Could Bacterial Vaginosis become an STI?

New research from The New England Journal of Medicine has shed new light on how Bacterial Vaginosis (BV) spreads between people, and may up-end how health professionals categorise the infection.

So, what could this mean for you? Keep reading to find out.

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What is BV?

BV is an incredibly common infection among women. It’s caused by an overgrowth of bacteria normally found in a healthy vaginal environment. Symptoms of BV can include:

White or grey vaginal discharge
Vaginal irritation, like itching and burning
A strong “fishy” odour, especially after sex
Pain during urination
Pain during sex

The symptoms of BV may go away without treatment, but it’s important to get checked if you’re worried about an infection.

Why is it important to treat BV?

Aside from the physical discomfort BV can cause, it’s important to treat BV since leaving it untreated can cause bad health outcomes.

BV can increase your risk of catching other infections that can lead to pelvic inflammatory disease (PID), which can damage your fertility. In pregnant women, BV can lead to premature birth and low weight in infants. Having it can also increase the likelihood of contracting other STIs like HIV, Chlamydia, and Gonorrhoea.

Why isn’t BV an STI?

While research has shown that the infection can be passed from women to men in rare cases, transmission the other way is unlikely.

The bacteria that cause BV naturally occurs within the vagina, so many women can get it without having sex. This is why BV isn’t considered an STI. Being sexually active does, however, increase your risk of BV.

So, is it sexually transmitted?

What does the research show?

Researchers publishing in The New England Journal of Medicine have tried a new approach to tracking how BV may be transmitted from men to women. Previous evidence has suggested that treating men for BV may increase the likelihood of cure.

This randomised trial involved couples in which the woman had BV and was in a monogamous relationship with a male partner. The male partners in the partner-treatment group were given oral and topical antimicrobials. In the control group, the women received first-line treatment, and the male partner received no treatment.

The results showed significant success in combining the treatment of male partners with the treatment of women for BV, which resulted in a lower rate of recurrence of the infection within 12 weeks. The trial was so successful that its ethics committee stopped it early as the weight of evidence was so strong. When comparing 81 couples where the male partner was treated to 83 couples where the male partner was not treated, the risk of the woman having BV recur was reduced by 63%.

This study shows that male partners can transmit BV bacteria to female partners.

There remains much more research to be done on this issue. For example, for every woman we see with BV bacteria, we don’t see 100 men who are positive, which would make us think that the men can kick out the bacteria much more easily than women. How and why this may happen are still to be determined.

What could be the drawbacks of calling BV an STI?

Such studies raise questions about how we classify BV as an infection.

How we feel about and approach a health condition depends on how we talk about it – what words we use and the emotions attached to those words.

For many people, feelings of stigma, moral judgement, and fear can be triggered when health professionals label an infection “sexually transmitted”. These feelings may not arise from illnesses that people get through no action of their own, like a rhinovirus or the flu.

Such associations may prevent some people from seeking treatment.

A similar question was raised about Mpox in 2022. During the outbreak in that year, most of the cases of Mpox were recorded in men who have sex with men. Some public health officials wondered if calling Mpox an STI would fuel stigma and discrimination and deter treatment efforts.

Others would argue that changing this classification is more scientifically accurate and would help people get the treatment they need to cure their infection. If their partners were notified, and they turn out to be the source of the infection, we may well see a huge impact on the number of cases in women if infected men get treated too.

To date, this debate is still ongoing.

Final thoughts

If you think you may have BV, it’s very important to get tested as soon as possible, and getting treatment for both you and your partner may increase your chances of a cure if your infection is stubborn.

Get in touch with Better2Know to schedule a full STI screen at a sexual health clinic near you.