Recurrent bacterial vaginosis - a female perspective

By Dr Jodie Abramovitch

Dr Jade Bilardi - first author of the BV study

The most common vaginal infection of women of reproductive age is bacterial vaginosis (BV). BV is characterised by an imbalance of natural vaginal bacteria species leading to symptoms such as abnormal odour and discharge. It has more seriously been associated with an increased incidence of miscarriage, premature birth, HIV and a higher risk of acquiring a sexually transmitted infection.

The cause of BV and the way it is transmitted from person to person are not well understood. However, there is increasing evidence BV may be sexually transmitted. Current treatment and patient management is suboptimal, leading to a high recurrence rate among affected women.

By interviewing 35 women of varying sexual orientation who had experienced recurrent BV infection over five years, Monash researchers from the Melbourne Sexual Health Clinic aimed to better understand women's experience of BV infection. The majority of participants reported sexual contact had triggered BV onset (1). Non-sexual triggers of BV infection such as stress and termination of pregnancy were described by a minority of participants. Flare-up of infection was associated with a range of sexual and non-sexual triggers including use of sanitation products, contact with latex based materials (eg. condoms), frequent sexual encounters, exercise and stress. Women who have sex with women more likely to attribute BV onset or recurrence to a past or new sexual partner. If their partner received treatment for BV or the relationship ended, no recurrence of BV was reported.

Further findings from the study indicated that women were unhappy with available treatments for BV (2). Many of the women infected had never heard of BV before and therefore pursued treatment for thrush (a vaginal yeast infection) without consulting a doctor. First line treatment for BV was the prescription of antibiotics which were associated with side-effects including nausea, gastrointestinal symptoms and thrush. Following cessation of a course of antibiotics, BV was sometimes reported to recur quickly leading to another course of antibiotics or the pursuit of alternative options including natural therapies. Self-help remedies were mostly ineffective though alteration of sexual practices and/or pursuing BV treatment for a sexual partner did resolve some persistent infections. Women also reported dissatisfaction with clinical management of BV - particularly in general practice - citing issues around the lack of knowledge about BV, misdiagnosis or mistreatment of infection and insensitive attitudes. 

This study provided anecdotal evidence that BV infection may be sexually transmitted. This, along with a high recurrence rate and potentially serious health risks, highlights the need for a better understanding around the nature and transmissibility of BV to improve diagnosis, treatment and management of the infection.  

(1) Reference: Bilardi J, Walker S, Mooney-Somers J, Temple-Smith M, McNair R, Bellhouse C, Fairley C, Chen M, Bradshaw C. Women's Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence. PLoS One. 2016 Mar; 11:e0150272.
doi: 10.1371/journal.pone.0150272.
(2) Reference: Bilardi J, Walker S, McNair R, Mooney-Somers J, Temple-Smith M, Bellhouse C, Fairley C, Chen M, Bradshaw C. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study. PLoS One. 2016 Mar; 11:e0151794.
doi: 10.1371/journal.pone.0151794.