Here's one 'women's problem' men need to know about
What's hard to diagnose, hard to treat, affects 10 to 15 per cent of Australian women – and could turn out to be sexually transmissible?
It's called bacterial vaginosis – or BV – and while it's considered a 'women's problem' there's growing evidence that men may also harbour the infection. Especially if they're uncircumcised, says Associate Professor Catriona Bradshaw, a staff specialist at the Melbourne Sexual Health Centre.
"BV is a neglected disease which imposes a burden on women. They often get fobbed off because BV is so difficult to treat – in 50 per cent of cases, the infection comes back within six months of treatment," Dr Bradshaw says.
"Recent studies show men can carry the same bacteria found in women with BV, particularly under the foreskin in uncircumcised men. While this is early research, circumcision appears to be linked to a reduction of these bacteria in men. Studies also suggest that women who are treated for BV may have high rates of recurrence because they are re-infected after sex with their partner after treatment."
BV is distressing for women on many counts. Along with the symptoms – a fishy odour and increased vaginal discharge – BV can double the risk of miscarriage or preterm birth during pregnancy.
It's also persistent, with re-infection by a partner only being one cause. Another is that the bacteria responsible for BV can sometimes outsmart antibiotics.
BV is caused by a group of different microbes with an ability to hide in what's called a biofilm – a kind of matrix where bacteria come together – and it's here microbes deep within the biofilm can evade both antibiotics and the body's own immune defences, Dr Bradshaw explains. Research is now looking for ways to disrupt this biofilm so that antibiotics can target the bacteria more easily.
Women with BV also have reduced numbers of healthy bacteria called lactobacilli which produce an important defence against harmful microbe – lactic acid. With less lactic acid, the vagina's pH drops, allowing BV to thrive, she adds.
"But we don't know what comes first. Is it an invasion of bad microbes that reduce the numbers of lactobacilli – or does something else cause the loss of lactobacilli so that the bad bugs invade? Although there are products on the market claiming to help replace lactobacilli in the vagina, none have been conclusively shown to reduce BV – although more research is underway."
So what would it take for BV to join the ranks of sexually transmitted diseases?
"What we have so far is a theory backed up by some data but to prove that BV is sexually transmitted we need randomised controlled trials – the gold standard of medical research – to prove that treating a woman's partner reduces BV," says Bradshaw who's working on a study to see if treating men with both an antibiotic cream and an oral antibiotic eliminates the bacteria responsible for BV.
"Studies have found that circumcision can substantially reduce the risk of sexually transmitted infections including herpes, syphilis, HIV, HPV and trichomoniasis," she says.
"This is information that's only emerged in the last ten years but it's important information that people need to be aware of. The fact that circumcision also appears to reduce BV in women is more evidence that BV is likely to be sexually transmitted. "
Meanwhile, if you're a woman faced with recurring BV, using condoms consistently with partners after treatment may prevent recurrence, says Dr Bradshaw – but at this point a doctor won't generally treat a woman's partner for BV because to do so would be outside the current guidelines for treatment.
"We need new trials of male partner treatment to provide the highest level of evidence that treating male partners reduces the recurrence of BV in women," she says.
Paula Goodyer is a Walkey-award winning health writer and twice winner of the Dietitians' Association of Australia Journalism Award.