By Wendy Tuohy
A common infection that can cause miscarriage, premature birth and newborn deaths, and was previously considered a female bacterial problem, has been found to be a sexually transmitted infection (STI) also carried by men.
Bacterial vaginosis (BV), which is experienced by one-third of women, is not caused by an imbalance in natural bacteria in women, but is transferred between sexual partners, breakthrough Australian research has shown.
Once Jessie and her partner were both treated for the bacteria that causes BV, the infection stopped returning.Credit: Penny Stephens
Men are “the missing link” in the riddle of why many women are often reinfected by BV, which can cause pain and discomfort, the study by Monash University, Alfred Health and researchers at the Melbourne Sexual Health Centre found.
The paper, published Thursday in the New England Journal of Medicine (NEJM), is likely to change how BV is understood and treated globally.
Earlier attempts to discover why women experience repeated bouts of BV had not included treatment of male partners with both antimicrobial drugs and a topical cream usually given to women.
Two of the study’s authors, Professor Catriona Bradshaw and Dr Lenka Vodstrcil, say the standard practice of treating BV as an imbalance to the vaginal microbiome means that more than 50 per cent of women have a recurrence within three months.
The researchers examined 164 monogamous couples in which the women had BV, and found treating it as an STI – giving men both oral and topical treatment – achieves significantly higher rates of cure than the current practice of treating only women.
Bradshaw has been working on understanding BV for 20 years and said the findings could lead to prevention of BV and its potentially serious complications.
The treatment for both men and women was relatively cheap and short.
“As a clinician it was quite obvious our recommended treatments, directed to women, were not highly effective and were associated with high rates of recurrence,” said Bradshaw.
“This [study] was the first time I saw recurrence of BV was very strongly associated with ongoing exposure to a regular untreated sex partner.”
The study found the risk of recurrence of BV, which can lead to infertility in women, was reduced by 60 per cent.
Women had more than double the probability of being cured at the 12-week follow-up when their male partner was also given treatment to eradicate the bacteria.
Because the infection involves many different microbes, this “contributes to the misconception that it is an imbalance and a woman’s problem”.
“BV is not just a bit of a nuisance … unfortunately when we see this loss of healthy vaginal bacteria and increase in BV bacteria, we see really significant consequences,” Bradshaw said.
Women can also transmit BV to male or female partners, she said.
Professor Christina Munzy, an infectious diseases expert at the University of Alabama at Birmingham, wrote an editorial for NEJM on the significance of the findings, which “represent a major paradigm shift in how the treatment of BV among women with regular male sex partners should occur”.
The study “is likely to have a major impact on the field”, Munzy told this masthead.
Melbourne woman Jessie, who does not want her surname published, participated in the Monash trial with her partner, hoping to be cured of repeated BV infections.
“Both my partner and I were quite convinced we were sending BV back and forth between ourselves, and we went to the doctor separately [asking for treatment]. We both felt dismissed, and were told this isn’t what’s done and there’s nothing you can do [for the partner],” said Jessie.
“You can just tell when something is an STD, and it was very frustrating when I went to regular doctors and had my concerns dismissed.
“The treatment worked very quickly and we haven’t had any issue since.”
Jessie says she was dismissed by doctors before she found help through the Monash trial.Credit: Penny Stephens
Jessie decided to go public to help increase understanding of BV and reduce stigma, hoping it would help more women have their concerns addressed and get treatment that prevented the infection from returning.
“I just think of all the women all over the world who are affected by this. It’s not nice, and besides that fact, you can become more susceptible to having health issues more widely. And it really affects intimacy,” she said.
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