Bacterial Vaginosis: Bringing male partners into the equation

A new study has shown that bacterial vaginosis is a sexually transmitted disease, and that male partners can help limit the recurrence of the condition.

Bacterial vaginosis (BV) affects one in four people of reproductive age Worldwide. Limited Australian data suggests an estimated prevalence of BV 12% among young women. BV may be associated with malodras excretion, but it is also asymptomatic. Regardless of symptoms, it is associated with serious aftereffects such as preterm birth and miscarriage, as well as increased risk of sexually transmitted diseases (STIs) and HIV acquisition. global and Australia The guidelines recommend that women only be treated with oral or vaginal antibiotics. However, this strategy is related to recurrence rates > 50%and until 60–80% of women with ongoing partners.

In BV Epidemiology of STI;Women who have it are not here I haven't started sexis associated with having a new Sex partnerand Condoms provide protection. Furthermore, BV-related bacteria have been detected in men at two penile sites. Urethra and penis skin. Previous partner treatment trials did not improve treatment, but most of them Big limit And importantly, there are no prior partner treatment trials targeting the transport of BV-associated bacteria at both penile sites. Only all oral antibiotics were used.

(i) We hypothesized that reinfection from partners was responsible for the high recurrence rate. (ii) that both verbal and topical antibiotics may be required to remove BV bacteria from two male genital sites. A was performed Randomized trials To assess whether treatment of male partners reduces BV recurrence over 12 weeks, using a combination of oral and topical antibiotics administered when the female partner was being treated.

Our research

Our research, New England Journal of Medicinewas conducted at Sexual Health and Family Planning Clinics in Australia. Women with BV reporting in a monogamous relationship with male partners were offered recruitment, and couples were randomly assigned to receive simultaneous female and male partner treatment (intervention group) or to receive global standard practices to treat women only.

Women were treated with the first strain regimen (400 mg oral metronidazole for 7 days, twice a day, or 2% vaginal clindamycin cream, or 0.75% vaginal intraobesoin metronidazole gel for 7 days). Men in the intervention group received a combination of two antibiotics: 400 mg oral metronidazole is applied twice daily for 7 days, and 2% topical clindamycin cream is applied twice for 7 days on the glans penis and the upper shaft (twice a day, under the foreskin).

The couple was then followed for 12 weeks, and the women attended the clinic for BV assessments.

Initially, they aimed to recruit 342 couples, but due to statistical differences in BV recurrence between the two groups, an independent data safety and monitoring committee stopped the trial with a planned interim analysis in 164 couples.

In the male partner treatment group, 35% of women (recurrence rate) [RR]1.6 per person; 95% confidence interval [CI]1.1-2.4) and 63% of the control group experienced recurrence of BV over 12 weeks (RR, 4.2 per person-year, 95% CI, 3.2-5.7). This corresponded to an approximately 60% reduction in the risk of BV recurrence (hazard ratio = 0.37; 95% CI, 0.22–0.61) in male partner treatment group compared to female-only treatment group.

This treatment was well tolerated by men, with similar side effects between men and women, mainly due to the expected side effects associated with metronidazole. Female male partners who reported taking all doses of both treatments had the lowest recurrence rate.

The group of women enrolled in this trial was at a higher risk of recurrence, 85% reported recurrence BV, 80% had noncirculating male partners, and 30% had an intrauterine device (IUD) (all strong risk factors for recurrence). As we saw a very high cure rate in this population, the results are very encouraging and treatment of male partners may be even more effective in women with low risk factors and partners with optimal adherence.

Our trial was held in Australia, limited to women and their regular male partners. Similar trials are required in other groups. This broadens the range of people who access partner treatment and expand their findings.

Meaning/Next Steps

The findings represent very important advances in BV treatment. We showed that treating male partners with oral and topical antibiotics for 7 days was associated with a much lower rate of BV recurrence than the recommended global practice of treating women only.

These results indicate that reinfection in women with BV bacteria from untreated male partners is responsible for a significant proportion of BV recurrence, impeding efforts to achieve treatment. Our approach creates real opportunities to reduce the burden on women's BV.

An important message to clinicians is that their partner's treatment is sensitive to compliance. If people missed medication, women have lower treatment rates and couples should avoid unprotected genders to maximize efficacy during the treatment period.

The next step is to analyze new longitudinal samples from the couple in this study to determine the specific BV organisms that promote recurrence. In particular, determine whether a man has a profile or agent for predicting female recurrence. This advancement allows for the development of more accurate diagnostic tests. This includes a new diagnostic tool that allows for the first time testing BV bacteria in male partners to prevent infection.

The results of the study confirmed that reinfection is a key factor in treatment failure, but that is not the only cause. Our efforts now focus on a small group of women who experienced BV persistence shortly after treatment when they resumed sex. IUDs are overrepresented in this group, suggesting that BV biofilms may play a key role. These women may benefit from longer courses of antibiotics, or combinations of treatments, to eradicate these bacteria, but this has not yet been established. Our group continues to study this.

I've created it Website It provides information to consumers and health professionals and helps to properly prescribe and use male partner treatments. It is important to recognize that this is a paradigm shift in how BV is discussed between patients and their treatment clinicians. Our resources will help people provide partner treatment to start these conversations, as provided to other STI patients.

Dr. Lenka Vodstrcitr is a senior researcher and is a vice-president and leading epidemiologist of the Genital Microbiota and Mycoplasma Group at the Melbourne Sexual Health Centre at Monash University. Dr. Vodstrcitr leads a translation research program that integrates epidemiological, microbiological and clinical research to improve sexual and reproductive health outcomes at the individual and population level.

Professor Catriona Bradshaw [MMBS (Hons), PhD, FAChSHM, FAHMS] Clinician researcher, NHMRC Leadership Fellow and Head of Research Translation and Teaching at Melbourne Sexual Health Centre, Monash University and Alfred Hospital. She leads a program focused on translational research to improve treatment and control of STIs, including developing and implementing resistance and point-of-care diagnosis, antibiotic resistance and stewardship of STIs, and interventions to optimize vaginal microbiome.

The authors have not worked, consulted, owned or received funds for shares from companies or organizations that benefit from this article, nor have they disclosed any relevant affiliations beyond academic appointments.

The statements and opinions expressed in this article reflect the author's views and do not necessarily represent the official AMA policy. servant or Insight+ Unless you're that.

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