Race of male sex partners and occurrence of bacterial vaginosis

Bacterial vaginosis (BV) is traditionally described as a condition in which the usual Lactobacillus-dominant vaginal bacteria are replaced by overgrowth of Gardnerella vaginalis and mixed, predominantly anaerobic organisms.1 BV is the most common cause of symptomatic vaginal discharge in reproductive-age women, and has been associated with serious health consequences such as preterm birth,2 postoperative gynecologic infection,3 and acquisition of HIV4 and other sexually transmitted organisms.5 The etiology of BV is unknown, and whether it is a sexually transmitted infection is controversial.6 Personal hygiene behaviors, particularly douching, have also been associated with BV.7,8 African-American women consistently have been found to be at doubled or greater risk of having prevalent BV compared to white women,9,10 although the reason is not known. Demographic factors such as less education, and behavioral factors such as douching, although more common among African-American women, do not explain the difference.11 Recently, the race of the male sex partner has been associated with prevalent BV in the first trimester of pregnancy.12 Among white women, when the father of the pregnancy was African-American, the prevalence of BV was 45.7%, compared with 20.9% when the father was white.12 The association of BV with a characteristic of the male might provide support for sexual transmission of BV, and it also suggests that difference in social networks13 between white and African-American women might account for the strong racial differences in this condition. We conducted this analysis to study the association between the race of the male sex partner and incident BV in a longitudinal cohort of non-pregnant women.