Bacterial vaginosis, vaginitis symptoms linked to high STI prevalence in women

Women with vaginitis and bacterial vaginosis symptoms were found to have high rates of sexually transmitted infections (STIs), highlighting the importance of STI screening for women who seek care for abnormal vaginal discharge and inflammation. These study results were published in the Journal of Clinical Microbiology.

To examine the intersection between vaginitis and STIs among women in the United States, researchers analyzed remnant vaginal swab specimens that were sourced from women with self-reported vaginitis symptoms at 21 clinical sites between June and October 2018. The specimens were collected during a previous prospective cross-sectional study and assessed for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium via nucleic acid amplification testing. Women eligible for the study included those aged 14 years and older. Multivariable logistic regression was used to identify associations between STI, bacterial vaginosis, and vulvovaginal candidiasis diagnoses and various demographic and clinical characteristics.

Among 1051 female patients included in the final analysis, 36.6% had bacterial vaginosis alone, 17.0% had vulvovaginal candidiasis alone, 13.1% had both infections, and 33.2% had neither infection. A total of 195 (18.5%) patients were diagnosed with at least 1 STI. The most common STI diagnosis identified among the population was T vaginalis (9.6%), followed by M genitalium (8.8%), C trachomatis (2.3%), and N gonorrhoeae (0.8%).

Patients aged 14 to 25 years and 41 to 60 years showed the highest prevalence of M genitalium (15.3%) and T vaginalis (13.2%), respectively, whereas Black women showed the highest prevalence of bacterial vaginosis. Black women also exhibited the highest overall STI prevalence (24.6%). The researchers noted significantly higher STI prevalence in patients who tested positive vs negative for bacterial vaginosis (26.3% vs 12.5%; P <.0002).

Patients diagnosed with bacterial vaginosis alone or in addition to vulvovaginal candidiasis were significantly more likely to report abnormal vaginal discharge and odor and test positive for modified Amsel criteria. Patients diagnosed with vulvovaginal candidiasis alone and those who were negative for both vulvovaginal candidiasis and bacterial vaginosis were significantly more likely to report genital-related itch, irritation, burning, and soreness.

Further analysis indicated that T vaginalis infection was significantly associated with abnormal vaginal odor (odds ratio [OR], 1.83; 95% CI, 1.26-2.65; P =.0014) and positive modified Amsel criteria (OR 1.99; 95% CI, 1.35-2.92; P =.0005), whereas M genitalium was significantly associated with only positive modified Amsel criteria (OR, 1.98; 95% CI, 1.29-2.87; P =.0013).

Compared with a negative diagnosis of both bacterial vaginosis and vulvovaginal candidiasis, factors significantly associated with a positive diagnosis of bacterial vaginosis alone were as follows:

• C trachomatis mixed and monoinfections (OR, 4.476; 95% CI, 1.342-16.291; P =.0192);
• M genitalium monoinfection (OR, 3.0751; 95% CI, 1.5797-5.9858; P =.01113);
• T vaginalis monoinfection (OR, 2.873; 95% CI, 1.5687-5.2619; P =.0017);
• M genitalium and T vaginalis mixed infections (OR, 3.4886; 95% CI, 1.8901-6.439; P =.0042); and,
• Mixed infection containing another STI (OR, 3.1858; 95% CI, 1.809-5.6103; P =.0014).

The researchers also observed a significant relationship between a diagnosis of both bacterial vaginosis and vulvovaginal candidiasis and mixed infection containing T vaginalis and another STI (OR, 3.0565; 95% CI, 1.524-6.1303; P =.0297).

Study limitations include the lack of comparative analyses for women with signs and symptoms of vaginitis or vaginosis who tested negative for bacterial vaginosis, candidiasis, and all 4 STIs. Other limitations include the lack of consideration for HIV status and the relatively small number of C trachomatis and N gonorrhoeae infections.

“These results underscore the importance of STI testing in women seeking care for symptoms of vaginal inflammation and abnormal discharge,” the researchers concluded.

Disclosure: This study was supported by Hologic, Inc., and multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Lisa Kuhns, PhD

References:

Schwebke JR, Nyirjesy P, Dsouza M, Getman D. Vaginitis and risk of sexually transmitted infections: results of a multi-center U.S. clinical study using STI nucleic acid amplification testing. J Clin Microbiol. Published online August 14, 2024. doi:10.1128/jcm.00816-24