An editorial co-written by a Wayne State University School of Medicine infectious diseases expert and published in the New England Journal of Medicine calls for a radical shift in the current treatment of bacterial vaginosis – reclassifying the condition as a sexually-transmitted infection and treating male partners of women affected by the condition.

Published March 5, “Bacterial Vaginosis — Time to Treat Male Partners,” the editorial was written by Jack Sobel, M.D., professor of Internal Medicine, Infectious Diseases at WSU, and Christina Muzny, M.D., M.S.P.H., professor of Medicine, Infectious Diseases at the University of Alabama at Birmingham School of Medicine, calls for health care providers to begin classifying bacterial vaginosis as a sexually transmitted infection. They also recommend male sexual partners receive medical treatment.

This would represent a major shift in the treatment of the condition, the most common cause of vaginal discharge in reproductive-age women. Bacterial vaginosis is associated with increased risk of adverse birth outcomes, acquisition of human immunodeficiency virus and other sexually transmitted infections, pelvic inflammatory disease and a high incidence of infection recurrence.

The editorial was published in conjunction with a study, “Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis,” in the journal that found adding combined oral and topical antimicrobial therapy (oral metronidazole and topical clindamycin) for monogamous male partners to the treatment of women resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than did the current standard care, which consists of treating women only.

“The results of this trial are timely and important. They provide substantial evidence supporting the role of sexual transmission of bacterial vaginosis–associated bacteria, particularly within regular sexual partnerships. They also signify a need for a major change to the treatment approach of women with bacterial vaginosis with respect to how women should be counseled regarding the origin of their infection and to the need to engage their male partners in sharing responsibility for transmission and treatment,” Drs. Sobel and Muzny write. “To date, there have been no effective strategies to prevent sexual transmission of bacterial vaginosis–associated bacteria, apart from consistent use of condoms.”

The “major paradigm shift” the trial represents, the doctors wrote, will require physicians to educate patients on the role of sexual transmission of bacterial vaginosis, just as they do with other sexually transmitted diseases. It also will require a willingness on the part of male partners to commit to treatment, something the authors admit could be challenging.

The trial, which was conducted in Australia, has some limitations related to racial and ethnic backgrounds and the fact that the majority of males in the study were uncircumcised. Despite the limitations, Dr. Sobel and his co-author said, the trial provides data critical to educating clinicians and patients about the sexual transmission of bacterial vaginosis–associated bacteria and the benefit of treating male partners.