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Asymptomatic Bacterial Vaginosis: to Treat or Not to Treat?

  • Female Genital Tract Infections (J Sobel, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

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.

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References

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  1. • Peebles K, Velloza J, Balkus JE, McClelland RS, Barnabas RV. High global burden and costs of bacterial vaginosis: a systematic review and meta-analysis. Sex Transm Dis. 2019;46(5):304–11 This article details the global prevalence of bacterial vaginosis and estimates the direct medical costs of treating symptomatic disease.

    Article  PubMed  Google Scholar 

  2. Klebanoff MA, Schwebke JR, Zhang J, Nansel TR, Yu KF, Andrews WW. Vulvovaginal symptoms in women with bacterial vaginosis. Obstet Gynecol. 2004;104(2):267–72.

    Article  PubMed  Google Scholar 

  3. • Muzny CA, Taylor CM, Swords WE, Tamhane A, Chattopadhyay D, Cerca N, et al. An updated conceptual model on the pathogenesis of bacterial vaginosis. J Infect Dis. 2019;220(9):1399–405 This article presents an updated conceptual model on BV pathogenesis.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Swidsinski A, Mendling W, Loening-Baucke V, Ladhoff A, Swidsinski S, Hale LP, et al. Adherent biofilms in bacterial vaginosis. Obstet Gynecol. 2005;106(5 Pt 1):1013–23.

    Article  PubMed  Google Scholar 

  5. Atashili J, Poole C, Ndumbe PM, Adimora AA, Smith JS. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS. 2008;22(12):1493–501.

    Article  PubMed  Google Scholar 

  6. Abbai NS, Reddy T, Ramjee G. Prevalent bacterial vaginosis infection - a risk factor for incident sexually transmitted infections in women in Durban, South Africa. Int J STD AIDS. 2016;27(14):1283–8.

    Article  PubMed  Google Scholar 

  7. Brotman RM, Klebanoff MA, Nansel TR, Yu KF, Andrews WW, Zhang J, et al. Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J Infect Dis. 2010;202(12):1907–15.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lokken EM, Balkus JE, Kiarie J, Hughes JP, Jaoko W, Totten PA, et al. Association of recent bacterial vaginosis with acquisition of mycoplasma genitalium. Am J Epidemiol. 2017;186(2):194–201.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brusselaers N, Shrestha S, van de Wijgert J, Verstraelen H. Vaginal dysbiosis and the risk of human papillomavirus and cervical cancer: systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(1):9–18 e8.

    Article  PubMed  Google Scholar 

  10. Abbai NS, Nyirenda M, Naidoo S, Ramjee G. Prevalent herpes simplex virus-2 increases the risk of incident bacterial vaginosis in women from South Africa. AIDS Behav. 2018;22(7):2172–80.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wiesenfeld HC, Hillier SL, Krohn MA, Landers DV, Sweet RL. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2003;36(5):663–8.

    Article  PubMed  Google Scholar 

  12. Kissinger P, Muzny CA, Mena LA, Lillis RA, Schwebke JR, Beauchamps L, et al. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial. Lancet Infect Dis. 2018;18(11):1251–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Laxmi U, Agrawal S, Raghunandan C, Randhawa VS, Saili A. Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study. J Matern Fetal Neonatal Med. 2012;25(1):64–7.

    Article  PubMed  Google Scholar 

  14. Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995;333(26):1737–42.

    Article  CAS  PubMed  Google Scholar 

  15. Oleen-Burkey MA, Hillier SL. Pregnancy complications associated with bacterial vaginosis and their estimated costs. Infect Dis Obstet Gynecol. 1995;3(4):149–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. van Oostrum N, De Sutter P, Meys J, Verstraelen H. Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis. Hum Reprod. 2013;28(7):1809–15.

    Article  PubMed  CAS  Google Scholar 

  17. Ness RB, Kip KE, Hillier SL, Soper DE, Stamm CA, Sweet RL, et al. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol. 2005;162(6):585–90.

    Article  PubMed  Google Scholar 

  18. Marrazzo JM, Martin DH, Watts DH, Schulte J, Sobel JD, Hillier SL, et al. Bacterial vaginosis: identifying research gaps proceedings of a workshop sponsored by DHHS/NIH/NIAID. Sex Transm Dis. 2010;37(12):732–44.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14–22.

    Article  CAS  PubMed  Google Scholar 

  20. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29(2):297–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. • McKinnon LR, Achilles SL, Bradshaw CS, Burgener A, Crucitti T, Fredricks DN, et al. The Evolving Facets of Bacterial Vaginosis: Implications for HIV Transmission. AIDS Res Hum Retrovir. 2019;35(3):219–28 This article clarifies the various terms to describe the vaginal microbiota and its non-optimal state, under the overarching term of BV.

