Association between obesity and bacterial vaginosis as assessed by Nugent score

Abstract

Background Bacterial vaginosis is one of the most common vaginal conditions in the U.S. Recent studies have suggested obese women have an abnormal microbiota reminiscent of BV; however, few studies have investigated the prevalence of bacterial vaginosis in overweight and obese populations. Moreover, despite the increased prevalence of obesity and bacterial vaginosis in black women, it is not known whether racial disparities exist in the relationship between obesity and bacterial vaginosis. Objective The objective of this study was to examine the relationship between body mass index and bacterial vaginosis as determined by Nugent score and to determine the influence of race in this context. Study Design We performed a cross-sectional study using patient data and vaginal smears from 5,918 participants of the Contraceptive CHOICE Project. Gram stained vaginal smears were scored using the Nugent method and categorized as BV-negative (Nugent score 0-3), BV-intermediate (Nugent score 4-6), or BV-positive (Nugent score 7-10). Body mass index was determined using Centers for Disease Control and Prevention guidelines and obese individuals were categorized as Class I, II, or III obese based on NIH and World Health Organization body mass index parameters. Linear regression was used to model mean differences in Nugent scores and Poisson regression with robust error variance was used to model prevalence of bacterial vaginosis. Results In our cohort, 50.7% of participants were black, 41.5% were white, and 5.1% were of Hispanic ethnicity with an average age of 25.3 years old. Overall, 28.1% of participants were bacterial vaginosis-positive. Bacterial vaginosis was prevalent in 21.3% of lean, 30.4% of overweight, and 34.5% of obese women (p<0.001). The distribution of bacterial vaginosis-intermediate individuals was similar across all body mass index categories. Compared to lean women, Nugent scores were highest among overweight and obese Class I women (adjusted mean difference; overweight 0.33 [95% CI 0.14, 0.51] and Class I obese 0.51 [95% CI 0.29, 0.72]). Consistent with this, overweight and obese women had a higher frequency of bacterial vaginosis compared to lean women, even after adjusting for variables including race. Among white women, the prevalence of BV was higher for overweight and Class I and Class II/III obese white women compared to lean white women, a phenomenon not observed among black women, suggesting an effect modification. Conclusion Overweight and obese women have higher Nugent scores and a greater occurrence of bacterial vaginosis compared to lean women. Black women have a greater prevalence of bacterial vaginosis independent of their body mass index compared to white women.