tag:theconversation.com,2011:/uk/topics/bacterial-vaginosis-24287/articlesbacterial vaginosis – The Conversation2024-03-06T13:23:22Ztag:theconversation.com,2011:article/2239182024-03-06T13:23:22Z2024-03-06T13:23:22ZBoxers, briefs and bacterial vaginosis: how your underwear can affect your health<figure><img src="https://images.theconversation.com/files/579029/original/file-20240229-22-9jmolr.jpg?ixlib=rb-1.1.0&rect=25%2C8%2C5582%2C3724&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/underwear-colored-funny-panties-256670413">Sylvia Biskupek/Shutterstock</a></span></figcaption></figure><p>Thongs, briefs, long johns, g-string, boxers, trunks: there’s a bewildering array of undies out there. But which ones are best for the health of your nether regions?</p>
<p>Well, the style of underwear you choose is less important than the material it is made of. Natural fibres such as cotton are far better for the skin, especially the sensitive areas around the genitals, where breathability of the garment is important. </p>
<p>But, even if your pants drawer is full of cotton briefs, you’ll still need to be wary of fit, dyes and dirt. Here’s what women and men need to know about the links between their underwear and their health.</p>
<p>For those who have one, it’s important to remember the vagina is a self-cleaning organ. It <a href="https://www.uptodate.com/contents/vaginal-discharge-in-adult-women-beyond-the-basics/print">produces up to 5ml</a> of fluid per day and has a balanced microflora consisting of many different bacteria – although it’s typically dominated by those of the <em>lactobacillus genus</em>. </p>
<p>These <a href="https://www.sciencedirect.com/science/article/pii/S0923250817300839">bacteria produce lactic acid</a> which ensures the vagina maintains the correct, <a href="https://pubmed.ncbi.nlm.nih.gov/15838694/">typically slightly acidic, pH</a>, reducing the risk of infection.</p>
<p>There’s limited research on how underwear style might impact vaginal health. The most <a href="https://journals.lww.com/greenjournal/abstract/2018/05001/brief_vs_thong_hygiene_in_obstetrics_and.375.aspx">notable study</a>, though, found that thong-wearers were more likely to report urinary tract infections (UTIs), vaginal yeast infections and bacterial vaginosis. </p>
<p>However, it may not be the thong itself that causes infection: in the study, UTIs were associated with oral sex and bacterial vaginosis was linked to non-cotton crotch underwear.</p>
<p><a href="https://www.nhs.uk/conditions/bacterial-vaginosis/">Bacterial vaginosis</a> is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141851/">dysbiosis</a> – a bacterial imbalance – in the vagina that can be caused by non-breathable underwear. Synthetic fibres, and the dyes used to colour them, can <a href="https://www.ncbi.nlm.nih.gov/books/NBK543220/">alter the conditions</a> of the vagina leading to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654610/">sub-optimal conditions</a> for good bacteria (such as <em>lactobacilli</em>) to exist. </p>
<p>Synthetic, dyed underwear can cause pH levels to <a href="https://www.ncbi.nlm.nih.gov/books/NBK2495/">increase to over 4.5</a> allowing anaerobic bacteria to thrive and <a href="https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2016.01936/full"><em>lactobacilli</em> to perish</a>. These conditions can lead to bacterial vaginosis, or an increase in the growth of fungi such as <em>candida albicans</em>, causing thrush.</p>
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<p>However, it seems that wearing tight-fitting clothing, including underwear, over time <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1649629/">may increase candida</a> levels in the groin. </p>
<p>Underwear that is too tight fitting can also cause friction and irritation around the genitals. This can result in anything from <a href="https://www.nhs.uk/conditions/skin-tags/">skin tags</a> (which may look like genital warts depending on their location), ingrown hairs and blisters.</p>
<h2>Forget the budgie-smugglers</h2>
<p>In men, the testes are the primary site of sperm production. They hang away from the body to achieve a 2°C-4°C cooler environment. Testicular temperature is so important that the body has its own means – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158898/">the pampiniform plexus</a> – to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971494/">cool the arterial blood</a> as it flows into the testes. </p>
<p>There is scant research on the exact effect of underwear type on sperm quality and quantity. However, research found that those who reported frequent wearing of boxer shorts had <a href="https://pubmed.ncbi.nlm.nih.gov/30102388/">a higher sperm concentration</a> than those who wore other types of underwear. Boxers, also demonstrated and maintained a reduced scrotal temperature. </p>
<p>There’s also research to show that <a href="https://www.ajog.org/article/0002-9378(65)90080-3/abstract">increased</a> scrotal temperatures in men from a variety of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2605.1997.d01-303.x">contexts and occupations</a>, resulted in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9588744/">marked reduction</a> in sperm count for weeks. Thankfully, in most settings sperm count is <a href="https://www.scielo.br/j/ibju/a/DZ7qfNnKzYGk6vdMC8HWjRB/?lang=en">recoverable</a>. </p>
<p>The impact across a number of weeks is likely because it takes approximately 74 days for a sperm to be born and reach maturity with ability to exit the body, and temperature can affect sperm at any point in its journey.</p>
