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Open Access Research article

Behavioural and medical predictors of bacterial vaginosis recurrence among female sex workers: longitudinal analysis from a randomized controlled trial

Fernand A Guédou1, Lut Van Damme2, Jennifer Deese2, Tania Crucitti3, Marissa Becker4, Florence Mirembe5, Suniti Solomon6 and Michel Alary1*

Author Affiliations

1 URESP, Centre de recherche FQRS du CHU de Québec, Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada

2 FHI360, Durham, NC, USA

3 Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium

4 Centre for Global Public Health, University of Manitoba, Winnipeg, Canada

5 Makerere University College of Health Sciences, Kampala, Uganda

6 Y.R. Gaitonde Center for AIDS Research and Education, Chennai, India

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BMC Infectious Diseases 2013, 13:208  doi:10.1186/1471-2334-13-208

Published: 8 May 2013

Abstract

Background

Data on risk factors of recurrent bacterial vaginosis (RBV) are still scarce. We used data from female sex workers (FSW) participating in a randomized controlled microbicide trial to examine predictors of BV recurrence.

Methods

Trial’s participants with at least an episode of BV which was treated and/or followed by a negative BV result and at least one subsequent visit offering BV testing were included in the analysis. Behavioural and medical data were collected monthly while laboratory testing for STI and genital tract infections were performed quarterly. The Andersen-Gill proportional hazards model was used to determine predictors of BV recurrence both in bivariate and multivariate analyses.

Results

440 women were included and the incidence rate for RBV was 20.8 recurrences/100 person-months (95% confidence interval (CI) =18.1–23.4). In the multivariate analysis controlling for the study site, recent vaginal cleansing as reported at baseline with adjusted hazard-ratio (aHR)=1.30, 95% CI = 1.02-1.64 increased the risk of BV recurrence, whereas consistent condom use (CCU) with the primary partner (aHR=0.68, 95% CI=0.49-0.93) and vaginal candidiasis (aHR=0.70, 95% CI=0.53-0.93), both treated as time-dependent variables, were associated with decreased risk of RBV.

Conclusion

This study confirms the importance of counselling high-risk women with RBV about the adverse effects of vaginal cleansing and the protective effects of condom use with all types of partners for the prevention of sexually transmitted infections, including BV. More prospective studies on risk factors of BV recurrence are warranted.

Trial registration

Trial registration: NCT00153777

Keywords:
Bacterial vaginosis; Recurrence; Predictors; Female sex workers; Microbicide trial