Prospective study of correlates of vaginal Lactobacillus colonisation among high-risk HIV-1 seronegative women. Issue 5 (26th March 2009)

• Record Type: Journal Article
• Authors: Baeten, J M; Hassan, W M; Chohan, V; Richardson, B A; Mandaliya, K; Ndinya-Achola, J O; Jaoko, W; McClelland, R S
• Is Part Of: Sexually transmitted infections. Volume 85:Issue 5(2009)
• Page Start: 348
• Page End: 353
• Publication Date: 2009-03-26
• Subjects: Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sti.2008.035451
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Objective: Vaginal colonisation with Lactobacillus species is characteristic of normal vaginal ecology. The absence of vaginal lactobacilli, particularly hydrogen peroxide (H2 O2 )-producing isolates, has been associated with symptomatic bacterial vaginosis (BV) and increased risk for HIV-1 acquisition. Identification of factors associated with vaginal Lactobacillus colonisation may suggest interventions to improve vaginal health. Methods: We conducted a prospective cohort study of correlates of vaginal Lactobacillus colonisation among Kenyan HIV-1 seronegative female sex workers. At monthly follow-up visits, vaginal Lactobacillus cultures were obtained. Generalised estimating equations were used to examine demographic, behavioural and medical correlates of Lactobacillus isolation, including isolation of H2 O2 -producing strains. Results: Lactobacillus cultures were obtained from 1020 women who completed a total of 8896 follow-up visits. Vaginal washing, typically with water alone or with soap and water, was associated with an approximately 40% decreased likelihood of Lactobacillus isolation, including isolation of H2 O2 -producing strains. Recent antibiotic use, excluding metronidazole and treatments for vaginal candidiasis, reduced Lactobacillus isolation by ∼30%. H2 O2 -producing lactobacilli were significantly less common among women with Trichomonas vaginalis infection and those who were seropositive for herpes simplex virus type 2. In contrast, H2 O2 -producing lactobacilli were significantly more common among women with concurrent vaginal candidiasis. Conclusions: Modifiable biological and behavioural factors are associated with Lactobacillus colonisation in African women. Our results suggest intervention strategies to improve vaginal health in women at high risk for HIV-1.