<p>However, men who undergo vasectomy are advised to wear <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444593/">tight fitting underwear for at least 48 hours</a> and up to seven days post-operation. The tight fit helps support the testes, reducing their movement and the strain on the very thin layers of <a href="https://theconversation.com/fascia-the-most-neglected-part-of-our-body-is-finally-starting-to-receive-attention-213511">fascia</a> and muscles that cover the testes. Movement results in pain, as well as a risk of opening any wounds, and increases the chances of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255399/">infection</a>.</p>
<h2>Keep it clean</h2>
<p>Cleanliness of the body and the underwear is essential for everyone. Research shows that even clean underwear can contain <a href="https://www.journalofinfection.com/article/S0163-4453(01)90852-7/pdf">0.1b-10g of faecal matter</a>, and those bacteria have the potential to make you ill. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/579219/original/file-20240301-16-ccf2gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579219/original/file-20240301-16-ccf2gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579219/original/file-20240301-16-ccf2gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579219/original/file-20240301-16-ccf2gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579219/original/file-20240301-16-ccf2gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579219/original/file-20240301-16-ccf2gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579219/original/file-20240301-16-ccf2gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Avoid brightly coloured underwear, choose natural fabrics and wash them regularly to keep your genitals happy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/red-panties-boxer-briefs-underwear-on-552320857">DenisProduction.com/Shutterstock</a></span>
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</figure>
<p>Cleaning the skin, as well as your underwear, reduces the potential for fungal infections too, such as <a href="https://patient.info/infections/fungal-infections/fungal-groin-infection-tinea-cruris">tinea cruis</a>, sometimes known as jock itch. </p>
<p>This red or brown itchy rash is four times more common in <a href="https://www.sciencedirect.com/science/article/pii/S1555415505003235#bib2">men than women</a>. Athletes typically present with fungal infections in their groin from increased heat and sweat generated while exercising. Sportsmen tend to develop the infection along the crease between the scrotum and thigh because of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804599/">tight-fitting underwear</a> worn during contact sports. </p>
<h2>You can go commando – but take care with zips</h2>
<p>Foregoing the barrier underwear creates between sensitive areas can actually be beneficial. Going commando enables air to circulate, allowing secretions to dry naturally, reducing the moist conditions that can contribute to infections.</p>
<p>The main risk of going underwear-free <a href="https://www.ncbi.nlm.nih.gov/books/NBK441886/">seems to be for men who’re careless with trouser fastenings</a>. Injuries from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692577/">zip fastenings</a> almost always involve men damaging their penis or scrotum. </p>
<p>So, picking natural, breathable fabrics – and perhaps button-fastenings – are best for health down there. And always remember, if something doesn’t look or smell right it is best to get it checked out.</p><img src="https://counter.theconversation.com/content/223918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Make sure you always wear clean pants’ isn’t just something your mum used to say – keeping your underwear scrupulously clean could stop you from getting illAdam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1667892021-09-16T14:20:47Z2021-09-16T14:20:47ZNew test to diagnose vaginal inflammation could help reduce risk of HIV infection<figure><img src="https://images.theconversation.com/files/420723/original/file-20210913-25-17afu2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://gift.org.za/">Migal Vanas</a></span></figcaption></figure><p>In healthcare systems where resources are limited, it’s common for some conditions to be overlooked or misdiagnosed. This is especially true if the patient doesn’t have obvious symptoms, and if tests are unaffordable. Sometimes, healthcare providers look at a group of symptoms to reach a likely diagnosis. This so-called syndromic management is less accurate than laboratory-based diagnostics.</p>
<p>A good example of syndromic management is the World Health Organisation’s <a href="https://www.who.int/hiv/topics/vct/sw_toolkit/guidelines_management_sti.pdf">guidelines</a> for managing sexually transmitted infections and bacterial vaginosis (a disturbance in healthy vaginal bacterial communities). These conditions are frequently missed using this approach. They may also go <a href="https://doi.org/10.1093/infdis/jis298">untreated</a> because women don’t always have clinical symptoms. Untreated infections and bacterial imbalances increase the risk of HIV infection <a href="https://doi.org/10.1111/j.1365-3156.2011.02906.x">in women</a> and the risk of pregnancy complications like <a href="https://doi.org/10.1038/s41598-019-47756-7">preterm birth</a>. </p>
<p>In sub-Saharan Africa, women and adolescent girls are at very high risk of <a href="https://doi.org/10.1016/S2352-3018(21)00079-5">HIV</a> and <a href="https://www.who.int/en/news-room/fact-sheets/detail/preterm-birth">preterm birth</a>.</p>
<p>In 2010, we discovered that South African women with asymptomatic sexually transmitted infections and bacterial vaginosis had levels of vaginal inflammation that were similar to women with clinically <a href="https://doi.org/10.1093/infdis/jis298">evident symptoms</a>. This could provide ideal conditions for <a href="https://doi.org/10.1093/cid/civ298">HIV infection</a>. Inflammation disrupts the <a href="https://doi.org/10.1038/mi.2015.51">epithelial barrier</a> – the thin lining of the body – allowing the HI virus to enter the tissue and replicate.</p>
<p>Most bacterial sexually transmitted infections are curable with antibiotics. But diagnostic tests are too expensive to use in resource poor settings. As a result, women in these areas are only treated if they have symptoms. Most women with these infections don’t have symptoms, though, and still have high levels of inflammation and risk of HIV infection.</p>
<p>We decided to find a better way to test for asymptomatic vaginal infections in women in resource poor settings. The result was the invention of the Genital Inflammation Test or GIFT. </p>
<p>First we screened inflammatory proteins in vaginal samples from women from different regions in sub-Saharan Africa. This allowed us to identify which proteins are an accurate sign, or biomarker, of sexually transmitted infections and bacterial vaginosis. The test looks for these proteins. </p>
<p>Our <a href="https://gift.org.za/">prototype</a> is a lateral flow test, similar to an off-the-shelf pregnancy test. This was chosen because of its low technology and low cost potential. And it can be done quickly and easily at the point of primary care or as part of home care. </p>
<figure class="align-center ">
<img alt="Medical test on a pink background" src="https://images.theconversation.com/files/420730/original/file-20210913-24-7a3olh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420730/original/file-20210913-24-7a3olh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420730/original/file-20210913-24-7a3olh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420730/original/file-20210913-24-7a3olh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420730/original/file-20210913-24-7a3olh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420730/original/file-20210913-24-7a3olh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420730/original/file-20210913-24-7a3olh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A prototype of the Genital InFlammation Test.</span>
<span class="attribution"><a class="source" href="https://migalvanas.com/">Migal Vanas</a></span>
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</figure>
<p>The next generation of the device and regulatory approval of the test is already in the <a href="https://gift.org.za/edctp-gift-consortium/">pipeline</a>.</p>
<h2>Next steps</h2>
<p>Now, the project will focus on refining the prototype. </p>
<p>This important step is about to be realised with a new [grant] from the <a href="http://www.edctp.org/call/innovative-approaches-to-enhance-poverty-related-diseases-research/#">European and Developing Countries Clinical Trials Partnership</a>. This is a public-public partnership which aims to accelerate the development of clinical interventions for HIV/AIDS, tuberculosis and malaria. </p>
<p>The new funding has given us the opportunity to form new and strengthen existing partnerships with African and international organisations. The study team includes researchers at the Burnet Institute, the Desmond Tutu Health Foundation, the Organization for Public Health Interventions and Development, the Institut Pasteur de Madagascar, Institut Pasteur, Hitotsubashi University, London School of Hygiene and Tropical Medicine, and Utrecht University Medical Centre.</p>
<p>In addition to manufacturing the next generation of the device, the funding will be used to conduct clinical trials. We will test the field performance of the device for women in South Africa, Zimbabwe and Madagascar. </p>
<p>We’ll also develop the plan for using it in the existing clinical framework for managing vaginal infections and bacterial vaginosis. </p>
<p>In addition, the funding will contribute to training young scientists in sub-Saharan Africa. It will build critical research capacity and expertise. </p>
<p>This strategic funding gets the device one step closer to national and EU registration of the device.</p>
<h2>Looking forward</h2>
<p>The next step is to look for partners to assist in the rollout of the lateral flow device, including funders, implementation partners and healthcare professionals. There is also an opportunity to use local diagnostic manufacturers and component suppliers to meet the demand and export the product.</p>
<p>Treatment based on symptoms has been a poor tool in management of vaginal infections and bacterial vaginosis in women. The goal is to have an effective, affordable and low tech tool to detect cases at the point of care. In turn, this could have a major impact on reproductive health and HIV risk in women in African countries.</p><img src="https://counter.theconversation.com/content/166789/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Saberi Marais works at UCT Research Contracts and Innovation, who receive funding support from the South African National Intellectual Property Management Organisation.
