Bacterial Vaginosis: Risk Factors Among Kenyan Women and... : Sexually Transmitted Diseases (original) (raw)

Article

Bacterial Vaginosis: Risk Factors Among Kenyan Women and Their Male Partners

Bukusi, Elizabeth A. MBChB, MMed(OB/GYN), MPH*†∥; Cohen, Craig R. MD, MPH***; Meier, Amalia S. PhD#; Waiyaki, Peter G. MSc, PhD*; Nguti, Rosemary MSc, PhD‡; Njeri, Jane N.§; Holmes, King K. MD, PhD¶

From the *Kenya Medical Research Institute, Center for Microbiology Research, Nairobi, Kenya; Departments of †Obstetrics and Gynecology, ‡Mathematics, and §Medical Microbiology, University of Nairobi, Nairobi, Kenya; Departments of ∥Obstetrics and Gynecology, Lab Medicine, and ¶Medicine, University of Washington, Seattle, Washington; and the #Program in Biostatistics, Fred Hutchinson Cancer Research Center, **Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Francisco, San Francisco, California

For their generous assistance on this project, the authors would like to thank the director of KEMRI, Dr. Davy Koech; Dr. J. G. Karanja, Department of Obstetrics and Gynecology, University of Nairobi; Dr. Teresa Kinyari, Eunice Mwiti, Grace Njau, Josephine Wangombe, and Oscar Lugalia, Department of Medical Microbiology, University of Nairobi; and Charity Maingi, Kenya Medical Research Institute. We also thank Dr. Sharon Hillier for providing quality control in reexamining most of the vaginal Gram stained smears in her laboratory.

Correspondence: King K. Holmes, MD, PhD, University of Washington Center for AIDS Research, Harborview Medical Center, Box 359931, 325 Ninth Avenue Seattle, WA 98104. E-mail: [email protected].

Elizabeth Bukusi is a fellow in the International AIDS Research and Training Program supported by the Fogarty International Center (#T22TW00001). This research was partially supported by the National Institutes of Health Sexually Transmitted Disease Cooperative Research Center at the University of Washington (AI 31448).

Received for publication May 17, 2005, and accepted November 8, 2005.

Objectives:

To simultaneously examine associations of bacterial vaginosis (BV) with potential risk factors in both the female and her male partner.

Study Design:

We recruited women 18–45 years of age and their male partners from clinics in Nairobi, Kenya. All underwent face-to-face standardized interview physical examination, human immunodeficiency virus (HIV)-1 and syphilis serologic testing, endocervical cultures for Neisseria gonorrhoeae, and vaginal swabs for diagnosis of BV by Gram stain and trichomoniasis by culture.

Results:

Of 219 women, 97 (44%) had BV. BV was significantly associated by univariate analyses with women’s own risk factors (young age, being unmarried, early sexual debut, more than 1 sexual partner, lifetime, rectal sex, trichomoniasis, HIV infection, and by principal components analysis, with low socioeconomic status [SES]) and also with male partners’ characteristics (HIV infection, and by principal components analysis, low SES, and poor hygiene). In multivariate analysis including risk factors from both genders, the odds of having BV was 5.7 times higher if either partner was HIV seropositive, 13.2 times higher if the female had trichomoniasis, 2.5 times higher if the female had more than 1 sex partner ever, and decreased with increasing age of the female.

Conclusion:

In this population, characteristics of males and of females were independently associated with BV. Close association of male hygiene and male HIV status precluded distinguishing the influence of male hygiene on partner’s BV.