Recent Biomarker-Confirmed Unprotected Vaginal Sex, But Not Self-Reported Unprotected Sex, Is Associated with Recurrent Bacterial Vaginosis
BACKGROUND:
Self-reported
unprotected vaginal sex seems to increase risk of bacterial vaginosis (BV).
However, the validity of self-reports is questionable, given their
inconsistency with more objective measures of recent semen exposure such as
detection of prostate-specific antigen (PSA). We examined whether recent
unprotected sex, as measured both by PSA detection on vaginal swabs and by
self-report, was associated with increased BV recurrence.
METHODS:
We
analyzed randomized trial data from nonpregnant, BV-positive adult women
recruited from a sexually transmitted disease clinic. Participants received BV
therapy at enrollment and were scheduled to return after 4, 12, and 24 weeks.
Bacterial vaginosis (by Nugent score) and PSA were measured at each visit. We
used Cox proportional hazards models to examine the association between PSA
positivity and recurrent BV. We also evaluated associations between
self-reported unprotected sex (ever/never since the last visit and in the last
48 hours, analyzed separately) and recurrent BV.
RESULTS:
Prostate-specific
antigen and BV results were available for 96 women who contributed 226
follow-up visits. Prostate-specific antigen positivity was associated with
increased BV recurrence (adjusted hazard ratio [aHR], 2.32; 95% confidence
interval [CI], 1.28-4.21). In contrast, we observed no significant increase in
BV recurrence among women self-reporting unprotected sex since the last visit
(aHR, 1.63; 95% CI, 0.77-3.43) or in the last 48 hours (aHR, 1.28; 95% CI,
0.70-2.36).
CONCLUSIONS:
Estimates
from earlier studies linking self-reported unprotected sex and BV may be biased
by misclassification. Biomarkers can improve measurement of unprotected sex, a
critical exposure variable in sexual health research.
- 1From the *Division of Infectious Diseases, College of Medicine, Ohio State University, Columbus, OH; †School of Medicine and Health Sciences, George Washington University, Washington, DC; ‡Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; §Sexual Health Clinic, Columbus Public Health, Columbus, OH; ¶The Research Institute at Nationwide Children's Hospital, Columbus, OH; and ∥Department of Pediatrics, Ohio State University, Columbus, OH; and **Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH.
- Sex Transm Dis. 2016 Mar;43(3):172-6. doi: 10.1097/OLQ.0000000000000414.
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