This publication was produced by GIFT which is part of the EDCTP Framework Programme for Research and Innovation (2014-2021) supported by the European Union (grant number RIA2020I-3297-GIFT). The views and opinions of authors expressed herein do not necessarily state or reflect those of EDCTP.</span></em></p><p class="fine-print"><em><span>Jo-Ann Passmore receives funding from South African Medical Research Council Strategic Health Innovation Partnerships to develop and test the GIFT device. In addition, Jo-Ann Passmore receives funding from the EDCTP RIA2020I and BMGF. </span></em></p><p class="fine-print"><em><span>Lindi Masson receives funding from the South African Medical Research Council Strategic Health Innovation Partnerships and the European and Developing Countries Clinical Trials Partnership to develop and test the GIFT device. She has also received funding from the Technology Innovation Agency for this work.</span></em></p>Sexually transmitted infections and bacterial vaginosis can provide ideal conditions for HIV infection in women. A new test aims to detect these conditions even when women don’t show symptoms.Saberi Marais, Innovation Commercialization Manager, University of Cape TownJo-Ann Passmore, Associate Professor, University of Cape TownLindi Masson, Senior Research Fellow and Head of the HIV, Inflammation and Microbiome Working Group , Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1059742018-11-18T18:56:57Z2018-11-18T18:56:57ZNeedless treatments: anti-fungal creams or tablets don’t always work for vaginal itch<figure><img src="https://images.theconversation.com/files/244873/original/file-20181110-36763-1uwzfrt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sometimes the symptoms of thrush can be caused by other infections.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>From time to time, we hear or read about medical procedures that can be ineffective and needlessly drive up the nation’s health-care costs. This occasional series explores such <a href="https://theconversation.com/au/topics/needless-treatments-or-procedures-62784">needless treatments or procedures</a> individually and explains why they could cause more harm than good in particular circumstances.</em></p>
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<p>Many women who experience persistent vaginal itch or discharge assume they have vaginal thrush (vulvolvaginal candidiasis). Treatments for thrush are available without a prescription. Since having a vaginal condition can be embarrassing, it’s sometimes preferable to buy creams or tablets from the chemist and treat yourself.</p>
<p>But this also means some women may be using treatments that aren’t best for their condition, or that could be ineffective. Guidelines on treating vaginal itch, from a <a href="http://www.choosingwisely.org.au/recommendations/achshm">campaign to eliminate</a> tests or procedures that could be harmful or ineffective, state: </p>
<blockquote>
<p>Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment.</p>
</blockquote>
<p>This is because if symptoms of thrush persist despite treatment, you may have an entirely different condition that would not be helped by anti-fungal creams or tablets. </p>
<h2>What causes thrush?</h2>
<p>Vaginal thrush is caused by a fungal organism from the Candida family, which usually exists in the vaginal environment (along with a huge number of other micro-organisms) without causing issues for women. When symptoms do occur, they may include itchiness, burning and discomfort, often accompanied by a “cottage-cheese” discharge. </p>
<p>A course of antibiotics (which can alter the balance of micro-organisms in the vagina and allow Candida to thrive) may bring about an episode of thrush. For others, it seems to occur after sexual intercourse. However, vaginal thrush is <a href="https://www.ncbi.nlm.nih.gov/pubmed/19454049">not considered</a> to be sexually transmitted.</p>
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<em>
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Read more:
<a href="https://theconversation.com/recurrent-thrush-how-some-women-live-with-constant-genital-itching-46609">Recurrent thrush: how some women live with constant genital itching</a>
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<p>Sometimes thrush occurs during pregnancy. It’s likely <a href="https://www.ncbi.nlm.nih.gov/pubmed/26164695">hormones play a part</a> in the condition as vaginal thrush is rare in girls before their first period and in women after menopause. Genetics could play a part too, and diet is possibly implicated. But for most women, it’s not clear what causes episodes of thrush.</p>
<h2>What is a topical and oral anti-fungal agent?</h2>
<p>Health practitioners often recommend anti-fungal treatment for thrush. There are two main types of treatment: oral (tablets taken by mouth) or topical (creams or vaginal pessaries applied directly to the vaginal area). The topical treatment generally works a bit quicker than the oral.</p>
<p>There is no <a href="https://www.ncbi.nlm.nih.gov/pubmed/17943774">difference in effect</a> between the types of treatments; it comes down to a preference or tolerability. Some women may experience stomach symptoms with the oral tables, for instance. And topical treatments may cause skin irritation for others. But generally both types of treatments are well tolerated.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244874/original/file-20181110-116853-1xk8lpu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Many assume if a woman is experiencing vaginal itch, thrush is the guilty party.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Because thrush is so common, many assume if a woman is experiencing vaginal itch, thrush is the guilty party. Anti-fungal treatments are highly effective if the symptoms are caused by thrush. The trouble is, <em>Candida albicans</em> isn’t the only cause of these symptoms. </p>
