AEGiS-13IAC: Bacterial vaginosis: evidence for sexual transmission and association with HIV-1 infection.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Bacterial vaginosis: evidence for sexual transmission and association with HIV-1 infection.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrA229)

Bukusi E, Cohen C, Karanja J, Waiyaki P, Bwayo J, Eschenbach D, Eschenbach D, Kreiss J, Holmes K
E. Bukusi, University of Nairobi, Department of Medical Microbiology, P.O. Box 19676, Nairobi, Kenya, Tel.: +254 2 714 851, Fax: +254 2 583 171, E-mail: ebukusi@ratn.org

INTRODUCTION: Bacterial vaginosis (BV), found in up to 50% of reproductive aged women in sub-Saharan Africa, has been estimated to account for 30% of female HIV-1 acquisition. Therefore, we wanted to define risk factors in women and their male sexual partners.

METHODS: Symptomatic and asymptomatic women aged 18 - 45, and their male partners, were recruited from a family planning clinic and a STD clinic in Nairobi, Kenya. Participants underwent a standardized questionnaire, physical examination, and STD and HIV-1 testing. A vaginal swab was collected for Gram stain to diagnose BV using Nugents criteria, and male urethral swabs were evaluated for bacteria with similar morphotypes found in BV. Women with BV were compared to women with normal vaginal flora.

RESULTS: One hundred and thirty-five women were recruited: 86 (64%) from the family planning clinic and 49 (36%) from the STD clinic. BV was diagnosed in 53 (40%), intermediate flora in 41 (30%) and normal flora in 41 (30%). BV positive women had an earlier sexual debut (17.2 vs. 18.3, p>.03), greater lifetime number of sexual partners (p>.01), shorter interval since last intercourse (2 vs. 3 days, p>.04) and greater likelihood of a current uncircumcised sexual partner (10% vs. 2%, p>.02) than women without BV. In addition, BV was positively associated with HIV-1 infection (20% vs. 5%, p = .05). Male partners of women with BV had a greater number of sexual partners in the last 3 months (p>.02) and last year (p>.03). Bacteria similar to the BV associated Gram negative morphotypes were detected in 20% of urethral swabs from men whose partner had BV and in none of those with partners without BV (p>.04).

CONCLUSION: Our finding that BV is associated with high risk sexual behavior in both women and men, the protective effect of male circumcision and identification of BV associated organisms in the male urethra support the hypothesis of sexual transmission of BV.

Keywords: AEGIS, Vaginosis, Bacterial, HIV Infections, Sexual Partners, Risk Factors, HIV-1, Vagina, Circumcision, Bacteria, Africa South of the Sahara, Kenya, Human, Female, Male, transmission, surgery
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MoOrA229