title: Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis.
abstract: BACKGROUND
  Bacterial vaginosis (BV) and Trichomonas vaginalis (TV) have been estimated to affect one-quarter to one-third of sexually active women worldwide, and are often found concurrently. Few studies have examined this relationship longitudinally to better understand the direction and temporality of this association.
  
  
  METHODS
  Between 2005 and 2006, a cohort of 853 young, sexually active women was followed in Mysore, India; participants were interviewed and tested for BV and TV at baseline, and at 3- and 6-month visit. Generalized estimating equations were used to estimate how changes in vaginal flora between consecutive visits-as defined by Nugent diagnostic criteria for BV-were related to the risk of TV infection at the latter visit, adjusted for sociodemographic and behavioral covariates. Treatment was offered to women with TV and/or symptomatic BV.
  
  
  RESULTS
  After adjustment for covariates, participants with abnormal vaginal flora at 2 consecutive visits had 9 times higher risk of TV (95% CI: 4.1, 20.0) at the latter visit, relative to those with persistently normal flora. An increased risk of TV was also observed for participants whose flora status changed from normal to abnormal (adjusted risk ratio: 7.11, 95% CI: 2.8, 18.2) and from abnormal to normal (adjusted risk ratio: 4.50, 95% CI: 1.7, 11.8).
  
  
  CONCLUSIONS
  Women experiencing abnormal flora during a 3-month span appear to have significantly increased risk of acquiring TV infection. Women of reproductive age in low-resource settings found to have abnormal vaginal flora should be assessed for TV.
authors.affiliation: School of Public Health, University of California, Berkeley, CA 94720, USA. sujit.rathod@yahoo.com
authors.forename: Sujit D
authors.initials: SD
authors.lastname: Rathod
authors.forename: Karl
authors.initials: K
authors.lastname: Krupp
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.forename: Anjali
authors.initials: A
authors.lastname: Arun
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008137:Longitudinal Studies; D008795:Metronidazole / Q000008:administration & dosage; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D014247:Trichomonas Vaginitis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D014246:Trichomonas vaginalis / Q000302:isolation & purification*; D014621:Vagina / Q000382:microbiology*; D014626:Vaginal Smears; D016585:Vaginosis, Bacterial / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D008795:Metronidazole