Factors Associated with Bacterial Vaginosis among Women Who Have Sex with Women: A Systematic Review

Dana S Forcey; Lenka A Vodstrcil; Jane S Hocking; Christopher K Fairley; Matthew Law; Ruth P McNair; Catriona S Bradshaw

doi:10.1371/journal.pone.0141905

Factors Associated with Bacterial Vaginosis among Women Who Have Sex with Women: A Systematic Review

PLoS One. 2015 Dec 16;10(12):e0141905. doi: 10.1371/journal.pone.0141905. eCollection 2015.

Authors

Dana S Forcey^{1

2}, Lenka A Vodstrcil^{1

2}, Jane S Hocking², Christopher K Fairley^{1

3}, Matthew Law⁴, Ruth P McNair⁵, Catriona S Bradshaw^{1

2

3}

Affiliations

¹ Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, 3053, Victoria, Australia.
² Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Level 5, 207 Bouverie Street, The University of Melbourne, Parkville, 3010, Victoria, Australia.
³ Central Clinical School, Monash University, The Alfred Centre, 55 Commercial Road, Melbourne, 3004, Victoria, Australia.
⁴ The Kirby Institute, The University of New South Wales, 101 West Street, Darlinghurst, 2010, New South Wales, Australia.
⁵ Department of General Practice, The University of Melbourne, Parkville, 3010, Victoria, Australia.

Abstract

Background: Women who have sex with women (WSW) have a higher burden of bacterial vaginosis (BV) than heterosexual women; studies of risk factors specific to this population are limited. We summarised current knowledge regarding risk factors for BV among WSW by systematic review.

Methods: This systematic review was conducted according to the PRISMA statement. PUBMED, EMBASE, Web of Science and The Cochrane Library were searched to 31st December, 2014.

Inclusion criteria: 1) WSW included in the study population; 2) accepted BV diagnostic method; 3) investigated or could extrapolate factors(s) associated with BV acquisition, persistence or transmission in WSW specifically by comparing BV positive to BV negative women. Search was limited to English-language publications.

Results: A limited number of studies have investigated BV in WSW. Of 71 unique references, 18 full-text articles were assessed and 14 studies fulfilled inclusion criteria. BV was positively associated with higher numbers of female partners, both lifetime and in the three months prior to diagnosis, and confirmed BV in a female partner, but inconsistently associated with partners' BV history or symptoms. BV was not associated with ethnicity, vaginal douching or hormonal contraception. The impact of specific sexual activities, male sexual contact, smoking and the menstrual cycle varied considerably between study populations.

Conclusion: BV in WSW is associated with increased numbers of recent and past female partners and confirmed BV in a female partner. There are limited studies of BV in WSW populations, and research is needed to further elucidate risk factors for BV among WSW. However these data provide epidemiological evidence that BV risk in women is directly related to exposure to other female partners and a partner with BV, providing support for the concept that BV is likely to be transmitted between women.

Systematic review registration number: CRD42014009536 (PROSPERO).

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Female
Homosexuality, Female*
Humans
Incidence
Male
Prevalence
Risk Factors
Sexual Behavior
Sexual Partners
Vaginosis, Bacterial / epidemiology*
Vaginosis, Bacterial / microbiology

Grants and funding

This work is supported by The University of Melbourne Medical School and the Melbourne School of Population and Global Health, a National Health and Medical Research Council Project Grant (APP 102457) and Fellowship grant (APP566576) to JSH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.