Experts are advocating for a significant shift in how a common condition affecting up to one in four women is classified, proposing it should be redefined as a sexually transmitted infection. This recommendation follows new evidence indicating that sexual activity plays a crucial role in driving bacterial vaginosis, known as BV.
Understanding Bacterial Vaginosis
Bacterial vaginosis occurs when there is an imbalance in the natural bacteria within the vagina. While often mild, typically causing discharge or a distinctive odour, approximately half of women experience no symptoms at all. However, the condition is far from harmless, as it has been linked to an increased risk of sexually transmitted infections such as chlamydia and gonorrhoea, as well as pregnancy complications including miscarriage and preterm birth.
Evidence for Reclassification
Leading gynaecologists assert that the case for classifying BV as an STI is strengthening, based on studies showing that treating male partners alongside women significantly improves outcomes. These findings suggest the condition may be sexually transmissible, even though men themselves do not develop symptoms.
Valentina Milanova, an expert in public and gynaecological health, commented: 'The traditional argument against calling bacterial vaginosis an STI is that it stems from an overgrowth of endogenous flora rather than a single external pathogen, but this is becoming increasingly difficult to defend.'
Treatment Challenges and Current Practices
BV is typically treated with antibiotics, but it is notoriously difficult to eradicate, with around half of women experiencing a recurrence within six months. One reason is that while men cannot develop BV, they can carry BV-associated bacteria, meaning untreated partners may reintroduce the imbalance.
Despite this, partners are not routinely treated in the UK, potentially exposing women to repeated infection and increasing their vulnerability to more serious conditions, including HIV. Experts are now calling for BV to be managed in the same way as an STI, with both partners treated to break the cycle of reinfection.
Global Disparities in Management
In countries such as the US, Canada, and Australia, BV is already managed within sexual health frameworks in line with World Health Organisation guidance. However, the UK has lagged behind. Ms Milanova noted: 'The British Association for Sexual Health and HIV's guidelines date back to 2012 and have not been updated to reflect current evidence. As a result, clinicians are not routinely treating partners, notifying contacts, or screening systematically – leaving many women stuck in a cycle of recurrence that affects their overall wellbeing.'
She added: 'The consequences extend well beyond discomfort. Recurrent BV significantly increases susceptibility to HIV, HPV, chlamydia, gonorrhoea, and urinary tract infections. It is also associated with serious reproductive risks, including preterm birth and miscarriage.'
Innovative Approaches to Prevention
The need for better prevention is becoming increasingly clear. Separate research has suggested that restoring so-called 'good' bacteria in the vaginal microbiome could help reduce recurrence. In a study of 90 women with BV, researchers from Mass General Brigham and the Vaginal Microbiome Research Consortium found those who took a daily probiotic containing beneficial bacteria after antibiotics were less likely to experience a recurrence.
Some participants only needed to take the treatment for a few days for the bacteria to establish themselves, helping make the vaginal environment more acidic and less hospitable to harmful microbes. Unlike antibiotics, which clear infection, this approach aims to rebuild a protective microbiome, potentially offering wider benefits such as reducing the risk of HIV in high-prevalence settings.
Practical Steps for Risk Reduction
There are also simple steps that may help reduce the risk of BV or prevent it returning. These include avoiding perfumed products, douching, or vaginal deodorants, and washing with water or mild soap. Factors such as smoking, having a new sexual partner, and using an intrauterine device have also been linked to a higher risk, as they can disrupt the natural balance of bacteria in the vagina.
What Is Bacterial Vaginosis?
Bacterial vaginosis is a common condition caused by a change in the natural bacteria in the vagina, affecting around one in three women at some point. Symptoms may include a fishy-smelling discharge, especially after sex, or grey or watery discharge, though about half of women have no symptoms. It is usually diagnosed by examining a vaginal sample and treated with prescribed antibiotics in the form of tablets, gels, or creams. However, BV can return after treatment, and some women may need repeated courses.
