Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2005 Dec;81(6):483–487. doi: 10.1136/sti.2005.014621

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics

L Brabin 1, S Roberts 1, E Fairbrother 1, D Mandal 1, S Higgins 1, S Chandiok 1, P Wood 1, G Barnard 1, H Kitchener 1
PMCID: PMC1745063  PMID: 16326852

Abstract

Objectives: Vaginal pH is related to hormonal status, and adolescents experience disturbed hormonal patterns following menarche. We assessed hormonal factors and risk of abnormal vaginal pH and bacterial vaginosis (BV) among adolescents attending genitourinary medicine (GUM) clinics.

Methods: In a cross sectional study adolescents within 5 years of menarche, ⩽17 years, or with oligo-amenorrhoea were recruited. Vaginal pH and BV were assessed and among those not using hormonal contraceptives, estrone-3-glucuronide (E3G) and pregnanediol-3α-glucuronide (P3G) concentrations were measured.

Results: Among 102 adolescents, 59.8% (61) had a high vaginal pH (>4.5), which was higher than the prevalence of BV, detected in 33% (34). No association was found between presence of sexually transmitted infections (STI) and vaginal pH. In logistic regression, after controlling for BV and condom use, vaginal pH was positively associated with cervical ectopy (OR = 2.5; 95% CI 1.0 to 6.6, p = 0.05) and STI treatment history (OR = 2.5; 95% CI 0.9 to 6.5, p = 0.07), and negatively associated with use of Depo-Provera (OR = 0.1; 95% CI 0.03 to 0.6, p = 0.003) and recent onset (<12 months) of sexual activity (OR = 0.2; 95% CI 0.1 to 0.7, p = 0.004). Among 23 adolescents not using hormonal contraceptives, a high pH occurred more often in abnormal compared to normal menstrual cycles (OR = 10.8; 95% CI 1.4 to 85.4; p = 0.026). E3G concentrations were inversely correlated with vaginal pH in the follicular phase (Spearman: r = 0.51; p = 0.024).

Conclusions: Ectopy and abnormal menstrual cycles are common features of adolescence. Their presence is associated with increased risk of abnormal pH, and may also predispose to BV.

