Two Pathways Behind Recurrent BV Identified — SkimNews
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- Monash University researchers, led by Dr Lenka Vodstrcil, identified two distinct pathways to recurrent bacterial vaginosis in a study of 188 couples published in The Lancet Obstetrics, Gynaecology & Women's Health: treatment-failure persistence and re-infection from partners.
- Approximately one-third of women had not cleared their BV before resuming sex after treatment and were nearly three times more likely to experience recurrence within four weeks, compared with the two-thirds whose microbiomes returned to a healthy Lactobacilli-dominant state.
- The study built on the team's March 2024 landmark finding that concurrent antibiotic treatment of women and their male partners cut BV recurrence by more than 60%, and sought to explain why roughly 20% of women in that trial were still not cured.
- Women received a weeklong course of oral antibiotics while their male partners were treated with both oral and topical antimicrobials; the researchers described persistence and re-infection as "distinct, but not mutually exclusive, pathways."
- Thirty percent of female participants used an intrauterine device, which the study found "could enhance the persistence of bacterial vaginosis following treatment in some women," though it flagged the finding as needing further research.
- The researchers plan next-stage trials of longer treatment durations and combinations of multiple antibiotics, with senior author Prof Catriona Bradshaw saying the goal is tailored regimens that "achieve higher levels of cure."
- The team noted a limitation: participant ethnicities were "representative of urban Australia," and results "might not be generalisable to other global populations, including those in low-income and middle-income countries."
Why it matters: Bacterial vaginosis affects roughly one in four women globally and is linked to heightened susceptibility to other infections plus pregnancy and childbirth complications. By separating persistence from re-infection as distinct causal pathways, the study gives clinicians a roadmap to tailor treatment — for example, extending antibiotic courses for the persistence group while relying on partner treatment for the re-infection group — instead of cycling patients through repeat antibiotic courses that have previously been the norm.
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