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Background  Bacterial vaginosis (BV) – a syndrome characterised by a shift in vaginal flora – appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge syndrome (VDS) in The Gambia, West Africa.    Methods  We enrolled 227 women with VDS from a large genito-urinary medicine clinic in Fajara, The Gambia. BV was diagnosed by the Nugent's score and Amsel's clinical criteria. Vaginal swabs were collected for  T vaginalis  and vaginal flora microscopy, and for  Lactobacillus  spp, aerobic organisms,  Candida  spp and BV-associated bacteria ( Gardnerella vaginalis , anaerobic bacteria, and  Mycoplasma  spp) cultures; and cervical swabs were collected for  N gonorrhoeae  culture and  C trachomatis  PCR. Sera were tested for HIV-1 and HIV-2 antibodies. Sexual health history including details on sexual hygiene were obtained by standardised questionnaire.    Results  BV prevalence was 47.6% by Nugent's score and 30.8% by Amsel's clinical criteria.  Lactobacillus  spp were isolated in 37.8% of women, and 70% of the isolates were hydrogen-peroxide (H 2 0 2 )-producing strains. Prevalence of BV-associated bacteria were:  G vaginalis  44.4%;  Bacteroides  16.7%;  Prevotella  15.2%;  Peptostretococcus  1.5%;  Mobiluncus  0%; other anaerobes 3.1%; and  Mycoplasma hominis  21.4%. BV was positively associated with isolation of  G vaginalis  (odds-ratio [OR] 19.42, 95%CI 7.91 – 47.6) and anaerobes (P = 0.001 [OR] could not be calculated), but not with  M hominis . BV was negatively associated with presence of  Lactobacillus  (OR 0.07, 95%CI 0.03 – 0.15), and H 2 O 2 -producing lactobacilli (OR 0.12, 95% CI 0.05 – 0.28). Presence of H 2 O 2 -producing lactobacilli was associated with significantly lower prevalence of  G vaginalis , anaerobes and  C trachomatis . HIV prevalence was 12.8%. Overall, there was no association between BV and HIV, and among micro-organisms associated with BV, only  Bacteroides  spp. and  Prevotella  spp. were associated with HIV. BV or vaginal flora patterns were not associated with any of the factors relating to sexual hygiene practices (vaginal douching, menstrual hygiene, female genital cutting).    Conclusion  In this population, BV prevalence was higher than in corresponding populations in industrialised countries, but the pattern of vaginal micro-flora associated with BV was similar. BV or vaginal flora patterns were not associated with HIV nor with any of the vaginal hygiene characteristics.

bmc infectious diseases

Bacterial vaginosis, vaginal flora patterns and vaginal hygiene practices in patients presenting with vaginal discharge syndrome in The Gambia, West Africa