Prevalence and factors associated with bacterial vaginosis in women in Brazil: a systematic review

Camargo, Kélvia Cristina de; Alves, Rosane Ribeiro Figueiredo; Saddi, Vera Aparecida

Introduction:

Bacterial vaginosis is characterized by the imbalance of the vaginal flora, with decrease in Lactobacillus and increase in other bacteria.

Objective:

To investigate the prevalence and factors associated with bacterial vaginosis.

Methods:

Systematic review based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, filed in the International Prospective Register of Systematic Reviews. The research was conducted in the PubMed and Scopus databases in September 2021. After reading the titles and abstracts of 84 articles and the full text of 20 articles, 10 of them were included in the review. The articles were considered eligible if they investigated the prevalence of bacterial vaginosis and used Amsel’s diagnostic criteria or Gram-stained bacterioscopy in women of reproductive age without comorbidities. The studies were evaluated by two investigators to establish reliability. The risk of bias and the quality of the selected studies were evaluated using the Joanna Briggs Institute tool.

Results:

The mean prevalence of bacterial vaginosis in the included studies was 25.4% (95%CI 24.0–26.8). In three population-based studies, the mean prevalence was 18.1% (95%CI 16.0–20.5); and in seven clinic-based studies, it was 27.2% (95%CI 24.6–29.9). The factors associated with bacterial vaginosis were the use of sex accessories (OR 2.4; 95%CI 1.1–4.9), marital status “single” (OR 1.4; 95%CI 1.1–1.8), partner infidelity (OR 1.5; 95%CI 1.2–1.9), abnormal vaginal secretion (OR 1.5; 95%CI 1.2–2.0), and the presence of trichomoniasis (OR 4.1; 95%CI 1.5–11.5).

Conclusion:

The prevalence of bacterial vaginosis was high, and the associated factors are linked to sexual behavior.

Introdução:

A vaginose bacteriana caracteriza-se pelo desequilíbrio da flora vaginal, com diminuição dos Lactobacillus e aumento de outras bactérias.

Objetivo:

Investigar a prevalência e os fatores associados à vaginose bacteriana.

Métodos:

Revisão sistemática baseada nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses, protocolado no International Prospective Register of Systematic Reviews. A pesquisa foi realizada nas bases de dados da PubMed e da Scopus, em setembro de 2021. Após a leitura dos títulos e dos resumos de 84 artigos e do texto completo de 20 artigos, dez foram incluídos na revisão. Os trabalhos foram considerados elegíveis quando investigaram a prevalência de vaginose bacteriana e utilizaram os critérios diagnósticos de Amsel ou a bacterioscopia corada pelo Gram em mulheres em idade reprodutiva e sem comorbidades. Os estudos foram avaliados por duas pesquisadoras para estabelecer a confiabilidade. O risco de viés e a qualidade das pesquisas selecionadas foram avaliados pela ferramenta do Joanna Briggs Institute.

Resultados:

A prevalência média de vaginose bacteriana nos trabalhos incluídos foi de 25,4% (intervalo de confiança — IC95% 24,0–26,8). Em três estudos de base populacional, a prevalência média foi de 18,1% (IC95% 16,0–20,5); e, em sete estudos de base clínica, a prevalência média foi de 27,2% (IC95% 24,6–29,9). Os fatores associados à vaginose bacteriana foram o uso de acessórios sexuais (odds ratio —OR 2,4; IC95% 1,1–4,9), estado civil “solteira” (OR 1,4; IC95% 1,1–1,8), infidelidade do parceiro (OR 1,5; IC95% 1,2–1,9), secreção vaginal anormal (OR 1,5; IC95% 1,2–2,0) e presença de tricomoníase (OR 4,1; IC95% 1,5–11,5).

Conclusão:

A prevalência de vaginose bacteriana foi elevada e os fatores associados estão ligados ao comportamento sexual.