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.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
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Special Emphasis Panel (ZRG1-EDC-3 (01))
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Deal, Carolyn D
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University of Alabama Birmingham
Internal Medicine/Medicine
Schools of Medicine
United States
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Schwebke, Jane R; Rivers, Charles; Lee, Jeannette (2009) Prevalence of Gardnerella vaginalis in male sexual partners of women with and without bacterial vaginosis. Sex Transm Dis 36:92-4
Meltzer, Michelle C; Desmond, Renee A; Schwebke, Jane R (2008) Association of Mobiluncus curtisii with recurrence of bacterial vaginosis. Sex Transm Dis 35:611-3
Schwebke, Jane R; Desmond, Renee (2007) A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases. Am J Obstet Gynecol 196:517.e1-6
Schwebke, Jane R; Desmond, Renee (2007) Natural history of asymptomatic bacterial vaginosis in a high-risk group of women. Sex Transm Dis 34:876-7
Schwebke, J R; Desmond, R A (2007) A randomized trial of the duration of therapy with metronidazole plus or minus azithromycin for treatment of symptomatic bacterial vaginosis. Clin Infect Dis 44:213-9