Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Dec 15;202(12):1907-15.
doi: 10.1086/657320. Epub 2010 Nov 10.

Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection

Rebecca M Brotman  1 , Mark A Klebanoff, Tonja R Nansel, Kai F Yu, William W Andrews, Jun Zhang, Jane R Schwebke
Affiliations

Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection

Rebecca M Brotman et al. J Infect Dis. .

Abstract

Background: We sought to assess the relationship between bacterial vaginosis (BV) assessed by Gram stain and incident trichomonal, gonococcal, and/or chlamydial genital infection.

Methods: This longitudinal study included 3620 nonpregnant women aged 15-44 years who presented for routine care at 12 clinics in Birmingham, Alabama. Participants were assessed quarterly for 1 year. Vaginal smears were categorized by the Nugent Gram stain score (0-3, normal; 4-6, intermediate state; 7-10, BV). Pooled logistic regression was used to estimate the hazard ratios for the comparison of trichomonal, gonococcal, and chlamydial infection incidence in participants by Nugent score at the prior visit. Participants were censored at their first visit with a positive test result for trichomonal, gonococcal, and/or chlamydial infection.

Results: Of the 10,606 eligible visits, 37.96% were classified by BV and 13.3% by positive detection of trichomonal, gonococcal, and/or chlamydial infection. An intermediate state or BV at the prior visit was associated with a 1.5-2-fold increased risk for incident trichomonal, gonococcal, and/or chlamydial infection (adjusted hazard ratio [AHR] for intermediate state, 1.41 [95% confidence interval {CI}, 1.12-1.76]; AHR for BV, 1.73 [95% CI, 1.42-2.11]; P= .058 for trend). Estimates were similar for trichomonal-only, gonococcal-only, and chlamydial-only infection outcomes.

Conclusion: BV microbiota as gauged by Gram stain is associated with a significantly elevated risk for acquisition of trichomonal, gonococcal, and/or chlamydial genital infection.

PubMed Disclaimer

Figures

Table 1.
Table 1.
Participant Characteristics at Study Entry by Sexually Transmitted Infection (STI) Acquisition during Observation in the Longitudinal Study of Vaginal Flora in Birmingham, Alabama, 1999–2003 (n=3077)
Table 2.
Table 2.
Number of Incident Sexually Transmitted Infection (STI) Cases and Unadjusted Hazard Ratios (HRs) for Risk of Incident STI by Nugent Score at Prior Visit
Table 3.
Table 3.
Adjusted Hazard Ratios (AHRs) between Bacterial Vaginosis at Prior Visit and Incident Sexually Transmitted Infection (STI)
See this image and copyright information in PMC

References

    1. Sewankambo N, Gray RH, Wawer MJ, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet. 1997;350(9077):546–550. - PubMed
    1. Sobel JD. Is there a protective role for vaginal flora? Curr Infect Dis Rep. 1999;1(4):379–383. - PubMed
    1. van deWijgert JH, Mason PR, Gwanzura L, et al. Intravaginal practices, vaginal flora disturbances, and acquisition of sexually transmitted diseases in Zimbabwean women. J Infect Dis. 2000;181(2):587–594. - PubMed
    1. Gupta K, Stapleton AE, Hooton TM, Roberts PL, Fennell CL, Stamm WE. Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections. J Infect Dis. 1998;178(2):446–450. - PubMed
    1. Wiesenfeld HC, Hillier SL, Krohn MA, Landers DV, Sweet RL. Bacterial vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. Clin Infect Dis. 2003;36(5):663–668. - PubMed

Publication types