<p>One <a href="https://www.ncbi.nlm.nih.gov/pubmed/11864668">study showed</a> that of women who treated themselves for vaginal thrush, only one-third actually had thrush, and around 14% had no infection at all. The other women had conditions such as bacterial vaginosis which can cause an offensive vaginal discharge and is caused by a bacteria not a fungus. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-a-cure-for-bacterial-vaginosis-one-of-the-great-enigmas-in-womens-health-50850">We need a cure for bacterial vaginosis, one of the great enigmas in women's health</a>
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</p>
<hr>
<p>Some women may also be experiencing a <a href="https://www.mydr.com.au/womens-health/vulval-problems-a-self-help-guide">vulval dermatitis</a>, or even a more serious but rare condition called <a href="https://www.thewomens.org.au/health-information/vulva-vagina/vulva-vagina-problems/lichen-sclerosus">lichen sclerosus</a>, which can cause itching and require completely different treatment.</p>
<h2>What’s wrong with self-treatment?</h2>
<p>If a woman uses the anti-fungal treatment and the condition clears up, usually within a few days, it’s likely that <em>Candida albicans</em> were responsible. But if it doesn’t clear up or keeps coming back, it’s important to have this investigated by a health professional.</p>
<p>This is because:</p>
<ul>
<li><p>The symptoms may not be caused by thrush but something else such as a sexually transmitted infection like bacterial vaginosis</p></li>
<li><p>There are a number of different types (or species) of Candida, and some don’t respond well to certain treatment</p></li>
<li><p>Inappropriate use of anti-fungals may lead to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26164695">fungal resistance</a> which means higher doses of treatment may be necessary, or that the anti-fungal treatment won’t work at all</p></li>
<li><p>There may be a more appropriate method of managing the condition, such as treating on a regular basis at certain times of the menstrual cycle</p></li>
<li><p>The woman may have an another medical condition, such as diabetes, which makes vaginal thrush <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-2-1">more difficult</a> to treat.</p></li>
</ul>
<h2>What if it’s thrush, but the anti-fungals don’t work?</h2>
<p>If you have thrush, anti-fungal treatments are usually effective. But for around 5% of women, thrush keeps coming back or doesn’t completely clear despite treatment. In these case, it may be necessary to see a specialist.</p>
<p>The <a href="https://tgldcdp.tg.org.au/etgAccessDenied?access=denied#toc_d1e247">recommended management</a> for problematic thrush is long-term treatment with regular (weekly or monthly) oral or topical anti-fungals. But <a href="https://www.ncbi.nlm.nih.gov/pubmed/18976735">tailored therapy</a> may <a href="https://www.ncbi.nlm.nih.gov/pubmed/18976735">sometimes be needed</a>, such as combinations of antifungal therapy (oral + topical) or different regiments according to response to the therapy.</p>
<p>Many women resort to alternative therapies such as tea-tree oil, garlic and gentian violet and yoghurt. But there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/17627679">inconsistent evidence</a> supporting these methods and they may cause allergic reactions.</p>
<p>Other treatments like probiotics also have limited supporting evidence and can be expensive. There are some promising treatments in the pipeline (such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/29697768">vaccines</a>, <a href="https://www.ajog.org/article/S0002-9378(17)31071-2/abstract">tetrazole antifungal agent</a> and <a href="https://www.jacionline.org/article/S0091-6749(16)31815-2/abstract">immunotherapy</a>) but these are still under trial and not commercially available.</p>
<p>So, if you’re suffering from a vaginal itching, burning or abnormal discharge that isn’t relieved by oral or topical anti-fungals, seek professional help. You should have swabs taken to rule out other infections or conditions and to decide on the most appropriate method of management.</p><img src="https://counter.theconversation.com/content/105974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cathy Watson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If symptoms of thrush persist despite treatment, you may have an entirely different condition that would not be helped by anti-fungal creams or tablets.Cathy Watson, Research Fellow in Women's Health at Monash University and Honorary Researcher, General Practice and Primary Health Care Academic Centre, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/881502017-12-12T19:11:40Z2017-12-12T19:11:40ZYour vagina cleans itself: why vagina cleaning fads are unnecessary and harmful<figure><img src="https://images.theconversation.com/files/198473/original/file-20171211-27689-k2apva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No, you don't need to douche yourself with a cucumber. Or anything for that matter. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>A staggering variety of so-called feminine hygiene products seek to help with “vaginal odour” and discharge, and “keep you fresh”. From <a href="https://www.amazon.com/Best-Sellers-Health-Personal-Care-Feminine-Hygiene-Deodorant-Sprays/zgbs/hpc/3779521">deodorants</a> to <a href="https://www.youtube.com/watch?v=Bw020j-G_b8">cucumber cleanses</a>, <a href="https://www.amazon.com/Panty-Liners-Scented-Feminine-Care/s?ie=UTF8&page=1&rh=n%3A3779581%2Cp_n_theme_browse-bin%3A389598011">scented “panty liners”</a>, and the <a href="http://acupunctureplus.com.au/clinic/vaginal-steaming/">newest fad</a> “vaginal steaming”. These products actively promote the view that women’s vaginas should be discharge-free and either have no smell at all or exude the whiff of rose petals or vanilla pods.</p>
<p>Many women perceive vaginal discharge as undesirable and unnatural rather than physiological and normal. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25128928">Data suggest around half of all women</a> use “panty liners” to absorb discharge with up to 30% using them on a daily basis. While Australian women are generally not big fans of “douching”, a French term for washing out the vagina using a liquid spray, it’s important to understand why cleaning the vagina is not recommended.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-is-normal-vaginal-discharge-and-whats-not-63815">Health Check: what is normal vaginal discharge and what's not?</a>
</strong>
</em>
</p>
<hr>
<h2>What is vaginal discharge and why is it important?</h2>
<p>The vagina is self-cleaning, and vaginal discharge plays an important role in keeping the vagina healthy. From puberty, when oestrogen kicks in, the vagina becomes colonised with healthy bacteria from the <em>Lactobacillus</em> group which produce lactic acid.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198476/original/file-20171211-27698-17g264l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many products are marketed as reducing vaginal odours. But the vagina isn’t supposed to smell like perfume.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>This finely balanced vaginal ecosystem is referred to as the vaginal microbiome and the resulting acidity of the vagina provides protection against sexually transmissible infections. </p>
<p>Healthy vaginal discharge is made up of fluid from the vaginal walls, mucus from the cervix as well as the lactobacilli, and because the vaginal environment is hormonally influenced, variation in the amount of discharge throughout the month is to be expected and completely normal. </p>
<p>As well as providing a protective environment, vaginal discharge provides natural lubrication with between one and 4mls of fluid produced every 24 hours. Healthy vaginal discharge has a characteristic smell – and in some women this can become stronger because of the large number of sweat glands in the hair-bearing pubic area. So while washing inside the vagina is not recommended, it’s important to keep the outer skin clean.</p>
<h2>Disruption of the healthy vaginal environment</h2>
<p>Anything put in the vagina can potentially disrupt the vaginal environment and its balanced vaginal flora, including tampons, penises, condoms, semen, fingers and hygienic sex toys. Disruption in these cases is almost always temporary and the vagina quickly restores itself. </p>
<p>But this may not be so in the case of vaginal cleansing products, or repeated douching. Homemade douches usually contain water and vinegar and commercial products contain antiseptics and fragrances that can reduce the lactobacilli and reduce the protective effect of the discharge.</p>
<p>So what about the latest “v-treatment”, vaginal steaming? To quote a version promoted on <a href="http://www.smh.com.au/lifestyle/beauty/gwyneth-paltrow-advises-women-to-steamclean-their-vaginas-20150130-131xsp.html">Gwyneth Paltrow’s site GOOP</a>:</p>
<blockquote>
<p>you sit on what is essentially a mini-throne, and a combination of infrared and mugwort steam cleanses your uterus, et al. It is an energetic release — not just a steam douche — that balances female hormone levels.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198474/original/file-20171211-27683-1hfssy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Steaming your vagina could be harmful.</span>
<span class="attribution"><a class="source" href="http://kingspa.com/chicago/v_steam.html">Screenshot, King Spa website</a></span>
</figcaption>
</figure>
<p>Apart from the risk of burning and scalding, there are many other reasons not to v-steam. Not only will steam have a drying effect on the vagina, it’s likely to disrupt the vaginal microbiome and reduce the body’s natural barrier against infections. </p>
<p>While no steam may actually reach the uterus, blowing hot herbal fumes into this important organ has no benefits and could in fact do harm. There would certainly be no effect of this pseudo-scientific treatment on female hormone levels.</p>
<h2>When to seek medical advice</h2>
<p>While vaginal discharge is certainly normal, if you experience a significant change in the volume, colour or odour of discharge, you should seek medical advice. </p>
<p>A change in vaginal discharge can be a sign of infection, although the most bacterial STIs, including chlamydia and gonorrhoea, usually do not cause any change in discharge. </p>
<p>More common causes are candida (vaginal thrush) or bacterial vaginosis (BV) which occur when the vaginal flora becomes over-colonised with either yeast (candida) or other vaginal bacteria. Bacterial vaginosis is a condition in which the vagina is unable to return to its normal state and becomes more alkaline. The alkalinity of menstrual blood can be associated with bacterial vaginosis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/recurrent-thrush-how-some-women-live-with-constant-genital-itching-46609">Recurrent thrush: how some women live with constant genital itching</a>
</strong>
</em>
</p>
<hr>
<p>The lactobacilli are reduced and replaced with other vaginal bacteria which can be associated with an increased greenish-greyish discharge and an unpleasant odour. Although the condition is not thought to be harmful, for women living with bacterial vaginosis, having a persistent and malodorous discharge can be debilitating and they should see their doctor to discuss how to manage the condition.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-a-cure-for-bacterial-vaginosis-one-of-the-great-enigmas-in-womens-health-50850">We need a cure for bacterial vaginosis, one of the great enigmas in women's health</a>
</strong>
</em>
</p>
<hr>
<p>As doctors working in sexual health we are keen to help women work out what is normal and what is not. It’s crucial to reject practices that masquerade as clinical treatments but have no base in evidence. Vaginal discharge is healthy and plays an important role in the defence against infection. Trying to eliminate it makes no sense and is in fact harmful.</p>
