Intermediate vaginal flora and bacterial vaginosis are associated with the same factors: findings from an exploratory analysis among female sex workers in Africa and India
- Fernand A Guédou1,2,
- Lut Van Damme3,4,
- Jennifer Deese3,
- Tania Crucitti5,
- Florence Mirembe6,
- Suniti Solomon7,
- Marissa Becker8,
- Michel Alary1,2
- 1URESP, Centre de recherche FRSQ du CHU de Québec, Quebec, Canada
- 2Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
- 3FHI360, Durham, North Carolina, USA
- 4CONRAD, Arlington, Virginia, USA
- 5Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
- 6Makerere University College of Health Sciences, Kampala, Uganda
- 7Y.R Gaitonde Center for AIDS Research and Education, Chennai, India
- 8Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Correspondence to Dr Michel Alary, URESP, Centre de recherche FRSQ du CHA Universitaire de Québec, Hôpital Saint-Sacrement, 1050, Chemin Sainte Foy, Québec, Canada G1S 4L8;
- Received 2 November 2012
- Revised 29 August 2013
- Accepted 14 October 2013
- Published Online First 13 November 2013
Objectives Several recent studies suggest that intermediate vaginal flora (IVF) is associated with similar adverse health outcomes as bacterial vaginosis (BV). Yet, it is still unknown if IVF and BV share the same correlates. We conducted a cross-sectional and exploratory analysis of data from women screened prior to enrolment in a microbicide trial to estimate BV and IVF prevalence and examine their respective correlates.
Methods Participants were interviewed, examined and provided blood and genital samples for the diagnosis of IVF and BV (using Nugent score) and other reproductive tract infections. Polytomous logistic regressions were used in estimating respective ORs of IVF and BV, in relation to each potential risk factor.
Results Among 1367 women, BV and IVF prevalences were 47.6% (95% CI 45.0% to 50.3%) and 19.2% (95% CI 17.1% to 21.2%), respectively. Multivariate polytomous analysis of IVF and BV showed that they were generally associated with the same factors. The respective adjusted ORs were for HIV 1.98 (95% CI 1.37 to 2.86) and 1.62 (95% CI 1.20 to 2.20) (p=0.2248), for gonorrhoea 1.25 (95% CI 0.64 to 2.4) and 2.01 (95% CI 1.19 to 3.49) (p=0.0906), for trichomoniasis 3.26 (95% CI 1.71 to 6.31) and 2.39 (95% CI 1.37 to 4.33) (p=0.2630), for candidiasis 0.52 (95% CI 0.36 to 0.75) and 0.59 (95% CI 0.44 to 0.78) (p=0.5288), and for hormonal contraception 0.65 (95% CI 0.40 to 1.04) and 0.62 (95% CI 0.43 to 0.90) (p=0.8819). In addition, the association between vaginal flora abnormalities and factors such as younger age, HIV, gonorrhoea trichomoniasis and candidiasis were modified by the study site (all p for interaction ≤0.05).
Conclusions IVF has almost the same correlates as BV. The relationship between some factors and vaginal flora abnormalities may be site-specific.