title: Bacterial vaginosis, gonorrhea, and chlamydial infection among women attending a sexually transmitted disease clinic: a longitudinal analysis of possible causal links.
abstract: OBJECTIVE
  Interactions between bacterial vaginosis (BV) and inflammatory sexually transmitted infections, such as gonorrhea and chlamydial infection, are not well understood. Furthermore, evidence regarding the sexual transmission of BV is equivocal.
  
  
  METHODS
  We assessed associations between incident BV and incidences of gonorrhea and/or chlamydial infection ("gonorrhea/chlamydia"), as well as similarities in associations for the two processes, among 645 female patients at a sexually transmitted disease clinic in Alabama followed prospectively for 6 months from 1995 to 1998. We identified predictors of both incident BV and gonorrhea/chlamydia and used bivariate logistic regression to determine whether these predictors differed.
  
  
  RESULTS
  Participants completed 3188 monthly, follow-up visits. Several factors associated with incident BV involved sexual intercourse: young age (<16 years) at first intercourse (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.1-1.9), recent drug use during sex (aOR, 1.7; 95% CI, 1.2-2.5), prevalent trichomoniasis (aOR, 2.8; 95% CI, 1.7-4.6) and incident syphilis (aOR, 9.7; 95% CI, 1.9-48.4). Few statistical differences between potential factors for BV and gonorrhea/chlamydia emerged. BV appeared to precede the acquisition of gonorrhea/chlamydia (pairwise odds ratio, 1.6; 95% CI, 1.1-2.3), and vice versa (pairwise odds ratio, 2.4; 95% CI, 1.7-3.5).
  
  
  CONCLUSIONS
  Findings are consistent with a causal role of sexual behavior in the acquisition of BV and confirm that BV facilitates acquisition of gonorrhea/chlamydia and vice versa independently from other risk factors.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA. mgallo@cdc.gov
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Macaluso
authors.forename: Lee
authors.initials: L
authors.lastname: Warner
authors.forename: Michael E
authors.initials: ME
authors.lastname: Fleenor
authors.forename: Edward W
authors.initials: EW
authors.lastname: Hook
authors.forename: Ilene
authors.initials: I
authors.lastname: Brill
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000407:Alabama; D002690:Chlamydia Infections / Q000453:epidemiology / Q000208:ethnology; D015897:Comorbidity; D003268:Contraception Behavior; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D008137:Longitudinal Studies; D012725:Sexual Behavior; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology* / Q000208:ethnology; D013587:Syphilis / Q000453:epidemiology / Q000208:ethnology; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D055815:Young Adult