Correlation of Behaviors with Microbiological Changes in Vaginal Flora

Abstract

Bacterial vaginosis (BV) is characterized by dramatic changes in the vaginal ecosystem. Women without evidence of vaginal infection may exhibit transient changes in their flora. We prospectively followed up women by using diaries and self-obtained vaginal smears to correlate behaviors with changes in flora. The majority of women (38/51, 78%) had significant, although transient, changes. Behaviors associated with unstable flora were a history of BV, a greater number of partners, and more frequent episodes of receptive oral sex. Only the latter remained significantly associated in the multivariate analysis. Variables that were associated with day-to-day variability in the flora included use of vaginal medication, menses, greater number of partners, spermicide use, more frequent vaginal intercourse, and less frequent use of condoms. Only a minority of women (11/51, 22%) maintained a "normal" lactobacillus-predominant flora. Factors associated with instability of the flora are similar to those epidemiologically associated with BV.

Sexually transmitted infections and risk behaviours in women who have sex with women

“…Potential for sexual transmission remains disputed. 13 15 Sexual practices in woman to woman sex have been implicated and in a recent study 16 more frequent episodes of receptive oral sexual intercourse were independently associated with BV. We acknowledge that our study is limited by lack of data on specific female-female sexual practices.…”

Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective

“…The concordance of BV status in monogamous lesbian couples ranges up to 95% (53,54), strongly suggesting that BV is sexually associated, although an infectious correlate has not been identified (55). Menses, a new sexual partner, vaginal douching, receptive oral sex, and lack of condom use are among the strongest risk factors for BV (54,(56)(57)(58)(59)(60)(61)(62)(63). In general, women with BV have more sex partners and an earlier age of sexual debut than women without BV (62).…”

“…These Gram stain studies are certainly suggestive, and several groups, including ours, have ongoing genomic studies which are investigating why the vaginal microbiota fluctuate and the outcomes associated with such fluctuations. Menstrual bleeding, the hormonal fluctuation over the menstrual cycle, sexual behaviors, hygiene practices, new sexual partners, diet, and vaginal bacterial community composition are known to be contributors to fluctuation of vaginal bacterial communities based on microscopy and cultivation-based studies (63,(92)(93)(94); genomic studies will benefit the investigation of how these behavioral and extrinsic factors affect bacterial composition and abundance.…”

Findings Associated with Recurrence of Bacterial Vaginosis among Adolescents Attending Sexually Transmitted Diseases Clinics

“…[11][12][13] More recently, an association between receptive oral sex and BV has been suggested. [14][15][16][17] Data from the first nationally representative sample to report on BV, the 2001 National Health and Nutrition Examination Survey (NHANES), which was based on nearly 2000 women in the United States, found the prevalence of BV was 27.4%. When evaluated by race/ethnicity, higher rates were detected in non-Hispanic blacks (50.3%) and Mexican American women (28.8%) compared to non-Hispanic whites (22.4%).…”