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For the follow-up visits, the study-specific algorithm was used. Google Scholar. Sex Transm Dis.

In logistic regression analyses, the estimated odds ratios ORs for chlamydia, gonorrhoea, trichomoniasis, and aggregate Prostitutes Damme were 0. The logistic regression Prostitutes Damme for reported condom use with clients in the past 30 days increased from 1.

Adjustment for baseline factors changed the regression results little. Conclusions: The impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction.

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Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multidimensional control programmes.

These references are in PubMed. This may not be the complete list of references from this article. National Center for Biotechnology InformationU. Journal List Sex Transm Infect v. Sex Transm Infect. Author information Copyright and License information Disclaimer. Copyright notice. This article has been cited by other articles in PMC. Abstract Objectives: To test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured Prostitutes Damme terms of STI prevalence Prostitutes Damme reported male condom use.

Am J Public Health. Predictors of Prostitutes Damme use among patients with sexually transmitted diseases in Uganda. Sex Transm Dis. Correlates of condom use stage of change: implications for intervention. HIV and female sex workers.

Bull Prostitutes Damme Health Organ. HIV prevention among male clients of female sex workers in Kaolack, Senegal: results of a peer education program. The condom conundrum: barriers to condom use among commercial sex workers Prostitutes Damme Durban, South Africa. Afr J Reprod Health. Soc Sci Med. Reducing the risk of HIV infection among South African sex workers: socioeconomic Prostitutes Damme gender barriers.

Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial. Measuring the impact of a behaviour change intervention for commercial sex workers and their potential clients in Prostitutes Damme.

Health Educ Res. Focused peer-mediated educational programs among female sex Prostitutes Damme to reduce sexually transmitted disease and human immunodeficiency virus transmission in Kenya and Zimbabwe. Behavioural and medical data were collected monthly while laboratory testing for STI and genital tract infections were performed quarterly.

The Andersen-Gill proportional hazards model was used to determine predictors of BV recurrence both in bivariate and multivariate analyses. Prostitutes Damme study confirms the Prostitutes Damme of counselling high-risk women with RBV about the adverse effects of vaginal cleansing and the protective effects of condom use with all types of partners for the prevention of sexually transmitted infections, including BV. More prospective studies on risk factors of BV recurrence are warranted. Peer Review reports.

Bacterial vaginosis BV is the most common vaginal infection in women of reproductive age. Besides its high frequency, BV is associated with many adverse Prostitutes Damme outcomes [ 4 — 10 ] including pelvic inflammatory disease, unfavourable pregnancy outcomes and recently HIV. BV is not only associated with female acquisition of HIV [ Prostitutes Damme10 ] but also with female-to-male transmission of HIV, as reported in a recent study [ 7 ].

Though it is increasingly clear that BV Prostitutes Damme from the replacement of the lactobacillus dominated normal flora by a predominantly anaerobic flora, no single causal agent has yet been identified. As a result, current treatment strategy aims at restoring the balance of the vaginal flora without specifically targeting any single causal agent. This may explain the high rate of treatment failure and recurrence that constitutes a Prostitutes Damme challenge for the clinical management and control of BV.

Some authors [ 11 — 14 ] have suggested periodic presumptive treatment PPT as response to this challenge; however, the high recurrence rate makes the cost-effectiveness of this strategy questionable [ 15 ].

Knowing predictors of BV recurrence may help identify subgroups in whom PPT may be more efficient and prevent BV recurrences and their subsequent adverse health outcomes.

The purpose of this study was to identify behavioural and medical predictors of BV Prostitutes Damme among women who experienced a prior BV episode during their follow-up at two African and two Indian sites Prostitutes Damme a randomized controlled microbicide trial. Participant recruitment, follow-up and laboratory methods are described elsewhere [ 16 ].

However, because of the occurrence of some local changes in the standardized method for BV laboratory diagnosis at the Durban site, and to Prostitutes Damme the comparability of our findings, the present analysis was restricted to participants from the latter four sites.

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Participants were FSWs who Prostitutes Damme 18 years or older, Prostitutes Damme seronegative, not pregnant and not desiring to become pregnant Prostitutes Damme their participation in the study.

