부산대학교 도서관

OBJECTIVES: (1) To identify correlates of incident Bacterial vaginosis (BV) among high-risk women and (2) to identify predictors of discordance between self-reported lack of semen exposure in the past 6 months and the detection of spermatozoa on Gram stain, which provides biological evidence of recent exposure. METHODS: Analyses were based on among 871 HIV-infected and 439 HIV-uninfected women participating in HIV Epidemiology Research Study (HERS) which was conducted in 4 sites in the US Participants completed study visits conducted at baseline and at 6-month intervals thereafter. We conducted both cohort and case-crossover analyses, stratified by HIV infection status, to evaluate potential correlates of incident BV. We also used logistic regression to identify predictors of discordance between self-reported lack of exposure to semen and the detection of spermatozoa on Gram stain. RESULTS: BV incidence was 21% among HIV-infected women and 19% among HIV-uninfected women. We found fewer correlates of incident BV when assessed with a case-crossover design than with a cohort design. Reporting frequent coitus (regardless of consistency of condom use) was correlated with incident BV in the cohort analyses but not in the case-crossover analyses. The sole correlate that emerged in both the cohort and case-crossover analyses among HIV-infected and -uninfected women was the detection of spermatozoa on Gram stain. Seven factors were associated with discordance between self-reported semen exposure and spermatozoa detection in the multivariable analysis. Discordance differed by study site and race/ethnicity and was more common among younger women. The following infections or conditions also were predictive of discordance: HIV (adjusted OR [aOR], 2.8; 95% CI, 1.7% to 4.6%), BV (aOR, 1.9; 95% CI, 1.5% to 2.5%), and human papillomavirus (aOR, 1.3; 95% CI, 1.0% to 1.8%). Finally, reporting current injection drug use (aOR, 0.6; 95% CI, 0.4% to 0.9%) was inversely related to discordance. CONCLUSIONS: The inconsistent association between condom use and BV found in prior studies could be the result of participant reporting bias. The present study found evidence of a relationship between semen exposure and incident BV. Also, given the number and range of correlates of discordance between self-reported and biological evidence of semen exposure, inaccuracies in the reporting of sexual behaviours cannot be assumed to be distributed randomly across a study population.