Abstract
ObjectiveThis study aimed to estimate the association between potential risk factors and common vaginal infections using nationwide primary health care and other national registers. MethodsAn open cohort study consisting of 2,357,711 women aged 15 years to 50 years (2001 to 2018) was conducted in Sweden. The outcomes were first event of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in relation to sociodemographic factors. Cox regression models were used. Sensitivity analyses including diabetes mellitus, contraceptive use, and cervical cancer were conducted. ResultsThe incidence rates per 1,000 person-years for VVC and BV were 3.3 (95% confidence interval [CI] 3.2-3.3) and 3.4 (95% CI 3.4-3.4), respectively. In the fully adjusted model, sociodemographic factors were significantly associated with both outcomes. Compared with Swedish-born women, women from Middle East/North Africa had the highest risk of VVC (hazard ratio [HR] 2.77, 95% CI, 2.72-2.83), followed by Africa (excluding North Africa) (HR 2.53, 95% CI, 2.45-2.61), and Latin America and the Caribbean (HR 2.18, 95% CI, 2.09-2.27). For BV, women from Latin America and the Caribbean had the highest risk (HR 1.83, 95% CI, 1.75-1.92). ConclusionThis study presents novel risk factors associated with medically attended vaginal infections. Women from non-Western countries seem to develop these conditions disproportionately.
Highlights
Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are very common vaginal infections mainly managed in outpatient settings as the foremost causes of medically attended vaginal infections
BV is a syndrome of vaginal dysbiosis due to the dominance of certain bacteria (e.g., Gardnerella vaginalis and anaerobic bacteria) (Cherpes et al, 2008, Coudray and Madhivanan, 2020), while VVC is caused by overgrowth of fungi from the genus Candida (Denning et al, 2018, Drell et al, 2013, Goncalves et al, 2016)
Representative population-based studies are lacking for BV and VVC (Coudray and Madhivanan, 2020, Denning et al, 2018, Kenyon et al, 2013)
Summary
Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are very common vaginal infections mainly managed in outpatient settings as the foremost causes of medically attended vaginal infections. They cause significant morbidity and psychological stress in affected women all around the globe, besides increasing the risk for other genitourinary infection (Coudray and Madhivanan, 2020, Denning et al, 2018, Goncalves et al, 2016, Kenyon et al, 2013). BV is a syndrome of vaginal dysbiosis due to the dominance of certain bacteria (e.g., Gardnerella vaginalis and anaerobic bacteria) (Cherpes et al, 2008, Coudray and Madhivanan, 2020), while VVC is caused by overgrowth of fungi from the genus Candida (Denning et al, 2018, Drell et al, 2013, Goncalves et al, 2016)
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