BV ETIOLOGY, NATURAL HISTORY, AND SEXUAL TRANSMISSION

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，BV是一种常见的阴道疾病，越来越多地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的风险增加。 BV的病因学和自然史知之甚少。这项研究将在乌干达的Rakai区进行，那里大约50%的育龄妇女患有BV。 我们建议开展两项相辅相成的研究活动：一是对250名妇女（有和没有BV、艾滋病毒和先前的性经验）进行BV自然史研究，二是对50个一夫多妻制家庭单位进行研究，将登记丈夫、他的妻子和居住在该家庭中的其他妇女。 两项研究中的重复访谈和样本采集将用于评估BV发作、持续性、消退和复发的转移概率，与以下方面相关：a）详细的社会人口统计学、行为和健康数据; B）阴道微生物区系，特别是乳杆菌属（其将使用DNA同源性表征并评估H2O2产生）和c）潜在的噬菌体的存在，其在乳酸菌消耗中的可能作用将被探索。 在一夫多妻家庭研究中，我们将通过比较一夫多妻性网络的妇女与家庭中的其他妇女，确定与正常阴道植物群或BV（包括乳酸杆菌、厌氧菌和厌氧菌）相关的因素是否可能通过性行为或通过密切的家庭接触（如共用洗浴用具或水）传播。Rakai人群提供了评估BV的独特机会。我们之前在一项以人群为基础的性病控制艾滋病预防试验中招募并随访了约7,000名妇女，记录了BV妇女感染艾滋病毒和不良出生结局的风险增加，并有证据表明STD/BV治疗可改善妊娠结局。 拟议的研究将提供关于非洲农村人群正常阴道植物群、BV自然史以及这种流行病的潜在原因的独特流行病学、微生物学和病毒学数据。 这些信息对于未来BV预防、治疗和对照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.