Bacterial vaginosis (BV) is a sexually associated disease caused by a complex mixture or anaerobic bacteria. BV is the most prevalent cause of symptomatic vaginal discharge in the U.S. and is associated with numerous complications including pre term delivery of infants, pelvic inflammatory disease, urinary tract infections and acquisition/transmission of sexually transmitted diseases including human immunodeficiency virus. Widespread control of BV has been suggested as a possible means for decreasing the incidence of HIV in the developing world, however, current achievable cure rates combined with high recurrence rates makes this solution impractical. Further, half of all women who meet the clinical diagnostic criteria for BV are asymptomatic and the appropriate management of these women is unknown. Although the microbiological changes which occur in women with symptomatic and asymptomatic BV appear by culture techniques to be identical, the clinical significance of asymptomatic BV is unclear. The current therapy for BV consists of seven days of oral or topical metronidazole or clindamycin. However, there is a growing concern that eradication of organisms from the lower genital tract may be inadequate to prevent recurrences or complications and that more intensive therapy may be required for eradication of upper tract infection/colonization. Further, some of the key organisms associated with BV such as Mobiluncus and mycoplasmas are resistant to the standard therapies. Lastly, although BV has epidemiological characteristics of an STD, the role of the male partner in its pathogenesis remains unknown. We propose to conduct clinical trials which will assess enhanced therapy for BV, including longer duration of therapy and combination therapy as well as increased use of condoms to improve initial cure rates and decrease recurrences. We will also utilize specimens from these prospective studies to further study the association of Mobiluncus, an organism strongly associated with BV using sensitive PCR technology.
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