Prospective study of correlates of vaginal Lactobacillus colonisation among high-risk HIV-1 seronegative women

Sex Transm Infect. 2009 Sep;85(5):348-53. doi: 10.1136/sti.2008.035451. Epub 2009 Mar 26.

Abstract

Objective: Vaginal colonisation with Lactobacillus species is characteristic of normal vaginal ecology. The absence of vaginal lactobacilli, particularly hydrogen peroxide (H(2)O(2))-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 H(2)O(2)-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 H(2)O(2)-producing strains. Recent antibiotic use, excluding metronidazole and treatments for vaginal candidiasis, reduced Lactobacillus isolation by approximately 30%. H(2)O(2)-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, H(2)O(2)-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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Female
  • HIV Seronegativity*
  • HIV-1 / isolation & purification
  • Herpesvirus 2, Human / isolation & purification
  • Humans
  • Hydrogen Peroxide / metabolism
  • Kenya / epidemiology
  • Lactobacillus / isolation & purification*
  • Prospective Studies
  • Risk Factors
  • Sex Work*
  • Soaps / adverse effects
  • Trichomonas Vaginitis / complications
  • Vagina / microbiology*
  • Vaginal Douching / adverse effects
  • Vaginosis, Bacterial / epidemiology*
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Soaps
  • Hydrogen Peroxide