Thank you for this analysis, and I am so glad BV is finally being taken more seriously. Since the second Obama Administration, I have been in an on-and-off letter-writing battle with the CDC over their BV web page, which advises that women can reduce their risk of BV by "not having sex." While this advice may be factually accurate, I noted that their web page on malaria did not advise people to avoid going to malaria-infested areas in order to avoid contracting malaria, but instead provided actually useful advice on how to visit such places more safely. I used to believe that, with persistence, I would eventually be able to get them to change this ridiculous advice, but I fear the situation is hopeless how.
Clindamycin is particularly active against one of the bacteria that is associated with BV so I think the hope was to get as broad a coverage as possible. But truthfully, we don't know how Metrogel would perform.
I’d love to see what the 12 month data would be and including more circumcised men. Don't know if you go to the ISSVD meetings, but Dr Jack Sobel from Wayne State has been on this bandwagon. Glad to see this published in the NEJ. It’s funny bc 30+ years ago bv was thought of as an STI. I clearly remember this from my rotation in med school. Everything old is new again
Thank you so much for this. I’m a mentor to a sexually active adventurous teen who I don’t want to terrify or to make her feel ashamed. This is solid information and supports what I’ve been telling her about caution. Everyone likes to bone but these are some consequences to avoid.
The only time I’ve tested positive for BV is when I had GSM. It all resolved with estrogen hrt so it is interesting to me that this is categorized as an “std”.
There are several people working on a lactobacillus crispatus probiotic. This looks like a proof of concept study, but I don't have access to it right now so can't read it. Let me do some digging.
I have anecdotal success with treatment resistant BV, consistent symptoms, and using this short term with vaginal estrogen to maintain. (Also tried hitting with tinidazole after cleocin or flagyl as you mention in The Vagina Bible which has helped too!) Again anecdotal with patients I have treated that were out of evidence based science options and frustrated. Did a month of VS01 in those desperate to try something and who were killing their biome with boric acid OTC to re “seed,” and twice weekly vaginal estrogen formulations (cream, vagifem, imvexxy etc) and this seemed to do the trick. Can’t wait for the science to corroborate and for whatever you find and write about next ;)
Hi! I have some questions and maybe I just need to reread it a few times. So at the beginning when you say “increased risk of preterm labor and increased acquisition of HIV and other sexually transmitted infections (STIs) if exposed.” Does this apply if you have had BV once/ a few times or only for chronic BV/ reoccurring BV? I participated in a study done by Dr. Poliquin with the University of Manitoba, a few years ago, and if I’m not mistaken I believe it was to research the tie to chronic conditions like BV to STIs (or something like that- it was definitely about BV and yeast and STIs). So I’m now wondering if its just anyone who has had BV or the increased risk is only for chronic. And how come for blood tests/ urine tests for STIs, BV isn’t tested for? I know you used the word “Believe” in terms of it being sexually transmitted- so is it a STI or not officially because there isn’t much information/ it’s too complex?
If you have BV and get exposed to HIV you are more likely to catch HIV than if you don't have BV and get exposed to HIV during sex. It's fairly well established that BV changes the microbiome so it is less able to protect women against certain pathogens. That is one of the reasons we have quite a lot of funding as reducing BV is seen as a way of reducing HIV and other STIS.
Thanks for the reply ☺️ Oh that’s interesting. So that meaning like BV is determined based on bacterial composition and scoring- similar to yeast infections if I’m correct. Cause yeast infections are I believe a 1-4 scale (as well as if the yeast that is present is causing symptoms) and BV is 1-10? What I’m wondering is why it isn’t more often suggested when someone comes into a doctors office asking for STI testing- like why isn’t it shared knowledge in the sense that they may say “oh hey BV testing is recommended if you’ve been sexually active” or the question is asked if they think they have developed a foul/ fishy odor? Or especially if virgins can have BV?
From my experience, I feel like so many people don’t know what BV is or a yeast infection and sometimes confuse the two. And in my school, it was never taught in sex ed. So if BV does increase risk, why isn’t it spoken about more often?
What do you think about the decision to stop the study because the results for the group getting the treatment were so much better? This is not a life-threatening disease or condition and they would have had more knowledge if they had kept going for longer, I feel.
I am 99% sure that is what it said, I remember re-reading it. It isn't uncommon to describe creams in cm of application, especially in a situation like this. For example, sometimes we say start squeezing the tube at the the most distal finger joint and then continue to the tip. I am traveling and don't hav eth PSF on me, but can double check when I get back.
Really exciting study -I think it will be challenging treating partners and gaining acceptance from primary care since they will need to be prescribing therapy
-right now we can only treat male partners for chlamydia or gonorrhea
Great analysis. As soon as I saw the NYTimes piece, I hoped you would write about the new study.
Thank you for this analysis, and I am so glad BV is finally being taken more seriously. Since the second Obama Administration, I have been in an on-and-off letter-writing battle with the CDC over their BV web page, which advises that women can reduce their risk of BV by "not having sex." While this advice may be factually accurate, I noted that their web page on malaria did not advise people to avoid going to malaria-infested areas in order to avoid contracting malaria, but instead provided actually useful advice on how to visit such places more safely. I used to believe that, with persistence, I would eventually be able to get them to change this ridiculous advice, but I fear the situation is hopeless how.
Do you have any idea why they chose clindamycin versus metronidazole gel?
