13 papers reviewed
Bacterial Vaginosis — Root Cause, Recurrence & Reproductive Impact
2025 · RCT · 1 of 13
Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis (StepUp trial)
Vodstrcil LA, Bradshaw CS et al. · New England Journal of Medicine
Landmark trial reframing BV as substantially sexually transmitted. Treating the male partner (oral metronidazole + topical 2% clindamycin, 7 days) alongside standard female treatment cut 3-month recurrence to 35% (24/69) versus 63% (43/68) with female-only treatment. The trial was stopped early for efficacy. Accompanying editorial recommends clinicians educate patients on sexual transmission and treat male partners in recurrent BV.
Read the paper ↗2023 · in vitro experimental · 2 of 13
Biofilm-Forming Capacity and Drug Resistance of Different Gardnerella Subgroups Associated with Bacterial Vaginosis
— · Microbiology Spectrum / PMC
Explains the core mechanism of treatment failure: antibiotics prevent biofilm formation but do not eradicate established Gardnerella biofilm. Minimum biofilm eradication concentration of clindamycin exceeded 512 ug/mL for 7 of 9 strains that were fully susceptible when free-floating. Approximately 68% of isolates show metronidazole resistance in recurrent cases.
Read the paper ↗2023 · review · 3 of 13
Bacterial vaginosis: a review of approaches to treatment and prevention
— · Frontiers in Reproductive Health
Within 6-12 months of finishing antibiotic therapy, 50-80% of women experience BV recurrence. Proposed drivers: reinfection from sexual partners, antimicrobial resistance, biofilm persistence, and failure to re-establish a Lactobacillus-dominant microbiota. Reframes BV as an ecological problem rather than a simple infection.
Read the paper ↗2025 · cohort · 4 of 13
Vaginal pharmacomicrobiomics modulates risk of persistent and recurrent bacterial vaginosis
— · npj Biofilms and Microbiomes
Baseline vaginal microbial composition and drug-metabolizing capacity predict who will respond to metronidazole and who will relapse, supporting a personalized rather than uniform treatment approach.
Read the paper ↗2013 · systematic review / meta-analysis · 5 of 13
Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis
van Oostrum N et al. · Human Reproduction
BV prevalence is significantly higher in women with tubal factor infertility than non-tubal infertility. In IVF, BV did not reduce conception rates but was significantly associated with preclinical pregnancy loss (RR 1.71, 95% CI 1.29-2.27).
Read the paper ↗2003 · meta-analysis · 6 of 13
Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis
Leitich H et al. · American Journal of Obstetrics and Gynecology
Across 18 studies and 20,232 patients, BV more than doubled the risk of preterm delivery (OR 2.19, 95% CI 1.54-3.12). Establishes BV as a pregnancy-relevant condition worth resolving preconception rather than during pregnancy.
Read the paper ↗2023 · systematic review / meta-analysis · 7 of 13
Antibiotic treatment of bacterial vaginosis to prevent preterm delivery: systematic review and individual participant data meta-analysis
— · PLOS Medicine / PMC
Important counterweight: antibiotics eradicate BV in pregnancy but overall preterm birth risk is not significantly reduced by treating during pregnancy. Supports addressing vaginal dysbiosis in the preconception window rather than relying on treatment once pregnant.
Read the paper ↗2023 · cross-sectional · 8 of 13
Risk factors of recurrent bacterial vaginosis among women of reproductive age: a cross-sectional study
— · Medicine / PMC
Modifiable risk factors for recurrent BV include douching, smoking, new or multiple sexual partners, lack of condom use, and antibiotic exposure. Smoking carries an adjusted OR of about 3.0 in cohort data, plausibly via biogenic amines that raise vaginal pH and disadvantage Lactobacillus.
Read the paper ↗2025 · review · 9 of 13
Dietary Influence on Bacterial Vaginosis
— · Nutrients / PMC
Diet plausibly shapes vaginal microbiota composition. Deficiencies in vitamins A, C, E and D are associated with greater BV susceptibility, and higher fruit and vegetable intake correlates with reduced risk. Evidence is observational and confounded — dietary change is a reasonable adjunct, not a treatment.
Read the paper ↗2024 · systematic review · 10 of 13
Boric Acid for the Treatment of Vaginitis: New Possibilities Using an Old Anti-Infective Agent — A Systematic Review
Laerkeholm Muller H et al. · Dermatologic Therapy
Intravaginal boric acid shows an average 76% cure rate in vulvovaginal candidiasis and useful adjunct results in recurrent BV, particularly when used after antibiotics to reduce recurrence. Boric acid has antibiofilm activity that standard antibiotics lack. Vaginal use only — boric acid is toxic if swallowed and is contraindicated in pregnancy.
Read the paper ↗2019 · retrospective cohort · 11 of 13
Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis
— · Sexually Transmitted Diseases
Chart review of maintenance boric acid: average duration of use 13 months with high patient satisfaction and few adverse events, supporting tolerability of longer-term suppressive use under clinician guidance.
Read the paper ↗2019 · RCT (phase 2) · 12 of 13
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
Marrazzo JM et al. · Clinical Infectious Diseases
A boric-acid-based vaginal anti-infective engineered for enhanced antibiofilm activity proved safe and effective for both BV and VVC, validating biofilm disruption as a treatment target rather than antimicrobial potency alone.
Read the paper ↗2021 · guideline · 13 of 13
Bacterial Vaginosis — CDC Sexually Transmitted Infections Treatment Guidelines
Centers for Disease Control and Prevention · CDC STI Treatment Guidelines
Reference standard for diagnosis and first-line therapy. Explicitly states no data support douching for treatment or symptom relief, and that douching may increase relapse risk.
Read the paper ↗A paper's presence documents the evidence reviewed; it does not mean Filia endorses every intervention or conclusion.