Association between bacterial vaginosis and STDs

Although bacterial vaginosis is not considered a sexually transmitted disease (STD), the condition increases the risk of acquiring STDs such as chlamydia, gonorrhoea, herpes, HIV etc [1,2]. Hence, it is worth getting treatment for bacterial vaginosis to protect yourself against acquiring STDs.

What is bacterial vaginosis? 

Bacterial vaginosis (BV) is a vaginal infection caused by a bacteria known as Gardnerella Vaginalis. Bacterial vaginosis typically occurs in women who are sexually active, though less commonly, can also occur in women who have never had sex. 

Bacterial vaginosis is a common condition that generally affects women aged between 15-44 years old [3]. While the exact underlying cause of bacterial vaginosis remains unknown, bacterial vaginosis typically occurs when there is an imbalance in the vaginal microenvironment. There is an association between reduced lactobacilli bacteria and hydrogen peroxide production which ultimately leads to a rise in vaginal pH [4-6]. This leads to a disruption of the ‘good’ and ‘bad’ bacteria in the vagina, resulting in an overgrowth of the ‘bad’ bacteria. The ‘good’, protective bacteria such as Lactobacilli are hence outnumbered and not able to maintain a healthy balance of natural disinfectant in the vagina.

What are the symptoms of bacterial vaginosis?

Approximately 50-75% of women with bacterial vaginosis are asymptomatic [3,7], while others may experience the following symptoms: 

• Fishy smell vaginal odour (odour may be worse around the time of menstruation, or after unprotected sexual intercourse)
• Thin, watery, grey-whitish vaginal discharge
• Itchy, painful, burning sensation in the vagina
• Painful sexual intercourse
• Painful urination

Recurring bacterial vaginosis

Unfortunately, 15-30% of women who have received bacterial vaginosis treatment can have a recurrence of the condition within 3 months [8,9]. Recurring bacterial vaginosis occurs when a woman presents with recurring or chronic symptoms of bacterial vaginosis requiring multiple or even long-term treatments. 

Predisposing factors for recurring bacterial vaginosis include:

• Young aged patients
• History of multiple sexual partners
• History of douching
• Smoking 
• Intrauterine contraceptive device (IUCD/IUD) usage 

Speak to your doctor about individual risk management and treatment options to mitigate recurring symptoms.

Can I get bacterial vaginosis from a female partner?

Yes, women with female partners have a higher chance of acquiring BV as vaginal fluid can act as a carrier of the bacteria. Sharing of sex toys and barriers such as condoms/dental dams can pass on BV as well.

Can I get bacterial vaginosis from a male partner?

Yes, women may develop bacterial vaginosis as the vagina microenvironment can be disrupted through intercourse. Interestingly, Gardnerella Bacteria can be seen on men’s genitalia even though bacterial vaginosis is not considered an STD.

What happens if I don’t treat bacterial vaginosis?

Bacterial vaginosis increases the risk of pelvic inflammatory disease (PID) which can cause an infection affecting the uterus, cervix, fallopian tubes, and ovaries [10]. In the long-term, this can be complicated with chronic pelvic or lower abdominal pain, increased risk of ectopic pregnancy, or even infertility. 

If bacterial vaginosis occurs in a pregnant woman, there is a risk of premature delivery of the baby, thus increasing the risk of low birth weight in comparison to babies born to women without BV [11,12].

As previously mentioned, the risk of acquiring other STDs including HIV, chlamydia, and gonorrhoea is higher in women who have untreated bacterial vaginosis [1,2]. Additionally, a person who is HIV-positive coupled with untreated bacterial vaginosis, has a higher chance of passing HIV to other sexual partners.

I tend to have recurring bacterial vaginosis with the same partner. Is this not an STD?

The question here is whether the frequent episodes of bacterial vaginosis are due to re-infection or relapse. It is evident that some women who have the same sexual partner before and after bacterial vaginosis treatment, are likely to have recurring BV. Does this suggest a bacteria infection that is passed on back and forth between the woman and her sexual partner? Or is the repeated occurrence of bacterial vaginosis due to disruption of the vagina ecosystem due to intercourse?

