Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
BMC Infect Dis. 2010 Mar 30;10:81. doi: 10.1186/1471-2334-10-81.
Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic micro-organisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.
G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced by penetrative sexual contact but also by non-penetrative digito-genital contact and oral sex, again indicating that sex per se, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of G. vaginalis, presumably explaining the high concordance rates of G. vaginalis carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection.
Though male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a sexually enhanced disease, with frequency of intercourse being a critical factor.
细菌性阴道病（BV）与性行为最密切相关，BV 的流行病学特征与已确立的性传播感染（STI）相似。然而，BV 的发病机制是否确实涉及病原体从男性传播到女性，这仍然存在争议。因此，我们对与性行为相关的 BV 文献进行了批判性评估。
阴道加德纳菌的携带和 BV 在儿童中很少见，但在青少年，甚至没有性经验的女孩中也有观察到，这表明性传播不是获得疾病的必要前提。阴道加德纳菌的携带通过有性接触的性行为增强，但也通过非有性的手指-生殖器接触和口交增强，这再次表明性本身，而不是性行为传播涉及其中。一些观察结果也表明阴道加德纳菌从女性传播给男性，而不是从男性传播给女性，这可以解释夫妻之间阴道加德纳菌携带的高一致性率。男性抗生素治疗并未发现可预防 BV，使用避孕套略有保护作用，而男性割礼可能预防 BV。BV 在女同性恋者中也很常见，这至少部分与非性接触性行为有关。虽然不能排除男性向女性的传播，但总体而言，BV 作为性传播疾病的证据很少。相反，我们建议将 BV 视为一种性增强疾病（SED），性交频率是一个关键因素。这可能与两种不同的发病机制有关：（1）在无保护的性交中，阴道腔的碱化增强了从乳杆菌主导的微生物群向 BV 样微生物群的转变；（2）在无保护和有保护的性交中，会通过性交增强会阴部肠道细菌的机械转移。类似的机械转移机制可能解释了非性接触性行为与 BV 之间的一致联系。支持 SED 发病机制模型的类似观察结果也在阴道念珠菌病和尿路感染中得到了证实。
虽然不能排除男性向女性的传播，但总体而言，BV 作为性传播感染的证据不足。然而，我们认为 BV 可能被视为一种性增强疾病，性交频率是一个关键因素。
