1. Risks for Bacterial Vaginosis in Lesbian & Bisexual Women
JM Marrazzo, K Ringwood, KK Thomas
University of Washington, Seattle WA

2. Marrazzo J Infect Dis 2002 Bradshaw J Infect Dis 2006
Background
Most common
Cause of vaginal symptoms prompting medical evaluation for vaginitis
Cause of vaginitis
>10% of women experience BV
May cause 11% of preterm deliveries in U.S.
Etiology not understood, but associated with douching, new male partner, unprotected sex in heterosexual women, sex between women
Limited information on mediators for increased risk among WSW
History of BV, shared vaginal sex toys: yes
Recent male partner, no. of female partners: no
Marrazzo J Infect Dis 2002 Bradshaw J Infect Dis 2006

3. Objective
Define risks for BV in lesbian & bisexual women with attention to detailed sexual risk history

4. Methods Subjects recruited to research clinic
16-35 years
Sex with woman (prior year)
Recruited through ads (self-referred) and partners
Computer-assisted self-interview (CASI) at enrollment
Symptoms defined as change in vaginal fluid
BV diagnosed by Amsel criteria
Confirmation with Nugent criteria
Associations between BV & subject characteristics estimated by Fisher’s exact test, chi-square, GEE
Adjusted for enrollment of both partners currently in sexual relationship

5. HC = hormonal contraception
Results
Study Population
335 women enrolled, Oct 2003-Mar 2007
Median age 25 y; 96 (29%) with BV 40
% All Enrolled 30 20
22% nonwhite race
6% Hispanic ethnicity
6% douching in last year
40% sex with men in past year
91% any sexual activity in past 3 months 10
HC = hormonal contraception

6. Results Sexual Partners, Last 90 Days
323 (91%): any sex
276 (82%): recent female partners
33% new partner
80 (24%): recent male partners
10% new partner
Of all 335, 40% with >1 male partner in last year %
Sex of Partners

7. Results Sexual Partners, Last 90 Days%
However, 40% of all 335 reported at least one male SP in last year
N = 277
N = 80
No. of Partners
Most reported 1 partner
22% - 34% reported >1 partner

8. Results Sexual Practices, Last 90 days%
All
Male Partner
“Any” receptive vaginal or anal sex: penis, fingers, toy; IC = intercourse
* For vaginal/anal intercourse & condom use, percentages refer to the 80 women reporting sex with men in last 90 days

9. Results Risk Factors for Prevalent BV: Univariate Analysis
Demographics
Prevalence of BV (%)
OR (95% CI)
Age >26 y 1.3 ( )
Black race 2.0 ( )
Current smoker 1.4 ( )
P=0.17
P=0.22
P=0.33

10. Results Risk Factors for Prevalent BV: Univariate Analysis
Demographics
Prevalence of BV (%)
OR (95% CI)
Age <26 y 1.3 ( )
Black race 2.0 ( )
Current smoker 1.4 ( )
P=0.17
P=0.22
P=0.33
BV-Related History
OR (95% CI)
P<0.001
Prior BV ( )
Partner w/ BV hx ( )
Current symptoms ( )
P=0.007
P=0.07

11. Results Sexual Practices, Last 90 Days
BV Prevalence (%)
P=0.12
P=0.02
P=0.2
P=0.02
P=0.18
OR (95% CI)
Share toy 1.9 (1.1, 3.3)
Vaginal lubricant 2.1 (1.1, 4.1)

12. Behaviors, 90 days prior to visit
Adjusted Risks for BV
Behaviors, 90 days prior to visit OR
95% CI
Vaginal lubricant use
1.86
Shared vaginal sex toy
1.70
Partner with BV history
4.53
Lubricant use and sex toy sharing were correlated (Spearman = 0.3) and thus assessed in separate MVA
No association: age, race, smoking, HCU, douching, vaginal IC, receptive anal or oral sex, no. of or new partners

13. BV+ in Partners Enrolled
47 Partnerships Enrolled
Both BV- 22
BV+/BV- 5
Both BV+ 20
rom the grant:  47 partnerships entering the study:20 couples - both had BV22 couples - neither had BV5 couples - discordant.
Degree of concordance for presence or absence of BV within couples higher than expected (P<0.001)

14. BV+ in Partners Enrolled
Both BV-
22 (13)
BV+/BV-
5 (11)
Both BV+
20 (24)
rom the grant:  47 partnerships entering the study:20 couples - both had BV22 couples - neither had BV5 couples - discordant.
Degree of concordance for presence or absence of BV within couples higher than expected (P<0.001)

15. Conclusions
Distinct risks predict prevalent BV among lesbian & bisexual women
Demographics, hygiene
Not prominent in this largely white group with douching rare
Sex
Vaginal fluid exchange
Vaginal lubricant
Further study needed
Intervention to prevent sexual transfer of vaginal fluid
Risks for incident, persistent and recurrent BV
Molecular description of partners’ vaginal flora
Assessment of lubricant use on vaginal lactobacilli

16. Other components vary: chlorhexidinepH
Other components vary: chlorhexidine

17. Limitations Subjects were self-referred or referred by partners
Limits on reproducibility, generalizability
However, excellent retention and diverse sexual practices
Though many reported sex with men, may not be generalizable to women who are only sexually active with men

18. Acknowledgements Study personnel Support Nancy Dorn Jim Hughes, CFAR
Dana Varon
Lauren Asaba
Susan Heideke
Emily Hancock
Kathy Agnew
Becca Hutcheson
Support
Jim Hughes, CFAR