburn said while there was currently no change to advice for GPs managing patients with BV, she suggests exploring concurrent MPT.
 
‘It’s still good to think about partner treatment, so at the moment, if people aren’t thinking about partner treatment, or haven’t used the advice from the previous study, that’s worth learning about and promoting, and that can be found on the Melbourne Sexual Health Centre website,’ she said.
 
‘At the moment I think it’s being aware and talking to people about these studies and recruitment, because that’s the only way we’re going to learn how to really support this condition.
 
‘Any improvement in treatment for bacterial vaginosis, specifically recurrent, will improve GPs’ ability to support people with a vulva or vagina.’
 
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