Women with a common gynaecological condition that is often treated ineffectively have a new hope.
BV, for bacterial vaginosis, has until recently been treated by giving women antibiotics, but now some doctors are starting to also treat their male partners, which can stop the women getting reinfected. And new guidelines are being drawn up that are likely to overhaul treatment across the country.
The change stems from a study that found treating women and their male partners at the same time improved cure rates for women.
The study showed that the condition is sexually transmitted. It was previously thought to be caused by an imbalance in vaginal bacteria.
The new thinking is that while BV does involve raised levels of harmful bacteria, those bacteria are usually passed on during sex.
“It’s a smoking gun to the concept of this as a sexually transmitted disease,” said Professor Jack Sobel, an infectious disease specialist at Wayne State University in Detroit, who wrote an accompanying editorial about the study.
BV, which causes discharge and odour, is the most common vaginal infection, affecting up to a third of women, although not all will have the symptoms from it.
Patients are usually advised it is caused by an imbalance between good and bad bacteria, and that they should focus on steps to keep their vaginal microbiome healthy, like avoiding douching or using scented toiletries around the genital area.
The condition is usually treated with antibiotics, which can help, because they reduce the harmful bacteria, but the symptoms often come back.
Repeated reinfections
That may be because the woman’s sexual partner is harbouring the bad bacteria, according to the new view.
Guidelines for UK sexual health doctors – which currently advise treating only the woman – are now being updated to reflect the latest study and are likely to be released this year.
They are being written by a medical body called BASHH (for British Association for Sexual Health and HIV). “BASHH considers the full range of available evidence in the development of its clinical guidelines, and the BV guideline is currently being updated,” said Dr Sarah Flew, their editor.
The trial, carried out in 150 Australian couples, found there was a large improvement in woman’s chances of their symptoms disappearing if their male partner was also treated.
In those whose partners got antibiotics, two thirds of the women had no return of symptoms within three months. In those whose partners were untreated, only one third stayed cured.
“This has been a very important event in the process of understanding the disease and how best to offer treatment,” said Prof Sobel.
British doctors are behind
American and Australian guidelines have already changed to advise treatment of male partners.
Some UK doctors are also prescribing antibiotics to the partners of women with BV, because of the study, which was published last year.
Dr Phillip Hay, a sexual health consultant at Guys and St. Thomas’ Hospital in London, said British sexual health doctors did not need to wait for guidelines to change before offering treatment to men. “Guidelines are minimal standard of treatment for people who don’t really know the disease area – if you do, you try and follow the research as it comes out.”
Dr Hay is also helping to rewrite his own hospital’s guidelines on BV to recommend treatment for male partners.
GPs in the UK – who may also treat women with BV – are more likely to stick to guidelines for primary care set by an NHS body called Nice, said Dr Hay. Nice has an evidence summary on BV treatment that makes no mention of men.
A Nice spokesperson said: “We’re aware of the new research showing that treating male partners can help reduce the chances of BV coming back, and we know BASHH is currently updating its guidelines to reflect this. When the [Nice evidence summary] on BV is reviewed in future, the latest evidence, including any updated BASHH guidance, would be taken into account.”
Bacteria working together
The idea of BV being sexually transmitted was previously controversial, partly because, unlike with other STDs, no single species of bacteria has been found responsible.
It now seems it could be caused by at least two species that need each other to survive. “Some of the bacteria produce molecules which are substrate for other ones to grow,” said Dr Hay.
Another reason for scepticism was that several previous trials of treating male partners with oral antibiotics had not improved the women’s cure rates.
But the Australian study was different, because it gave men not just tablets but also an antibiotic cream.
A lack of good bacteria in the vagina may also contribute to women being more likely to have their symptoms recur, said Dr Hay. “But at some point you do have to become colonised with the wrong bacteria, which generally seem to be sexually transmitted.”
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