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

被引:103
|
作者
Bradshaw, Catriona S. [1 ,5 ,6 ]
Vodstrcil, Lenka A. [1 ]
Hocking, Jane S. [1 ,2 ]
Law, Matthew [9 ]
Pirotta, Marie [3 ]
Garland, Suzanne M. [4 ,7 ,8 ,10 ]
De Guingand, Deborah [1 ]
Morton, Anna N. [5 ]
Fairley, Christopher K. [1 ,5 ]
机构
[1] Univ Melbourne, Melbourne Sch Populat Hlth, Melbourne, Vic, Australia
[2] Univ Melbourne, Ctr Womens Hlth Gender & Soc, Melbourne, Vic, Australia
[3] Univ Melbourne, Dept Gen Practice, Melbourne, Vic, Australia
[4] Univ Melbourne, Dept Obstet & Gynaecol, Melbourne, Vic, Australia
[5] Alfred Hosp, Melbourne Sexual Hlth Ctr, Melbourne, Vic, Australia
[6] Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic 3004, Australia
[7] Royal Womens Hosp, Dept Microbiol & Infect Dis, Melbourne, Vic, Australia
[8] Royal Childrens Hosp, Dept Microbiol, Melbourne, Vic, Australia
[9] Univ New S Wales, Kirby Inst, Darlinghurst, NSW, Australia
[10] Murdoch Childrens Res Inst, Parkville, Vic, Australia
基金
英国医学研究理事会;
关键词
bacterial vaginosis; contraceptive use; estrogen; sexual partner; condom use; HYDROGEN-PEROXIDE; VAGINAL FLORA; GARDNERELLA-VAGINALIS; METRONIDAZOLE PLUS; ORAL METRONIDAZOLE; WOMEN; LACTOBACILLI; PARTNERS; RISK; COLONIZATION;
D O I
10.1093/cid/cis1030
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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.
引用
收藏
页码:777 / 786
页数:10
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