The epidemiology of bacterial vaginosis in relation to sexual behaviour
Open Access
- 30 March 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 10 (1), 81
- https://doi.org/10.1186/1471-2334-10-81
Abstract
Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic micro-organisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour. G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced by penetrative sexual contact but also by non-penetrative digito-genital contact and oral sex, again indicating that sex per se, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of G. vaginalis, presumably explaining the high concordance rates of G. vaginalis carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection. Though male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a sexually enhanced disease, with frequency of intercourse being a critical factor.Keywords
This publication has 105 references indexed in Scilit:
- Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microfloraBMC Microbiology, 2009
- The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, UgandaAmerican Journal of Obstetrics and Gynecology, 2008
- Bacterial vaginosis and HIV acquisition: a meta-analysis of published studiesAIDS, 2008
- The effect of vaginal douching cessation on bacterial vaginosis: a pilot studyAmerican Journal of Obstetrics and Gynecology, 2008
- Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community settingSexually Transmitted Infections, 2007
- Bacterial vaginosis and human immunodeficiency virus infectionAIDS Research and Therapy, 2007
- Comparison of the vaginal flora in sexually abused and nonabused girlsThe Journal of Pediatrics, 1992
- Bacterial vaginosis: a double‐blind randomized trial of the effect of treatment of the sexual partnerBJOG: An International Journal of Obstetrics and Gynaecology, 1988
- Microbiology of the lower genital tract in postmenarchal adolescent girls: Differences by sexual activity, contraception, and presence of nonspecific vaginitisThe Journal of Pediatrics, 1985
- Nonspecific VaginitisNew England Journal of Medicine, 1978