<hr>
<p><em>Dr Ellie Freedman, Medical Director of the Northern Sydney Sexual Assault Service Staff Specialist Clinic at Royal North Shore Hospital co-authored this article.</em></p><img src="https://counter.theconversation.com/content/88150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Bateson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The vagina is self-cleaning, and vaginal discharge plays an important role in keeping the vagina healthy.Deborah Bateson, Clinical Associate Professor, Discipline of Obstetrics, Gynaecology and Neonatology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/508502016-02-07T19:06:41Z2016-02-07T19:06:41ZWe need a cure for bacterial vaginosis, one of the great enigmas in women’s health<figure><img src="https://images.theconversation.com/files/110243/original/image-20160204-5826-zpjw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bacterial vaginosis affects at least 12% of Australian women.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our series examining hidden women’s conditions. You can also read today’s pieces on why women <a href="http://theconversation.com/why-women-see-their-gp-more-than-men-49051">see their GP</a> more than men; and the need to empower women with <a href="http://theconversation.com/vulvas-periods-and-leaks-women-need-the-right-words-to-seek-help-for-conditions-down-there-53638">appropriate language</a> to seek help when their body “malfunctions”.</em></p>
<p>Few have heard of bacterial vaginosis (BV) although it’s a relatively common condition. It affects at least <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057688">12% of Australian women</a>, <a href="http://journals.lww.com/greenjournal/Abstract/2007/01000/Prevalence_of_Bacterial_Vaginosis__2001_2004.18.aspx">30% of American women</a> and up to <a href="http://jama.jamanetwork.com/article.aspx?articleid=1157494&resultclick=1">50% in parts of Africa</a>.</p>
<p>Symptoms <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/bacterial-vaginosis">include a watery, milky discharge</a> and fishy odour coming from the vagina. </p>
<p>Women with BV are <a href="http://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm">more likely to get</a> sexually transmitted infections (STIs) – such as chlamydia, gonorrhoea and herpes – and to transmit or acquire HIV. They are more likely to develop pelvic inflammatory disease, a painful condition that can result in infertility. </p>
<p>Pregnant women with BV are <a href="http://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm">more likely to suffer miscarriages</a> and deliver premature and low birth-weight babies.</p>
<p>Studies have shown women’s self-esteem, sexual relationships and quality of life <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0074378">suffer significantly</a> from this infection. Women have reported BV symptoms make them feel embarrassed, “dirty” and concerned others may be able to detect their odour.</p>
<p>Many women with BV symptoms think they are <a href="http://medicinetoday.com.au/2004/june/feature-article/vulval-itch-all-itches-not-thrush!">experiencing thrush</a>, and commonly report being treated for this. But BV doesn’t cause itching and there is often a noticeable fishy odour. Improper treatment for this condition leads to persistent symptoms, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0074378">frustration and distress</a>.</p>
<h2>Why BV is hard to treat</h2>
<p>Bacterial vaginosis is caused by groups of bacteria. This makes it different from other genital infections, such as chlamydia and gonorrhoea, where one bacterium is responsible. </p>
<p>While the cause of BV remains the subject of ongoing research, we do know there is a marked <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa043802">disruption of the vaginal bacterial community</a> in women with BV compared to those with a healthy vaginal state.</p>
<p>BV is associated with a <a href="http://www.sciencedirect.com/science/article/pii/S0002937801772353">decreased number of good bacteria</a>, known as lactobacilli, and an increase in bad bacteria. Lactobacilli dominate the healthy vagina, fighting bad bacteria and other other disease-causing agents.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/110070/original/image-20160203-6936-lv0lo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110070/original/image-20160203-6936-lv0lo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110070/original/image-20160203-6936-lv0lo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110070/original/image-20160203-6936-lv0lo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110070/original/image-20160203-6936-lv0lo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110070/original/image-20160203-6936-lv0lo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110070/original/image-20160203-6936-lv0lo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">BV is associated with a decrease in good bacteria in the vagina, and increase in bad.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Latest research into the bacterial profile of the vagina has suggested that as well as this imbalance, women with BV have a <a href="http://journals.lww.com/greenjournal/Abstract/2005/11000/Adherent_Biofilms_in_Bacterial_Vaginosis.19.aspx">bacterial biofilm</a> on their vaginal wall.</p>
<p>This is a kind of network and scaffolding of bacteria that cause cells to stick to each other. The biofilm blocks the body’s defence mechanisms and <a href="http://www.sciencedirect.com/science/article/pii/S0002937807008150">protects bacteria against antibiotics</a> which have difficulty penetrating the biofilm.</p>
<p>Current <a href="http://reproduct-endo.com/article/view/55214">treatment guidelines</a> include seven days of either oral antibiotic tablets or the insertion of a vaginal antibiotic cream for seven nights. </p>