  22. Gaydos CA, Beqaj S, Schwebke JR, Lebed J, Smith B, Davis TE, et al. Clinical validation of a test for the diagnosis of vaginitis. Obstet Gynecol. 2017;130(1):181–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Schwebke JR, Taylor SN, Ackerman R, Schlaberg R, Quigley NB, Gaydos CA, et al. Clinical validation of the aptima bacterial vaginosis and aptima candida/trichomonas vaginitis assays: results from a prospective multicenter clinical study. J Clin Microbiol. 2020;58(2):e01643–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Cartwright CP, Lembke BD, Ramachandran K, Body BA, Nye MB, Rivers CA, et al. Development and validation of a semiquantitative, multitarget PCR assay for diagnosis of bacterial vaginosis. J Clin Microbiol. 2012;50(7):2321–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hilbert DW, Smith WL, Chadwick SG, Toner G, Mordechai E, Adelson ME, et al. Development and validation of a highly accurate quantitative real-time PCR assay for diagnosis of bacterial vaginosis. J Clin Microbiol. 2016;54(4):1017–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Coleman JS, Gaydos CA. Molecular Diagnosis of Bacterial Vaginosis: an Update. J Clin Microbiol. 2018;56(9):e00342–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. •• Committee on practice bulletins - gynecology. Vaginitis in nonpregnant patients: ACOG Practice Bulletin, Number 215. Obstet Gynecol. 2020;135(1):e1–e17 This article details the 2020 ACOG recommendations for the treatment of vaginitis in non-pregnant women.

    Article  Google Scholar 

  28. Workowski KA, Bolan GA. Centers for disease control and prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137.

    PubMed  Google Scholar 

  29. Nyirjesy P, Schwebke JR. Secnidazole: next-generation antimicrobial agent for bacterial vaginosis treatment. Future Microbiol. 2018;13:507–24.

    Article  CAS  PubMed  Google Scholar 

  30. Hillier SL, Nyirjesy P, Waldbaum AS, Schwebke JR, Morgan FG, Adetoro NA, et al. Secnidazole treatment of bacterial vaginosis: a randomized controlled trial. Obstet Gynecol. 2017;130(2):379–86.

    Article  CAS  PubMed  Google Scholar 

  31. Schwebke JR, Morgan FG Jr, Koltun W, Nyirjesy P. A phase-3, double-blind, placebo-controlled study of the effectiveness and safety of single oral doses of secnidazole 2 g for the treatment of women with bacterial vaginosis. Am J Obstet Gynecol. 2017;217(6):678 e1–9.

    Article  CAS  Google Scholar 

  32. • Bradshaw CS, Sobel JD. Current treatment of bacterial vaginosis-limitations and need for innovation. J Infect Dis. 2016;214(Suppl 1):S14–20 This article summarizes current BV treatments and their limitations and suggests next steps for the field.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Swidsinski A, Mendling W, Loening-Baucke V, Swidsinski S, Dorffel Y, Scholze J, et al. An adherent Gardnerella vaginalis biofilm persists on the vaginal epithelium after standard therapy with oral metronidazole. Am J Obstet Gynecol. 2008;198(1):97 e1–6.

    Article  CAS  Google Scholar 

  34. Swidsinski A, Dorffel Y, Loening-Baucke V, Schilling J, Mendling W. Response of Gardnerella vaginalis biofilm to 5 days of moxifloxacin treatment. FEMS Immunol Med Microbiol. 2011;61(1):41–6.

    Article  CAS  PubMed  Google Scholar 

  35. Reichman O, Akins R, Sobel JD. Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sex Transm Dis. 2009;36(11):732–4.

    Article  CAS  PubMed  Google Scholar 

  36. Hymes SR, Randis TM, Sun TY, Ratner AJ. DNase inhibits Gardnerella vaginalis biofilms in vitro and in vivo. J Infect Dis. 2013;207(10):1491–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Marrazzo JM, Dombrowski JC, Wierzbicki MR, Perlowski C, Pontius A, Dithmer D, et al. Safety and efficacy of a novel vaginal anti-infective, TOL-463, in the treatment of bacterial vaginosis and vulvovaginal candidiasis: a randomized, single-blind, phase 2. Controlled Trial Clin Infect Dis. 2019;68(5):803–9.

    Article  CAS  PubMed  Google Scholar 

  38. Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34(11):864–9.

