Abstract
BackgroundData on risk factors of recurrent bacterial vaginosis (RBV) are still scarce. We used data from female sex workers (FSW) participating in a randomized controlled microbicide trial to examine predictors of BV recurrence.MethodsTrial’s participants with at least an episode of BV which was treated and/or followed by a negative BV result and at least one subsequent visit offering BV testing were included in the analysis. Behavioural and medical data were collected monthly while laboratory testing for STI and genital tract infections were performed quarterly. The Andersen-Gill proportional hazards model was used to determine predictors of BV recurrence both in bivariate and multivariate analyses.Results440 women were included and the incidence rate for RBV was 20.8 recurrences/100 person-months (95% confidence interval (CI) =18.1–23.4). In the multivariate analysis controlling for the study site, recent vaginal cleansing as reported at baseline with adjusted hazard-ratio (aHR)=1.30, 95% CI = 1.02-1.64 increased the risk of BV recurrence, whereas consistent condom use (CCU) with the primary partner (aHR=0.68, 95% CI=0.49-0.93) and vaginal candidiasis (aHR=0.70, 95% CI=0.53-0.93), both treated as time-dependent variables, were associated with decreased risk of RBV.ConclusionThis study confirms the importance of counselling high-risk women with RBV about the adverse effects of vaginal cleansing and the protective effects of condom use with all types of partners for the prevention of sexually transmitted infections, including BV. More prospective studies on risk factors of BV recurrence are warranted.Trial registrationTrial registration: NCT00153777
Highlights
Data on risk factors of recurrent bacterial vaginosis (RBV) are still scarce
The clinical trial Settings and participants selection We performed a secondary longitudinal analysis of data from HIV-negative female sex workers (FSW) enrolled in the cellulose sulphate (CS) trial, a double-blind randomized placebo-controlled trial evaluating the effect of 6% vaginal CS gel on HIV acquisition
Variables reported in previous studies as potential predictors of RBV were selected for the analysis
Summary
We used data from female sex workers (FSW) participating in a randomized controlled microbicide trial to examine predictors of BV recurrence. BV is associated with many adverse health outcomes [4,5,6,7,8,9,10] including pelvic inflammatory disease, unfavourable for the clinical management and control of BV. Knowing predictors of BV recurrence may help identify subgroups in whom PPT may be more efficient and prevent BV recurrences and their subsequent adverse health outcomes. The purpose of this study was to identify behavioural and medical predictors of BV recurrence among women who experienced a prior BV episode during their followup at two African and two Indian sites of a randomized controlled microbicide trial
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