Ongoing open labelled trials and randomised controlled trials to consider concurrent bacterial vaginosis treatment of the women’s sexual partner with oral antibiotics and topical antibiotics have shown that, although the recurrence rate of bacterial vaginosis may be lower in those whose partner is concurrently treated, there remains insufficient clinical evidence to recommend male partners to be treated concurrently with the symptomatic woman [13,14]. 

If I have recurring bacterial vaginosis, should my partner be tested?

Yes. In view of the association between bacterial vaginosis and the predisposition to STDs, both partners are encouraged to undergo STD screening and treatment for any concurrent infections. It is also worth noting, especially in women, a vaginal infection can be associated with a predisposition to other forms of vaginal infection (including STDs). By screening and treating concurrent infections, vaginal health and microenvironment can be restored over time, hence reducing the risk of recurring bacterial vaginosis.

Treatment of recurring bacterial vaginosis in Singapore

The 3-point approach method is advised to reduce the risk of recurrence of bacterial vaginosis:

1. Treating the overgrowth bacteria: antibiotics treatment. 
2. Maintaining a conducive vaginal pH: lactate gel treatment in the form of pessaries or vaginal applicators.
3. Promote long-term colonisation of good vagina bacterial floral: probiotic treatment in the form of tablets or pessaries.

In recalcitrant cases or persistent recurring bacterial vaginosis infection, your doctor will discuss further individual suppressive options for treatment. Please discuss with your doctor with regard to further management, as the treatment regimen is individualised and dependent on triggers and lifestyle.

How can I reduce the risk of recurring bacterial vaginosis?

You can reduce your risk of bacterial vaginosis by incorporating the following:

• Abstain from sex
• Limit your number of sexual partners
• Not douching
• Using condom correctly 

Conclusion

Bacterial vaginosis is a common vaginal infection that can affect your quality of life and brings in its wake possible health complications if left untreated. If you are experiencing abnormal or recurring vaginal symptoms, do not hesitate to reach out to your doctor for further screening and treatment.

References

1.  Jenifer E. Allsworth, J. F. (2011). Severity of Bacterial Vaginosis and the Risk of Sexually Transmitted Infection. American Journal of Obstetrics and Gynecology, doi: 10.1016/j.ajog.2011.02.060.
2. Centers for Disease Control and Prevention. (2022, January 5). Bacterial Vaginosis – CDC Basic Fact Sheet. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm
3. Koumans Emilia H., S. M. (2007). The Prevalence of Bacterial Vaginosis in the United States, 2001–2004; Associations With Symptoms, Sexual Behaviors, and Reproductive Health. Sexually Transmitted Diseases, 864-869.
4. Wallace Jeng Yang Chee, S. Y. (2020). Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Annals of Microbiology.
5. Sonal Pendharkar, A. S.-H. (2023). Lactobacilli and Their Probiotic Effects in the Vagina of Reproductive Age Women. Microorganisms, doi: 10.3390/microorganisms11030636.
6. Eva Miko, A. B. (2023). The Role of Hydrogen-Peroxide (H2O2) Produced by Vaginal. Antioxidants, doi: 10.3390/antiox12051055.
7. Mark A Klebanoff, J. R.-F. (2004). Vulvovaginal symptoms in women with bacterial vaginosis. Obstetrics and Gynecology, 267-272.
8. Wilson, J. (2004). Managing recurrent bacterial vaginosis. Sexually Transmitted Infections, doi: 10.1136/sti.2002.002733.
9. Larsson, P. G. (1992). Treatment of bacterial vaginosis. International Journal of STD and AIDS, doi: 10.1177/095646249200300402.
10. Jacques Ravel, I. M. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology, 251-257.
11. C A Flynn, A. L. (1999). Bacterial vaginosis in pregnancy and the risk of prematurity: a meta-analysis. Journal of Family Practice, 885-892.
12. Adam S. Dingens, T. S. (2016). Bacterial vaginosis and adverse outcomes among full-term infants: a cohort study. BMC Pregnancy and Childbirth, doi: 10.1186/s12884-016-1073-y.
13. Jairo Amaya‐Guio, D. A.‐C.‐B.‐V.‐A. (2016). Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database of Systemic Reviews, doi: 10.1002/14651858.CD011701.pub2.
14. Erica L Plummer, L. A. (2021). A Prospective, Open-Label Pilot Study of Concurrent Male Partner Treatment for Bacterial Vaginosis. mBio, doi: 10.1128/mBio.02323-21.