Abstract
BackgroundBacterial vaginosis (BV) is common in women who have sex with women. While cross-sectional data support a role for sexual transmission, risks for incident BV have not been prospectively studied in this group.Methodology/Principal FindingsWe studied risks for BV acquisition in a prospective cohort study of women (age 16–35 years) who reported sex with other women (≥1 partner, prior year). Women were followed for one year with examinations at quarterly visits and for genital symptoms at any time. Species-specific 16S rRNA gene PCRs for BV-associated bacteria (BVAB) were applied to vaginal fluid obtained at enrollment. Sexual behaviors were ascertained by computer-assisted interview. Of 335 participants, 239 had no BV at baseline; 199 were seen in follow-up (median follow-up 355 days, 4.0 visits/subject). Forty women experienced ≥1 BV episode. Risks for incident BV were presentation ≤14 days since onset of menses (hazard ratio (HR) 2.3 (95% CI, 1.2–4.7), report of new sex partner with BV history (HR 3.63 (1.1–11.9)), change in vaginal discharge (HR 2.6 (1.3–5.2)) and detection of any of several BVAB in vaginal fluid at enrollment, including BVAB1 (HR 6.3 (1.4–28.1)), BVAB2 (HR 18.2 (6.4–51.8)), BVAB3 (HR 12.6 (2.7–58.4)), G. vaginalis (HR 3.9 (1.5–10.4)), Atopobium vaginae (HR 4.2 (1.9–9.3)), Leptotrichia spp (9.3 (3.0–24.4)), and Megasphaera-1 (HR 11.5 (5.0–26.6)). Detection of Lactobacillus crispatus at enrollment conferred reduced risk for subsequent BV (HR 0.18 (0.08–0.4)). Detailed analysis of behavioral data suggested a direct dose-response relationship with increasing number of episodes of receptive oral-vulvovaginal sex (HR 1.02 (95% CI, 1.00–1.04).Conclusions/SignificanceVaginal detection of several BVAB in BV-negative women predicted subsequent BV, suggesting that changes in vaginal microbiota precede BV by weeks or months. BV acquisition was associated with report of new partner with BV; associations with sexual practices – specifically, receptive oral sex – require further investigation.
Highlights
Bacterial vaginosis (BV) is the most prevalent vaginal infection in reproductive age women, and has been consistently associated with adverse outcomes related to the upper genital tract, and with increased risk of HIV acquisition.[1,2,3] Of 3,739 women enrolled during 2001–2004 in a nationally representative sample of the U.S civilian non-institutionalized population, almost one in three (29.2%; 95% C.I. 27.2–31.3) had BV by Gram stain of vaginal fluid.[4,5]Microbiologically, BV is characterized by depletion of hydrogen peroxide-producing lactobacilli that characterize normal vaginal microbiota, with profound overgrowth of anaerobic bacteria.[6]
Forty episodes of BV occurred among these 199 women over a total of 172.6 woman-years at risk, with a median number of days to BV diagnosis after a visit at which BV was not detected of 92 days
Among women without BV who were subsequently followed for an average of one year, we found that detection of several BV
Summary
Bacterial vaginosis (BV) is the most prevalent vaginal infection in reproductive age women, and has been consistently associated with adverse outcomes related to the upper genital tract, and with increased risk of HIV acquisition.[1,2,3] Of 3,739 women enrolled during 2001–2004 in a nationally representative sample of the U.S civilian non-institutionalized population, almost one in three (29.2%; 95% C.I. 27.2–31.3) had BV by Gram stain of vaginal fluid.[4,5]Microbiologically, BV is characterized by depletion of hydrogen peroxide-producing lactobacilli that characterize normal vaginal microbiota, with profound overgrowth of anaerobic bacteria.[6]. Bacterial vaginosis (BV) is the most prevalent vaginal infection in reproductive age women, and has been consistently associated with adverse outcomes related to the upper genital tract, and with increased risk of HIV acquisition.[1,2,3] Of 3,739 women enrolled during 2001–2004 in a nationally representative sample of the U.S civilian non-institutionalized population, almost one in three (29.2%; 95% C.I. 27.2–31.3) had BV by Gram stain of vaginal fluid.[4,5]. Several crosssectional studies have reported a wide variety of risks for this common condition, including Black race, douching, smoking, menses, chronic stress, and sexual behaviors (including higher numbers of male sex partners, unprotected vaginal intercourse, anal intercourse, and sex with other women).[7,8,9,10,11,12,13] Fewer studies have followed women prospectively for incident BV. While cross-sectional data support a role for sexual transmission, risks for incident BV have not been prospectively studied in this group
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