Women with laboratory-confirmed bacterial vaginosis may have higher concurrent nonviral sexually transmitted infection positivity compared with those without bacterial vaginosis, according to a retrospective cross-sectional study.
Investigators evaluated the association between bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and sexually transmitted infection (STI) positivity in de-identified laboratory data from women aged 15 years or older who underwent testing between 2022 and 2024.
The analysis included molecular testing for STIs such as Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium.
The investigators included one BV test per patient and excluded those who underwent BV testing during the prior 12 months or had more than one BV test from 2022 to 2024. Testing for VVC, C trachomatis, N gonorrhoeae, T vaginalis, or M genitalium within 7 days of a BV result was considered a single testing event. When multiple tests for the same analyte were performed within 7 days, one result was included. If the results were discordant, the positive result was selected.
Positivity rates were stratified by age and US Department of Health and Human Services region. Multivariable logistic regression compared STI positivity between women with and without BV following adjustment for age group, geographic region, and VVC result.
The investigators found that 39% of women tested positive for BV, 29% tested positive for VVC, and 11% tested positive for both. While testing volume increased from 2022 to 2024, BV and VVC positivity remained stable. Positivity for C trachomatis and N gonorrhoeae was highest among patients aged 15 to 24 years. T vaginalis positivity peaked among patients aged 35 to 54 years, and M genitalium positivity was highest among patients aged 15 to 29 years.
At least one STI was detected in 12% of women with BV and 4% of women without BV, 1.1% and 0.2% of whom had two to four STIs, respectively.
Following adjustment, women with BV had 2.8 times the odds of C trachomatis positivity, 3.8 times the odds of N gonorrhoeae positivity, 3.6 times the odds of T vaginalis positivity, and 1.9 times the odds of M genitalium positivity compared with women without BV.
In the interaction analyses, women with BV but without VVC had the highest adjusted odds of C trachomatis, N gonorrhoeae, and T vaginalis positivity compared with women negative for both conditions. For M genitalium, women with BV had 2.0 times the odds of positivity regardless of VVC status. Just 2.4% of the study population underwent additional testing for M genitalium, reflecting the smaller subgroup included in those analyses.
The investigators noted that the retrospective laboratory-based study lacked detailed clinical information such as presenting symptoms, infection history, and patient risk factors, which limited adjustment for potential confounders and made it difficult to distinguish newly acquired infections from preexisting infections. Because specimens were submitted according to clinicians' testing decisions, the study population likely reflected insured patients.
“These findings have important implications for clinical practice and public health and support routine comprehensive STI testing in the management of BV,” wrote lead study author Elizabeth M. Marlowe, MS, PhD, of Quest Diagnostics, and colleagues.
The study was supported by Quest Diagnostics. Full disclosures of the study authors can be found in the study.
Source: O&G Open
