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In bacterial vaginosis (BV), hydrogen peroxide+ lactobacilli (LB), which define normal vaginal microbiology, are replaced by anaerobic/facultative bacteria.1 BV is the most common cause of vaginitis and associated with preterm delivery, pelvic inflammatory disease and HIV acquisition.2,3 Its cause is unknown. Treatment with metronidazole, clindamycin or tinidazole improves symptoms and restores normal flora and associated mucosal defences,4,5 but BV frequently persists (11–29%) and recurs (72% by 7 months).6–8 Unprotected sex may contribute.7,9 In fact, the debate about sexual transmission of a potentially causative agent for BV has been given new urgency by the report of newly defined Clostridiales bacteria detected, along with other novel BV-associated bacteria (such as Atopobium vaginae), which appear to be highly specific for BV—that is, they appear to be present rarely in women without BV.10,11 Newer data also support a role for BV in promoting HIV acquisition in women.12 The prevalence of BV in lesbians has been reported to be high (25–52%) in several studies and most female sex partners are concordant for …
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