Bacterial vaginosis: an overlooked STI?

introductionDespite 70+ years of research, the etiology of bacterial vaginosis (BV), the most common vaginal infection, is unknown. Numerous studies suggest that BV-associated bacteria (BVAB) are sexually transmitted. Additionally, a recent male partner treatment trial found that the addition of combination oral and topical antimicrobial therapy for regular male sexual partners to treatment of women with BV resulted in a lower rate of recurrence at 12 weeks. However, unlike other common sexually transmitted infections such as chlamydia and trichomoniasis, no sole infectious pathogen has been identified as the causative agent of BV. In addition, non-sexual factors (e.g. smoking, copper intrauterine device use, douching, and testosterone use) have been associated with an increased risk of BV in some studies. These findings underscore the complexity of BV pathogenesis and make it challenging to counsel patients on infection acquisition and prevention of recurrent disease. AREAS COVERED: This work summarizes the evidence for and against sexual transmission of BVAB. EXPERT OPINION: A large body of data provide substantial evidence suggesting that sexual activity is the predominant mode of initial BV acquisition. There are no data showing a direct causal association between non-sexual factors and BV development. Additional research investigating BV etiology is imperative.