BV: the STI you have when you don’t have an STI?


Although Bacterial Vaginosis (BV) is globally the  commonest vaginal infection in women of reproductive age, very little is known  about the disease. Importantly, its cause and whether it  is sexually transmitted is unknown, according to the Sexual Health Unit’s Dr  Catriona Bradshaw, principal researcher of the WOW (Woman on Woman’s Health)  project.

“It’s a very common disease. We see prevalences of 10%  in Australian women attending general practices but this rises to 30% within  the lesbian population – and we don’t know why. We wonder if that is related to  the fact that it is more easily transmissible between women than between men  and women.”
The WOW study is focusing on BV in the lesbian community. Since March 2010, WOW has  recruited more than 300 participants. The recruitment drive has been  innovative: festivals like Mardi Gras and Midsumma, advertising on lesbian  Internet dating sites and other gay media. Participants commit to regularly  posting in self-administered swabs during the two-year study. The swabs are  tested for BV and, if diagnosed, participants receive treatment.

“A  key objective of our BV research is to determine what factors or behavioural  practices are associated with the development of BV in women and their female  partners and this will help us understand whether it is an STI. If it’s an STI,  this has enormous implications for improving our management of this common  infection and for prevention,” Dr Bradshaw says.
While BV is still not considered an STI, it certainly co-exists with all the other  STIs, she says. “We see it in sex workers, we see it other groups that have a  high prevalence of STIs often due to factors such as poor access to healthcare,  so BV is common in women in developing countries and in indigenous populations.  The exceptions to this are lesbians, who don’t have a high prevalence of STIs.”
Another  reason for focusing on women is that there is no diagnostic method that can be  applied to men – so the BV status of men remains a mystery, much like the  disease itself. What is known is that BV can have serious health implications.  In pregnancy it increases the risk of miscarriage, pre-term delivery and low  birth weight, and it also increases the risk of sexual acquisition of HIV and  other STIs.
Why has BV remained under the STI radar? Dr Bradshaw says that in previous trials,  after treatment with antibiotics, up to 50% of women got the disease again  within six months. “But when we give those antibiotics to male partners in  randomised trials it doesn’t seem to make any difference to the recurrence  rates in women. So usually, if a disease is sexually transmitted, if you treat  the woman and you treat the man, you eradicate it from a relationship. So those  treatment trials were used as evidence that this is not a sexually transmitted  disease.” However, Dr Bradshaw suggests that perhaps the treatments used were  not sufficiently effective to eradicate BV in either women or men, given that  we don’t actually know the cause. “We might not be treating men or women  correctly – we might be partially treating them but not completely treating  them.”

Caption: The WOW (Women on Women’s Health) website.