Trial participants provided written informed consent. At the screening visit, a questionnaire was administered to consenting women by trained health providers, asking about their socio-demographics, current contraceptive use, intra-vaginal cleansing practices products used and reasonpast history of STI and sexual behaviours detail with the Additional file 1.

All procedures, with the exception of the baseline questionnaire, were repeated at the enrolment visit occurred within 28 Prostitutes Damme of screening. At enrolment, eligible women were Prostitutes Damme to active or placebo vaginal gel and were instructed to use their gel before each sexual act for 12 months.

The participants received intensive counselling about condom use and were Prostitutes Damme free condoms at Prostitutes Damme visit. Monthly behavioural data were collected detail with Additional file 2 and pelvic exams with laboratory testing for HIV and other STI were performed quarterly. Follow-up was planned for 12 months, but the trial was closed prematurely following an interim analysis which suggested an increased risk of HIV among women in the active arm.

Trichomoniasis and candidiasis were diagnosed microscopically on wet mount. The endocervical swabs were tested with nucleic acid amplification tests for genital gonococcal and chlamydial Prostitutes Damme. For syphilis diagnosis, blood samples were screened with Rapid Plasma Reagin RPR test and reactive samples were confirmed with a treponemal antibody test. At the screening and enrolment visits, HIV antibody testing was performed using the national HIV testing guidelines Prostitutes Damme place at each study site.

For the follow-up visits, the study-specific algorithm was used. Pregnancy tests brands varied by site. For all curable genital tract infections which were diagnosed, including BV, women with symptoms were treated at the same visit, whether lab test result Prostitutes Damme available or not using the Prostitutes Damme approach while others were treated once test results became available, mostly in less than a week.

A case of incident BV Prostitutes Damme assumed to have occurred at the midpoint between the date of the last negative BV Prostitutes Damme and the date of the visit at which Prostitutes Damme incident BV was diagnosed.

A participant could have multiple recurrences during the follow-up period. Participants with prior BV index BV were considered at risk of a RBV for the period spanning from the end of the index BV episode to the beginning of the next BV episode, or to the end of their follow-up, whichever occurred first.

In cases of multiple BV recurrences, periods between BV episodes were considered as at-risk periods.

The present Prostitutes Damme involved trial participants who, during follow-up including the enrolment visithad at least one BV episode, followed by:. Variables reported in previous studies as potential predictors of Prostitutes Damme were selected for the analysis. These included socio-demographic characteristics, sexual behaviours, past history of, and current STI or reproductive tract infections.

Prostitutes Damme proportional hazard models were used to identify independent predictors of RBV as multiple events by estimating hazard ratios HR [ 19 ]. Univariate models were fit with and without control for study site. Backward selection was used and variables which reached a significance level of 0. Proportionality and linearity hypotheses were verified for the models. Statistical Prostitutes Damme were two-tailed. Data were analysed with SAS software version 9. From July to Januarya total of women were screened and were enrolled at the four study sites.

Out of thewomen met the eligibility criteria for BV recurrence as described above and were included in the present analysis. Baseline socio-demographic, behavioural Prostitutes Damme biological Prostitutes Damme of the participants are summarized in Table 1. One hundred and twenty-eight Seventy-three Among Prostitutes Damme women, The BV recurrences occurred over a total at-risk-period of In univariate analysis without control for the study site, several baseline factors were significantly associated with RBV, as presented in Table 2.

For positive associations these include being older than 28 years, cohabiting with a man, exerting an occupation besides sex Prostitutes Damme, recent intra-vaginal cleansing [since the visit preceding that of baseline for women with BV Prostitutes Damme the enrolment visit in the trial, the preceding visit was the screening visit ], having an STI history and having had oral or anal sex with other partners in the 30 days prior to the baseline visit.

In contrast, Prostitutes Damme been to school for at least six years, consistent condom use CCU with the primary partner in the past seven days and surprisingly, higher number of sexual partners, were inversely associated with RBV.

There was a trend towards a positive association between use of intra-uterine device and RBV, and a negative association between hormonal contraception and RBV, but neither was statistically significant. Treatment group was not associated with BV Prostitutes Damme. Results from the univariate analysis of the associations between time-dependent Prostitutes Damme and RBV are presented in Table 3.

Oral sex, whether with the primary or other partners whether all acts or those without condom use was significantly and positively associated with RBV.

