BV ETIOLOGY, NATURAL HISTORY, AND SEXUAL TRANSMISSION

细菌性阴道病（BV）是一种常见的阴道疾病，越来越被认为具有严重的健康后遗症，包括不良妊娠结局、盆腔炎和艾滋病毒感染风险增加。拟议的研究将测试有关细菌性阴道病（BV）发展的微生物、病毒学和行为风险因素的假设。细菌性阴道炎的病因学和自然史尚不清楚。这项研究将在乌干达拉凯区进行，那里约有50%的育龄妇女患有细菌性阴阳炎。我们建议开展两项互补的研究活动：一是在250名妇女（有或没有细菌性感染、艾滋病毒和既往性经历）中进行细菌性感染自然史研究；二是在50个一夫多妻制家庭单位中进行研究，包括丈夫、妻子和其他居住在家庭中的妇女。两项研究中的重复访谈和样本收集将用于评估BV发病、持续、回归和复发的过渡概率，涉及：a)详细的社会人口、行为和健康数据；b)阴道菌群，特别是乳酸菌种类（将使用DNA同源性进行表征并评估其产生H2O2）和c)乳酸菌噬菌体的潜在存在，其在乳酸菌消耗中的可能作用将被探索。在一夫多妻制家庭研究中，我们将通过将一夫多妻性网络中的妇女与家庭中的其他妇女进行比较，确定与正常阴道菌群或细菌性阴道炎相关的因素（包括乳酸杆菌、厌氧菌和噬菌体）是否可能通过性行为或家庭密切接触（如共用洗浴器具或水）传播。Rakai人口为评估BV提供了一个独特的机会。我们之前招募并跟踪了大约7000名妇女，进行了一项以人群为基础的性病控制艾滋病预防试验，记录了感染性病的妇女感染艾滋病毒和不良分娩结果的风险增加，并有证据表明性病/细菌性感染治疗改善了妊娠结局。拟议的研究将提供独特的流行病学、微生物学和病毒学数据，涉及非洲农村人口的正常阴道菌群、细菌性阴道炎的自然史以及这种流行疾病的潜在原因。这些信息对于未来细菌性阴道炎预防、治疗和控制试验的设计至关重要，包括选择要测试的干预措施、样本量要求和研究终点的定义。

The proposed study will test hypotheses regarding microbiological, virological and behavioral risk factors for the development of bacterial vaginosis (BV), a common vaginal condition which is increasingly recognized as having serious health sequelae, including adverse pregnancy outcomes, pelvic inflammatory disease, and increased risk of HIV infection. The etiology and natural history of BV are poorly understood. The study will be conducted in Rakai District, Uganda, where approximately 50 percent in the general population of women of reproductive age have BV. We propose to conduct two complementary research activities: I, a BV natural history study in a cohort of 250 women (with and without BV, HIV and prior sexual experience), and II, a study in 50 polygamous family units which will enrol the husband, his wives and other women residing in the household. Repeated interview and sample collection in the two studies will be used to assess transition probabilities of BV onset, persistence, regression and recurrence in relation to: a) detailed sociodemographic, behavioral and health data; b) vaginal microflora, particularly Lactobacillus species (which will be characterized using DNA homology and assessed for H2O2 production) and c) the potential presence of lactobacillus bacteriophages, whose possible role in Lactobacillus depletion will be explored. In the polygamous household study, we will determine whether factors associated with normal vaginal flora or with BV (including lactobacilli, anaerobes and phages) may be transmitted sexually or via close household contact such as through the sharing of bathing utensils or water, by comparing women with a polygamous sexual network to other women within the household. The Rakai population offers a unique opportunity to assess BV. We previously enrolled and followed approximately 7,000 women in a population-based trial of STD control for AIDS prevention, have documented increased risk of HIV and adverse birth outcomes in women with BV, and have evidence of improved pregnancy outcomes with STD/BV treatment. The proposed study will provide unique epidemiological, microbiological and virological data regarding normal vaginal flora in this rural African population, the natural history of BV, and on potential causes of this prevalent condition. Such information will be critical for the design of future BV prevention, treatment and control trials, including selection of interventions to be tested, sample size requirements and definition of study end points.