Studies of Vaginal Flora and Bacterial Vaginosis

这项前瞻性的观察性研究旨在提高我们对阴道微生物区系的自然历史和异常变化的认识，并确定与这些变化相关的危险因素。共登记了3600名健康的非怀孕育龄妇女，并在阿拉巴马州伯明翰进行了为期一年的跟踪调查(基线访问加上之后每三个月一次，总共五次访问)。通过面对面访谈收集了有关社会人口状况、病史、卫生习惯、性行为和心理社会压力的详细信息。在研究访问期间进行了常规的妇科和牙科检查。采集阴道分泌物和血样。进行了实验室测试，以量化阴道微生物菌群，并确定细菌性阴道病和常见性传播疾病的感染情况。子研究评估每天阴道菌群的变化，以及停止冲洗的效果。 最后的考察访问已于2003年6月完成，目前正在进行各种分析。目前正在出版的一项分析描述了除冲洗外的个人卫生行为与细菌性阴道病之间的联系。据推测，如果冲洗仅仅是对BV症状的反应(而不是BV的原因)，那么其他女性卫生行为(如使用除臭剂喷雾、粉末、湿巾等)在BV女性中也会更常见。然而，当这些行为被发现大体上与BV没有统计学意义时。这表明冲洗不仅仅是对BV症状的一种反应。 如上所述，BV是否通过性传播尚不确定。也不清楚为什么BV在非裔美国人中的流行率是白人女性的两倍。为了探索这两种可能性，我们评估性伴侣的种族与BV发病率之间的关联。在白人女性中，与只有白人男性性伴侣相比，拥有非裔美国男性性伴侣的BV发病率增加了一倍。发病率最低的是在没有性行为的时候。只有白人男性性伴的非裔美国女性太少了，无法研究男性性伴的种族。 最近开始的第三项分析评估了细菌性阴道病和牙周病之间的联系。 最后，2010年及以后的计划包括应用元基因组技术(细菌16S核糖体基因的扩增和测序)来研究BV的基本微生物学。

This prospective observational study aims to advance our knowledge of the natural history and abnormal alteration in vaginal microbial flora, and to identify risk factors that are associated with these changes. A total of 3600 healthy, non-pregnant women of reproductive age have been enrolled and were followed in Birmingham, Alabama for one year (baseline visit plus once every three months afterwards, totaling five visits). Detailed information on sociodemographic status, medical history, hygiene practice, sexual behavior and psychosocial stress was collected through in-person interviews. Routine gynecological and dental examinations were carried out during the study visits. Samples of vaginal secretion and blood were collected. Laboratory tests to quantify vaginal microbial flora and to identify infection of bacterial vaginosis as well as common sexually transmitted diseases were conducted. Sub-studies evaluate the day-to-day change in vaginal flora, and the effect of cessation of douching. The final study visits were completed in June 2003, and various analyses are underway. One analysis, currently in press, describes the association between personal hygienic behaviors other than douching and bacterial vaginosis. It is reasoned that if douching were merely a response to symptoms of BV (rather than a cause of BV) then other feminine hygiene behaviors (such as use of deodorant sprays, powders, wipes, etc) would also be more common among women with BV. However, when these behaviors were found by-and-large not to be statistically significantly associated with BV. This suggests that douching is not merely a response to BV symptoms. As noted above, whether BV is sexually transmitted is uncertain. It is also not understood why BV is twice as prevalent among African-American compared to white women. To explore both of these possibilities, the association between race of the sex partner and incidence of BV was evaluated. Among white women, having an African-American male sex partner was associated with a doubled incidence of BV compared to having only white male sex partners. The lowest incidence was observed in times without sexual activity. There were too few African-American women who had only white male sex partners to study the race of male sex partners. A third analysis, recently begun, evaluates the association between bacterial vaginosis and periodontal disease. Finally, plans for 2010 and beyond include application of metagenomic techniques (amplification and sequencing of bacterial 16S ribosomal genes) to study the basic microbiology of BV.