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BV is a vaginal dysbiosis resulting from replacement of normal hydrogen peroxide and lactic-acid–producing Lactobacillus species in the vagina with high concentrations of anaerobic bacteria, including G.

vaginalis, Prevotella species, Mobiluncus species, A. vaginae, and other BV-associated bacteria. A notable feature is the appearance of a polymicrobial biofilm on vaginal epithelial cells (970).

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Certain women experience transient vaginal microbial changes, whereas others experience them for longer intervals (971). BV is a highly prevalent condition and the most common cause of vaginal discharge worldwide (972).

However, in a nationally representative survey, the majority of women with BV were asymptomatic (310).

BV is associated with having multiple male sex partners, female partners, sexual relationships with more than one person (973), a new sex partner, lack of condom use (974), douching (975,976), and HSV-2 seropositivity (977).

Male circumcision reduces the risk for BV among women (978). In addition, BV prevalence incr

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