EYNTK about bacterial vaginosis

Charlie Elizabeth Culverhouse speaks to gynaecology expert Dr Susanna Unsworth about the new research into bacterial vaginosis, its symptoms, treatment, and whether or not it really is an STI

Bacterial vaginosis is one of the most common conditions affecting women across the globe, yet it is also one of the most misunderstood.

It affects one in three women worldwide, according to the World Health Organisation, and is caused by an overgrowth of certain bacteria in the vagina which, while necessary in the right levels, disrupts normal pH levels.

This can cause discomfort and a fishy-smelling discharge, and while it is treatable and curable, rates of recurrence are unbelievably high with 60% of cured patients experiencing recurrent bacterial vaginosis within a year.

And researchers have just figured out why. In a new landmark study published in the New England Journal of Medicine, researchers have revealed that bacterial vaginosis, or BV, can be sexually transmitted.

Read more: Gen Z is having less sex, so why are they getting more STIs?

So while women suffering from symptoms may be treated with rigorous courses of antibiotics, the moment they have sex, they can be reinfected by their male partners who were, until now, thought to be immune from the condition. 

Dr Susanna Unsworth, a GP specialising in gynaecology and in-house intimate wellness expert at INTIMINA, says this new insight is a ‘significant finding’ that will impact not only the course of treatment she recommends to her patients, but that of all gynaecologists globe-wide.  

“The study has questioned the previous understanding that BV is not a sexually transmitted infection,” she says. “It’s found evidence that BV can be exchanged from male partners, and treating male partners reduces the risk of recurrence. This could be a significant finding in the recommendations for treating BV as current advice does not recommend treating male partners.”

Is bacterial vaginosis an STI?

As Unsworth explains, it has long been assumed that BV is not an STI, though it does leave sufferers with a higher risk of getting sexually transmitted infections, particularly when it comes to chlamydia. 

She explains, “BV causes a disruption to the natural balance of bacteria and pH, which normally acts as a line of defence to other infections. 

“It enables other organisms, if exposed to them, to grow more effectively and cause infection,” she adds. “It is also suggested that BV may result in formation of a biofilm which may reduce the effectiveness of other immune responses to infections.”

But does the new research change anything?

Even though it does suggest that men can re-infect their partners through sexual activity, Unsworth says that it’s not an open and shut case like other infections classed as STIs. 

“There are situations where women will develop BV not related to sex, and it can occur in women who have never been sexually active,” she explains.

“However, it is important to consider this new evidence that suggests the risk of infection is associated with sex, and that sex also increases the risk of recurrence.

“The infection process is not as straightforward as other STIs. So it is definitely an area that needs more research.”

What is bacterial vaginosis caused by?

So if it’s not just sex that causes infection, what other pesky culprits are messing with a vagina’s bacteria level and causing bacterial vaginosis? There’s no clear cut answer, but Unsworth says there are certain things that increase a person’s likelihood of being affected. 

These include having multiple sexual partners, both partners being female, having anal sex followed by vaginal penetration, receiving oral sex, sharing sex toys, performing vaginal douching, and using perfumed soaps or vaginal deodorants. 

Of course, she doesn’t recommend avoiding all of those infection-causing activities to minimise your risk – it would be impossible. But she does say to completely avoid vaginal douching and to also cut down on scented soaps and bubble baths to avoid messing with your pH balance. 

There are also less extreme ways to better protect yourself, including using pH balanced products to wash externally, while also ensuring that all your sex toys are well cleaned. You should also consider using condoms, which is always the best practice against any infection.

How to know if you have bacterial vaginosis

According to NICE, 50% of women suffering from BV are asymptomatic, which is both a blessing and a curse. It means you don’t have any of the irritating symptoms, but it also means that the infection can easily spread if you and your sexual partner are both seeing other people. If you’re worried that you may have it, you can ask your GP for a screening. 

For the other 50%, there is just one overarching symptom to look out for, Unsworth says. “The most common symptom is a change in vaginal discharge – it is often thin and watery, can be frothy, and often a grey-white colour,” she explains. “It also typically has a fish-like smell.” 

Read more: Can tech really de-stigmatise STIs? The founders of Zults think so

What happens if BV goes untreated?

If you’re worried about BV, the best course of action is always to visit your GP and get treatment, which will be a simple antibiotic, though Unsworth does say those experiencing very mild symptoms will often find they settle on their own. 

However, she says, while it is unusual for significant complications to occur, with research showing how BV can increase your risk of getting an STI, and yet more even suggesting an increased risk of miscarriage in women who develop symptomatic BV in pregnancy, you definitely want to visit a medical professional to get their advice.

It’s time for more research

The new research in the New England Journal of Medicine might have brought the term BV into the popular consciousness for the first time…well, ever, but Unsworth is keen to remind us that it’s just the first step in looking into this common and under-studied condition. 

“I do think there is still a lot to learn about BV, and the whole vaginal microbiome,” she says, which is true about a lot of medical problems specifically affecting women – just look at how little research has gone into endometriosis when compared with studies on male baldness! 

Still, she says, it’s a vital step. “I feel this new evidence, even though small, will change my practice in women who are struggling to manage recurrent BV, and I will be recommending we consider treating the partner too.”