The epidemiology of bacterial vaginosis in relation to sexual behaviour

<p>Abstract</p> <p>Background</p> <p>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 micro-organisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.</p> <p>Discussion</p> <p><it>G. vaginalis </it>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. <it>G. vaginalis </it>carriage is enhanced by penetrative sexual contact but also by non-penetrative digito-genital contact and oral sex, again indicating that sex <it>per se</it>, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of <it>G. vaginalis</it>, presumably explaining the high concordance rates of <it>G. vaginalis </it>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.</p> <p>Summary</p> <p>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 <it>sexually enhanced disease</it>, with frequency of intercourse being a critical factor.</p

Gynaecological and microbiological findings in women attending for a general health check-up

Two hundred apparently healthy sexually active women, 17-34 years of age, who had presented for a general health check-up at the Clinic of Dermatology and Venereology, Medical University, Plovdiv, Bulgaria, were asked about genital symptoms, sexual behaviour, contraceptive use and smoking habits, and examined for signs of genital infections. They were searched for genital chlamydial infection, gonorrhoea, trichomoniasis, bacterial vaginosis (BV) and vulvovaginal candidosis, syphilis and HIV. Polymerase chain reaction (PCR) was used for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine samples and the results were compared with direct immunofluorescence (DFA) and enzyme immunoassays (EIA) for C. trachomatis in urethral, cervical and urine samples. In 56 (28%) women, an STD and/or an STD-related condition were diagnosed. The prevalence of genital chlamydial infection, trichomoniasis, BV and vulvovaginal candidosis was 4.5%, 0.5%, 17.5% and 7.5% respectively. On direct questioning 39 (19.5%) women reported symptoms suggestive of an infection, while 58 (29%) had signs that may have been caused by genital infection. In urine the PCR tests detected more (3.5%) chlamydia-positive women than the DFA (2.5%) and EIA tests (1.5%). The urine PCR test was as sensitive as the DFA when testing cervical samples. The chlamydia-positive women and women with BV were less likely to have a steady partner than the controls. No woman had syphilis or HIV infection. The women with BV were more frequent users of an intrauterine device and were more likely to smoke heavily compared with other women. STDs and STD-related conditions are common among adult women who consider themselves gynaecologically healthy. Screening for genital infections among women in reproductive age attending for health check-up could improve women's reproductive health

History, clinical findings, sexual behavior and hygiene habits in women with and without recurrent episodes of urinary symptoms

BACKGROUND: To compare women with and without a history of recurrent symptoms suggestive of a urinary tract infection but a current negative urine culture regarding symptoms and signs of a genital infection, carriership of sexually transmitted agents and vaginal flora changes, sexual behavior and genital hygiene practice. SETTINGS: Contraceptive attendees at family planning and youth clinics. MATERIALS AND METHODS: Two hundred and seventeen women who reported recurrent symptoms of dysuria, frequent micturition, and urgency and had a negative bacterial urine culture were recruited as cases. Seven hundred and ten culture-negative women lacking such symptoms served as controls. A careful record was made including details about gynecological symptoms, sexual behavior and genital hygiene practice. Gynecological signs were noted at gynecological examination. Genital infections, including sexually transmitted diseases, were diagnosed. RESULTS: The mean age of the two groups studied was 26.2 and 25.8 years, respectively. Symptoms, such as dysmenorrhea, vaginal discharge, genital pruritus, abdominal pain and superficial dyspareunia were more frequent in the study group than among the controls. On examination, only erythema was observed more often. However, the cases more often had a history of genital herpes and vulvovaginal candidosis. They used tampons only for menstrual purposes, and soap for genital hygiene, but more often used low-pH solutions and took hot baths less frequently. The women with recurrent urinary symptoms more often masturbated and more often had experience of anal sex and sex during menstruation than the control group. CONCLUSIONS: Sexual behavior and genital hygiene habits may play an etiological role in the lives of women with recurrent episodes of urinary symptoms with a negative bacterial urine culture

The health of the Roma people: a review of the published literature

BACKGROUND—The Roma people originated in northern India and have been known in Europe for nearly a thousand years. For much of that time they have been the subjects of discrimination and oppression, culminating in the extermination of half a million Roma in the Nazi death camps. While it is widely believed that the health of Roma people is often poorer than the majority population, these inequalities remain largely unresearched.
METHODS—Published literature on the health of the Roma people was identified using Medline. Opinion pieces were excluded, as were papers relating to anthropometry and to genetic markers. The resultant papers were analysed by country of study and by disease type or care group.
RESULTS—Some 70% of papers identified related to just three countries; Spain and the Czech and Slovak Republics. Much literature concentrates upon communicable disease or reproductive health. The limited evidence suggests increased morbidity from non-communicable disease, but there is little published on this topic. Evidence on health care, though fragmentary, suggests poorer access to health services and uptake of preventative care.
DISCUSSION—Published research on the health needs of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. There is a need for both further research into the health of Roma people; with particular emphasis on non-communicable disease; and also for interventions that improve Roma health. Such research must, however, be handled with sensitivity, recognising the social and political context of the society concerned.


Keywords: gypsies; inequalities; ethnicity; social exclusio