Take aim at BV and trichomoniasis

Power up the radar when it comes to bacterial vaginosis (BV) and trichomoniasis. The first national data on the subject show high prevalence of both reproductive tract infections.1,2

More than one-quarter of U.S. women overall, and half of black women, have BV, say researchers at the Centers for Disease Control and Prevention (CDC). The scientists analyzed data from a nationally representative health survey of nearly 2,000 women conducted in 2001 and 2002 to present their findings.1 Broken down by self-reported race/ethnicity, BV was detected in 50.3% of black women, 22.4% of white women, and 28.8% of Mexican-American women.1

Looking at the same population of some 2,000 women, CDC researchers found that one in eight black women were infected with the parasite that causes trichomoniasis, and that overall prevalence among U.S. women was 3%.2 Prevalence among black women (13.5%) was more than nine times higher than that among white and Mexican-American women (1.2% and 1.5%), researchers report.2 Further research is needed to identify reasons for racial and ethnic disparities in both conditions, say researchers.

BV and trichomoniasis: 'Health threats'

It is important to raise awareness of the full range of sexually transmitted disease (STD) threats, both among health care providers and women at risk, says Lauri Markowitz, MD, a co-author on the studies and a medical epidemiologist in the Centers for Disease Control and Prevention's (CDC) Division of STD Prevention. Bacterial vaginosis and trichomoniasis are common, but unrecognized, health threats for sexually active women and their babies, she notes.

Symptoms of bacterial vaginosis include excessive or malodorous discharge; other signs and symptoms include erythema, edema, and pruritus of the external genitalia.3 Excessive, frothy, diffuse, yellow-green vaginal discharge is common for trichomoniasis, although clinical presentation varies from no signs or symptoms to erythema, edema, and pruritus of the external genitalia.3

Both conditions often go undiagnosed and can cause premature or low-birth weight babies, as well as increase the risk for HIV, says Markowitz. Untreated bacterial vaginosis also is associated with pelvic inflammatory disease, which can cause infertility. Still, many women remain unaware of the threat of these and other common STDs, says Markowitz.

"We must ensure that both providers and women at risk recognize the signs and symptoms of these diseases," states Markowitz. "Because bacterial vaginosis and trichomoniasis can be treated if diagnosed, the first step is raising the awareness of these STDs and their symptoms."

Recommended BV treatment regimens for nonpregnant women include:

  • metronidazole, 500 mg orally twice a day for seven days;
  • or clindamycin cream, 2%, one full applicator (5 g) intravaginally at bedtime for seven days;
  • or metronidazole gel, 0.75%, one full applicator (5 g) intravaginally, once daily for five days.3

Treatment of bacterial vaginosis can be challenging.4 Treatment trials report cure rates of 80–90% at one week, but recurrence rates of 15%-30% within three months.5

Why is recurrent BV so common? Jeanne Marrazzo, MD, MPH, assistant professor of medicine in the University of Washington's Division of Infectious Diseases and medical director of the STD/HIV Prevention and Training Center, both in Seattle, has examined recurrent BV6 and weighs in on the subject:

"While antibiotic treatment is currently aimed at the predominance of anaerobes that characterize the syndrome, they probably don't treat the root cause of BV, which is absence of vaginal lactobacilli," says Marrazzo. "Since we don't understand what causes these lactobacilli to disappear in BV, we can't really target treatment in the appropriate or effective way."

Puzzle: Lactobacilli re-establishment

Some women have difficulty recolonizing or re-establishing the vagina with a healthy population of lactobacilli after BV, states Marrazzo. Lactobacilli re-establishment is the key to maintaining normal vaginal flora, and researchers haven't figured out a way to effectively promote this state in women who have experienced or are experiencing BV, she notes.

What is the role of condoms in BV prevention? While condoms have been shown in small studies to reduce BV recurrence,7 few providers probably recommend this to women, and relatively few women are using it as a preventive approach to recurrence, Marrazzo observes.

Douching has been found to be strongly associated with increased risk for pelvic inflammatory disease, bacterial vaginosis, and ectopic pregnancy.8

"Many women continue to douche, even after a BV diagnosis," says Marrazzo. "Douching is a recognized risk for BV and undermines the vaginal lactobacilli populations."

References

1. Koumans EH, Sternberg MR, McQuillan G, et al. Prevalence of bacterial vaginosis in the United States, 2001-2002. Presented at the 2006 National STD Prevention Conference. Jacksonville, FL; May 2006.

2. Sutton MY, Sternberg MR, Koumans EH, et al. Prevalence of Trichomonas vaginalis in the United States, 2001-2002. Presented at the 2006 National STD Prevention Conference. Jacksonville, FL; May 2006.

3. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th revised edition. New York City: Ardent Media; 2004.

4. Wilson J. Managing recurrent bacterial vaginosis. Sex Transm Infect 2004; 80:8-11.

5. Larsson P-G. Treatment of bacterial vaginosis. Int J STD AIDS 1992; 3:239–247.

6. Marrazzo J, Thomas KK, Ringwood K, et al. Incidence and predictors of treatment failure for bacterial vaginosis (BV). Presented at the 2006 National STD Prevention Conference. Jacksonville, FL; May 2006.

7. Calzolari E, Masciangelo R, Milite V, et al. Bacterial vaginosis and contraceptive methods. Int J Gynaecol Obstet 2000; 70:341-346.

8. Merchant JS, Oh K, Klerman LV. Douching: A problem for adolescent girls and young women. Arch Pediatr Adolesc Med 1999; 153:834-847.