Behavioural and medical predictors of bacterial vaginosis recurrence among female sex workers: longitudinal analysis from a randomized controlled trial

Abstract

BackgroundData on risk factors of recurrent bacterial vaginosis (RBV) are still scarce. We used data from female sex workers (FSW) participating in a randomized controlled microbicide trial to examine predictors of BV recurrence.MethodsTrial’s participants with at least an episode of BV which was treated and/or followed by a negative BV result and at least one subsequent visit offering BV testing were included in the analysis. Behavioural and medical data were collected monthly while laboratory testing for STI and genital tract infections were performed quarterly. The Andersen-Gill proportional hazards model was used to determine predictors of BV recurrence both in bivariate and multivariate analyses.Results440 women were included and the incidence rate for RBV was 20.8 recurrences/100 person-months (95% confidence interval (CI) =18.1–23.4). In the multivariate analysis controlling for the study site, recent vaginal cleansing as reported at baseline with adjusted hazard-ratio (aHR)=1.30, 95% CI = 1.02-1.64 increased the risk of BV recurrence, whereas consistent condom use (CCU) with the primary partner (aHR=0.68, 95% CI=0.49-0.93) and vaginal candidiasis (aHR=0.70, 95% CI=0.53-0.93), both treated as time-dependent variables, were associated with decreased risk of RBV.ConclusionThis study confirms the importance of counselling high-risk women with RBV about the adverse effects of vaginal cleansing and the protective effects of condom use with all types of partners for the prevention of sexually transmitted infections, including BV. More prospective studies on risk factors of BV recurrence are warranted.Trial registrationTrial registration: NCT00153777

Women View Key Sexual Behaviours As the Trigger for the Onset and Recurrence of Bacterial Vaginosis

“…The lifestyle triggers and modifications women reported, including long term dietary and exercise changes, are analogous with our previous findings Triggers of bacterial vaginosis-Women's views [31], and also reflect generic advice given to women (to avoid douching, soap or feminine hygiene products) and women's desire to improve their general health to reduce their susceptibility to BV. Women's use of self-help remedies to treat symptoms of BV mirror those found in other studies examining women's experiences of vaginal conditions or recurring STIs [25-31, 40, 57], however it is encouraging to see in this study only a minority of women reported douching, given its association with an increased risk of BV [1,[32][33][34][35]. Interestingly, while women commonly felt BV was associated with sexual contact, few actually think BV is an STI.…”

“…While some women report these remedies can be useful, most report little effect [31], with past research showing douching may be associated with a higher incidence of BV [1,[32][33][34][35] along with other ethnic and lifestyle factors including stress, the use of an intrauterine device, smoking, and non-white ethnicity [15,[36][37][38][39]. Currently, there is limited evidence to suggest probiotics, lactic acid or antiseptic and disinfectant treatments (e.g.…”

Recent Biomarker-Confirmed Unprotected Vaginal Sex, But Not Self-reported Unprotected Sex, Is Associated With Recurrent Bacterial Vaginosis

“…However several risk factors have been associated with increased BV risk, including non-white race, new or multiple sex partners, intravaginal hygiene practices including douching, high sexual frequency, and unprotected vaginal sex (4–7). In some studies, consistent condom users had significantly lower BV risk than women who did not use condoms (8–10). However, other studies have failed to find a significant association between condom use and BV, suggesting that if present, the protective benefit of condoms might be quite modest (11).…”

Cessation of intravaginal practices to prevent bacterial vaginosis: a pilot intervention in Zimbabwean women

“…We believe that additional interventions are likely needed to meaningfully impact BV. For example, increasing use of male condoms,27 together with reductions in intravaginal practices, may have greater impact. Various combinations of interventions could be evaluated in a factorial design to assess the effects of each component intervention alone, as well as their impact in combination.…”