nationalgeographic
ByHelen Bradshaw
March 13, 2025
原文文章網址：https://www.nationalgeographic.com/health/article/bacterial-vaginosis-sexually-transmitted
翻譯: Alice Choy
For decades, bacterial vaginosis (BV) has been treated as a frustrating but routine infection—one that afflicts nearly a third of women in the U.S. and often comes back again and again for more than half of patients. But what if the reason for these relentless recurrences isn’t just a quirk of the vaginal microbiome?
A groundbreaking new study suggests BV isn’t just an imbalance—it’s sexually transmitted. And the key to stopping it may not lie in treating women alone but in treating their male partners as well.
“One dominant risk factor… in our clinical studies was a regular partner,” says Catriona Bradshaw, an author of the study and a clinician at Melbourne Sexual Health Centre at Monash University. “[It] kept popping out and just smacking us between the eyes, and we got to a point where we thought ‘we just have to do a partner treatment trial.’”
Is bacterial vaginosis sexually transmitted?
BV occurs when the perfect storm of bacteria combines in the vagina. Unlike typical sexually transmitted infections (STIs), no single pathogen is responsible. But, it has long been suspected that these bacteria can be sexually transmitted.
“We’ve had evidence for many years that bacterial vaginosis might be a sexually transmitted infection, based on data that includes increased risk of bacterial vaginosis with increasing number of sexual partners, increased risk with sex without a condom, and other evidence,” says David Fredricks, a clinician and microbiologist at the University of Washington. “Although this hypothesis has been out there for many decades, some limited studies of male partner treatment to eradicate BV associated bacteria have not met with success.”
(STDs are at a shocking high. How do we reverse the trend?)
In fact, BV has long been treated as an STI in same-sex female partners. “There’s been studies since the 80s, and lesbian monogamous couples had astonishingly high concordance for BV,” Bradshaw says. “We’re talking at 80 percent.”
A study she worked on found that lesbian couples had nearly a 20 percent higher rate of BV than the general population of Australia. And, when monogamous same-sex couples entered the study without BV, they also ended it that way, she says. “It’s clearly being transmitted between women. So why on earth wouldn’t it be transmitted between men and women?” she says.
A new approach to treatment
To test that idea, Bradshaw and epidemiologist Lenka Vodstrcil studied opposite-sex monogamous couples in which the woman had BV. Unlike past studies, which had failed to show a clear benefit, their research introduced a key difference: In addition to taking oral antibiotics, men also applied a topical antibiotic, clindamycin, directly to the penis.
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After seven days of treatment and regular testing over 12 weeks, the difference between couples in the treatment and the control groups was striking. The number of women who experienced recurrent BV when their partners were treated was nearly half the amount of women whose partners hadn’t, providing strong evidence that BV might be sexually transmitted.
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The difference was so significant that a data and safety monitoring board advised the researchers to stop the trial early. “I think that was obviously really exciting at that point,” says Vodstrcil. “It meant that we were really showing a strong effect of male partner treatment.” The study also showed that couples with an uncircumcised partner saw higher rates of recurrence and that the more partners stuck to their treatment regimen, the better the results.
Can this stop BV from reoccurring?
More research will need to be done on what the best treatment course for men is in these instances, but knowing that treatment can help their female partners is a big step. “This [study] kind of confirmed what many of us have suspected in the past,” Fredricks says.
For now, the standard treatment of BV is often short-term and always focused on treating the vagina. But even after a round of antibiotics, over half of women experience a recurrence of the infection within three months. In those cases, doctors often use an extended period of antibiotic gels in suppressive therapy.
The process can last upwards of six months, depending on the patient, says Traci Kurtzer, clinical assistant professor of obstetrics and gynecology at Northwestern Medicine. “[BV] is [an infection] that is so commonly recurrent for them, and it gets frustrating. And of course, it becomes frustrating for the medical professional taking care of them, who feels…helpless,” she adds.
Although there are certainly still a lot of unknowns about BV, this study may quickly change treatment for monogamous opposite-sex couples. “My institution, at the University of Washington, for instance, they’re already talking about changing policy,” says Fredericks.
But for this to work, it will take buy-in from male partners and a commitment to treatment by both parties. Still, researchers are optimistic. “There’s no symptoms in men, so it is harder for them to feel like they’re part of the problem,” Vodstrcil says. “But we really emphasize that they can now be part of the solution.”
這個影響數百萬女性的常見感染，實際上是一種性傳染病
數十年來，細菌性陰道炎 (bacterial vaginosis)一直被視為女性健康問題，但新的研究表明，男性伴侶參與治療可能會顯著降低復發率。
細菌性陰道炎一直被視為一種令人困擾又常見的感染病，這種感染困擾著美國近三分之一的女性，且超過一半的患者經常復發。但如果反覆復發的原因不僅只是陰道微生物群的失衡呢？
一項突破性的研究表明，患上細菌性陰道炎的原因不僅是微生物的失衡，也是透過性傳播的。阻止它復發的關鍵可能不僅在於治療女性，而是治療她們的男性伴侶。
這項研究的作者之一墨爾本蒙納許大學性健康中心的臨床醫師Catriona Bradshaw表示，「我們的臨床研究中，固定伴侶是細菌性陰道病的其中一個主要風險因素。這個事實非常明顯，以至於讓人無法忽視，最後我們想到，我們必須做一個伴侶治療試驗。」
細菌性陰道炎是性傳播的嗎？
當陰道內的細菌群失衡時，會引發細菌性陰道炎。與典型的性傳播感染（STI）不同，並沒有單一的病原體引起。但長期以來人們懷疑這些細菌可以透過性傳播的。
華盛頓大學的臨床醫師和微生物學家David Fredricks表示：「我們有多年來的證據表明，細菌性陰道炎可能是一種可以透過性傳播感染的，這些證據包括：性伴侶數量增加時，細菌性陰道炎的風險增加、無保險套的性行為增加風險，以及其他證據。」他補充：「儘管這個假設已經存在幾十年，雖然有一些針對男性進行治療的研究，試圖根除與細菌性陰道炎相關的細菌，但這些研究的結果並不成功。」
事實上，細菌性陰道炎在女同性伴侶中早已被視為性傳播感染。Bradshaw說道:「自1980年代以來就有研究發現，女同性戀的固定伴侶有很高的比率同時患上細菌性陰道炎。我們談的是80％的比率。」
她參與的研究發現，女同性戀伴侶的發病率比澳大利亞一般女性人群高出近20%。此外，當固定女同性伴侶進入這項研究時，如果她們沒有患上細菌性陰道病，最終也不會患上，她表示。「顯然，這在女性之間會傳播的，那麼為什麼細菌性陰道炎不能在男性和女性之間傳播呢？」她問道。
一種新的治療方法
為了測試這個想法，Bradshaw 和流行病學家 Lenka Vodstrcil 研究了患有細菌性陰道炎的異性戀固定伴侶。與過去那些未能顯示明顯效果的研究不同，他們的研究引入了一個關鍵的區別：除了服用口服抗生素外，男性還要在陰部上塗上局部抗生素——克林黴素(clindamycin)。
經過7天的治療並在12週內進行定期測試後，治療組和對照組之間的差異非常明顯。當男性接受治療時，女性的細菌性陰道病復發率顯著下降，這與男性沒有接受治療的女性相比，復發率幾乎減少了一半。這提供了強而有力的證據，表明細菌性陰道炎可能是透過性傳播的。
這個差異如此顯著，甚至讓數據和安全監測委員會建議研究者提前停止試驗。Vodstrcil 說：「我認為結果顯著是非常令人興奮的。這意味著我們真的顯示出男性伴侶治療的強大效果。」研究還發現，未割包皮的男性伴侶，女性復發率較高。此外，如果如果伴侶們堅持遵循治療方案，結果會越好。
這能阻止細菌性陰道炎復發嗎？
在這些情況下，還需要進一步研究男性的最佳治療方案，但知道治療能幫助女性伴侶已經是邁出了一大步。Fredricks 說：「這項研究某種程度上證實了我們許多人過去的猜測。」
目前，細菌性陰道炎的標準治療通常是短期的，並且集中於治療陰道。但即使經過一次抗生素治療，超過一半的女性在三個月內會經歷復發。在這些情況下，醫生通常會使用延長期間的抗生素凝膠進行抑制療法。
北西醫學的婦產科臨床助理教授 Traci Kurtzer 指出，這個過程可能會持續長達六個月，具體時間取決於患者。她補充道：「細菌性陰道炎是一個對她們來說非常容易復發的感染，這讓人感到困擾。當然，這也讓照顧她們的醫療專業人員感到沮喪，因為他們會覺得……無助。」
儘管關於細菌性陰道炎仍有很多未知數，但這項研究可能會迅速改變異性戀固定伴侶的治療方法。Fredricks 說:「以我所在的華盛頓大學為例，他們已經在討論修改相關政策。」
但要使這個治療方法奏效，需要男性伴侶的配合，並且雙方都必須承諾參與治療。儘管如此，研究人員仍持樂觀態度。Vodstrcil說:「男性沒有症狀，所以他們較難意識到自己是問題的一部分，」Vodstrcil 說「但我們強調，男性也可以參與治療。」
台灣紅絲帶基金會回應：這項最新研究為細菌性陰道炎（BV）帶來了全新的理解，顯示它可能是一種被低估的性傳播感染（STI）。研究發現，透過伴侶共同治療，可以顯著降低女性的復發率，為婦女健康帶來突破性的進展。
這不僅是醫學上的發現，更是對女性健康照護模式的一大躍進。過去 BV 的治療多聚焦於女性個體，但如今，我們看見更全面、互相支持的治療方向——讓伴侶攜手面對，從源頭降低復發風險，為長期健康帶來更多保障。
☀️ 這項發現帶來的希望與行動方向：
✅ 提升公眾認知——讓更多人了解 BV 可能與 STI 有關，並鼓勵主動檢測與健康管理。
✅ 推動臨床實踐更新——未來治療策略應更關注伴侶間的互動，提供更完整的健康支持。
✅ 倡導更友善的健康對話——讓婦女在與伴侶、醫療人員溝通時，能擁有更多選擇與資訊，安心照顧自己的健康。
這不僅關乎疾病治療，更是對女性健康、伴侶關係與公共衛生的積極投資。透過科學的進步與共同努力，我們可以為更多人帶來健康與安心的未來 🌿💙
