title: Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis.
abstract: BACKGROUND
  Bacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women's views and experiences of the triggering factors associated with BV onset and recurrence.
  
  
  METHODS
  Women aged 20-49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV.
  
  
  RESULTS
  103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical-and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV.
  
  
  CONCLUSIONS
  These data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use.
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia.|Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jade E
authors.identifier: http://orcid.org/0000-0003-0461-2605
authors.initials: JE
authors.lastname: Bilardi
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia.|Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Walker
authors.affiliation: Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Meredith J
authors.initials: MJ
authors.lastname: Temple-Smith
authors.affiliation: Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Ruth P
authors.initials: RP
authors.lastname: McNair
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Mooney-Somers
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia.|Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Lenka A
authors.initials: LA
authors.lastname: Vodstrcil
authors.affiliation: Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Bellhouse
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia.|Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia.|Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia.|Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Catriona S
authors.initials: CS
authors.lastname: Bradshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D001419:Bacteria / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D008875:Middle Aged; D036301:Qualitative Research; D012008:Recurrence; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000150:complications*; D011795:Surveys and Questionnaires; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000209:etiology* / Q000523:psychology*; D055815:Young Adult