Bacterial Vaginosis Recurrence: Drivers, Challenges, and Treatment Original paper
Researched by:
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Divine Aleru
ID
Divine Aleru
I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
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Bacterial Vaginosis
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.
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Divine Aleru
Researched by:
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Divine Aleru
ID
Divine Aleru
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What Was Reviewed?
This review examines the drivers of bacterial vaginosis (BV) recurrence and the challenges and opportunities in partner treatment. BV is a prevalent vaginal condition with a high recurrence rate, often within six months of treatment. The review explores the mechanisms behind recurrence, including reinfection from untreated sexual partners, the persistence of BV-associated bacteria (BVAB), and the role of biofilms. It also discusses past research on whether treating male and female sexual partners can improve BV cure rates and the barriers to implementing partner treatment in clinical settings.
Who Was Reviewed?
The review evaluates studies involving women diagnosed with BV, particularly those who experience recurrent infections. It also incorporates research on the sexual partners of these women, analyzing the microbial composition of the male urethra and penile skin and how bacterial exchange between partners may contribute to reinfection. Clinical trials on partner treatment strategies, including those testing antibiotics like metronidazole and clindamycin, are also assessed.
Key Findings and Microbial Associations
BV recurrence has multiple causes, with reinfection from sexual partners being an overlooked factor. The review shows that BV-associated bacteria like Gardnerella vaginalis, Atopobium vaginae, and Prevotella spp. can transfer between partners, including heterosexual and same-sex couples. This supports the idea that BV may have a sexually transmissible component.
Past studies on partner treatment have had mixed results, leading to skepticism. Many were limited by small sample sizes, inconsistent diagnostic criteria, and short follow-ups. However, newer research suggests that when partners adhere to antibiotics, recurrence rates may drop. The review highlights challenges in partner treatment trials, including low participation and the need for therapies targeting bacterial biofilms and antimicrobial resistance.
Implications of the Review
BV’s high recurrence rate not only causes discomfort but also increases risks like preterm birth and STI susceptibility. This review calls for a fresh approach, including reconsidering partner treatment. While current guidelines do not recommend treating partners, emerging evidence suggests that doing so, alongside therapies that promote a stable, lactobacilli-dominated vaginal microbiota, may improve long-term cure rates. Future studies should refine partner treatment, enhance antimicrobial strategies, and develop microbiome-targeted therapies to prevent recurrence.
Bacterial Vaginosis
Bacterial vaginosis (BV) is caused by an imbalance in the vaginal microbiota, where the typically dominant Lactobacillus species are significantly reduced, leading to an overgrowth of anaerobic and facultative bacteria.