Full Text

The Full Text of this article is available as a PDF (105.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Apter D. Development of the hypothalamic-pituitary-ovarian axis. Ann N Y Acad Sci. 1997 Jun 17;816:9–21. doi: 10.1111/j.1749-6632.1997.tb52125.x. [DOI] [PubMed] [Google Scholar]
  2. Baeten J. M., Nyange P. M., Richardson B. A., Lavreys L., Chohan B., Martin H. L., Jr, Mandaliya K., Ndinya-Achola J. O., Bwayo J. J., Kreiss J. K. Hormonal contraception and risk of sexually transmitted disease acquisition: results from a prospective study. Am J Obstet Gynecol. 2001 Aug;185(2):380–385. doi: 10.1067/mob.2001.115862. [DOI] [PubMed] [Google Scholar]
  3. Behre H. M., Kuhlage J., Gassner C., Sonntag B., Schem C., Schneider H. P., Nieschlag E. Prediction of ovulation by urinary hormone measurements with the home use ClearPlan Fertility Monitor: comparison with transvaginal ultrasound scans and serum hormone measurements. Hum Reprod. 2000 Dec;15(12):2478–2482. doi: 10.1093/humrep/15.12.2478. [DOI] [PubMed] [Google Scholar]
  4. Boskey E. R., Cone R. A., Whaley K. J., Moench T. R. Origins of vaginal acidity: high D/L lactate ratio is consistent with bacteria being the primary source. Hum Reprod. 2001 Sep;16(9):1809–1813. doi: 10.1093/humrep/16.9.1809. [DOI] [PubMed] [Google Scholar]
  5. Brabin L., Fairbrother E., Mandal D., Roberts S. A., Higgins S. P., Chandiok S., Wood P., Barnard G., Kitchener H. C. Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics. Sex Transm Infect. 2005 Apr;81(2):128–132. doi: 10.1136/sti.2004.010223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brabin L. Hormonal markers of susceptibility to sexually transmitted infections: are we taking them seriously? BMJ. 2001 Aug 18;323(7309):394–395. doi: 10.1136/bmj.323.7309.394. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cherpes Thomas L., Meyn Leslie A., Krohn Marijane A., Lurie Joel G., Hillier Sharon L. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis. 2003 Jul 15;37(3):319–325. doi: 10.1086/375819. [DOI] [PubMed] [Google Scholar]
  8. Duke P. M., Litt I. F., Gross R. T. Adolescents' self-assessment of sexual maturation. Pediatrics. 1980 Dec;66(6):918–920. [PubMed] [Google Scholar]
  9. Eschenbach D. A., Thwin S. S., Patton D. L., Hooton T. M., Stapleton A. E., Agnew K., Winter C., Meier A., Stamm W. E. Influence of the normal menstrual cycle on vaginal tissue, discharge, and microflora. Clin Infect Dis. 2000 Jun 13;30(6):901–907. doi: 10.1086/313818. [DOI] [PubMed] [Google Scholar]
  10. Hill G. B., St Claire K. K., Gutman L. T. Anaerobes predominate among the vaginal microflora of prepubertal girls. Clin Infect Dis. 1995 Jun;20 (Suppl 2):S269–S270. doi: 10.1093/clinids/20.supplement_2.s269. [DOI] [PubMed] [Google Scholar]
  11. Holzman C., Leventhal J. M., Qiu H., Jones N. M., Wang J., BV Study Group Factors linked to bacterial vaginosis in nonpregnant women. Am J Public Health. 2001 Oct;91(10):1664–1670. doi: 10.2105/ajph.91.10.1664. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Keane F. E., Ison C. A., Taylor-Robinson D. A longitudinal study of the vaginal flora over a menstrual cycle. Int J STD AIDS. 1997 Aug;8(8):489–494. doi: 10.1258/0956462971920631. [DOI] [PubMed] [Google Scholar]
  13. Kesner J. S., Knecht E. A., Krieg E. F., Jr, Barnard G., Mikola H. J., Kohen F., Gani M. M., Coley J. Validations of time-resolved fluoroimmunoassays for urinary estrone 3-glucuronide and pregnanediol 3-glucuronide. Steroids. 1994 Mar;59(3):205–211. doi: 10.1016/0039-128x(94)90029-9. [DOI] [PubMed] [Google Scholar]
  14. Lamont R. F., Morgan D. J., Wilden S. D., Taylor-Robinson D. Prevalence of bacterial vaginosis in women attending one of three general practices for routine cervical cytology. Int J STD AIDS. 2000 Aug;11(8):495–498. doi: 10.1258/0956462001916371. [DOI] [PubMed] [Google Scholar]
  15. McLaughlan J. M., Seth R., Vautier G., Robins R. A., Scott B. B., Hawkey C. J., Jenkins D. Interleukin-8 and inducible nitric oxide synthase mRNA levels in inflammatory bowel disease at first presentation. J Pathol. 1997 Jan;181(1):87–92. doi: 10.1002/(SICI)1096-9896(199701)181:1<87::AID-PATH736>3.0.CO;2-J. [DOI] [PubMed] [Google Scholar]
