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The Prevalence of Bacterial Vaginosis in the United States, 2001-2004; Associations With Symptoms, Sexual Behaviors, and Reproductive Health.
Sex Transm Dis 2007; 34(11):864-869.
Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick
J, Sutton M, Markowitz LE.
Abstract
OBJECTIVES: Bacterial vaginosis (BV), a disturbance of vaginal microflora,
is a common cause of vaginal symptoms and is associated with an increased
risk of acquisition of sexually transmitted infections, HIV, and with adverse
pregnancy outcomes. We determined prevalence and associations with BV among
a representative sample of women of reproductive age in the United States.
STUDY DESIGN: Women aged 14-49 years participating in the National Health
and Nutrition Examination Survey 2001-2004 were asked to submit a self-collected
vaginal swab for Gram staining. BV, determined using Nugent's score, was defined
as a score of 7-10. RESULTS: The prevalence of BV was 29.2% (95% confidence
interval 27.2%-31.3%) corresponding to 21 million women with BV; only 15.7%
of the women with BV reported vaginal symptoms. Prevalence was 51.4% among
non-Hispanic blacks, 31.9% among Mexican Americans, and 23.2% among non-Hispanic
whites (P <0.01 for each comparison). Although BV was also associated with
poverty (P <0.01), smoking (P <0.05), increasing body mass index (chi2
P <0.0001 for trend), and having had a female sex partner (P <0.005),
in the multivariate model, BV only remained positively associated with race/ethnicity,
increasing lifetime sex partners (chi2 P <0.001 for trend), increasing
douching frequency (chi2 P for trend <0.001), low educational attainment
(P <0.01), and inversely associated with current use of oral contraceptive
pills (P <0.005). CONCLUSION: BV is a common condition; 84% of women with
BV did not report symptoms. Because BV increases the risk of acquiring sexually
transmitted infections, BV could contribute to racial disparities in these
infections.