Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting.
OBJECTIVE
High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK.


METHODS
A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history.


RESULTS
Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p = 0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, kappa = 0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p = 0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora.


CONCLUSIONS
Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.
Evans
Amy L
AL
Department of Genitourinary Medicine, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK. amyevans@doctors.org.uk
Scally
Andrew J
AJ
Wellard
Sarah J
SJ
Wilson
Janet D
JD
D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D020010:Heterosexuality / Q000706:statistics & numerical data*; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*