New Research Reveals a Paradigm Shift in BV Treatment
A groundbreaking study by Australian researchers has found that treating male partners can significantly reduce bacterial vaginosis (BV) recurrence. The research, published in the New England Journal of Medicine, confirms BV can be sexually transmitted.
BV affects nearly one in three women, disrupting the natural balance of vaginal bacteria. While antibiotics temporarily treat the infection, many women experience frequent relapses.
Hanae, a Melbourne resident, shared her struggles. “It came back time and time again, no matter how many times I got antibiotic treatment,” she said.
The new study offers hope, showing that treating both partners more than doubles the chances of curing BV.
Changing the Understanding of BV Transmission
For decades, experts debated whether BV was sexually transmitted. Earlier trials in the 1980s and 1990s found no benefit in treating male partners, leading researchers to dismiss the theory.
Professor Catriona Bradshaw of Monash University’s Melbourne Sexual Health Centre said previous studies relied solely on oral antibiotics. “The key thing is that all previous trials had only tried oral antibiotics,” she said.
Bradshaw’s team hypothesised that adding a topical antibiotic for male partners might improve outcomes.
Breakthrough Clinical Trial Confirms Sexual Transmission
Researchers conducted a trial with 164 monogamous heterosexual couples from April 2019 to November 2023. Women received oral antibiotics, while men in the treatment group took oral antibiotics and applied an anti-bacterial cream.
The results were striking. BV recurred in 63% of women whose male partners were untreated, compared to just 35% in the treatment group.
Bradshaw described the findings as “a big paradigm shift.” She said, “It’s proven sexual transmission of BV.”
Why Some Women Still Experience BV Recurrence
Although partner treatment reduced BV cases, some women were not cured.
Researchers believe dense biofilms—protective bacterial layers—could shield BV-causing bacteria from antibiotics. Women with intrauterine devices (IUDs) also had higher recurrence rates.
Bradshaw said more research is needed. “Further strategies need to be developed for these women, such as a longer course of antibiotics,” she said.
Male Partner Adherence is Crucial
Treatment success depends on male partner participation. The study found that 14% of men in the intervention group took less than 70% of their prescribed medication.
Bradshaw noted that women whose partners fully adhered to the treatment had higher cure rates.
Professor Rebecca Guy from the Kirby Institute’s Sexual Health Program called the study “the first to show sustained and substantial benefit for a common and debilitating vaginal infection.”
She added, “Success will rely on strategies to ensure high cooperation rates among male partners, as achieved in the trial.”
A Step Towards Changing BV Treatment Guidelines
Medical guidelines have not yet changed, but experts believe this research will influence future protocols.
Dr Clare Keogh from SHINE SA called the trial “promising” but warned that adherence issues could limit its real-world effectiveness.
“With the ointment being used twice a day [plus oral antibiotics] for the partner with the penis, how long is that adherence or compliance likely to continue for?” she asked.
Bradshaw acknowledged the challenge. Recruiting male participants was difficult, and many did not complete their full treatment.
Expanding Research Beyond Heterosexual Couples
To fully understand BV transmission, researchers plan to study other populations, including women who have sex with women and different cultural groups.
Professor Gilda Tachedjian from the Burnet Institute called the study “landmark” research. “It’s a really important proof of concept that BV recurrence is driven, in part, by transfer of bacteria from the male to the female,” she said.
BV’s Impact and the Need for Better Awareness
BV is more than just a nuisance. It increases the risk of sexually transmitted infections, pelvic inflammatory disease, and pregnancy complications like miscarriage and premature birth.
Despite its prevalence, BV remains misunderstood. Many women blame themselves for recurring infections, unaware that their partners could be reinfecting them.
Bradshaw believes BV needs a new name. “It needs a new name and this is part of the problem, because—as one of our male partners eloquently said—[BV] is a shared responsibility,” she said.
A Major Leap Forward in Women’s Health
This study challenges long-held assumptions about BV. Treating male partners could dramatically reduce recurrence and improve treatment outcomes.
While guidelines may take years to change, this research marks a significant step in redefining BV management. Experts hope it will lead to new clinical protocols and better treatment strategies for affected women worldwide.
