title: Recent Biomarker-Confirmed Unprotected Vaginal Sex, But Not Self-reported Unprotected Sex, Is Associated With Recurrent Bacterial Vaginosis.
abstract: BACKGROUND
  Self-reported unprotected vaginal sex seems to increase risk of bacterial vaginosis (BV). However, the validity of self-reports is questionable, given their inconsistency with more objective measures of recent semen exposure such as detection of prostate-specific antigen (PSA). We examined whether recent unprotected sex, as measured both by PSA detection on vaginal swabs and by self-report, was associated with increased BV recurrence.
  
  
  METHODS
  We analyzed randomized trial data from nonpregnant, BV-positive adult women recruited from a sexually transmitted disease clinic. Participants received BV therapy at enrollment and were scheduled to return after 4, 12, and 24 weeks. Bacterial vaginosis (by Nugent score) and PSA were measured at each visit. We used Cox proportional hazards models to examine the association between PSA positivity and recurrent BV. We also evaluated associations between self-reported unprotected sex (ever/never since the last visit and in the last 48 hours, analyzed separately) and recurrent BV.
  
  
  RESULTS
  Prostate-specific antigen and BV results were available for 96 women who contributed 226 follow-up visits. Prostate-specific antigen positivity was associated with increased BV recurrence (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.28-4.21). In contrast, we observed no significant increase in BV recurrence among women self-reporting unprotected sex since the last visit (aHR, 1.63; 95% CI, 0.77-3.43) or in the last 48 hours (aHR, 1.28; 95% CI, 0.70-2.36).
  
  
  CONCLUSIONS
  Estimates from earlier studies linking self-reported unprotected sex and BV may be biased by misclassification. Biomarkers can improve measurement of unprotected sex, a critical exposure variable in sexual health research.
authors: From the *Division of Infectious Diseases, College of Medicine, Ohio State University, Columbus, OH; †School of Medicine and Health Sciences, George Washington University, Washington, DC; ‡Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; §Sexual Health Clinic, Columbus Public Health, Columbus, OH; ¶The Research Institute at Nationwide Children's Hospital, Columbus, OH; and ∥Department of Pediatrics, Ohio State University, Columbus, OH; and **Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH.
authors: Abigail
authors: A
authors: Norris Turner
authors: Patricia
authors: P
authors: Carr Reese
authors: Margaret Christine
authors: MC
authors: Snead
authors: Karen
authors: K
authors: Fields
authors: Melissa
authors: M
authors: Ervin
authors: Athena P
authors: AP
authors: Kourtis
authors: Mark A
authors: MA
authors: Klebanoff
authors: Maria F
authors: MF
authors: Gallo
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000032:analysis*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D057566:Self Report; D012661:Semen / Q000737:chemistry; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D014621:Vagina / Q000737:chemistry* / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology
chemical_list: D015415:Biomarkers; D017430:Prostate-Specific Antigen