Recurrence of Bacterial Vaginosis Is Significantly Associated With Posttreatment Sexual Activities and Hormonal Contraceptive Use

• Published in: Clinical infectious diseases 2013-03, Vol.56 (6), p.777-786
• Main Authors: Bradshaw, Catriona S., Vodstrcil, Lenka A., Hocking, Jane S., Law, Matthew, Pirotta, Marie, Garland, Suzanne M., De Guingand, Deborah, Morton, Anna N., Fairley, Christopher K.
• Format: Article
• Language: English
• Subjects: Administration, Intravaginal; Administration, Oral; Adolescent; Adult; Anti-Infective Agents - administration & dosage; ARTICLES AND COMMENTARIES; Australia - epidemiology; Bacteria; Bacterial diseases; Bacterial diseases of the genital system; Bacterial infections; Bacterial vaginosis; Biological and medical sciences; Birth control; Clindamycin; Clindamycin - administration & dosage; Clinical trials; Condoms; Contraception; Contraceptive Agents - administration & dosage; Contraceptives; Data processing; Double-Blind Method; Estrogens; Female; Flora; Human bacterial diseases; Human sexual behavior; Humans; Infectious diseases; Inventories; Medical practice; Medical sciences; Metronidazole; Metronidazole - administration & dosage; Middle Aged; Oral sex; Placebos - administration & dosage; probiotics; Probiotics - administration & dosage; Recurrence; Risk Factors; Sexual Behavior; Sexual partners; Vagina; Vaginosis; Vaginosis, Bacterial - drug therapy; Vaginosis, Bacterial - epidemiology; Women; Womens health; Young Adult
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cis1030

Background. Bacterial vaginosis (BV) recurrence posttreatment is common. Our aim was to determine if behaviors were associated with BV recurrence in women in a randomized controlled trial (RCT). Methods. Symptomatic 18- to 50-year-old females with BV (≥3 Amsel criteria and Nugent score [NS] = 4–10) were enrolled in a 3-arm randomized double-blind RCT Melbourne Sexual Health Centre, Australia, in 2009–2010. All 450 participants received oral metronidazole (7 days) and were equally randomized to vaginal clindamycin, lactobacillus-vaginal probiotic or vaginal placebo. At 1, 2, 3, and 6 months, participants self-collected vaginal smears and completed questionnaires. Primary endpoint was NS = 7–10. Cox regression was used to estimate hazard ratios (HRs) for risk of BV recurrence associated with baseline and longitudinal characteristics. Results. Four hundred four (90%) women with postrandomization data contributed to analyses. Cumulative 6-month BV recurrence was 28% (95% confidence interval [CI], 24%–33%) and not associated with treatment. After stratifying for treatment and adjusting for age and sex frequency, recurrence was associated with having the same pre-/posttreatment sexual partner (adjusted HR [AHR] = 1.9; 95% CI, 1.2–3.0), inconsistent condom use (AHR = 1.9; 95% CI, 1.0–3.3), and being non-Australian (AHR = 1.5; 95% CI, 1.0–2.1), and halved with use of an estrogen-containing contraceptive (AHR = 0.5; 95% CI, .3–.8). Conclusions. Risk of BV recurrence was increased with the same pre-/posttreatment sexual partner and inconsistent condom use, and halved with use of estrogen-containing contraceptives. Behavioral and contraceptive practices may modify the effectiveness of BV treatment. Clinical Trials Registration. ACTRN12607000350426.