Abstract
Objectives: To determine whether the risk factors associated with bacterial vaginosis (BV) are consistent with it being a sexually transmitted infection (STI) by comparing the characteristics of women with BV with those of women with infections recognised as being sexually and non-sexually transmitted.
Methods: A prospective cross sectional study was conducted among female patients presenting for diagnosis at a genitourinary medicine clinic in Sheffield between January 1996 and September 1998. Demographic and behavioural characteristics were reported from patient records and a standardised questionnaire was administered. Risk factor models for BV, two STIs, and two non-STIs were compiled using a multivariable logistic regression analysis.
Results: Among the 8989 females under 45 years eligible for analysis, the prevalence of BV was 12.9%. Risk factors associated with BV included some in common with gonorrhoea and Chlamydia trachomatis and some that were not associated with these two STIs. Risk factors common to BV and the STIs included having had more than one sexual partner in the past 3 months, having a history of a bacterial STI, being of black Caribbean ethnicity, and living in a deprived area. However, BV had a contrasting age profile, being most prevalent among those over the age of 30. BV was also more common in those who were divorced.
Conclusions: BV is associated with some factors related to the acquisition of gonorrhoea and Chlamydia trachomatis. However, infection is not only determined by those factors and therefore factors other than sexual activity may be important in the development of the condition.
Key Words: bacterial vaginosis; sexually transmitted infections
Full Text
The Full Text of this article is available as a PDF (126.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Amsel R., Totten P. A., Spiegel C. A., Chen K. C., Eschenbach D., Holmes K. K. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14–22. doi: 10.1016/0002-9343(83)91112-9. [DOI] [PubMed] [Google Scholar]
- Aral S. O., Mosher W. D., Cates W., Jr Vaginal douching among women of reproductive age in the United States: 1988. Am J Public Health. 1992 Feb;82(2):210–214. doi: 10.2105/ajph.82.2.210. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Berger B. J., Kolton S., Zenilman J. M., Cummings M. C., Feldman J., McCormack W. M. Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin Infect Dis. 1995 Dec;21(6):1402–1405. doi: 10.1093/clinids/21.6.1402. [DOI] [PubMed] [Google Scholar]
- Bump R. C., Buesching W. J., 3rd Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol. 1988 Apr;158(4):935–939. doi: 10.1016/0002-9378(88)90097-x. [DOI] [PubMed] [Google Scholar]
- Crowley T., Horner P., Hughes A., Berry J., Paul I., Caul O. Hormonal factors and the laboratory detection of Chlamydia trachomatis in women: implications for screening? Int J STD AIDS. 1997 Jan;8(1):25–31. doi: 10.1258/0956462971918724. [DOI] [PubMed] [Google Scholar]
- Eschenbach D. A., Hillier S., Critchlow C., Stevens C., DeRouen T., Holmes K. K. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol. 1988 Apr;158(4):819–828. doi: 10.1016/0002-9378(88)90078-6. [DOI] [PubMed] [Google Scholar]
- Evans B. A., Kell P. D., Bond R. A., MacRae K. D. Racial origin, sexual lifestyle, and genital infection among women attending a genitourinary medicine clinic in London (1992). Sex Transm Infect. 1998 Feb;74(1):45–49. doi: 10.1136/sti.74.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Foxman B., Aral S. O., Holmes K. K. Interrelationships among douching practices, risky sexual practices, and history of self-reported sexually transmitted diseases in an urban population. Sex Transm Dis. 1998 Feb;25(2):90–99. doi: 10.1097/00007435-199802000-00006. [DOI] [PubMed] [Google Scholar]
- GARDNER H. L., DUKES C. D. Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis. Am J Obstet Gynecol. 1955 May;69(5):962–976. [PubMed] [Google Scholar]
- Goldenberg R. L., Klebanoff M. A., Nugent R., Krohn M. A., Hillier S., Andrews W. W. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol. 1996 May;174(5):1618–1621. doi: 10.1016/s0002-9378(96)70617-8. [DOI] [PubMed] [Google Scholar]
- Hallén A., Påhlson C., Forsum U. Bacterial vaginosis in women attending STD clinic: diagnostic criteria and prevalence of Mobiluncus spp. Genitourin Med. 1987 Dec;63(6):386–389. doi: 10.1136/sti.63.6.386. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hay P. E., Lamont R. F., Taylor-Robinson D., Morgan D. J., Ison C., Pearson J. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ. 1994 Jan 29;308(6924):295–298. doi: 10.1136/bmj.308.6924.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hillier S. L., Nugent R. P., Eschenbach D. A., Krohn M. A., Gibbs R. S., Martin D. H., Cotch M. F., Edelman R., Pastorek J. G., 2nd, Rao A. V. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. N Engl J Med. 1995 Dec 28;333(26):1737–1742. doi: 10.1056/NEJM199512283332604. [DOI] [PubMed] [Google Scholar]
- Kent H. L. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1168–1176. doi: 10.1016/s0002-9378(12)90722-x. [DOI] [PubMed] [Google Scholar]
- Koch A., Bilina A., Teodorowicz L., Stary A. Mycoplasma hominis and Ureaplasma urealyticum in patients with sexually transmitted diseases. Wien Klin Wochenschr. 1997 Aug 8;109(14-15):584–589. [PubMed] [Google Scholar]
- Krohn M. A., Hillier S. L., Eschenbach D. A. Comparison of methods for diagnosing bacterial vaginosis among pregnant women. J Clin Microbiol. 1989 Jun;27(6):1266–1271. doi: 10.1128/jcm.27.6.1266-1271.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
- LEOPOLD S. Heretofore undescribed organism isolated from the genitourinary system. U S Armed Forces Med J. 1953 Feb;4(2):263–266. [PubMed] [Google Scholar]
- Larsson P. G., Platz-Christensen J. J., Sundström E. Is bacterial vaginosis a sexually transmitted disease? Int J STD AIDS. 1991 Sep-Oct;2(5):362–364. doi: 10.1177/095646249100200511. [DOI] [PubMed] [Google Scholar]
- Mabey D. The diagnosis and treatment of urethritis in developing countries. Genitourin Med. 1994 Feb;70(1):1–2. doi: 10.1136/sti.70.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moi H., Erkkola R., Jerve F., Nelleman G., Bymose B., Alaksen K., Tornqvist E. Should male consorts of women with bacterial vaginosis be treated? Genitourin Med. 1989 Aug;65(4):263–268. doi: 10.1136/sti.65.4.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moi H. Prevalence of bacterial vaginosis and its association with genital infections, inflammation, and contraceptive methods in women attending sexually transmitted disease and primary health clinics. Int J STD AIDS. 1990 Mar;1(2):86–94. doi: 10.1177/095646249000100203. [DOI] [PubMed] [Google Scholar]
- Peipert J. F., Montagno A. B., Cooper A. S., Sung C. J. Bacterial vaginosis as a risk factor for upper genital tract infection. Am J Obstet Gynecol. 1997 Nov;177(5):1184–1187. doi: 10.1016/s0002-9378(97)70038-3. [DOI] [PubMed] [Google Scholar]
- 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]
- Rajamanoharan S., Low N., Jones S. B., Pozniak A. L. Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: a case control study. Sex Transm Dis. 1999 Aug;26(7):404–409. doi: 10.1097/00007435-199908000-00008. [DOI] [PubMed] [Google Scholar]
- Rodrigues A. G., Mârdh P. A., Pina-Vaz C., Martinez-de-Oliveira J., da Fonseca A. F. Is the lack of concurrence of bacterial vaginosis and vaginal candidosis explained by the presence of bacterial amines? Am J Obstet Gynecol. 1999 Aug;181(2):367–370. doi: 10.1016/s0002-9378(99)70563-6. [DOI] [PubMed] [Google Scholar]
- Schmid G., Markowitz L., Joesoef R., Koumans E. Bacterial vaginosis and HIV infection. Sex Transm Infect. 2000 Feb;76(1):3–4. doi: 10.1136/sti.76.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Simms I., Catchpole M. A., Robinson A. J., Laas C. Provision of diagnostic services for genital chlamydial infection in genitourinary medicine clinics: England and Wales 1996. Genitourin Med. 1997 Apr;73(2):147–148. doi: 10.1136/sti.73.2.147. [DOI] [PMC free article] [PubMed] [Google Scholar]