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

Prostitution in Riga, Latvia--a socio-medical matter of concern

OBJECTIVES: To study the background and the working and socio-economic conditions, and the prevalence of some sexually transmitted diseases (STDs), among street and sex club female Latvian prostitutes. STUDY DESIGN: Structured in-depth interviews, as well as clinical examination and laboratory tests for gonorrhea, syphilis, bacterial vaginosis, trichomoniasis, ectoparasites and HIV-infections. RESULTS: Approximately half of the 107 women stemmed from rural Latvian villages, the rest from the capital city of Riga. Of the women, 15-43 years, 36% were ethnic Latvians and 56% ethnic Russians, as compared to 58% vs. 32% of the population of Latvia. Poor economy with unemployment and miserly living conditions were the main reasons for recruitment to prostitution. The income per client was in the range of 25-30 USD (10-15 Ls), but the pimp and brothel/sex club owner often requires half of the women's fees. Unprotected intercourse was common. Twenty of the women were found to be pregnant. One tenth used narcotic drugs, e.g. ecstasy. The prevalences of gonorrhea, active syphilis, bacterial vaginosis, trichomoniasis and ectoparasites were 10.2%, 15.7%, 68.2%, 35.5% and 15.9% respectively. None was HIV-infected. CONCLUSIONS: There is an urgent need for regulation of the Latvian 'sex industry', means for providing prostitutes with adequate contraceptives, and to allocate resources to clinics for investigation, therapy and counseling