Bacterial Vaginosis: Resistance, Recurrence, and/or Reinfection?

Bacterial vaginosis (BV) is one of the most common infections among sexually active women that is responsive to antibiotics. BV is present in at least 15% of the sexually active population; this makes BV 3–4 times more common than urinary tract infections, many times more common than Trichomonas vaginalis infection (even among sexually transmitted disease clinic populations), and much more common than vulvovaginal candidiasis. Furthermore, BV is linked to a wide variety of serious upper genital tract infections, including amniotic fluid infection, chorioamnionitis, and preterm delivery; postpartum endometritis and post-Cesarean delivery wound infection; posthysterectomy infection; postabortion endometritis; and, to a lesser degree, pelvic inflammatory disease. Thus, the need for successful treatment of BV in both symptomatic and selected asymptomatic populations is compelling. However, this is 2006, fifty-one years after Dr. Gardner first reported the presence of the condition we now call BV. At this late date, we have only limited—and clearly not conclusive—evidence with regard to 3 fundamental issues: whether BV is an infection, the microbial cause of BV, and effective treatment. This deplorable state calls for a vast expansion of research into fundamental, important questions. The association of BV with multiple upper genital tract infections, particularly after surgery, strongly suggests the presence of an infectious agent. Production of BV by the experimental inoculation of such infectious material into women [1] and concordance of BV among lesbian couples [2] further suggests infection.