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Prospective study of correlates of vaginal Lactobacillus colonization among high-risk HIV-1 seronegative women
  1. Jared Baeten (jbaeten{at}u.washington.edu)
  1. University of Washington, United States
    1. Wisal Hassan
    1. University of Nairobi, Kenya
      1. Vrasha Chohan
      1. University of Nairobi, Kenya
        1. Barbra Richardson
        1. University of Washington, United States
          1. Kishorchandra Mandaliya
          1. Coast Provincial General Hospital, Kenya
            1. Jeckoniah Ndinya-Achola
            1. University of Nairobi, Kenya
              1. Walter Jaoko
              1. University of Nairobi, Kenya
                1. R Scott McClelland
                1. University of Washington, United States

                  Abstract

                  Objective: Vaginal colonization 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 colonization may suggest interventions to improve vaginal health.

                  Methods: We conducted a prospective cohort study of correlates of vaginal Lactobacillus colonization among Kenyan HIV-1 seronegative female sex workers. At monthly follow-up visits, vaginal Lactobacillus cultures were obtained. Generalized estimating equations were used to examine demographic, behavioral, 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 biologic and behavioral factors are associated with Lactobacillus colonization in African women. Our results suggest intervention strategies to improve vaginal health in women at high risk for HIV-1.

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