    Article  PubMed  Google Scholar 

  39. Bump RC, Zuspan FP, Buesching WJ 3rd, Ayers LW, Stephens TJ. The prevalence, six-month persistence, and predictive values of laboratory indicators of bacterial vaginosis (nonspecific vaginitis) in asymptomatic women. Am J Obstet Gynecol. 1984;150(8):917–24.

    Article  CAS  PubMed  Google Scholar 

  40. Schwebke JR. Asymptomatic bacterial vaginosis: response to therapy. Am J Obstet Gynecol. 2000;183(6):1434–9.

    Article  CAS  PubMed  Google Scholar 

  41. Schwebke JR, Desmond RA. A randomized trial of the duration of therapy with metronidazole plus or minus azithromycin for treatment of symptomatic bacterial vaginosis. Clin Infect Dis. 2007;44(2):213–9.

    Article  CAS  PubMed  Google Scholar 

  42. • Schwebke JR, Desmond R. Natural history of asymptomatic bacterial vaginosis in a high-risk group of women. Sex Transm Dis. 2007;34(11):876–7 This study examines the natural history of asymptomatic BV in a cohort of women presenting to a sexually transmitted diseases clinic.

    Article  PubMed  Google Scholar 

  43. Muzny CA, Lensing SY, Aaron KJ, Schwebke JR. Incubation period and risk factors support sexual transmission of bacterial vaginosis in women who have sex with women. Sex Transm Infect. 2019;95(7):511–5.

    Article  PubMed  Google Scholar 

  44. Plummer EL, Vodstrcil LA, Murray GL, Fairley CK, Danielewski JA, Garland SM, et al. Gardnerella vaginalis clade distribution is associated with behavioral practices and Nugent score in women who have sex with women. J Infect Dis. 2020;221(3):454–63.

    PubMed  Google Scholar 

  45. Mehta SD, Agingu W, Nordgren RK, Green SJ, Bhaumik DK, Bailey RC, et al. Characteristics of women and their male sex partners predict bacterial vaginosis among a prospective cohort of Kenyan women with non-optimal vaginal microbiota. Sex Transm Dis. 2020; e-published online 8/7/20.

  46. Schwebke JR, Muzny CA, Josey WE. Role of Gardnerella vaginalis in the pathogenesis of bacterial vaginosis: a conceptual model. J Infect Dis. 2014;210(3):338–43.

    Article  PubMed  Google Scholar 

  47. Srinivasan S, Fredricks DN. The human vaginal bacterial biota and bacterial vaginosis. Interdiscip Perspect Infect Dis. 2008;2008:750479.

    Article  PubMed  CAS  Google Scholar 

  48. O'Connell CM, Ferone ME. Chlamydia trachomatis genital infections. Microb Cell. 2016;3(9):390–403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Meites E, Gaydos CA, Hobbs MM, Kissinger P, Nyirjesy P, Schwebke JR, et al. A review of evidence-based care of symptomatic trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clin Infect Dis. 2015;61(Suppl 8):S837–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Sena AC, Miller WC, Hobbs MM, Schwebke JR, Leone PA, Swygard H, et al. Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment, and prevention. Clin Infect Dis. 2007;44(1):13–22.

    Article  PubMed  Google Scholar 

  51. • Schwebke JR, Desmond R. A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases. Am J Obstet Gynecol. 2007;196(6):517 e1–6 This study examines whether treatment of asymptomatic BV decreases the risk of incident STIs compared to observation-only.

    Article  CAS  Google Scholar 

  52. Ziklo N, Huston WM, Taing K, Katouli M, Timms P. In vitro rescue of genital strains of Chlamydia trachomatis from interferon-gamma and tryptophan depletion with indole-positive, but not indole-negative Prevotella spp. BMC Microbiol. 2016;16(1):286.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  53. Zozaya M, Ferris MJ, Siren JD, Lillis R, Myers L, Nsuami MJ, et al. Bacterial communities in penile skin, male urethra, and vaginas of heterosexual couples with and without bacterial vaginosis. Microbiome. 2016;4:16.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Nelson DE, Dong Q, Van der Pol B, Toh E, Fan B, Katz BP, et al. Bacterial communities of the coronal sulcus and distal urethra of adolescent males. PLoS One. 2012;7(5):e36298.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Mandar R, Punab M, Borovkova N, Lapp E, Kiiker R, Korrovits P, et al. Complementary seminovaginal microbiome in couples. Res Microbiol. 2015;166(5):440–7.

    Article  PubMed  Google Scholar 

  56. Eren AM, Zozaya M, Taylor CM, Dowd SE, Martin DH, Ferris MJ. Exploring the diversity of Gardnerella vaginalis in the genitourinary tract microbiota of monogamous couples through subtle nucleotide variation. PLoS One. 2011;6(10):e26732.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T, Holmes KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol. 1988;158(4):819–28.

