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The epidemiology of bacterial vaginosis in relation to sexual behaviour

Hans Verstraelen UGent, Rita Verhelst, Mario Vaneechoutte UGent and Marleen Temmerman UGent (2010) BMC INFECTIOUS DISEASES. 10.
abstract
Background: Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic microorganisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour. Discussion: G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced by penetrative sexual contact but also by non-penetrative digitogenital contact and oral sex, again indicating that sex per se, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of G. vaginalis, presumably explaining the high concordance rates of G. vaginalis carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection. Summary: Though male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a sexually enhanced disease, with frequency of intercourse being a critical factor.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
HAEMOPHILUS-VAGINALIS, NONSPECIFIC VAGINITIS, CONDOM USE, PEROXIDE-PRODUCING LACTOBACILLI, SIMPLEX-VIRUS TYPE-2, GARDNERELLA-VAGINALIS INFECTION, TRANSMITTED-DISEASE ACQUISITION, URINARY-TRACT-INFECTION, RISK-FACTORS, FEMALE GENITAL-TRACT
journal title
BMC INFECTIOUS DISEASES
BMC Infect. Dis.
volume
10
pages
11 pages
Web of Science type
Article
Web of Science id
000276836800001
JCR category
INFECTIOUS DISEASES
JCR impact factor
2.825 (2010)
JCR rank
27/57 (2010)
JCR quartile
2 (2010)
ISSN
1471-2334
DOI
10.1186/1471-2334-10-81
language
English
UGent publication?
yes
classification
A1
additional info
article no. 81 (11 p.)
copyright statement
I have retained and own the full copyright for this publication
id
941709
handle
http://hdl.handle.net/1854/LU-941709
date created
2010-05-04 10:46:10
date last changed
2016-12-19 15:46:23
@article{941709,
  abstract     = {Background: Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic microorganisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.
Discussion: G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced by penetrative sexual contact but also by non-penetrative digitogenital contact and oral sex, again indicating that sex per se, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of G. vaginalis, presumably explaining the high concordance rates of G. vaginalis carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection.
Summary: Though male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a sexually enhanced disease, with frequency of intercourse being a critical factor.},
  author       = {Verstraelen, Hans and Verhelst, Rita and Vaneechoutte, Mario and Temmerman, Marleen},
  issn         = {1471-2334},
  journal      = {BMC INFECTIOUS DISEASES},
  keyword      = {HAEMOPHILUS-VAGINALIS,NONSPECIFIC VAGINITIS,CONDOM USE,PEROXIDE-PRODUCING LACTOBACILLI,SIMPLEX-VIRUS TYPE-2,GARDNERELLA-VAGINALIS INFECTION,TRANSMITTED-DISEASE ACQUISITION,URINARY-TRACT-INFECTION,RISK-FACTORS,FEMALE GENITAL-TRACT},
  language     = {eng},
  pages        = {11},
  title        = {The epidemiology of bacterial vaginosis in relation to sexual behaviour},
  url          = {http://dx.doi.org/10.1186/1471-2334-10-81},
  volume       = {10},
  year         = {2010},
}

Chicago
Verstraelen, Hans, Rita Verhelst, Mario Vaneechoutte, and Marleen Temmerman. 2010. “The Epidemiology of Bacterial Vaginosis in Relation to Sexual Behaviour.” Bmc Infectious Diseases 10.
APA
Verstraelen, H., Verhelst, R., Vaneechoutte, M., & Temmerman, M. (2010). The epidemiology of bacterial vaginosis in relation to sexual behaviour. BMC INFECTIOUS DISEASES, 10.
Vancouver
1.
Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M. The epidemiology of bacterial vaginosis in relation to sexual behaviour. BMC INFECTIOUS DISEASES. 2010;10.
MLA
Verstraelen, Hans, Rita Verhelst, Mario Vaneechoutte, et al. “The Epidemiology of Bacterial Vaginosis in Relation to Sexual Behaviour.” BMC INFECTIOUS DISEASES 10 (2010): n. pag. Print.