Clindamycin is particularly active against one of the bacteria that is associated with BV so I think the hope was to get as broad a coverage as possible. But truthfully, we don't know how Metrogel would perform.
I was wondering the same thing.
I’d love to see what the 12 month data would be and including more circumcised men. Don't know if you go to the ISSVD meetings, but Dr Jack Sobel from Wayne State has been on this bandwagon. Glad to see this published in the NEJ. It’s funny bc 30+ years ago bv was thought of as an STI. I clearly remember this from my rotation in med school. Everything old is new again
Thank you so much for this. I’m a mentor to a sexually active adventurous teen who I don’t want to terrify or to make her feel ashamed. This is solid information and supports what I’ve been telling her about caution. Everyone likes to bone but these are some consequences to avoid.
Curious, thoughts as to why clindamycin topical was chosen in lieu of metronidazole topical given the dual Rx included oral metronidazole? Thank you
I believe because of it's effectiveness for Atopobium vaginae
The only time I’ve tested positive for BV is when I had GSM. It all resolved with estrogen hrt so it is interesting to me that this is categorized as an “std”.
It *can* be sexually transmitted, but isn't necessarily.
Id love to know your thoughts on VS01 lactobacillus crispatus tablets to help combat BV. They have a study! https://www.ajog.org/article/S0002-9378(24)00933-5/abstract
There are several people working on a lactobacillus crispatus probiotic. This looks like a proof of concept study, but I don't have access to it right now so can't read it. Let me do some digging.
I have anecdotal success with treatment resistant BV, consistent symptoms, and using this short term with vaginal estrogen to maintain. (Also tried hitting with tinidazole after cleocin or flagyl as you mention in The Vagina Bible which has helped too!) Again anecdotal with patients I have treated that were out of evidence based science options and frustrated. Did a month of VS01 in those desperate to try something and who were killing their biome with boric acid OTC to re “seed,” and twice weekly vaginal estrogen formulations (cream, vagifem, imvexxy etc) and this seemed to do the trick. Can’t wait for the science to corroborate and for whatever you find and write about next ;)
Great analysis/summary.
Hi! I have some questions and maybe I just need to reread it a few times. So at the beginning when you say “increased risk of preterm labor and increased acquisition of HIV and other sexually transmitted infections (STIs) if exposed.” Does this apply if you have had BV once/ a few times or only for chronic BV/ reoccurring BV? I participated in a study done by Dr. Poliquin with the University of Manitoba, a few years ago, and if I’m not mistaken I believe it was to research the tie to chronic conditions like BV to STIs (or something like that- it was definitely about BV and yeast and STIs). So I’m now wondering if its just anyone who has had BV or the increased risk is only for chronic. And how come for blood tests/ urine tests for STIs, BV isn’t tested for? I know you used the word “Believe” in terms of it being sexually transmitted- so is it a STI or not officially because there isn’t much information/ it’s too complex?
If you have BV and get exposed to HIV you are more likely to catch HIV than if you don't have BV and get exposed to HIV during sex. It's fairly well established that BV changes the microbiome so it is less able to protect women against certain pathogens. That is one of the reasons we have quite a lot of funding as reducing BV is seen as a way of reducing HIV and other STIS.
Oh I get it now! That makes so much sense. Thanks for clarifying
My pleasure!
Also thanks for the wonderful article again 🥰 always such informative information that’s very relevant and important
BV is diagnosed using criteria. There is no blood/urine test. Virgins have been found to have BV by nugent criteria
Thanks for the reply ☺️ Oh that’s interesting. So that meaning like BV is determined based on bacterial composition and scoring- similar to yeast infections if I’m correct. Cause yeast infections are I believe a 1-4 scale (as well as if the yeast that is present is causing symptoms) and BV is 1-10? What I’m wondering is why it isn’t more often suggested when someone comes into a doctors office asking for STI testing- like why isn’t it shared knowledge in the sense that they may say “oh hey BV testing is recommended if you’ve been sexually active” or the question is asked if they think they have developed a foul/ fishy odor? Or especially if virgins can have BV?
From my experience, I feel like so many people don’t know what BV is or a yeast infection and sometimes confuse the two. And in my school, it was never taught in sex ed. So if BV does increase risk, why isn’t it spoken about more often?
I work in Public Health and our STI clinic is FULL of women with recurrent BV. This is exciting news.
What do you think about the decision to stop the study because the results for the group getting the treatment were so much better? This is not a life-threatening disease or condition and they would have had more knowledge if they had kept going for longer, I feel.
The study was deigned for 12 weeks only follow up. It's appropriate to stop in this situation, and fairly standard.
Thanks for this article. I read about the study just yesterday, and was hoping you'd write about it.
In tx of partners, you wrote 2 cm. of Clindamycin cr. Did you mean 2 gm?
I am 99% sure that is what it said, I remember re-reading it. It isn't uncommon to describe creams in cm of application, especially in a situation like this. For example, sometimes we say start squeezing the tube at the the most distal finger joint and then continue to the tip. I am traveling and don't hav eth PSF on me, but can double check when I get back.
Really exciting study -I think it will be challenging treating partners and gaining acceptance from primary care since they will need to be prescribing therapy
-right now we can only treat male partners for chlamydia or gonorrhea
I think it may be challenging to get some men to do this twice a day for a week, but I guess we'll see.
I don't know where you work, but when I was 'in the business,' we treated partners for Trich. as well.