<p>These antibiotics have 80% to 90% cure rates one month after treatment. But more than half of treated women get BV back again <a href="http://jid.oxfordjournals.org/content/193/11/1478.short">within six months</a>. </p>
<p>No other <a href="http://www.ncbi.nlm.nih.gov/pubmed/16647911">treatment approaches</a> (longer antibiotic regimens, combinations of different antibiotics or supplementing <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0034540">antibiotics with probiotics</a> to try and restore the healthy vaginal bacterial balance) have resulted in a sustained, long-term cure. </p>
<p>This is likely due to the bugs causing BV persisting after treatment or because women are being reinfected by their partners.</p>
<h2>Sexual transmission</h2>
<p>Trials between 1985 and 1997, where males were treated alongside their female partners, didn’t consistently reduce BV recurrence rates. These trials <a href="http://journals.lww.com/stdjournal/Abstract/2012/10000/Systematic_Review_of_Randomized_Trials_of.15.aspx">have since been shown</a> as flawed and inconclusive.</p>
<p>Now there is mounting evidence to suggest sex is strongly linked with the acquisition of BV and its recurrence in treated women.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/109305/original/image-20160127-19637-1235nk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/109305/original/image-20160127-19637-1235nk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109305/original/image-20160127-19637-1235nk1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109305/original/image-20160127-19637-1235nk1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109305/original/image-20160127-19637-1235nk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109305/original/image-20160127-19637-1235nk1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109305/original/image-20160127-19637-1235nk1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is mounting evidence of sexual transmission.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/oid-w/7750998534/in/photolist-cNVTPL-fPf9X7-qpAQ1-yMPWCm-MMM9b-tAET4-cKreAJ-cLB82J-cMGJMG-bP9DE-MNc1x-9abtXG-8oNQQ-cVPFvd-7DAGSL-8BpXwP-afYnY5-4GXQSh-fnBkq-7R9upo-4GTFjt-4GXQZ7-o4qu2-5Pu7UN-afpKdW-3aUFQd-qpAKC-5nXoWh-efhMWd-9abtXL-MMNWA-MNfTx-MMUjZ-MN4Uq-MN8Mk-a3oDt6-qpAPH-daxfRf-qpAQu-4dQK6t-qpAL7-9abtXJ-7xzam-8DRiTY-75fdpB-6Pje4q-j9Zrd-2VoeKM-bfj35r-9aJe12">Miles Cave/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Studies have found women with male sexual partners who <a href="http://cid.oxfordjournals.org/content/47/11/1426.short">didn’t use condoms were consistently</a> more likely to have BV. And women who have been treated and then <a href="http://cid.oxfordjournals.org/content/56/6/777.short">re-exposed to the same partner</a> were more likely to get their BV back. </p>
<p>Studies exploring bacterial communities on the penis have found <a href="http://mbio.asm.org/content/6/3/e00589-15.full">BV-linked bugs</a> under the foreskin and at the end of the urine tube. These were more common in men whose partners had BV than in those whose partners didn’t.</p>
<p>In African trials, female partners of <a href="http://www.sciencedirect.com/science/article/pii/S0140673607603134">circumcised males were found to have less BV</a> than those of uncircumcised males.</p>
<p>Despite men not having associated symptoms, the data support the hypothesis that in treated women, sex with an untreated partner may be re-introducing the BV bugs responsible for high recurrence rates.</p>
<p>Other <a href="http://cid.oxfordjournals.org/content/60/7/1042.short">studies have shown women</a> with female sexual partners were more likely to develop BV if they had more partners or a partner with BV. </p>
<h2>We need a cure</h2>
<p>The current state of BV treatment is unacceptable. Despite mounting evidence of sexual transmission, treatment of male and female partners of women with BV is not recommended by international <a href="http://www.cdc.gov/std/tg2015/references.htm#595">guidelines</a>, based on the trials two decades ago.</p>
<p>There are few conditions where doctors know that more than 50% of patients will be back with symptoms within six months. This characteristic of BV highlights the importance of finding the cause of high reinfection rates.</p>
<p>Failure to find a single organism responsible for BV and the difficulty in establishing whether BV is sexually transmitted have all been significant barriers to making progress with a cure.</p>
<p>A number of treatment strategies must be explored, include conducting well-designed clinical trials of partner treatment to see if eradicating the bacteria from women and their partners simultaneously (as we do routinely for STIs such as chlamydia) improves the cure rate.</p>
<p>It is quite possible that no single strategy will eliminate BV in all women and that combinations of approaches may be needed; including using antibiotics with biofilm-disrupting agents and partner treatment. </p>
<p>Drugs that <a href="http://cid.oxfordjournals.org/content/early/2015/04/29/cid.civ353.short">disrupt biofilm</a> are highly experimental, but will also be subject to clinical trials over the next few years and may prove essential in the fight to eradicate BV.</p><img src="https://counter.theconversation.com/content/50850/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catriona Bradshaw receives funding from The NHMRC</span></em></p><p class="fine-print"><em><span>Lenka Vodstrcil does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Few women have heard of bacterial vaginosis (BV) and often confuse its symptoms with thrush. But improper treatment of BV can lead to persistent symptoms and distress.Lenka Vodstrcil, Research Fellow, Melbourne Sexual Health Centre, Monash UniversityCatriona Bradshaw, Associate Professor, Melbourne School of Population and Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.