Prevalence and correlates of bacterial vaginosis in different sub-populations of women in sub-Saharan Africa: a cross-sectional study - PubMed (original) (raw)

. 2014 Oct 7;9(10):e109670.

doi: 10.1371/journal.pone.0109670. eCollection 2014.

Tania Crucitti 2, Joris Menten 3, Rita Verhelst 4, Mary Mwaura 5, Kishor Mandaliya 5, Gilles F Ndayisaba 6, Sinead Delany-Moretlwe 7, Hans Verstraelen 8, Liselotte Hardy 1, Anne Buvé 1, Janneke van de Wijgert 9; Vaginal Biomarkers Study Group

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Prevalence and correlates of bacterial vaginosis in different sub-populations of women in sub-Saharan Africa: a cross-sectional study

Vicky Jespers et al. PLoS One. 2014.

Abstract

Background: Clinical development of vaginally applied products aimed at reducing the transmission of HIV and other sexually transmitted infections, has highlighted the need for a better characterisation of the vaginal environment. We set out to characterise the vaginal environment in women in different settings in sub-Saharan Africa.

Methods: A longitudinal study was conducted in Kenya, Rwanda and South-Africa. Women were recruited into pre-defined study groups including adult, non-pregnant, HIV-negative women; pregnant women; adolescent girls; HIV-negative women engaging in vaginal practices; female sex workers; and HIV-positive women. Consenting women were interviewed and underwent a pelvic exam. Samples of vaginal fluid and a blood sample were taken and tested for bacterial vaginosis (BV), HIV and other reproductive tract infections (RTIs). This paper presents the cross-sectional analyses of BV Nugent scores and RTI prevalence and correlates at the screening and the enrolment visit.

Results: At the screening visit 38% of women had BV defined as a Nugent score of 7-10, and 64% had more than one RTI (N. gonorrhoea, C. trachomatis, T. vaginalis, syphilis) and/or Candida. At screening the likelihood of BV was lower in women using progestin-only contraception and higher in women with more than one RTI. At enrolment, BV scores were significantly associated with the presence of prostate specific antigen (PSA) in the vaginal fluid and with being a self-acknowledged sex worker. Further, sex workers were more likely to have incident BV by Nugent score at enrolment.

Conclusions: Our study confirmed some of the correlates of BV that have been previously reported but the most salient finding was the association between BV and the presence of PSA in the vaginal fluid which is suggestive of recent unprotected sexual intercourse.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1

Figure 1. Recruitment flow chart.

This Figure presents the screening and enrolment flow diagram, including reasons for screening failure. A total of 595 women were screened and 430 were enrolled in the study: 219 in the reference group; 60 pregnant women; 60 adolescents; 31 women engaging in vaginal practices; 30 FSW; and 30 HIV-positive women. ICRHK: International Centre of Reproductive Health, Mombasa, Kenya; RU: Rinda Ubuzima, Kigali, Rwanda; WrHI: Wits Reproductive Health and HIV Institute, Johannesburg, South Africa. Other ineligibility reasons: moving out of the area; not able to keep appointments due to mobility; unknown. Vaginal practices: Using traditional vaginal practices with anything other than water, soap and/or fingers alone.

Figure 2

Figure 2. The prevalence of Bacterial Vaginosis at screening and at enrolment.

The prevalence of BV at enrolment was highest in female sex workers (68%) and HIV-positive women (48%) in Rwanda. Black bar: Nugent score 7–10 classified as BV; Grey bar: Nugent score 4–6 classified as intermediate; White bar: Nugent score 0–3 classified as normal. Groups: R = Reference group, P = Pregnant women, A = adolescents, V = vaginal practices, FSW = female sex worker, and HIV+ = HIV-positive women.

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The project was funded by the European & Developing Countries Clinical Trials Partnership (IP_2007_33070_001) (http://www.edctp.org/) and the Research Foundation Flanders (FWO - 3GA13210) (http://www.fwo.be/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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