Partner Treatment Prevention of BV
Of all risk factors explored thus far, the majority of epidemiologic studies have identified sexual behaviour as the primary risk factor to the occurrence of BV. The nature of this association remains fraught, however, considering that a number of observations somewhat paradoxically point at a very consistent correlation with sexual contact, yet seem to contradict at least in part a traditional mode of sexual transmission.
Still, as the epidemiological profile of BV mirrors that of established sexually transmitted infections, the putative role of partner treatment with antibiotics and condom use have been scrutinized with regard to the treatment and prevention of BV.
To date, six randomized controlled trials[74,127–131] have been directed towards the effectiveness of male partner treatment in the treatment of BV. Five out of the six studies failed to document any benefit from partner treatment with antibiotics.[74,127–129,131] It may be acknowledged here that most of these studies suffer from multiple methodological shortcomings. Moreover, the antibiotic regimens applied to male partners of women diagnosed with BV, mostly single doses or short courses with metronidazole or tinidazole, are also poorly effective in women with BV and are therefore not recommended by the CDC. In only one of the six randomized, controlled trials, a CDC-recommended regimen for women was administered to the spouses of women with BV, consisting of a 7-day course of oral clindamycin, although again without any noticeable effect. Finally, while partner treatment might not be effective in treating BV, what one really wants to know is whether male treatment might prevent the recurrence of BV among their female partners, presuming that women might get reinfected from a male reservoir. This was addressed in two studies with a 3 month follow-up[129,131] – when a recurrence rate of at least 50% among women is expected – although both studies failed to document any benefit of male sexual partner treatment on 3-month cure rates among their female partners. It may be concluded that the evidence suggests that there is no benefit in treating the sexual partner of women with BV with the drug regimens tested, although it may be argued that no evidence of effect does not equate to evidence of no effect. It may further be acknowledged that when assuming a male-to-female route of transmission, the true effect of male treatment on the incidence of BV could only be evaluated in a study in which male carriers would be treated prophylactically.
With regard to condom use as a means of preventing BV, six cross-sectional studies were equivocal,[133–138] whereas longitudinal and cohort studies on the other hand are more in line with each other towards a beneficial effect of condom use in relation to BV acquisition,[139–142] although overall the observed effects tend to be very moderate, with an average relative risk reduction associated with condom use in a recent meta-analysis estimated to be merely 20%. Interestingly, the two most recent studies also addressed recurrent incident BV.[142,144] Hutchinson et al. found a very strong overall protective effect of consistent condom use on the occurrence of both incident and recurrent incident BV in a 3-year follow-up study (adjusted OR: 0.37; 95% CI: 0.20–0.70%). Conversly, Yotebieng et al. found that consistent condom use in a 6-month follow-up study was protective against incident BV, although not against recurrent incident BV. Hence, the evidence on consistent condom use as a protective means for BV overall seems to suggest a rather moderate effect on the prevention of BV.
Expert Rev Anti Infect Ther. 2009;7(9):1109-1124. © 2009 Expert Reviews Ltd.
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