    Article  CAS  PubMed  Google Scholar 

  58. Hill GB. The microbiology of bacterial vaginosis. Am J Obstet Gynecol. 1993;169(2 Pt 2):450–4.

    Article  CAS  PubMed  Google Scholar 

  59. Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN. Relationship of specific vaginal bacteria and bacterial vaginosis treatment failure in women who have sex with women. Ann Intern Med. 2008;149(1):20–8.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Catlin BW. Gardnerella vaginalis: characteristics, clinical considerations, and controversies. Clin Microbiol Rev. 1992;5(3):213–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Plummer EL, Vodstrcil LA, Danielewski JA, Murray GL, Fairley CK, Garland SM, et al. Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: acceptability, tolerability and impact on the genital microbiota of couples - a pilot study. PLoS One. 2018;13(1):e0190199.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  62. Marrazzo JM, Koutsky LA, Eschenbach DA, Agnew K, Stine K, Hillier SL. Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. J Infect Dis. 2002;185(9):1307–13.

    Article  PubMed  Google Scholar 

  63. Soper DE. Bacterial vaginosis and surgical site infections. Am J Obstet Gynecol. 2020;222(3):219–23.

    Article  CAS  PubMed  Google Scholar 

  64. Larsson PG, Carlsson B. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infect Dis Obstet Gynecol. 2002;10(3):133–40.

    Article  PubMed  PubMed Central  Google Scholar 

  65. McElligott KA, Havrilesky LJ, Myers ER. Preoperative screening strategies for bacterial vaginosis prior to elective hysterectomy: a cost comparison study. Am J Obstet Gynecol. 2011;205(5):500 e1–7.

    Article  Google Scholar 

  66. • Haahr T, Zacho J, Brauner M, Shathmigha K, Skov Jensen J, Humaidan P. Reproductive outcomes of patients undergoing in vitro fertilisation treatment and diagnosed with bacterial vaginosis or abnormal vaginal microbiota: a systematic PRISMA review and meta-analysis. BJOG. 2019;126(2):200–7 This systemic review and meta-analysis investigates reproductive health outcomes in women undergoing IVF and diagnosed with BV or abnormal vaginal microbiota.

    Article  CAS  PubMed  Google Scholar 

  67. Srinivasan S, Liu C, Mitchell CM, Fiedler TL, Thomas KK, Agnew KJ, et al. Temporal variability of human vaginal bacteria and relationship with bacterial vaginosis. PLoS One. 2010;5(4):e10197.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  68. Gajer P, Brotman RM, Bai G, Sakamoto J, Schutte UM, Zhong X, et al. Temporal dynamics of the human vaginal microbiota. Sci Transl Med. 2012;4(132):132ra52.

    Article  PubMed  PubMed Central  Google Scholar 

  69. • Muzny CA, Blanchard E, Taylor CM, Aaron KJ, Talluri R, Griswold ME, et al. Identification of key bacteria involved in the induction of incident bacterial vaginosis: a prospective study. J Infect Dis. 2018;218(6):966–78 This article studies the sequence of microbiological event prior to incident BV, finding that G. vaginalis, P. bivia, and A. vaginae may play a significant role in its pathogenesis.

  70. Ferris DG, Dekle C, Litaker MS. Women's use of over-the-counter antifungal medications for gynecologic symptoms. J Fam Pract. 1996;42(6):595–600.

    CAS  PubMed  Google Scholar 

  71. Nyirjesy P, Weitz MV, Grody MH, Lorber B. Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Obstet Gynecol. 1997;90(1):50–3.

    Article  CAS  PubMed  Google Scholar 

  72. Muzny CA. Why does Trichomonas vaginalis continue to be a “neglected” sexually transmitted infection? Clin Infect Dis. 2018;67(2):218–20.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Gibbs RS. Asymptomatic bacterial vaginosis: is it time to treat? Am J Obstet Gynecol. 2007;196(6):495–6.

    Article  PubMed  Google Scholar 

  74. Nygren P, Fu R, Freeman M, Bougatsos C, Guise JM. Screening and treatment for bacterial vaginosis in pregnancy: systematic review to update the 2001 US Preventive Services Task Force Recommendation. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Rockville, 2008.

  75. Nygren P, Fu R, Freeman M, Bougatsos C, Klebanoff M, Guise JM, et al. Evidence on the benefits and harms of screening and treating pregnant women who are asymptomatic for bacterial vaginosis: an update review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;148(3):220–33.

