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Sex Transm Infect 2009;85:348-353 doi:10.1136/sti.2008.035451
  • Epidemiology

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
  • Accepted 18 March 2009
  • Published Online First 26 March 2009

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.

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.

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