Asymptomatic Bacterial Vaginosis: to Treat or Not to Treat?
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FEMALE GENITAL TRACT INFECTIONS (J SOBEL, SECTION EDITOR)
Asymptomatic Bacterial Vaginosis: to Treat or Not to Treat? Christina A. Muzny 1
&
Jane R. Schwebke 2
Accepted: 27 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this review is to summarize current evidence for and against the treatment of asymptomatic bacterial vaginosis (BV) in women. Recent Findings Asymptomatic BV is common although its pathogenesis remains incompletely understood. In favor of treating asymptomatic BV is the large body of data supporting that it is sexually transmitted. Along these lines and similar to other STIs, treatment of BV, regardless of symptom status, should be considered to reduce adverse outcomes of infection (i.e., adverse birth outcomes, infertility, post-gynecologic surgery infections) and prevent further sexual transmission of BV pathogen(s) to sexual partners. One study has found that treatment of women with asymptomatic BV led to a significant reduction in incident chlamydial infections over a 6-month follow-up period, compared to observation-only women. Additionally, some women with asymptomatic BV actually have symptomatic BV but do not recognize these symptoms as an infection. Nevertheless, limitations of the trial regarding treatment of asymptomatic BV as well as the 2020 United States Preventative Task Force recommendation against screening and treatment of asymptomatic BV in pregnant women dampen enthusiasm for recommending treatment in this setting. Summary Treatment of asymptomatic BV remains controversial. Additional studies are needed to further investigate the pathogenesis of BV, which will directly influence advances in its diagnosis, treatment, and prevention. Keywords Bacterial vaginosis . Vaginal microbiota . Sexually transmitted infection . Asymptomatic . Treatment . Metronidazole
Introduction Bacterial vaginosis (BV) is the most common cause of vaginal discharge worldwide, with a global prevalence ranging between 23 and 29% that is higher in racial and ethnic groups (i.e., African American women 33.2%, Hispanic women 30.7%) [1•]. It is also common in women of low income [2]. BV is characterized by the loss of healthy, hydrogen peroxide and lactic acid–producing Lactobacillus species, and high concentrations of facultative and strict anaerobic bacteria
This article is part of the Topical Collection on Female Genital Tract Infections * Christina A. Muzny [email protected] 1
Division of Infectious Diseases, University of Alabama at Birmingham, ZRB 242; 1530 3rd Avenue South, Birmingham, AL 35294, USA
2
Division of Infectious Diseases, University of Alabama at Birmingham, ZRB 239; 1530 3rd Avenue South, Birmingham, AL 35294, USA
[3•], which form a polymicrobial biofilm on vaginal epithelial cells [4]. Women with BV are at increased risk of acquisition of HIV [5] and other sexually transmitted infections (STIs), including chlamydia [6], gonorrhea [7], trichomoniasis [6], Mycoplasma genitalium [8], human papilloma virus (HPV
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