Women need better treatments for bacterial vaginosis

BALTIMORE, May 2, 2024: Bacterial Vaginosis (BV) affects about one-quarter of reproductive-age women and is linked to adverse health outcomes, such as increased HIV risk. Yet for decades, BV treatment in the United States has largely relied on antibiotics, and BV recurrence is common following antibiotic therapy.

Now, two European clinical trials have shown limited success with a different type of medication used to treat BV called dequalinium chloride (DQC). DQC—an antiseptic—has been in use for several decades in countries throughout Europe as an alternative treatment for BV. It is not currently approved by the U.S. Food and Drug Administration. In a commentary published May 2 in JAMA Network Open, researchers from the Institute for Genome Sciences (IGS) within the University of Maryland School of Medicine (UMSOM) and Johns Hopkins University School of Medicine (JHUSOM) have called for more robust clinical trials in the United States to confirm if DQC is as good or better than existing BV treatments.

“For women suffering from BV, there is a critical need for more effective treatments,” said corresponding author Rebecca Brotman, PhD, MPH, a researcher at IGS and UMSOM Professor of Epidemiology and Public Health. “We need more robust clinical trials to fill in the knowledge gaps of what we know about DQC from the European studies.”

In the commentary, the authors discuss three main knowledge gaps from the European trials.

“First, we know that vaginal microbiota may vary regionally and the DQC clinical trials so far have only been conducted in Europe,” said first author Kayla Carter, PhD, MPH, a postdoc in the Brotman Lab at IGS. “In addition, the trials did not last longer than five weeks, so we don’t know long-term outcomes after DQC treatment; and, finally, there’s very limited data on its use and its safety during pregnancy.”

DQC works differently than current treatments because it is an antiseptic with antibacterial and antifungal activity, rather than an antibiotic. It also is an intravaginal tablet, not an oral treatment. The antibiotic treatments currently available to U.S. women are metronidazole and clindamycin as first-line medications, with alternatives of secnidazole and tinidazole. While these treatments are generally effective in the short term, as many as 50 percent of women will have a BV recurrence by six months after treatment.

“We’ve seen a growing investment in innovative BV treatments in recent years, including live biotherapeutics and vaginal microbiome transplants, but those are still in relatively early stages of development,” said Dr. Brotman. “In the meantime, the European trials indicate that DQC could be a viable, well-tolerated alternative BV treatment. That’s why it deserves further investigation with well-funded clinical trials.”

Susan Tuddenham, MD, MPH, Associate Professor of Medicine at the Johns Hopkins University School of Medicine also contributed to this commentary.

About the Institute for Genome Sciences

The Institute for Genome Sciences’ (IGS) has been part of the University of Maryland School of Medicine (UMSOM) since 2007. IGS scientists work in diverse areas, applying genomics and systems biology approaches to better understand health issues in premature infants, women, and transgender people; to improve vaccine development; to study evolutionary biology; and to understand cancer, parasitic, fungal, and infectious diseases, as well as identifying the underpinnings of aging, brain development, addiction, and mental health. IGS also remains at the forefront of high-throughput genomic technologies and bioinformatics analyses through its core facility, Maryland Genomics which provides researchers around the world with cutting-edge, collaborative, and cost-effective sequencing and analysis.

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has more than $500 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2023, the UM School of Medicine is ranked #10 among the 92 public medical schools in the U.S., and in the top 16 percent (#32) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu