Bacterial vaginosis after menopause: factors associated and women’s experiences: a cross-sectional study of Australian postmenopausal women
Linde L. Stewart A * , Lenka A. Vodstrcil A B C , Jacqueline Coombe A , Catriona S. Bradshaw A B C and Jane S. Hocking AA
B
C
Abstract
Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women.
We conducted an online survey (July–September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression.
Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12 months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5 years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships.
BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women.
Keywords: Australian postmenopausal women, bacterial vaginosis, BV, factors associated, menopause, postmenopausal, postmenopausal women, vaginosis, women.
References
1 Koumans EH, Sternberg M, Bruce C, et al. The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007; 34: 864-9.
| Google Scholar |
2 Gravett MG, Nelson HP, DeRouen T, Critchlow C, Eschenbach DA, Holmes KK. Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. J AMA 1986; 256: 1899-903.
| Google Scholar |
3 Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of sexually transmitted infection. Am J Obstet Gynecol [205] 2011; 113e1-113e6.
| Google Scholar |
4 Allsworth JE, Peipert JF. Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data. Obstet Gynecol 2007; 109: 114-20.
| Google Scholar |
5 Peebles K, Velloza J, Balkus JE, McClelland RS, Barnabas RV. High global burden and costs of bacterial vaginosis: a systematic review and meta-analysis. Sex Transm Dis 2019; 46: 304-311.
| Crossref | Google Scholar | PubMed |
6 Vodstrcil LA, Walker SM, Hocking JS, et al. Incident bacterial vaginosis (BV) in women who have sex with women is associated with behaviors that suggest sexual transmission of BV. Clin Infect Dis 2015; 60: 1042-53.
| Google Scholar |
7 Evans AL, Scally AJ, Wellard SJ, Wilson JD. Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting. Sex Transm Infect 2007; 83: 470-5.
| Google Scholar |
8 Bradshaw C, Bilardi J, Walker S, et al. Behavioural factors associated with bacterial vaginosis (bv) in women who have sex with women (WSW): The women on women’s (WOW) health study. Sex Transm Infect 2011; 87: A32-A3.
| Google Scholar |
9 Marrazzo JM, Koutsky LA, Eschenbach DA, Agnew K, Stine K, Hillier SL. Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. J Infect Dis 2002; 185: 1307-13.
| Google Scholar |
10 Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol 2013; 209: 505-23.
| Google Scholar |
11 Bukusi EA, Cohen CR, Meier AS, et al. Bacterial vaginosis: risk factors among Kenyan women and their male partners. Sex Transm Dis 2006; 33: 361-7.
| Google Scholar |
12 Chico RM, Mayaud P, Ariti C, Mabey D, Ronsmans C, Chandramohan D. Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review. Jama 2012; 307: 2079-86.
| Google Scholar |
13 Torrone EA, Morrison CS, Chen PL, et al. Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med 2018; 15: e1002511.
| Google Scholar |
14 Cherpes TL, Hillier SL, Meyn LA, Busch JL, Krohn MA. A delicate balance: risk factors for acquisition of bacterial vaginosis include sexual activity, absence of hydrogen peroxide-producing lactobacilli, black race, and positive herpes simplex virus type 2 serology. Sex Transm Dis 2008; 35: 78-83.
| Crossref | Google Scholar | PubMed |
15 Ness RB, Hillier S, Richter HE, et al. Can known risk factors explain racial differences in the occurrence of bacterial vaginosis? J Natl Med Assoc 2003; 95: 201-12.
| Google Scholar | PubMed |
16 Brown JM, Hess KL, Brown S, Murphy C, Waldman AL, Hezareh M. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet Gynecol 2013; 121: 773-80.
| Crossref | Google Scholar | PubMed |
17 Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 2005; 353: 1899-911.
| Crossref | Google Scholar | PubMed |
18 Srinivasan S, Hoffman NG, Morgan MT, et al. Bacterial communities in women with bacterial vaginosis: high resolution phylogenetic analyses reveal relationships of microbiota to clinical criteria. PLoS ONE 2012; 7: e37818.
| Crossref | Google Scholar | PubMed |
19 Spiegel CA, Amsel R, Eschenbach D, Schoenknecht F, Holmes KK. Anaerobic bacteria in nonspecific vaginitis. N Engl J Med 1980; 303: 601-7.
