title: Prevalence and correlates of bacterial vaginosis in different sub-populations of women in sub-Saharan Africa: a cross-sectional study.
abstract: BACKGROUND
  Clinical development of vaginally applied products aimed at reducing the transmission of HIV and other sexually transmitted infections, has highlighted the need for a better characterisation of the vaginal environment. We set out to characterise the vaginal environment in women in different settings in sub-Saharan Africa.
  
  
  METHODS
  A longitudinal study was conducted in Kenya, Rwanda and South-Africa. Women were recruited into pre-defined study groups including adult, non-pregnant, HIV-negative women; pregnant women; adolescent girls; HIV-negative women engaging in vaginal practices; female sex workers; and HIV-positive women. Consenting women were interviewed and underwent a pelvic exam. Samples of vaginal fluid and a blood sample were taken and tested for bacterial vaginosis (BV), HIV and other reproductive tract infections (RTIs). This paper presents the cross-sectional analyses of BV Nugent scores and RTI prevalence and correlates at the screening and the enrolment visit.
  
  
  RESULTS
  At the screening visit 38% of women had BV defined as a Nugent score of 7-10, and 64% had more than one RTI (N. gonorrhoea, C. trachomatis, T. vaginalis, syphilis) and/or Candida. At screening the likelihood of BV was lower in women using progestin-only contraception and higher in women with more than one RTI. At enrolment, BV scores were significantly associated with the presence of prostate specific antigen (PSA) in the vaginal fluid and with being a self-acknowledged sex worker. Further, sex workers were more likely to have incident BV by Nugent score at enrolment.
  
  
  CONCLUSIONS
  Our study confirmed some of the correlates of BV that have been previously reported but the most salient finding was the association between BV and the presence of PSA in the vaginal fluid which is suggestive of recent unprotected sexual intercourse.
authors.affiliation: Unit of Epidemiology and Control of HIV/STD, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Vicky
authors.initials: V
authors.lastname: Jespers
authors.affiliation: HIV/STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Tania
authors.initials: T
authors.lastname: Crucitti
authors.affiliation: Clinical Trials Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.affiliation: International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.
authors.forename: Rita
authors.initials: R
authors.lastname: Verhelst
authors.affiliation: ICRH Kenya, Mombasa, Kenya.
authors.forename: Mary
authors.initials: M
authors.lastname: Mwaura
authors.affiliation: ICRH Kenya, Mombasa, Kenya.
authors.forename: Kishor
authors.initials: K
authors.lastname: Mandaliya
authors.affiliation: Rinda Ubuzima, Kigali, Rwanda.
authors.forename: Gilles F
authors.initials: GF
authors.lastname: Ndayisaba
authors.affiliation: Wits Reproductive Health & HIV Institute, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: Verstraelen
authors.affiliation: Unit of Epidemiology and Control of HIV/STD, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Hardy
authors.affiliation: Unit of Epidemiology and Control of HIV/STD, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Buvé
authors.affiliation: Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom, and AMC-CPCD, Amsterdam, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: van de Wijgert
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D060085:Coinfection; D003267:Contraception / Q000523:psychology / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007610:Kallikreins / Q000032:analysis; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D011247:Pregnancy; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000032:analysis; D013587:Syphilis / Q000453:epidemiology*; D014210:Treponema pallidum / Q000302:isolation & purification; D014245:Trichomonas Infections / Q000453:epidemiology*; D014246:Trichomonas vaginalis / Q000302:isolation & purification; D014621:Vagina / Q000737:chemistry / Q000382:microbiology / Q000821:virology; D016585:Vaginosis, Bacterial / Q000453:epidemiology*
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen