Bacterial vaginosis (BV) is the most common vaginal dysbiosis to affect women globally, yet an unacceptably high proportion of women experience BV recurrence within 6 months of recommended antibiotic therapy. The low rate of sustained cure highlights our limited understanding of the pathogenesis of BV recurrence, which has been attributed to possible persistence and re-emergence of BV-associated bacteria (BVAB) or a BV-associated biofilm following antimicrobials and/or reinfection occurring from sexual partners. There is a robust body of evidence to support the exchange of bacteria between partners during sexual activity, and while the hypothesis that women treated for BV are subsequently reinfected with BVAB following sex with an untreated sexual partner is not new, failure of past partner treatment trials has eroded confidence in this concept. If reinfection is a key driver of recurrence, current antimicrobial regimens directed to women alone are unlikely to achieve a high level of sustained cure, and the approach of partner treatment to reduce reinfection is justified. In this manuscript, we present the molecular and epidemiological evidence that underlies the hypothesis that BV is sexually transmitted, and summarise why research that continues to consider sexual partnerships is necessary. We also outline the significant barriers and challenges that we have identified while undertaking partner treatment studies, and we discuss the factors that impact on our ability to determine their effectiveness. Ultimately, the pathogenesis of BV recurrence is likely to be multifaceted and not attributable to a single mechanism in all women. If we are to achieve sustained cure for women, it is likely that combined and individualised approaches to eradicate BVAB, support an optimal vaginal microbiome, and prevent reinfection from partners will be required.

中文翻译：

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细菌性阴道病：复发的驱动因素以及伴侣治疗中的挑战和机遇

细菌性阴道病 (BV) 是影响全球女性的最常见的阴道生态失调，但在推荐抗生素治疗后 6 个月内，仍有高比例的女性会出现 BV 复发。持续治愈率低凸显了我们对 BV 复发发病机制的有限理解，这归因于 BV 相关细菌 (BVAB) 或 BV 相关生物膜在使用抗生素和/或从性伴侣。有大量证据支持性活动期间伴侣之间的细菌交换，虽然接受 BV 治疗的女性在与未经治疗的性伴侣发生性行为后随后再次感染 BVAB 的假设并不新鲜，但过去的伴侣治疗试验失败削弱了对这个概念的信心。如果再感染是复发的关键驱动因素，那么目前单独针对女性的抗菌治疗方案不太可能实现高水平的持续治愈，而采用伴侣治疗来减少再感染的方法是合理的。在这份手稿中，我们提出了 BV 是性传播假设基础的分子和流行病学证据，并总结了为什么继续考虑性伙伴关系的研究是必要的。我们还概述了我们在开展合作伙伴治疗研究时发现的重大障碍和挑战，并讨论了影响我们确定其有效性的能力的因素。归根结底，BV 复发的发病机制可能是多方面的，并且不能归因于所有女性的单一机制。如果我们要实现对女性的持续治愈，