Bacterial vaginosis and intravaginal practices: association with HIV.

OBJECTIVES: To determine the prevalence of bacterial vaginosis and to identify risk factors associated with this condition among urban women in Harare, Zimbabwe.
DESIGN: A cross sectional study. MAIN OUTCOME MEASURES: Prevalent bacteria vaginosis (BV), HIV and intravaginal practices.
SETTING: Urban primary health care clinics in Harare.
SUBJECTS: 177 pregnant and 212 non pregnant women attending mother and child health care clinics.
INTERVENTIONS: The women were recruited, counselled, interviewed, examined and tested for reproductive tract infections including HIV. Those with reproductive tract infections were given free treatment.
RESULTS: The prevalence of bacterial vaginosis was 36% among HIV seropositive women and 26% among those seronegative. Fifty one per cent of the women practiced intravaginal cleansing, while another 28% reported use of intravaginal herbs. Women reporting intravaginal cleansing and/or use of intravaginal herbs were more likely to have bacterial vaginosis (OR 6.2 CI 3.6 to 10.7) and (OR 1.5 CI 1.1 to 2.5) and to be HIV seropositive (OR 1.8 CI 1.2 to 2.8) and (OR 1.8 CI 1.1 to 2.9) respectively. Other factors associated with bacterial vaginosis were malodorous vaginal discharge (OR 5.8 CI 2.9 to 10.7), genital warts (OR CI 3 CI 1.1 to 10.1) and Trichomonas vaginalis (OR 25.5 CI 11.6 to 56.7).
CONCLUSIONS: BV was shown to be a common condition among the women the majority of whom indulged in intravaginal practices. HIV infection among women with BV and those that practiced intravaginal cleansing and/or use of herbs was significantly higher. Although causal relationship could not be established in this cross sectional study the results suggest that BV may facilitate HIV infection and we suggest the inclusion of information regarding risks associated with intravaginal practices into health education information disseminated to women.