Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis.

Jade E Bilardi,Sandra M Walker,Christopher K Fairley,Ruth P Mcnair,Lenka A Vodstrcil,Catriona S Bradshaw,Meredith J Temple-Smith,Julie Mooney-Somers,Clare E Bellhouse,Caroline Mitchell

doi:10.1371/journal.pone.0173637

Abstract

BackgroundBacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women’s views and experiences of the triggering factors associated with BV onset and recurrence.MethodsWomen aged 20–49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV.Results103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical–and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV.ConclusionThese data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use.

Highlights

Bacterial vaginosis (BV) is the most common vaginal condition affecting women of childbearing age, with between 10–30% of women in developed nations experiencing BV [1, 2]
The top 3 factors women attributed to both BV onset and recurrence were identical–and all sexual
While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%)

Summary

Introduction

Bacterial vaginosis (BV) is the most common vaginal condition affecting women of childbearing age, with between 10–30% of women in developed nations experiencing BV [1, 2]. Microbiological data has shown evidence of male-carriage of BV associated bacteria (BVAB), with uncircumcised male partners of females with BV showing a higher prevalence of BVAB than male partners of women without BV [21]. Concordant with this is evidence to show male circumcision is associated with a significant reduction of BVAB in men [22, 23] and a reduced risk of BV in women [24]. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women’s views and experiences of the triggering factors associated with BV onset and recurrence

Objectives

Results

Discussion

Conclusion