In contrast, CCU with the primary partner, the Prostitutes Damme of a vaginal candidiasis in the at-risk period and high number of sexual partners in the past seven days were inversely associated with RBV. For CCU with the primary partner and the presence of candidiasis, the Prostitutes Damme remained significant after controlling for study site.

Recent intra-vaginal cleansing as self-reported at the baseline visit was positively associated with RBV, whereas CCU with the primary partner in the past seven days and vaginal candidiasis in the at-risk period were protective Table 4.

In addition, study site remained significantly associated with RBV. The incidence rate was Prostitutes Damme prior studies on RBV looked only at the first recurrence, in the context of treatment regimen evaluation [ 20 — 23 ]. Therefore, their primary outcome was the proportion of treated subjects experiencing at least one BV recurrence in a given post-treatment length of time. This makes it difficult to compare the RBV frequency in the present study to those previously reported.

The two studies which reported BV incidence as multiple events were sub-studies of the same trial that evaluated the effect of PPT on the incidence of vaginal infections [ 12 ]. Prostitutes Damme discrepancy Prostitutes Damme be due to the fact that, unlike in the current study where all microscopically diagnosed BV were treated, regardless of the presence of symptomsonly symptomatic BV were treated in the PPT and post-PPT studies.

Prostitutes Damme two studies may have thus reported several times some persistently asymptomatic and thus untreated BV. In the multivariate analysis controlling for study site, Prostitutes Damme vaginal cleansing, as reported at study entry, was a risk factor for RBV, whereas CCU with the primary partner and vaginal candidiasis were negatively associated with it. While several previous cross-sectional or prospective studies found that intra-vaginal cleansing increased the risk of single BV, very few dealt with recurrent BV [ Prostitutes Damme2627 ].

Schwebke et al. These findings are consistent with our results, though we did Prostitutes Damme collect data on vaginal washing frequency.

However, some studies Prostitutes Damme no association between vaginal douching and BV [ 2127 ]. In fact, although vaginal washing is a common practice, the frequency, techniques, products Prostitutes Damme and circumstances vary from one individual to another, and from culture to culture.

This might explain the inconsistencies in studies results. Compared to women who reported inconsistent condom use with their primary Prostitutes Damme in the previous seven days, those who reported CCU were Prostitutes Damme at lower RBV risk, and interestingly their aHR was similar to that of women with no primary partner or no sexual act with the latter.

These results support the idea that consistent and proper use of condoms may be as effective as Prostitutes Damme abstinence in protecting against BV recurrence. The non-significance of the association between CCU with other sexual partners clients and RBV may be due to a lack of statistical power resulting from the high percentage of condom use However, Yotebieng et al. However, in some studies, trichomoniasis was associated with RBV [ 2432 ].

Prostitutes Damme candidiasis VC during follow-up but not at baseline was inversely associated with RBV, consistent with the results of McClelland et al.

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The Prostitutes Damme explanation is that the two conditions are incompatible as they are inversely related to vaginal pH. Another study found that VC often preceded a BV episode though they rarely coexisted [ 33 ]. The Prostitutes Damme of such a chronology remains unknown.

Finally, the study site exhibited a consistently strong association with BV recurrence, independently of all other factors, suggesting that RBV may be determined by a more Prostitutes Damme network of site-specific unmeasured and probably interrelated factors.

A striking finding in the Prostitutes Damme study is the overwhelming effect of the study site on the associations between investigated risk factors and RBV. With the exception of recent vaginal cleansing as self-reported at baseline, CCU with the primary partner and vaginal candidiasis as time-dependent variablesall the associations which were initially significant lost their significance when controlled for study site.

This suggests strong confounding by site due to a highly variable distribution of Prostitutes Damme and medical variables across sites.

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Nevertheless, the univariate association between anal or oral Prostitutes Damme receiving penis in the mouth and Prostitutes Damme deserves some attention. The role of oral or anal sex in BV occurrence is supported by several studies [ 3234 — 37 ]. In a recent prospective study [ 35 ], women with incident BV were more likely to have previous colonization of anus or oral cavity with BV-associated bacteria.

Schwebke JR, Desmond R: A randomized trial of metronidazole in asymptomatic bacterial vaginosis to prevent the acquisition of sexually transmitted diseases.