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Where Are We With Partner Treatment in Bacterial Vaginosis? A Critical Appraisal of the Latest Systematic Review

Madhivanan, Purnima MPH, PhD; Barreto, Giselle A. BA; Revawala, Amisha BDS; Anderson, Chelsie MA; McKinney, Sheila MA; Pierre-Victor, Dudith MPH

Sexually Transmitted Diseases: June 2013 - Volume 40 - Issue 6 - p 518
doi: 10.1097/OLQ.0b013e31828fffb2
Letter to the Editor

Robert Stempel College of Public Health and Social Work Florida International University Miami, FL

Ethical review: Not applicable.

Statement of authorship: All authors have contributed to the critical revision of the manuscript for important intellectual content.

Funding/Support: None.

Conflicts of interest: None.

Correspondence: Purnima Madhivanan, PhD, MPH, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami 11200 SW 8 Street, HLS 390W2, Miami, FL 33199. E-mail:

To the Editors

There is a great need for high-quality systematic reviews that improve clinical management of bacterial vaginosis (BV), but we have serious reservations about a review by Mehta1 published in the October 2012 issue of Sexually Transmitted Diseases. Dr Mehta fails to add to the existing literature because the same 6 studies she reviews were previously evaluated in a 1999 systematic review by Potter.2 At a minimum, we would expect her to be aware of that review and give reasons why it needs updating. This omission and the lack of acknowledgement of Potter’s work are a serious oversight.

The research community has gone to great lengths since Potter’s time to improve the quality of systematic reviews through the development of the PRISMA statement.3 The methods described in the recommendations are sorely lacking in Mehta’s work. Her limited search strategy, lack of procedures for minimizing potential bias, and failure to describe review processes have produced a work of questionable value. Not acknowledging Potter’s review also raises serious questions about the validity of her search. In the future, we hope that authors like Mehta will register their systematic reviews with a Web site such as PROSPERO so that unneeded duplication of effort like this can be avoided.4 A review by a single author using a single database also has potential for compromising validity in results. Authors should use several databases such as Cochrane, EMBASE, or CENTRAL to minimize this risk.5,6 Mehta also fails to include her review protocol, thus preventing replication or future updates.7 Neither does she share her inclusion and exclusion criteria,8 provide information about the period for which data were extracted, or identify “controlled vocabulary” for indexing PubMed such as MeSH terms. Conducting a scoping search of PubMed for instance, we were able to identify a randomized clinical trial showing positive results for a treatment regimen for BV in women that included partner treatment that has not been included in the review.9 We do not know if it was excluded for some reason, or simply not identified in the original search. Furthermore, conducting a hand search of references included in a review on BV treatment,10 we found an additional 4 studies that included partner treatment.11–14 We have no idea if these studies should have been included or might have altered the conclusions of Mehta’s review. Although we are aware of the controversy surrounding the use of English-only language literature15,16 and unpublished data,17 it may also have been useful if Mehta had discussed some ineligible studies to give additional context and completeness to the analysis and possibly suggest new avenues for research. Finally, although Mehta reports that studies reviewed are heterogeneous, she fails to suggest how this might impact her analysis.

It is important for researchers conducting reviews to be thorough and rigorous to ensure that results contribute to improved policy and practice. In these respects, Mehta’s work highlights the types of shortcomings that can compromise the important value of systematic reviews.

Purnima Madhivanan, MPH, PhD

Giselle A. Barreto, BA

Amisha Revawala, BDS

Chelsie Anderson, MA

Sheila McKinney, MA

Dudith Pierre-Victor, MPH

Robert Stempel College of Public

Health and Social Work

Florida International University

Miami, FL

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