International study finds BV prevalence nearly 50%

Roughly one of two Ethiopian women were found to have bacterial vaginosis (BV) that strongly correlated with personal hygiene, according to a cross-sectional study in the International Journal of Microbiology.

The study of 210 patients, which examined microscopically Gram-stained vaginal swabs graded as per Nugent’s procedure, was led by Adane Bitew, PhD, of the Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Ethiopia.

In addition, the investigators characterized the bacteria causing aerobic vaginitis and determined their antimicrobial susceptibility pattern.

The global incidence of bacterial vaginosis varies widely, with estimates ranging from 8% to 75%. The infection is also more likely to occur in females of reproductive age.

The authors emphasized that BV should not be considered a “trivial disease” but rather a “morbid disease” because of loss of working days and treatment cost. It is also associated with increased risk of acquiring HIV and other sexually transmitted infections, plus higher rates of miscarriage, preterm labor, preterm delivery and postpartum complications.

Among the information collected from study participants during a face-to-face interview were number of lifetime male sex partners, history of abortion, previous history of genital tract infection, frequency of vaginal bathing and how often they changed pants.

Concerning personal hygiene, women who changed their pants twice a day were much less likely to have BV (36.9%) than those who only changed their pants once every 2 to 4 days (57.6%).

Incidence of infection was also much lower in women who bathed their vaginal area more frequently (40.2%) than not (53.9%).

Although the overall pervasiveness of BV for the study was 48.6%, younger women (15 to 24) had a slightly lower incidence (41.5%), whereas the older group (25 and older) had prevalence between 47.8% and 60.0%.

Likewise, women with a college-level education were less likely to test positive for BV (35.9%) than those with a high school education or less (44.7–55.3%).

Moreover, prevalence of infection was highest among unmarried women (53.8%) versus those who were married (44.8%) or divorced (50.0%).

On the other hand, BV was less likely in women who with a history of the infection (46.3%) than in those with no such history (50.4%). Women with a history of abortion had a higher incidence (53.8%) than those with no history of abortion (46.8%).

Further, women who reported having one to three lifetime male sex partners had a 43.4% prevalence of infection compared to 58% for those who reported at least four lifetime male sex partners.

For diagnosing BV in the laboratory, the study scored bacterial morphotypes from a Gram stain of vaginal fluid: 0–3 representing normal vaginal flora, 4–6 deemed intermediate vaginal flora, and a score of 7–10 as diagnostic for BV.

The five most frequently reported isolated microorganisms with aerobic vaginitis were Escherichia coli, Pseudomonas spp., Staphylococcus aureus, Mycoplasma hominis and Ureaplasma urealyticum.

Of 151 bacterial isolates, 69.5% were Gram-negative and 30.5% were Gram-positive bacteria.

For Gram-positive bacteria, the overall drug resistance level was highest for penicillin (67.4%), tetracycline (58.7%) and erythromycin (45.6%), whereas the three most effective drugs for S. aureus were cefoxitin (97.2%), tobramycin (88.8%) and clindamycin (86.1%).

Conversely, for Gram-negative bacteria, the overall drug resistance level was highest for tetracycline (77.3%), ampicillin (77.1%) and amoxicillin (70.6%), compared to the overall sensitivity rate of amikacin (85.7%) and tobramycin (82.8%).

The authors advocate scheduling routine culture of vaginal samples in patients with vaginitis and the drug susceptibility pattern of each isolate identified. Comprehensive healthcare education targeting bacterial vaginosis is also needed.