This was a retrospective cross-sectional study using electronic medical records from an urban academic emergency department and urgent care system in the United States. It included adult women who had a positive test for at least one vaginitis condition (BV, vulvovaginal candidiasis, or trichomoniasis) between 2014 and 2018 and who were also tested for non-viral STIs (chlamydia, gonorrhea, Mycoplasma genitalium) at the same visit. The sample size was several thousand encounters (noted in the article’s tables; mostly reproductive-age women). The main outcome was how often women with each type of vaginitis also had a non-viral STI, and which clinical factors were linked to coinfection.
Women who tested positive for BV were more than three times as likely to also test positive for at least one non-viral STI compared with BV-negative women (adjusted odds ratio just over 3, statistically significant). Trichomoniasis also showed strong links with STIs, while vulvovaginal candidiasis had a weaker or no consistent association. Many women with BV or STIs did not have classic symptoms, meaning symptom-based diagnosis alone would miss a portion of infections. Younger age and certain behavioral or clinical factors (such as prior STI history) increased the likelihood of BV–STI coinfection.
This was a retrospective chart review, so it can show associations but not prove that BV causes STIs or vice versa. The population came from emergency and urgent care settings in one health system, which may not represent lower-risk or routinely screened women in primary care or fertility clinics. Only women who were actually tested for both vaginitis and STIs at the same visit were included; testing decisions (driven by symptoms or clinician concern) may bias the results. The study did not detail menstrual cycle phase, contraceptive use, detailed sexual practices, microbiome profiles, or fertility outcomes, leaving gaps in understanding root causes and long-term reproductive impact.
This study reinforces that BV is not only a nuisance infection but also a marker of higher risk for concurrent STIs, which can carry important fertility consequences. The large real-world dataset and use of lab-confirmed results strengthen the findings, although the emergency/urgent care setting may select for higher-risk patients. The link between BV and STIs aligns with existing research suggesting that disruption of the vaginal microbiome (less protective Lactobacillus, higher pH, more inflammation) may both reflect and promote susceptibility to infections like chlamydia and gonorrhea. For restorative practice, this supports routine STI screening when BV is diagnosed, and a broader focus on restoring a healthy vaginal microbiome rather than only short-term symptom control.
For patients with BV—especially if it recurs—clinicians should strongly consider testing for non-viral STIs such as chlamydia, gonorrhea, and Mycoplasma genitalium. Atypical or minimal symptoms do not rule out coinfection; decisions should be based on risk factors, exam findings, and shared decision-making, not symptoms alone. Restorative care should look beyond a single prescription and ask why BV is occurring: sexual health risks, microbiome imbalance, antibiotic exposures, hormonal shifts, immune or metabolic stressors, menstrual product use, and vaginal hygiene practices. Protecting fertility means addressing both infection and the underlying environment—supporting a Lactobacillus-dominant vaginal flora, cycle awareness, and partner evaluation when appropriate.
This study looked at women who had common vaginal infections and asked: how often do these happen at the same time as sexually transmitted infections (STIs)? It found that women with bacterial vaginosis (BV) were more than three times as likely to also have an STI like chlamydia or gonorrhea compared with women without BV. Many didn’t have classic symptoms, so a “normal-feeling” vagina did not always mean everything was fine. If you have BV—especially if it keeps coming back—it’s important to talk with your clinician about checking for STIs and about deeper causes: your vaginal bacteria balance, sexual health, immune and hormone health, and anything in your lifestyle that might be upsetting your natural protective environment. This matters for fertility because silent STIs can damage the tubes and pelvis, and BV-related inflammation may also affect sperm survival, implantation, and pregnancy health.
BV in this cohort was a strong marker for concurrent non-viral STIs, supporting routine STI co-testing when BV is identified, particularly in younger or higher-risk patients. From a restorative perspective, consider BV an indicator of vaginal ecosystem dysbiosis and possible immune/inflammatory activation; evaluate broader contributors: recent antibiotics, hormonal milieu (anovulation, low estrogen, hypoestrogenic states), high-cycle estrogen/progesterone imbalances, smoking, douching, and unprotected intercourse with multiple/untested partners. For women on a fertility journey or with recurrent pregnancy loss, integrate testing for BV and STIs (NAATs for chlamydia, gonorrhea, trichomonas; consider Mycoplasma genitalium where available) alongside assessment of cervical mucus quality, midcycle pH, and inflammatory markers when appropriate. Align treatment with microbiome restoration: targeted antimicrobials when indicated; avoidance of unnecessary broad-spectrum antibiotics; support for Lactobacillus predominance (non-irritating hygiene practices, cycle-aware timing of interventions, and consideration of evidence-informed probiotic approaches), and ensure partner evaluation and treatment where guidelines support it to reduce reinfection risk.
Educational insights, not a diagnosis or individualized treatment advice. Discuss findings with your own clinician. Visit Reproductive Health Insights to explore fertility resources.