Characterization of the Clinical Manifestations of Bacterial Vaginosis at a Tertiary Care Infectious Diseases Vaginitis Clinic in the United States

BACKGROUND: Bacterial vaginosis (BV) is common and characterized by heterogeneous presentations. We aimed to determine BV subtype prevalence among women attending a United States infectious diseases vaginitis specialty clinic at initial and follow-up visits and identify factors associated with BV subtypes. METHODS: Medical records from adult patients were reviewed, including demographics, visit frequency, STI history, symptoms, and diagnoses. Chi-square, Fisher's exact, and Wilcoxon rank-sum tests compared women with and without BV. Modified Poisson models with generalized estimating equations assessed associations between characteristics and BV subtypes. RESULTS: Between June 2021-December 2024, 149 patients were evaluated; 49 (32.9%) had BV at the initial visit. Recurrent BV was most common (n=27, 55.1%), followed by uncomplicated symptomatic BV (n=18, 36.7%), asymptomatic BV (n=3, 6.1%), and refractory BV (n=1, 2.0%). Black women were more likely than White women to have BV (adjusted relative risk [aRR] 3.92, 95% CI: 1.66-9.27), as were women with a pregnancy history (aRR 2.37, 95% CI: 1.23-5.03). No predictors were identified for uncomplicated BV. Recurrent BV was associated with younger age (≤25 years; aRR 4.29, 95% CI: 1.06-17.29), higher BMI (aRR 3.48 for BMI 25-29.9; aRR 3.06 for BMI ≥30), STI history (aRR 2.19, 95% CI: 1.05-4.57), and a pregnancy history (aRR 3.14, 95% CI: 1.22-8.06). CONCLUSIONS: High BV prevalence and frequent recurrent BV were observed. Race, obesity, STI history, and a pregnancy history were associated with recurrent BV. Further research is needed to characterize factors influencing recurrent BV to optimize sexual health outcomes.