Association between obesity and bacterial vaginosis as assessed by Nugent score

Background Bacterial vaginosis is one of the most common vaginal conditions in the U.S. Recent studies have suggested obese women have an abnormal microbiota reminiscent of BV; however, few studies have investigated the prevalence of bacterial vaginosis in overweight and obese populations. Moreover, despite the increased prevalence of obesity and bacterial vaginosis in black women, it is not known whether racial disparities exist in the relationship between obesity and bacterial vaginosis. Objective The objective of this study was to examine the relationship between body mass index and bacterial vaginosis as determined by Nugent score and to determine the influence of race in this context. Study Design We performed a cross-sectional study using patient data and vaginal smears from 5,918 participants of the Contraceptive CHOICE Project. Gram stained vaginal smears were scored using the Nugent method and categorized as BV-negative (Nugent score 0-3), BV-intermediate (Nugent score 4-6), or BV-positive (Nugent score 7-10). Body mass index was determined using Centers for Disease Control and Prevention guidelines and obese individuals were categorized as Class I, II, or III obese based on NIH and World Health Organization body mass index parameters. Linear regression was used to model mean differences in Nugent scores and Poisson regression with robust error variance was used to model prevalence of bacterial vaginosis. Results In our cohort, 50.7% of participants were black, 41.5% were white, and 5.1% were of Hispanic ethnicity with an average age of 25.3 years old. Overall, 28.1% of participants were bacterial vaginosis-positive. Bacterial vaginosis was prevalent in 21.3% of lean, 30.4% of overweight, and 34.5% of obese women (p<0.001). The distribution of bacterial vaginosis-intermediate individuals was similar across all body mass index categories. Compared to lean women, Nugent scores were highest among overweight and obese Class I women (adjusted mean difference; overweight 0.33 [95% CI 0.14, 0.51] and Class I obese 0.51 [95% CI 0.29, 0.72]). Consistent with this, overweight and obese women had a higher frequency of bacterial vaginosis compared to lean women, even after adjusting for variables including race. Among white women, the prevalence of BV was higher for overweight and Class I and Class II/III obese white women compared to lean white women, a phenomenon not observed among black women, suggesting an effect modification. Conclusion Overweight and obese women have higher Nugent scores and a greater occurrence of bacterial vaginosis compared to lean women. Black women have a greater prevalence of bacterial vaginosis independent of their body mass index compared to white women

Tuboovarian Abscesses: Is Size Associated with Duration of Hospitalization & Complications?

Objective. To evaluate the association between abscess size and duration of hospitalization and need for surgical intervention. Methods. We collected data from patients admitted with ICD-9 codes 614.9 (PID) and 614.2 (TOA) from January 1, 1999—December 31, 2005. We abstracted data regarding demographics, diagnostic testing/laboratory testing, imaging, treatment, and clinical course. Two abscess groups were created: ≤8 cm or >8 cm. Descriptive statistics were calculated, and duration of hospitalization and surgical intervention for women with large abscesses were compared to women with smaller collections. Results. Of the 373 charts reviewed, 135 had a TOA and 31% required management with drainage and/or surgery. The average abscess size for those treated successfully with conservative management was 6.3 cm versus those requiring drainage and/or surgery (7.7 cm, P = .02). Every 1 cm increase in abscess size as associated with an increase in hospitalization by 0.4 days (P = .001). Abscesses greater than 8 cm were associated with an increased risk of complications (P < .01). Conclusions. Larger tubo-ovarian abscesses are associated with an increased duration of hospitalization and more complications including an increased need for drainage or surgery. Additional research to determine the most efficacious antibiotic regimen management strategy is needed

Correlates of Dual-Method Contraceptive Use: An Analysis of the National Survey of Family Growth (2006–2008)

Objective. To analyze a nationally representative sample of women for correlates of dual-contraceptive-method use. Materials and Methods. We conducted an analysis of the National Survey of Family Growth, 2006–2008, a cross-sectional survey of reproductive-aged women in the United States. Results. Dual method use was reported by 7.3% of the 5,178 women in the sample. Correlates of higher rates of dual-contraceptive-method use included age younger than 36 years and nonmarried marital status. Lower rates of dual method use were observed for women with less than a high-school education and women without consistent health insurance in the past year. Compared to women using oral contraceptives, use of the contraceptive injection or long-acting reversible contraception was associated with lower dual-method use. Conclusions. The overall rate of dual-method use in the USA is low. Future interventions to promote dual method use should target high-risk groups with modifiable risk factors

Adherence to dual-method contraceptive use

Background: Patient characteristics associated with adherence to dual-method contraceptive use are not known. Study Design: Project PROTECT was a 24-month-long randomized trial designed to promote the use of dual methods of contraception using an individualized computer-based intervention or enhanced standard care counseling intervention. We analyzed 463 women with follow-up data and examined sustained dual-method use (reported at 2+ interviews). Results: While 32% initiated dual-method contraceptive use, only 9% reported sustained use. Education increased (RRadj=4.42; 95% confidence interval [CI] 1.19–16.42), substance abuse decreased (adjusted relative risk [RRadj]=0.49; 95% CI 0.24–0.97), no contraceptive use at baseline decreased (RRadj=0.32; 95% CI 0.11–0.92) and contraceptive stage of change increased (RRadj=5.04; 95% CI 1.09–23.4) adherence to dual-method use. Conclusion: To effectively prevent sexually transmitted diseases and unplanned pregnancies, dual-method use must be consistent and sustained. Future interventions to promote dual-method use should focus on high-risk groups and additional dual-method combinations (e.g., barrier plus intrauterine devices or implants)

Tailored intervention to increase dual-contraceptive method use: a randomized trial to reduce unintended pregnancies and sexually transmitted infections

Objective: The objective of the study was to determine whether a transtheoretical model–tailored expert system intervention increases dual-method contraceptive use, compared with a nontailored educational intervention. Study Design: We performed a randomized clinical trial of 542 women at high risk for sexually transmitted infections (STIs) and unintended pregnancy. The intervention group received computer-based tailored feedback using a multimedia program. The control group received general contraceptive information and nontailored advice. Results: Participants in the intervention group were more likely to report use of dual contraceptive methods during follow-up (adjusted hazard rate ratio 1.70, 95% confidence interval 1.09, 2.66), compared with controls. However, there were no differences in the rates of incident STI or unintended pregnancy between the 2 groups. Conclusions: The computer-based transtheoretical model–tailored intervention resulted in a 70% increase in reported dual-method contraceptive use in a group of women at high risk for STIs and unintended pregnancy. Inconsistent use of dual methods may explain the lack of effect on unintended pregnancy rates and incident STIs

Is a previous unplanned pregnancy a risk factor for a subsequent unplanned pregnancy?

Objective: The objective of the study was to determine whether a history of unplanned pregnancy was a risk factor for a subsequent unplanned pregnancy. Study Design: We analyzed 542 women aged 14-35 years, enrolled in Project PROTECT, a randomized clinical trial to promote dual-method contraception use to prevent sexually transmitted diseases and unplanned pregnancy. Predictors of unplanned pregnancy were assessed by comparing women with and without a history of unplanned pregnancy. Results: More than 1 in 5 women (22.5%) experienced an unintended pregnancy. History of an unintended pregnancy was a predictor of unintended pregnancy (adjusted odds ratio, 1.91; 95% confidence interval, 1.09-3.34). Other factors that were significantly associated with unplanned pregnancy included young age and low educational status. Conclusions: Future efforts should focus on bridging the gap between identifying risk factors for unplanned pregnancy and interventions aimed at reducing the incidence in high-risk groups