  16. Morrison Charles S., Bright Patricia, Wong Emelita L., Kwok Cynthia, Yacobson Irina, Gaydos Charlotte A., Tucker Heidi T., Blumenthal Paul D. Hormonal contraceptive use, cervical ectopy, and the acquisition of cervical infections. Sex Transm Dis. 2004 Sep;31(9):561–567. doi: 10.1097/01.olq.0000137904.56037.70. [DOI] [PubMed] [Google Scholar]
  17. Munro C. J., Stabenfeldt G. H., Cragun J. R., Addiego L. A., Overstreet J. W., Lasley B. L. Relationship of serum estradiol and progesterone concentrations to the excretion profiles of their major urinary metabolites as measured by enzyme immunoassay and radioimmunoassay. Clin Chem. 1991 Jun;37(6):838–844. [PubMed] [Google Scholar]
  18. Mårdh P. A., Tchoudomirova K., Elshibly S., Hellberg D. Symptoms and signs in single and mixed genital infections. Int J Gynaecol Obstet. 1998 Nov;63(2):145–152. doi: 10.1016/s0020-7292(98)00140-4. [DOI] [PubMed] [Google Scholar]
  19. Peeters M., Piot P. Adhesion of Gardnerella vaginalis to vaginal epithelial cells: variables affecting adhesion and inhibition by metronidazole. Genitourin Med. 1985 Dec;61(6):391–395. doi: 10.1136/sti.61.6.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Priestley C. J., Jones B. M., Dhar J., Goodwin L. What is normal vaginal flora? Genitourin Med. 1997 Feb;73(1):23–28. doi: 10.1136/sti.73.1.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pybus V., Onderdonk A. B. Microbial interactions in the vaginal ecosystem, with emphasis on the pathogenesis of bacterial vaginosis. Microbes Infect. 1999 Apr;1(4):285–292. doi: 10.1016/s1286-4579(99)80024-0. [DOI] [PubMed] [Google Scholar]
  22. Redondo-Lopez V., Cook R. L., Sobel J. D. Emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora. Rev Infect Dis. 1990 Sep-Oct;12(5):856–872. doi: 10.1093/clinids/12.5.856. [DOI] [PubMed] [Google Scholar]
  23. Shafer M. A., Sweet R. L., Ohm-Smith M. J., Shalwitz J., Beck A., Schachter J. Microbiology of the lower genital tract in postmenarchal adolescent girls: differences by sexual activity, contraception, and presence of nonspecific vaginitis. J Pediatr. 1985 Dec;107(6):974–981. doi: 10.1016/s0022-3476(85)80208-0. [DOI] [PubMed] [Google Scholar]
  24. Shoubnikova M., Hellberg D., Nilsson S., Mårdh P. A. Contraceptive use in women with bacterial vaginosis. Contraception. 1997 Jun;55(6):355–358. doi: 10.1016/s0010-7824(97)00044-9. [DOI] [PubMed] [Google Scholar]
  25. Smart S., Singal A., Mindel A. Social and sexual risk factors for bacterial vaginosis. Sex Transm Infect. 2004 Feb;80(1):58–62. doi: 10.1136/sti.2003.004978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stergachis A., Scholes D., Heidrich F. E., Sherer D. M., Holmes K. K., Stamm W. E. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol. 1993 Aug 1;138(3):143–153. doi: 10.1093/oxfordjournals.aje.a116840. [DOI] [PubMed] [Google Scholar]
  27. Stevens-Simon C., Jamison J., McGregor J. A., Douglas J. M. Racial variation in vaginal pH among healthy sexually active adolescents. Sex Transm Dis. 1994 May-Jun;21(3):168–172. doi: 10.1097/00007435-199405000-00007. [DOI] [PubMed] [Google Scholar]
  28. Taha T. E., Hoover D. R., Dallabetta G. A., Kumwenda N. I., Mtimavalye L. A., Yang L. P., Liomba G. N., Broadhead R. L., Chiphangwi J. D., Miotti P. G. Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS. 1998 Sep 10;12(13):1699–1706. doi: 10.1097/00002030-199813000-00019. [DOI] [PubMed] [Google Scholar]
  29. Wiesenfeld Harold C., Hillier Sharon L., Krohn Marijane A., Landers Daniel V., Sweet Richard L. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2003 Feb 7;36(5):663–668. doi: 10.1086/367658. [DOI] [PubMed] [Google Scholar]
  30. Wilcox M. H., Reynolds M. T., Hoy C. M., Brayson J. Combined cervical swab and urine specimens for PCR diagnosis of genital Chlamydia trachomatis infection. Sex Transm Infect. 2000 Jun;76(3):177–178. doi: 10.1136/sti.76.3.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. de Roda Husman A. M., Walboomers J. M., van den Brule A. J., Meijer C. J., Snijders P. J. The use of general primers GP5 and GP6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol. 1995 Apr;76(Pt 4):1057–1062. doi: 10.1099/0022-1317-76-4-1057. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES