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

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 oligoamenorrhoea were recruited. Vaginal pH and BV were assessed and among those not using hormonal contraceptives, estrone-3-glucuronide (E3G) and pregnanediol-3a-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 DepoProvera (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.

Longitudinal Changes in Vaginal Microbiota Composition Assessed by Gram Stain Among Never Sexually Active Pre- and Postmenarcheal Adolescents in Rakai, Uganda

“…This study investigated changes in vaginal microbiota and pH in never sexually active Ugandan adolescents accounting for different stages of menarche, whereas other studies were limited to sexually active postmenarcheal girls or prepubescent girls (11;13;21;22). Two cross-sectional studies by Brabin et al among postmenarcheal, sexually active adolescents found that younger gynecologic age was associated with increased bacterial vaginosis (BV) but not with higher vaginal pH among sexually active adolescents attending a genitourinary clinic in Manchester, UK (13;21).…”

“…Two cross-sectional studies by Brabin et al among postmenarcheal, sexually active adolescents found that younger gynecologic age was associated with increased bacterial vaginosis (BV) but not with higher vaginal pH among sexually active adolescents attending a genitourinary clinic in Manchester, UK (13;21). In contrast, Stevens-Simon et al .…”

Requirements for Germination ofClostridium sordelliiSporesIn Vitro

“…Thus, vaginal pH that correlates with pathogenicity results in the formation of bicarbonate-carbonic acid mixtures that are required for C. sordellii spore germination. Hence, altered vaginal pH conditions could result in a better environment for C. sordellii spores to germinate and establish infections (9).…”

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

“…20 A prevalence rate of 34% was reported from adolescents at genitourinary medicine clinics in Manchester, UK. 21 Nonpenetrative intimate sexual contact was associated with detection of G. vaginalis and Atopobium vaginae in a study of vaginal samples from asymptomatic virginal women. 22 A. vaginae has been recognized as part of abnormal vaginal flora, and the metronidazole-resistant characteristics of this anaerobe may contribute to BV recurrence.…”