title: A prospective study of risk factors for bacterial vaginosis in HIV-1-seronegative African women.
abstract: BACKGROUND
  Bacterial vaginosis (BV) is common and has been associated with increased HIV-1 susceptibility. The objective of this study was to identify risk factors for BV in African women at high risk for acquiring HIV-1.
  
  
  METHODS
  We conducted a prospective study among 151 HIV-1-seronegative Kenyan female sex workers. Nonpregnant women were eligible if they did not have symptoms of abnormal vaginal itching or discharge at the time of enrollment. At monthly follow-up, a vaginal examination and laboratory testing for genital tract infections were performed. Multivariate Andersen-Gill proportional hazards analysis was used to identify correlates of BV.
  
  
  RESULTS
  Participants completed a median of 378 (interquartile range 350-412) days of follow-up. Compared with women reporting no vaginal washing, those who reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29, 95% confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98-2.61), and >28 times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of BV. Higher BV incidence was also associated with the use of cloth for intravaginal cleansing (aHR 1.48, 95% CI 1.06-2.08) and with recent unprotected intercourse (aHR 1.75, 95% CI 1.47-2.08). Women using depot medroxyprogesterone acetate contraception were at lower risk for BV (aHR 0.59, 95% CI 0.48-0.73).
  
  
  CONCLUSIONS
  Vaginal washing and unprotected intercourse were associated with increased risk of BV. These findings could help to inform the development of novel vaginal health approaches for HIV-1 risk reduction in women.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA 98104, USA. mcclell@africaonline.co.ke
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: Linnet N
authors.initials: LN
authors.lastname: Masese
authors.forename: Ruth
authors.initials: R
authors.lastname: Gitau
authors.forename: Ludo
authors.initials: L
authors.lastname: Lavreys
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
mesh_terms: D000328:Adult; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D011477:Sex Work; D012747:Sexual Partners; D047568:Unsafe Sex; D044364:Vaginal Douching; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology*