Article Text

PDF
Prospective study of correlates of vaginal Lactobacillus colonisation among high-risk HIV-1 seronegative women
  1. J M Baeten1,2,
  2. W M Hassan3,4,
  3. V Chohan4,
  4. B A Richardson5,
  5. K Mandaliya6,
  6. J O Ndinya-Achola4,
  7. W Jaoko4,
  8. R S McClelland2,3,4
  1. 1
    Department of Global Health, University of Washington, Seattle, Washington, USA
  2. 2
    Department of Medicine, University of Washington, Seattle, Washington, USA
  3. 3
    Department of Epidemiology, University of Washington, Seattle, Washington, USA
  4. 4
    Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
  5. 5
    Department of Biostatistics, University of Washington, Seattle, Washington, USA
  6. 6
    Coast Provincial General Hospital, Mombasa, Kenya
  1. Dr J Baeten, Department of Global Health, University of Washington, 901 Boren Ave, Suite 1300, Seattle, WA 98104, USA; jbaeten{at}u.washington.edu

Abstract

Objective: Vaginal colonisation with Lactobacillus species is characteristic of normal vaginal ecology. The absence of vaginal lactobacilli, particularly hydrogen peroxide (H2O2)-producing isolates, has been associated with symptomatic bacterial vaginosis (BV) and increased risk for HIV-1 acquisition. Identification of factors associated with vaginal Lactobacillus colonisation may suggest interventions to improve vaginal health.

Methods: We conducted a prospective cohort study of correlates of vaginal Lactobacillus colonisation among Kenyan HIV-1 seronegative female sex workers. At monthly follow-up visits, vaginal Lactobacillus cultures were obtained. Generalised estimating equations were used to examine demographic, behavioural and medical correlates of Lactobacillus isolation, including isolation of H2O2-producing strains.

Results: Lactobacillus cultures were obtained from 1020 women who completed a total of 8896 follow-up visits. Vaginal washing, typically with water alone or with soap and water, was associated with an approximately 40% decreased likelihood of Lactobacillus isolation, including isolation of H2O2-producing strains. Recent antibiotic use, excluding metronidazole and treatments for vaginal candidiasis, reduced Lactobacillus isolation by ∼30%. H2O2-producing lactobacilli were significantly less common among women with Trichomonas vaginalis infection and those who were seropositive for herpes simplex virus type 2. In contrast, H2O2-producing lactobacilli were significantly more common among women with concurrent vaginal candidiasis.

Conclusions: Modifiable biological and behavioural factors are associated with Lactobacillus colonisation in African women. Our results suggest intervention strategies to improve vaginal health in women at high risk for HIV-1.

Statistics from Altmetric.com

Footnotes

  • Funding: This work was supported by US National Institutes of Health (NIH) through grants R01-AI33873, R01-AI52480, R01-AI38518, D43-TW00007 and K23-AI52480, and by Family Health International (subcontract N01-A1-35173-119).

  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by the institutional review boards of the University of Washington and the University of Nairobi.

  • Patient consent: Obtained.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.