Data from 1.5 million women show patients with bacterial vaginosis are three times more likely to test positive for chlamydia or gonorrhea.
Women who test positive for bacterial vaginosis (BV) are more than three times as likely to also test positive for one or more non-viral sexually transmitted infections (STIs) compared to women who test negative for BV, according to a study from Quest Diagnostics and Hologic.
The study, published in O&G Open, evaluated laboratory data from more than 1.5 million women across the US who received molecular testing from Quest Diagnostics between 2022 and 2024. The study found that 38.7% of women tested were positive for BV, and of those, 12% were co-infected with at least one STI.
“BV is one of the most common health problems in women, and yet research in this area of women’s healthcare is sadly lacking. Our new analysis provides compelling evidence that women with BV are at significant risk for STIs based on a uniquely large dataset reflecting the nation’s heterogenous population,” says Damian P Alagia III, a board-certified obstetrician/gynecologist and senior medical director, women’s health, Quest Diagnostics, in a release.
Alagia notes that STIs can lead to serious reproductive health complications if left untreated. He says the data should reinforce the value of a “comprehensive diagnostic approach” that includes STI testing for patients with BV.
Impact of the Vaginal Microbiome
Research suggests that changes in the vaginal microbiome may contribute to vaginitis and increase susceptibility to other infections, including HIV, chlamydia, gonorrhea, and trichomonas. Nearly 30% of women in the US are estimated to experience BV at some point in their lives.
Current guidelines from the Centers for Disease Control and Prevention recommend that women with BV be tested for STIs because the conditions often present with similar symptoms, which can complicate clinical diagnosis.
The study highlights that modern molecular diagnostics allow for the assessment of various vaginal infections from a single specimen, which supports the detection and management of co-infections.
“This research confirms and expands on previous research on increased STI risk in women with BV, but with the advantage of a much larger data set from which to draw conclusions,” says Elizabeth M Marlowe, executive director, infectious disease, Quest Diagnostics, in a release.
Marlowe says that molecular testing enables clinicians to “optimize patient management, and strengthen evidence-based care.”
Study Scope and Limitations
The study utilized a large, diverse, and nationally representative sample size to provide evidence for clinical guidelines regarding advanced molecular testing. However, researchers noted limitations, including the fact that data was provided by a single national laboratory and specific patient information, such as additional risk factors, was not available for analysis.
In 2024, Quest Diagnostics launched self-collection services for bacterial vaginitis and other common genital tract infections at its patient service centers for patients who prefer not to have a specimen collected by a healthcare provider.
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