title: Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use.
abstract: BACKGROUND
  Bacterial vaginosis (BV) recurrence posttreatment is common. Our aim was to determine if behaviors were associated with BV recurrence in women in a randomized controlled trial (RCT).
  
  
  METHODS
  Symptomatic 18- to 50-year-old females with BV (≥3 Amsel criteria and Nugent score [NS] = 4-10) were enrolled in a 3-arm randomized double-blind RCT Melbourne Sexual Health Centre, Australia, in 2009-2010. All 450 participants received oral metronidazole (7 days) and were equally randomized to vaginal clindamycin, lactobacillus-vaginal probiotic or vaginal placebo. At 1, 2, 3, and 6 months, participants self-collected vaginal smears and completed questionnaires. Primary endpoint was NS = 7-10. Cox regression was used to estimate hazard ratios (HRs) for risk of BV recurrence associated with baseline and longitudinal characteristics.
  
  
  RESULTS
  Four hundred four (90%) women with postrandomization data contributed to analyses. Cumulative 6-month BV recurrence was 28% (95% confidence interval [CI], 24%-33%) and not associated with treatment. After stratifying for treatment and adjusting for age and sex frequency, recurrence was associated with having the same pre-/posttreatment sexual partner (adjusted HR [AHR] = 1.9; 95% CI, 1.2-3.0), inconsistent condom use (AHR = 1.9; 95% CI, 1.0-3.3), and being non-Australian (AHR = 1.5; 95% CI, 1.0-2.1), and halved with use of an estrogen-containing contraceptive (AHR = 0.5; 95% CI, .3-.8).
  
  
  CONCLUSIONS
  Risk of BV recurrence was increased with the same pre-/posttreatment sexual partner and inconsistent condom use, and halved with use of estrogen-containing contraceptives. Behavioral and contraceptive practices may modify the effectiveness of BV treatment.
  
  
  BACKGROUND
  ACTRN12607000350426.
authors.affiliation: Melbourne School of Population Health, University of Melbourne, Australia. cbradshaw@mshc.org.au
authors.forename: Catriona S
authors.initials: CS
authors.lastname: Bradshaw
authors.forename: Lenka A
authors.initials: LA
authors.lastname: Vodstrcil
authors.forename: Jane S
authors.initials: JS
authors.lastname: Hocking
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Marie
authors.initials: M
authors.lastname: Pirotta
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Garland
authors.forename: Deborah
authors.initials: D
authors.lastname: De Guingand
authors.forename: Anna N
authors.initials: AN
authors.lastname: Morton
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
mesh_terms: D000282:Administration, Intravaginal; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001315:Australia / Q000453:epidemiology; D002981:Clindamycin / Q000008:administration & dosage*; D003270:Contraceptive Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage; D019936:Probiotics / Q000008:administration & dosage*; D012008:Recurrence; D012307:Risk Factors; D012725:Sexual Behavior; D016585:Vaginosis, Bacterial / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D003270:Contraceptive Agents; D010919:Placebos; D008795:Metronidazole; D002981:Clindamycin