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Bacterial Vaginosis and Season, a Proxy for Vitamin D Status

Klebanoff, Mark A. MD, MPH*†; Turner, Abigail Norris PhD

Sexually Transmitted Diseases: May 2014 - Volume 41 - Issue 5 - p 295–299
doi: 10.1097/OLQ.0000000000000124
Original Study

Background Low serum vitamin D concentration has been associated with increased prevalence of bacterial vaginosis (BV) among pregnant women, but the few studies conducted in nonpregnant women have produced inconsistent results. Because serum vitamin D concentration is generally higher in the summer and fall than winter and spring, if vitamin D insufficiency causes BV, then BV would be expected to be more common during seasons with lower vitamin D concentrations.

Methods The Longitudinal Study of Vaginal Flora followed up women in Birmingham, Alabama (33.5° latitude), quarterly for up to 1 year. We used a case-crossover design with conditional logistic regression among women who attended visits in each season, to assess the adjusted association between season and BV. We compared each woman’s BV status in summer, fall, and spring to her own status in winter.

Results Among the 3620 women in the parent study, 2337 attended visits in each season; BV prevalence was 40% in winter, 38% in spring, and 41% in summer and fall. One thousand three hundred thirty-five women had BV at some but not all visits and were therefore included in the case-crossover analysis. Season was not associated with BV in women who were BV negative at study entry (odds ratio vs. winter were 1.0 for spring, 1.0 for summer, and 0.9 for fall; P = 0.81). Among women BV positive at study entry, the corresponding odds ratios were 0.9, 1.4, and 1.4 (P < 0.001).

Conclusions These results do not support an association between vitamin D, measured through the proxy variable of season, and BV.

In a longitudinal study, bacterial vaginosis (BV) was more common in summer and fall among women BV positive at entry, but season was not associated with BV among women BV negative at entry.

From the *Research Institute at Nationwide Children’s Hospital, †Departments of Pediatrics and Obstetrics and Gynecology, and ‡Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH

The authors have no conflicts of interest to disclose.

The Longitudinal Study of Vaginal Flora was supported by contract NO1-HD-8-3293 and by Intramural Funds from the National Institutes of Health. A.N.T. was supported by R21 AI095987.

Correspondence: Mark A. Klebanoff, MD, MPH, Nationwide Children’s Hospital, 700 Children’s Dr, WB 5231, Columbus, OH 43215. E-mail:

Received for publication August 30, 2013, and accepted March 3, 2014.

© Copyright 2014 American Sexually Transmitted Diseases Association