title: Risk of Bacterial Vaginosis Among Women With Herpes Simplex Virus Type 2 Infection: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Bacterial vaginosis (BV) is a perturbation of vaginal flora characterized by reduced levels of lactobacilli and concomitant overgrowth of anaerobic bacterial species. BV is highly prevalent and associated with multiple adverse outcomes, including enhanced human immunodeficiency virus transmission. Because recent reports reveal that herpes simplex virus type 2 (HSV-2) infection may increase BV risk, we initiated a systematic review and meta-analysis of the link between HSV-2 infection and BV.
  
  
  METHODS
  We searched the MEDLINE, EMBASE, and CENTRAL databases to identify articles posted before 1 December 2014. Two screeners independently reviewed the titles and abstracts of all identified articles, reviewed the full text of articles deemed potentially eligible, and extracted data from 14 cross-sectional and 3 prospective studies. Using random-effects models, we computed separate pooled estimates for cross-sectional and prospective studies.
  
  
  RESULTS
  The pooled odds ratio for cross-sectional studies was 1.60 (95% confidence interval, 1.32-1.94). Stronger support for the causal effect of HSV-2 infection on BV risk was revealed by the summary relative risk for the prospective studies, which was 1.55 (95% confidence interval, 1.30-1.84), with minimal heterogeneity (I(2) = 0).
  
  
  CONCLUSIONS
  These analyses imply that HSV-2 infection is an important BV risk factor. Pharmacologic HSV-2 suppression may reduce BV incidence and BV-associated adverse events.
authors.affiliation: Division of Epidemiology.
authors.forename: Allahna
authors.initials: A
authors.lastname: Esber
authors.affiliation: Department of Microbial Infection and Immunity Department of Obstetrics and Gynecology.
authors.forename: Rodolfo D
authors.initials: RD
authors.lastname: Vicetti Miguel
authors.affiliation: Department of Microbial Infection and Immunity Department of Obstetrics and Gynecology.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Cherpes
authors.affiliation: Department of Pediatrics Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Klebanoff
authors.affiliation: Division of Epidemiology.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Ohio State University.
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
mesh_terms: D005260:Female; D006558:Herpes Genitalis / Q000150:complications*; D006801:Humans; D018570:Risk Assessment; D016585:Vaginosis, Bacterial / Q000453:epidemiology*
keywords: bacterial vaginosis; herpes simplex virus type 2; meta-analysis; systematic review