High rate of bacterial vaginosis among women with intrauterine devices in Manado, Indonesia.

Recent research reported that bacterial vaginosis (BV) might enhance the acquisition and transmission of HIV. BV is also associated with an increased risk of pelvic inflammatory disease, a disease also associated with intrauterine device (IUD) insertion. To measure the magnitude of this problem, we conducted a prevalence survey of BV and sexually transmitted diseases (STDs; defined as current infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and/or Trichomonas vaginalis) among all patients attending a family planning clinic in Manado from May to July 1999. BV was diagnosed by Gram stain using Nugent's criteria and vaginal trichomoniasis by wet mount or culture. Cervical infections with C. trachomatis and N. gonorrhoeae were diagnosed by DNA probe. Of 357 patients, 116 (32.5%) had BV, 83 (23.3%) had trichomoniasis, 9 (2.5%) had chlamydia, and 8 (2.2%) had gonorrhea. The prevalence of STD was similar among users of all types of contraception. However, BV was more common among IUD users (47.2%) than among non-IUD users (29.9%). This association persisted after controlling for age, education, ever had douching, and any STD (odds ratio 2.0, 95% CI 1.1-3.8). BV was also associated with STD (41.3% in women with STD vs. 29.4% in women without). This association remained significant after adjusting for age, education, ever had douching, and IUD use (odds ratio 1.7, 95% CI 1.1-2.9). Because we found that BV was associated with IUDs and that other studies reported that both BV and IUDs were associated with pelvic inflammatory disease, a Gram stain evaluation of BV may be considered prior to IUD insertion