    Article  PubMed  Google Scholar 

  76. •• Kahwati LC, Clark R, Berkman N, Urrutia R, Patel SV, Zeng J, et al. Screening for bacterial vaginosis in pregnant adolescents and women to prevent preterm delivery: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020;323(13):1293–309 This article summarizes the 2020 USPSTF recommendations on the screening and treatment of asymptomatic BV in women.

    Article  PubMed  Google Scholar 

  77. • Subtil D, Brabant G, Tilloy E, Devos P, Canis F, Fruchart A, et al. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet. 2018;392(10160):2171–9 This study found that systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies shows no evidence of risk reduction of late miscarriage or spontaneous preterm birth.

  78. Lewis AL, Laurent LC. USPSTF 2020 recommendations on screening for asymptomatic bacterial vaginosis in pregnancy. JAMA. 2020;323(13):1253–5.

    Article  PubMed  Google Scholar 

  79. Morales WJ, Schorr S, Albritton J. Effect of metronidazole in patients with preterm birth in preceding pregnancy and bacterial vaginosis: a placebo-controlled, double-blind study. Am J Obstet Gynecol. 1994;171(2):345–7 discussion 348-349.

    Article  CAS  PubMed  Google Scholar 

  80. Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Copper RL. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med. 1995;333(26):1732–6.

    Article  CAS  PubMed  Google Scholar 

  81. McDonald HM, O'Loughlin JA, Vigneswaran R, Jolley PT, Harvey JA, Bof A, et al. Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): a randomised, placebo controlled trial. Br J Obstet Gynaecol. 1997;104(12):1391–7.

    Article  CAS  PubMed  Google Scholar 

  82. Vermeulen GM, Bruinse HW. Prophylactic administration of clindamycin 2% vaginal cream to reduce the incidence of spontaneous preterm birth in women with an increased recurrence risk: a randomised placebo-controlled double-blind trial. Br J Obstet Gynaecol. 1999;106(7):652–7.

    Article  CAS  PubMed  Google Scholar 

  83. Carey JC, Klebanoff MA, Hauth JC, Hillier SL, Thom EA, Ernest JM, et al. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 2000;342(8):534–40.

    Article  CAS  PubMed  Google Scholar 

  84. Odendaal HJ, Popov I, Schoeman J, Smith M, Grove D. Preterm labour--is bacterial vaginosis involved? S Afr Med J. 2002;92(3):231–4.

    CAS  PubMed  Google Scholar 

  85. Milliken S, Allen RM, Lamont RF. The role of antimicrobial treatment during pregnancy on the neonatal gut microbiome and the development of atopy, asthma, allergy and obesity in childhood. Expert Opin Drug Saf. 2019;18(3):173–85.

    Article  CAS  PubMed  Google Scholar 

  86. Sobel JD, Ferris D, Schwebke J, Nyirjesy P, Wiesenfeld HC, Peipert J, et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194(5):1283–9.

    Article  CAS  PubMed  Google Scholar 

  87. • DeLong K, Bensouda S, Zulfiqar F, Zierden HC, Hoang TM, Abraham AG, et al. Conceptual design of a universal donor screening approach for vaginal microbiota transplant. Front Cell Infect Microbiol. 2019;9:306 This article describes a universal donor approach for vaginal microbiota transplant, implemented in a small study of 20 women.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Christina A. Muzny, MD, MSPH is currently supported by NIAID (R01AI146065-01A1).

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  1. Division of Infectious Diseases, University of Alabama at Birmingham, ZRB 242; 1530 3rd Avenue South, Birmingham, AL, 35294, USA

    Christina A. Muzny

  2. Division of Infectious Diseases, University of Alabama at Birmingham, ZRB 239; 1530 3rd Avenue South, Birmingham, AL, 35294, USA

    Jane R. Schwebke

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Correspondence to Christina A. Muzny.

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Conflict of Interest

Christina A. Muzny, MD, MSPH has received research grant support from Lupin Pharmaceuticals, is a consultant for Lupin Pharmaceuticals and BioFire Diagnostics, and has received honoraria from Elsevier, Abbott Molecular, Cepheid, Becton Dickinson, Roche Diagnostics, and Lupin Pharmaceuticals. Jane R. Schwebke, MD has received grant support and consultant fees from StarPharma, BD Diagnostics, Talis, and Hologic.

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Muzny, C.A., Schwebke, J.R. Asymptomatic Bacterial Vaginosis: to Treat or Not to Treat?. Curr Infect Dis Rep 22, 32 (2020). https://doi.org/10.1007/s11908-020-00740-z

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