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High Global Burden and Costs of Bacterial Vaginosis

A Systematic Review and Meta-Analysis

Peebles, Kathryn MPH*; Velloza, Jennifer MPH*; Balkus, Jennifer E. PhD*†§; McClelland, R. Scott MD*‡§; Barnabas, Ruanne V. MBChB, DPhil*‡§

Sexually Transmitted Diseases: May 2019 - Volume 46 - Issue 5 - p 304–311
doi: 10.1097/OLQ.0000000000000972
Original Studies

Background Bacterial vaginosis (BV) is the most common vaginal infection among women of reproductive age and is associated with important adverse health outcomes. Estimates of the burden of BV and associated costs are needed to inform research priorities.

Methods We conducted a systematic review and meta-analysis of global BV prevalence among reproductive-aged women in the general population. We searched PubMed and Embase and used random effects models to estimate BV prevalence by global regions. We estimated the direct medical costs of treating symptomatic BV. Assuming a causal relationship, we also estimated the potential costs of BV-associated preterm births and human immunodeficiency virus cases in the United States.

Results General population prevalence of BV is high globally, ranging from 23% to 29% across regions (Europe and Central Asia, 23%; East Asia and Pacific, 24%; Latin America and Caribbean, 24%; Middle East and North Africa, 25%; sub-Saharan Africa, 25%; North America, 27%; South Asia, 29%). Within North America, black and Hispanic women have significantly higher (33% and 31%, respectively) prevalence compared with other racial groups (white, 23%; Asian, 11%; P < 0.01). The estimated annual global economic burden of treating symptomatic BV is US $4.8 (95% confidence interval, $3.7–$6.1) billion. The US economic burden of BV is nearly tripled when including costs of BV-associated preterm births and human immunodeficiency virus cases.

Conclusions The BV prevalence is high globally, with a concomitant high economic burden and marked racial disparities in prevalence. Research to determine the etiology of BV and corresponding prevention and sustainable treatment strategies are urgently needed to reduce the burden of BV among women. Additionally, the exceptionally high cost of BV-associated sequelae highlights the need for research to understand potential causal linkages between BV and adverse health outcomes.

This meta-analysis found globally high prevalence of bacterial vaginosis, with approximately a quarter of women of the general population meeting Nugent criteria for bacterial vaginosis and a concomitantly high economic burden.

From the *Department of Epidemiology, University of Washington;

Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center;

Department of Medicine, and

§Department of Global Health, University of Washington, Seattle, WA

Acknowledgments: The authors thank Diana Louden, MLib, for her guidance in developing their database search strategies, and Gui Liu, MPH, for her assistance in translating articles from Chinese.

Conflict of interest statement: This work was supported by a grant from Symbiomix Therapeutics, LLC. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation. We report no further conflicts of interest.

Sources of Funding: This work was supported by a grant from Symbiomix Therapeutics, LLC. The funders played no role in study design, analysis, or interpretation of data, writing of the manuscript or the decision to submit the paper for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Correspondence: Kathryn Peebles, MPH, 325 Ninth Ave, University of Washington Box 359927, Seattle, WA 98104-2499. E-mail:

Received for publication August 9, 2018, and accepted December 29, 2018.

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© Copyright 2019 American Sexually Transmitted Diseases Association