| Crossref | Google Scholar | PubMed |
20 Ferris MJ, Masztal A, Aldridge KE, Fortenberry JD, Fidel PL, Jr, Martin DH. Association of Atopobium vaginae, a recently described metronidazole resistant anaerobe, with bacterial vaginosis. BMC Infect Dis 2004; 4: 5.
| Crossref | Google Scholar | PubMed |
21 Cox C, Watt AP, McKenna JP, Coyle PV. Mycoplasma hominis and Gardnerella vaginalis display a significant synergistic relationship in bacterial vaginosis. Eur J Clin Microbiol Infect Dis 2016; 35: 481-7.
| Crossref | Google Scholar | PubMed |
22 Plummer EL, Vodstrcil LA, Bodiyabadu K, et al. Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum associated with specific genital symptoms and clinical signs in nonpregnant women? Clin Infect Dis 2021; 73: 659-68.
| Crossref | Google Scholar | PubMed |
23 Bilardi JE, Walker S, Temple-Smith M, et al. The burden of bacterial vaginosis: women’s experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLoS ONE 2013; 8: e74378.
| Crossref | Google Scholar | PubMed |
24 Bradshaw CS, Morton AN, Hocking J, et al. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis 2006; 193: 1478-86.
| Crossref | Google Scholar | PubMed |
25 Stewart LL, Vodstrcil LA, Coombe J, Bradshaw CS, Hocking JS. Prevalence of bacterial vaginosis in postmenopausal women: a systematic review and meta-analysis. Sex Health 2022; 19: 17-26.
| Crossref | Google Scholar | PubMed |
26 Spiegel CA, Amsel R, Holmes KK. Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid. J Clin Microbiol 1983; 18: 170-7.
| Crossref | Google Scholar | PubMed |
27 Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T, Holmes KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988; 158: 819-28.
| Crossref | Google Scholar | PubMed |
28 Klebanoff MA, Nansel TR, Brotman RM, et al. Personal hygienic behaviors and bacterial vaginosis. Sex Transm Dis 2010; 37: 94-9.
| Crossref | Google Scholar | PubMed |
29 Hutchinson KB, Kip KE, Ness RB. Vaginal douching and development of bacterial vaginosis among women with normal and abnormal vaginal microflora. Sex Transm Dis 2007; 34: 671-5.
| Crossref | Google Scholar | PubMed |
30 Amaral R, Giraldo PC, Gonçalves AK, et al. Evaluation of hygienic douching on the vaginal microflora of female sex workers. Int J STD AIDS 2007; 18: 770-3.
| Crossref | Google Scholar | PubMed |
31 Bradshaw CS, Morton AN, Garland SM, Morris MB, Moss LM, Fairley CK. Higher-risk behavioral practices associated with bacterial vaginosis compared with vaginal candidiasis. Obstet Gynecol 2005; 106: 105-14.
| Crossref | Google Scholar | PubMed |
32 Atashili J, Poole C, Ndumbe PM, Adimora AA, Smith JS. Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS 2008; 22: 1493-501.
| Crossref | Google Scholar | PubMed |
33 Lyons A, Heywood W, Fileborn B, et al. Sexually active older Australian’s knowledge of sexually transmitted infections and safer sexual practices. Aust N Z J Public Health 2017; 41: 259-61.
| Crossref | Google Scholar | PubMed |
34 Bourchier L, Malta S, Temple-Smith M, Hocking J. Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018. Sex Health 2020; 17: 517-24.
| Crossref | Google Scholar |
35 Malta S, Temple-Smith M, Bickerstaffe A, Bourchier L, Hocking J. ‘That might be a bit sexy for somebody your age’: older adult sexual health conversations in primary care. Australas J Ageing 2020; 39(Suppl 1): 40-8.
| Crossref | Google Scholar |
36 Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357: 762-74.
| Crossref | Google Scholar | PubMed |
37 Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983; 74: 14-22.
| Crossref | Google Scholar |
38 Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991; 29: 297-301.
| Crossref | Google Scholar |
39 Cauci S, Driussi S, De Santo D, et al. Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women. J Clin Microbiol 2002; 40: 2147-52.
| Crossref | Google Scholar | PubMed |
40 Hoffmann JN, You HM, Hedberg EC, Jordan JA, McClintock MK. Prevalence of bacterial vaginosis and Candida among postmenopausal women in the United States. J Gerontol B Psychol Sci Soc Sci 2014; 69(Suppl 2): S205-S214.
| Crossref | Google Scholar | PubMed |