If you’re sexually active, you’re hopefully aware of STIs like chlamydia, gonorrhoea, and syphilis.
But there could soon be a fresh addition to the line-up, as doctors call for a common infection which affects around one billion women worldwide to be reclassified as a sexually transmitted infection.
Bacterial vaginosis, caused by a change in the natural balance of bacteria in your vagina, will impact a third of women in the UK at least once in their lifetime.
The Push to Reclassify Bacterial Vaginosis
Gynaecologist and founder of gynaecological-health brand Daye, Valentina Milanova, is pushing for urgent action to update UK guidance surrounding this infection, since it can be caused by being sexually active or changing sexual partners.
Even as men can’t secure BV themselves, they can carry the bacteria which can cause this infection in women.
‘The traditional argument against calling bacterial vaginosis an STI is that it stems from an overgrowth of endogenous flora rather than a single external pathogen,’ Dr Milanova explains. ‘But This represents becoming increasingly difficult to defend.’
Why? Because a 2025 New England Journal of Medicine trial found that treating male partners alongside women with BV significantly improved cure rates.
‘This provides the strongest evidence to date that BV is sexually transmissible and that reinfection is a primary driver of its notoriously high recurrence rate, which can reach up to 50% within six months,’ Dr Milanova adds.
Britain Lags Behind Global Trends
This change wouldn’t be a world-first. Countries like Australia, America and Canada already manage bacterial vaginosis within their STI frameworks and treatment pathways.
The World Health Organisation also recognizes this approach, and the American College of Obstetrics and Gynaecology began recommending partner treatment in recurrent and first-occurrence symptomatic cases as of late 2025.
‘The UK is an outlier,’ Dr Milanova explains. She points out the British Association for Sexual Health and HIV’s guidelines on bacterial vaginosis have not been updated since 2012.
‘clinicians are not routinely treating partners, notifying contacts, or screening systematically — leaving many women stuck in a cycle of recurrence which impacts women’s holistic wellbeing,’ she adds.
Bacterial Vaginosis: at a glance
Bacterial Vaginosis is a common condition affecting the vaginal microbiome, where there’s a disruption of the normal balance of bacteria, particularly a reduction in lactobacilli which help maintain an acidic environment and an overgrowth of other bacteria.
It can be symptomless but around half of women will experience some changes. According to the World Health Organisation, these include:
- unusual discharge from the vagina
- a strong fishy or musty odour from the vagina
- itching or irritation around the vagina
- burning during urination
It’s usually not serious, but if untreated, it could lead to issues during pregnancy like miscarriage or premature birth. It also increases the likelihood of you contracting other STIs including HIV, as well as pelvic inflammatory disease.
What causes BV?
The cause isn’t entirely clear but you’re more likely to get BV if you’re sexually active, have changed partners, have an IUD, or use perfumed products in or around your vagina.
A ‘Sexually Associated Dysbiosis’?
For Dr Giuseppe Aragona, GP and medical advisor for Prescription Doctor, whether BV should be formally reclassified as an STI depends ‘how strictly you define the term’.
‘While there’s growing evidence of sexual transmission dynamics and partner involvement in recurrence, it still doesn’t behave like a classic STI in terms of a single causative organism or straightforward transmission pattern,’ he tells Metro.
Dr Aragona suggests it could be more accurately labelled as a ‘sexually associated dysbiosis’, which refers to an imbalance of bacteria typically induced by sexual activity.
‘But, I can understand why some clinicians argue that recognising its sexual transmissibility more explicitly could improve prevention strategies and partner management,’ he adds.
What Would Reclassification Mean?
If BV was officially labelled as an STI in the UK, it would ‘become one of the most prevalent diagnosed conditions in sexual health services’.
It would be more prevalent than chlamydia or gonorrhoea, although it’s not included in STI statistics currently because it’s not defined as one.
This could impact service demand, screening practices, and public awareness.
‘It could potentially reduce diagnostic delay, and encourage more consistent consideration of partner factors in recurrence, but it could also risk over-medicalisation or stigma if not framed carefully,’ he explains.
‘However, reclassification could shift treatment pathways towards more partner-inclusive approaches, and place greater emphasis on recurrence prevention.’
This could also drive research funding into microbiome restoration therapies and vaccine-like approaches.
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