American journal of epidemiology 2017 05 03() doi 10.1093/aje/kwx043
We assessed the association between recent bacterial vaginosis (BV) and incident Mycoplasma genitalium, a sexually transmitted bacterium associated with adverse female reproductive health outcomes. Female sex workers in Mombasa, Kenya completed a monthly sexual behavior interview and clinical examination. During February 2005-February 2006, vaginal fluid specimens collected from women every other month were tested for M. genitalium by nucleic acid amplification testing. Vaginal microbiota was assessed monthly and categorized by Nugent score (0-3 normal, 4-6 intermediate microbiota, 7-10 BV). A discrete time failure analysis for multiple events using logistic regression was used to estimate the odds of incident M. genitalium infection at follow-up visits in women with BV versus normal microbiota at the preceding visit. Among the 280 women, 54.3% were HIV positive. At baseline, 16.1% had prevalent M. genitalium infections and 40.4% had prevalent BV. There were 59 incident M. genitalium infections among 50 women for an incidence rate of 34.6 per 100 person-years. Following adjustment for age, HIV status, and time, prior BV was associated with a 3.5-fold increase in odds of incident M. genitalium (adjusted odds ratio = 3.49; 95% confidence interval: 1.86, 6.56). This strong association suggests that BV may enhance susceptibility to M. genitalium infection.