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Association between bacterial vaginosis and Herpes simplex virus type-2 infection: implications for HIV acquisition studies
  1. Nicolas Nagot1,
  2. Abdoulaye Ouedraogo1,
  3. Marie-Christine Defer1,
  4. Roselyne Vallo1,
  5. Philippe Mayaud2,
  6. Philippe Van de Perre3
  1. 1Centre Muraz, Bobo-Dioulasso, Burkina Faso
  2. 2London School of Hygiene & Tropical Medicine, London, UK
  3. 3Université Montpellier 1, EA 4205 ≪Transmission, Pathogenese et Prevention de I’infection per le VIH≫; CHU Montpellier, Laboratoire de Bactériologie-Virologie, Montpellier, France
  1. Correspondence to:
 Dr Nicolas Nagot
 London School of Hygiene & Tropical Medicine, ITD/CRU, WC1E7HT London, UK; n_nagot{at}


Objectives: Bacterial vaginosis (BV) and Herpes simplex virus type-2 (HSV-2) have been linked to an increased risk of HIV-1 acquisition. Recent research suggests an association between BV and HSV-2 acquisition, but the converse has not been studied. Here, we investigate whether an association exists between BV and HSV-2 infection

Methods: We examined the determinants of BV occurrence in a cohort of female sex workers in Burkina Faso. Participants were followed every 3 months for diagnosis of genital infections and report of sexual behaviours. Factors associated with BV occurrence were assessed using generalised estimating equation models.

Results: We enrolled 273 women (mean age, 28 years) and conducted 812 follow-up visits (mean 2.93 visit per woman). Baseline seroprevalence of HIV-1, HSV-2 and recent syphilis were 31.5%, 70.1% and 0.4%, respectively, while baseline prevalence of BV, Trichomonas vaginalis (TV) and Candida albicans were 20.5%, 3.3% and 2.5%, respectively. In multivariable analysis, HSV-2 (relative risk (RR) = 1.73, 95% CI 1.12 to 2.65), HIV-1 (RR = 1.76, 95% CI 1.30 to 2.40), TV (RR = 1.5, 95% CI 1.0 to 2.3), and having ⩾3 sexual partners in the preceding week (RR = 2.2, 95% CI 1.1 to 4.6) were independently associated with BV, while hormonal contraception showed a protective effect (RR = 0.11, 95% CI 0.02 to 0.70).

Conclusions: HSV-2 infection was associated with BV occurrence in this population. As HSV-2 is strongly linked to HIV-1 acquisition, studies assessing the cofactor effect of BV on HIV acquisition should control for the presence of HSV-2. Further studies are required to investigate the relative effect of asymptomatic HSV-2 shedding and/or genital ulcerations on BV occurrence.

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  • Funding: Funding was received from the Agence Nationale de Recherches sur le SIDA et les Hépatites (ANRS), France.

  • Competing interests: None declared.