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Bacterial vaginosis: an overlooked STI?
Sheridan D George1, Olivia T Van Gerwen1, Christina A Muzny1
1Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
Expert Review of Anti-Infective Therapy
|October 29, 2025
Summary
Bacterial vaginosis (BV) is a common vaginal infection with an unknown cause. Evidence strongly suggests sexual activity is the primary way BV-associated bacteria are acquired, though non-sexual factors lack direct causal links.
Area of Science:
- Gynecology
- Infectious Diseases
- Microbiology
Background:
- Bacterial vaginosis (BV) is the most prevalent vaginal infection, affecting women globally.
- Despite over 70 years of research, the precise etiology and causative agents of BV remain elusive.
- Existing research points towards bacterial vaginosis-associated bacteria (BVAB) potentially being sexually transmitted.
Purpose of the Study:
- To critically evaluate the existing scientific evidence supporting and refuting the sexual transmission of BVAB.
- To synthesize current understanding of BV pathogenesis, considering both sexual and non-sexual contributing factors.
- To inform clinical practice regarding patient counseling on BV acquisition and recurrence prevention.
Main Methods:
- Comprehensive review of epidemiological studies investigating BV etiology.
- Analysis of clinical trial data, including male partner treatment trials for BV.
- Examination of research on non-sexual risk factors associated with BV development.
Main Results:
- A substantial body of evidence indicates that sexual activity is the predominant route for initial BV acquisition.
- No direct causal relationship has been established between non-sexual factors (e.g., smoking, IUD use) and BV development.
- Male partner treatment, alongside female treatment, demonstrated a reduced rate of BV recurrence.
Conclusions:
- Sexual transmission is strongly implicated as the primary driver of BV acquisition.
- The role of non-sexual factors in BV etiology requires further investigation to establish causality.
- Further research into BV etiology is essential for effective prevention and management strategies.
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