Bacterial vaginosis increases STI risk

Bacterial vaginosis increases STI risk | Image Credit: © Kzenon - © Kzenon - stock.adobe.com.

According to a recent study published in the Indian Journal of Dermatology, Venerology, and Leprology, there is a significant association between dysbiosis in vaginal microbiota and increased sexually transmitted infection (STI) and vulvovaginal candidiasis risk.

Bacterial vaginosis (BV) occurs because of shifts in vaginal flora, with the vaginal lactobacilli dominated by anaerobes and gram-negative bacteria growth. This causes disruptions in the vaginal microflora and presents as white, thin, and malodorous discharge. 

BV is seen in about 15% to 49% of women worldwide, causing morbidity and complications in reproductive health. Categories of vaginal flora include BV normal, intermediate and positive. Categorization is often accomplished using Nugent scoring. However, there is little information on intermediate Nugent Score.

To determine the association of STIs in BV positive and BV intermediate categories separately, investigators conducted a study from January 1, 2017, to December 31, 2021. Data was gathered at the regional STIs reference, research and training center of the Postgraduate Institute of Medical Education and Research, Chandigarh.

Participants included female individuals aged 16 to 65 years with vaginitis and one of the primary complaints, which included burning micturition, vaginal discharge, lower abdominal pain, itching, and infertility. There were 3531 clinical samples collected from these patients, with health care professionals obtaining 2 vaginal swabs during routine pelvic examinations.

Exclusion criteria included having received antifungals or antibiotics in the previous week, having tuberculosis and malignancies, and being menstruating or pregnant. Analyses of BV, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis Ureaplasmaurealyticum, syphilis, and yeast were performed.

Enrolled patients were aged a median 28 years. When examining Nugent scores, positive BV was seen in 13.6% of patients, intermediate in 23.7%, and negative in 62.7%. The presence of 1 or 2 infected sexually transmitted organisms was seen in 7.7% of BV positive patients, 6.2% of BV intermediate, and 2.8% of BV negative.

BV positive was seen more often in patients aged 21 to 35 years, followed by those aged 36 to 50 years. BV intermediate cases were also more common in patients aged 21 to 35 years.Cervicitis and discharge were reported in 10.9% of the BV intermediate group, 7.1% of the BV negative group, and 7.7% of the BV positive group.

Trichomonas vaginaliswas seen in 31.3% of patients with BV, with a diagnosis 3 times more likely in BV positive patients than BV negative patients. The odds of positive Trichomonas vaginalistest results coincided with the increase of abnormal vaginal flora.

These results indicated increased STI risk among BV positive patients with an increase of Nugent scoring. Investigators recommended future studies be conducted to determine if intervention should be applied to BV intermediate individuals.

Reference

Sethi S, Kanaujia R, Yadav R, et al.Association of intermediate Nugent Score and bacterial vaginosis with sexually transmitted infections and vulvovaginal candidiasis. Indian J Dermatol Venereol Leprol. 2023:1-6. doi:10.25259/IJDVL_775_2022