Dx Dialogue | SEKISUI Diagnostics

Evolution to Revolution: Bacterial Vaginosis Testing & Treatment

Written by Jeff Reid and Galit Gelman | Jun 9, 2025 2:58:41 PM

A landmark study, Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis, published in the New England Journal of Medicine (NEJM) on March 5th, 2025 has profoundly impacted our understanding of Bacterial vaginosis (BV), a condition affecting nearly a third of women worldwide.1,2 This research, conducted in Melbourne Australia, reveals that BV is likely a Sexually Transmitted Infection (STI), challenging the long-held belief that it results from an imbalance in the vaginal microbiome and considered a common vaginal disorder. The findings have significant implications, and the medical community is now questioning how we approach BV testing and treatment, necessitating a shift towards a more comprehensive and inclusive diagnostic and therapeutic strategy.

Current Diagnostic Methods

Previously, BV diagnosis relied on clinical criteria, such as Amsel's Criteria, or determining the Nugent score from a vaginal Gram stain.3 These methods involve assessing symptoms such as vaginal discharge, odor, and pH levels, as well as microscopic examination of vaginal smears for specific bacterial patterns. However, more modern and convenient methodologies for diagnosing BV have become available over the past decade. A prime example is the OSOM® BVBLUE® Test, which is a visual read enzymatic assay that detects sialidase activity in only 10 minutes.4 This rapid, CLIA-waived test is designed for point-of-care testing, empowering healthcare professionals with the ability to test-&-treat at the very first patient visit. Also, there are molecular platforms available, such as the BD Max Vaginal Panel, that can accurately diagnose BV in a lab-based setting.5

While there are several effective tools and protocols diagnosing BV in females, there are no established diagnostic tests specifically for BV in males or a general test for both sexes. Current detection-in-males research focuses on detecting BV-associated bacteria in penile skin and urethral samples, but these methods are not widely available or standardized.6

The Melbourne Study

The Melbourne study, led by Professor Catriona Bradshaw and Dr. Lenka Vodstrcil, demonstrates that treating both partners simultaneously significantly reduces BV recurrence rates. In their trial involving 164 heterosexual, monogamous couples, the recurrence of BV was halved when both the female and her male partner received treatment compared to treating the female alone.7 This breakthrough suggests that reinfection from sexual partners is a major factor in BV recurrence, supporting the notion that BV is indeed an STI.

Implications for Testing and Treatment: A Paradigm Shift

Given the new evidence, testing for BV should evolve to include considerations for sexual transmission. Here are several key changes that could enhance diagnostic accuracy and treatment efficacy:

  1. Diagnostic Accuracy:
    • Point-of-Care Tests: Tools like the OSOM® BVBLUE® Test continues to offer a rapid, affordable and reliable solution, which could be particularly beneficial in settings with limited laboratory resources or to patients experience reoccurrence of symptoms.9 Affordable diagnostic tools are especially important if BV is added into national and international guidelines for routine STI screening.
    • PCR Testing: While more expensive, polymerase chain reaction (PCR) tests can identify specific bacterial genetic material, potentially improving diagnostic accuracy. These tests could be used more widely, especially in cases where traditional methods are inconclusive.3

 

  1. Inclusion of Sexual Partners in Testing and Treatment Protocols:
    • Testing for Male Partners: Developing tests to detect BV-associated bacteria in males could help identify carriers and prevent reinfection. This would involve analyzing penile skin and urethral samples for bacteria linked to BV. 6
    • Partner Treatment: Incorporating partner treatment into standard care could significantly reduce recurrence rates. This involves administering oral and topical antibiotics to male partners simultaneously with female treatment.8

Challenges and Future Directions

While the Melbourne study offers promising insights, several challenges remain:

  1. Stigma Associated with STIs: Labeling BV as an STI may increase stigma, requiring healthcare providers to approach discussions sensitively and emphasize the importance of partner involvement in treatment.12
  2. Further Research Needs:
    • Diverse Populations: Studies should be conducted in diverse populations, including non-monogamous relationships and LGBTQIA+ communities, to ensure that treatment strategies are universally effective.13
    • Bacterial Identification: Identifying the specific bacteria responsible for BV could lead to more targeted treatments and diagnostic tests.14
  3. Guideline Updates:
    • Educating both healthcare providers and the public about BV as an STI is crucial. This includes discussing the role of sexual transmission and the importance of partner treatment to reduce stigma and improve treatment adherence.
    • National and international health guidelines should be revised to reflect BV's status as an STI and recommend partner treatment. This will require coordination among health organizations and policymakers.
    • Adding BV testing into the routine screening protocol when testing for STI’s to reduce transmission and spread of the infection. As of now the CDC STI Treatment Guidelines list 9 of the most prevalent STIs, screening recommendations and treatment considerations.15

Conclusion

The Melbourne study marks a significant turning point in our understanding and management of BV. By acknowledging BV as a STI and incorporating it into standard screening and treatment as well as providing partner treatment into standard care, we can improve cure rates and reduce recurrence. However, this shift requires a multifaceted approach, including enhanced diagnostic tools, public education, and further research to address the complexities of sexual transmission. As we move forward, it is essential to balance the need for effective treatment with sensitivity towards the stigma associated with STIs, ensuring that all individuals affected by BV receive comprehensive and compassionate care.

 

 

 

References:

  1. Vodstrcil LA, Plummer EL, Doyle M, et al. Treating male partners of women with bacterial vaginosis (StepUp): a protocol for a randomised controlled trial to assess the clinical effectiveness of male partner treatment for reducing the risk of BV recurrence. BMC Infect Dis. 2020;20(1):834. Published 2020 Nov 11. doi:10.1186/s12879-020-05563-w
  2. New STI impacts 1 in 3 women: landmark study reveals men are the missing link. Medicine, Nursing and Health Sciences. Published March 28, 2025. https://www.monash.edu/medicine/news/latest/2025-articles/new-sti-impacts-1-in-3-women-landmark-study-reveals-men-are-the-missing-link
  3. CDC. Bacterial Vaginosis - STI Treatment Guidelines. www.cdc.gov. Published 2021. https://www.cdc.gov/std/treatment-guidelines/bv.htm
  4. OSOM® BVBLUE® Test. Sekisui Diagnostics. Published April 14, 2025. Accessed April 4, 2025. https://sekisuidiagnostics.com/product/osom-bvblue-test/
  5. ‌Savicheva AM. Molecular Testing for the Diagnosis of Bacterial Vaginosis. Int J Mol Sci. 2023;25(1):449. Published 2023 Dec 28. doi:10.3390/ijms25010449
  6. Zozaya M, Ferris MJ, Siren JD, et al. Bacterial communities in penile skin, male urethra, and vaginas of heterosexual couples with and without bacterial vaginosis. Microbiome. 2016;4:16. Published 2016 Apr 19. doi:10.1186/s40168-016-0161-6
  7. Mayo Clinic. Bacterial vaginosis - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. Published 2019. https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285
  8. ‌Dall C. Trial finds male-partner antibiotic treatment cuts bacterial vaginosis recurrence. CIDRAP. March 6, 2025. Accessed April 4, 2025. https://www.cidrap.umn.edu/sexually-transmitted-infections/trial-finds-male-partner-antibiotic-treatment-cuts-bacterial.
  9. Bradshaw CS, Morton AN, Garland SM, Horvath LB, Kuzevska I, Fairley CK. Evaluation of a point-of-care test, BVBlue, and clinical and laboratory criteria for diagnosis of bacterial vaginosis. J Clin Microbiol. 2005;43(3):1304-1308. doi:10.1128/JCM.43.3.1304-1308.2005
  10. Datcu R, Gesink D, Mulvad G, et al. Bacterial vaginosis diagnosed by analysis of first-void-urine specimens. J Clin Microbiol. 2014;52(1):218-225. doi:10.1128/JCM.02347-13
  11. Naicker D, Ramsuran V, Naicker M, et al. Strong correlation between urine and vaginal swab samples for bacterial vaginosis. S Afr J Infect Dis. 2021;36(1):199. Published 2021 Jun 17. doi:10.4102/sajid.v36i1.199
  12. newsGP - Key to bacterial vaginosis treatment unlocked. NewsGP. Published 2025. Accessed April 4, 2025. https://www1.racgp.org.au/newsgp/clinical/key-to-bacterial-vaginosis-treatment-unlocked?feed=RACGPnewsGPArticles
  13. ‌Partner cohort treatment study for Bacterial vaginosis PACT. Mshc.org.au. Published 2025. Accessed April 4, 2025. https://www.mshc.org.au/research/research-studies/pact-study
  14. ‌Gupta AH. Bacterial Vaginosis May Be Sexually Transmitted, New Study Shows. The New York Times. https://www.nytimes.com/2025/03/05/well/bacterial-vaginosis-sexually-transmitted-study.html. Published March 5, 2025.
  1. Centers for Disease Control and Prevention. STI screening recommendations. www.cdc.gov. Published 2021. https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm
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