Characterizations of Bacterial Vaginosis among HIV-positive and HIV-negative Women in Rural Eastern Cape Province, South Africa

Identification: Apalata, Teke

Characterizations of Bacterial Vaginosis among HIV-positive and HIV-negative Women in
Rural Eastern Cape Province, South Africa
Teke Apalata1,2, Nojaholo Sandisiwe1, Ntombizodumo Nxasana1 and Sandeep Vasaikar1,2
1Division of Medical Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Health Sciences - Walter Sisulu University & 2National Health Laboratory Services (NHLS), Mthatha, South Africa  
Background: Bacterial vaginosis (BV) is associated with the transmission and acquisition of HIV infection. The present study sought to determine the prevalence and characteristics of BV among HIV infected and uninfected women in rural Estern Cape province of South Africa.
Methods: A descriptive cross sectional study design was conducted between September 2017 and March 2018. Women aged 18 years and above, attending Nelson Mandela Academic Hospital and Ngangelizwe Community Health Centre with signs and symptoms suggestive of vaginal infection were enrolled. A clinical diagnosis was made by the attending doctor or nurse, clinical records were used to identify patients' clinical and demographic information. Women were also interviewed using structured questionnaires. High vaginal swabs were collected and the laboratory diagnosis of BV was made using Nugent's score. SPSS version 22 software was used for analysis and a p-value below 0.05 was considered significant.
Results: A total of 100 women were enrolled (61% HIV positive and 39% HIV negative). The mean age of participants was 27.6 years ranging from 18 to 50 years. The pravalence rate of BV was 70% irrespective of HIV status. Of 61 HIV infected patients, 49 (80.3%) and 12 (19.7%) were BV posive and BV negative respectively; whilst of 39 HIV uninfected women, 21 (53.8%) and 18 (46.2%) were BV positive and BV negative respectively (OR = 3.5 CI: 1.4 - 8.5; p = 0.005). Women aged above 35 years were high likely to develop BV as compared to those below 35 years (p = 0.049). The presence of Mobiluncus species (>25 per high microscopic field) was significantly associated with BV among HIV infected patients (p = 0.030). A recent history of antibiotic use (≤3 months) was significantly associated with BV among HIV negative patients (p = 0.044). The presence of Gardnerella vaginalis and other known BV traditional risk factors (douching, diabetes mellitus, contraceptive use and sexually transmitted infections) were not found to be significantly associated with BV among the study participants (p > 0.05) irrespective of their HIV status.
Conclusion: BV is more prevalent among HIV-positive women than their HIV-negative counterparts, and its occurrence is higher among those aged above 35 years. Antibiotic use is associated with BV occurrence among HIV negative patients while the predominance of Mobiluncus species in the vagina microbiota of HIV infected women might play a significant role in the development of BV.
Keywords: Bacterial vaginosis, HIV infection, Mobiluncus species, antibiotics, and Nugent score


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