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Viral Sexually Transmitted Infections and Bacterial Vaginosis: 2001–2004 National Health and Nutrition Examination Survey Data

Allsworth, Jenifer E. PhD*; Lewis, Vanessa A. BA; Peipert, Jeffrey F. MD, PhD*

doi: 10.1097/OLQ.0b013e3181788301

Background: Bacterial vaginosis (BV) is a common condition believed to be associated with sexually transmitted infection (STI) susceptibility. Most studies of BV and STIs have come from treatment-seeking or high-risk populations. This study examines the association between 5 viral STIs, human papilloma virus (HPV), HIV, herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2), and Hepatitis C (HCV), and BV among women in the general US population.

Methods: Data from the 2001 and 2003–2004 National Health and Nutrition Examination Surveys were combined. Crude and adjusted relative risks and 95% confidence intervals were estimated from logistic regression analyses for rare outcomes (<10%) and from Poisson regression with robust error variance for common outcomes. Complex survey design was taken into consideration using the survey functions in Stata.

Results: Crude analyses found an association between BV and the prevalence of all 5 STIs. After adjustment for important confounders, only HSV-1 and HSV-2 were significantly associated with the presence of BV. Moreover, crude analyses stratified by race/ethnicity suggested that associations between BV and viral STIs may not be consistent across race/ethnicity subgroups.

Conclusion: This population-based study found that BV was significantly associated with the prevalence of HSV-1 and HSV-2 and potentially associated with HIV and HPV. Given the frequency of BV in US women, small increases in STI susceptibility may have important impacts on STI transmission.

Among women in the United States, bacterial vaginosis was associated with a number of viral sexually associated infections, especially herpes simplex (types I and II).

From the *Department of Obstetrics and Gynecology and †Washington University in St. Louis School of Medicine, St. Louis, Missouri

This research was supported in part by a Midcareer Investigator Award in Women’s Health Research (Peipert, K24 HD01298). Dr. Allsworth is supported by Grant KL2RR024994/5K12RR023249 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

Correspondence: Jenifer E. Allsworth, PhD, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Campus Box 8219, 4533 Clayton Avenue, Suite 100, St. Louis, Missouri 63110. E-mail:

Received for publication November 15, 2007, and accepted March 21, 2008.

© Copyright 2008 American Sexually Transmitted Diseases Association