Jeanne M. Marrazzo, MD, MPH; Katherine K. Thomas, MS; Tina L. Fiedler, BS; Kathleen Ringwood, MSW; David N. Fredricks, MD
Acknowledgment: The authors thank the study staff, including Susan Heideke, Nancy Dorn, Lauren Asaba, and Dana Varon; Kathy Agnew for performance of Gram staining of vaginal fluid; James Hughes for valuable statistical insights; and the women who participated in the study. 3M Pharmaceuticals (St. Paul, Minnesota) provided vaginal metronidazole (Metrogel vaginal, 0.75%) for some participants.
Grant Support: By the National Institute of Allergy and Infectious Diseases (grants RO1 AI052228 [Dr. Marrazzo] and RO3 AI053250 and RO1 AI061628 [Dr. Fredricks]).
Potential Financial Conflicts of Interest:Consultancies: J.M. Marrazzo (K-V Pharmaceuticals, Mission Pharmacal). Honoraria: J.M. Marrazzo (3M).
Reproducible Research Statement:Study protocol: Available by contacting Dr. Marrazzo (e-mail, firstname.lastname@example.org). Statistical code: Available by contacting Ms. Thomas (e-mail, email@example.com). Data set: Not available.
Requests for Single Reprints: Jeanne Marrazzo, MD, MPH, Harborview Medical Center, Mailbox 359931, 325 Ninth Avenue, Seattle, WA 98104; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Marrazzo, Ms. Thomas, and Ms. Ringwood: Harborview Medical Center, Division of Infectious Diseases, 325 Ninth Avenue, Mailbox 359931, Seattle, WA 98104.
Ms. Fiedler and Dr. Fredricks: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D3-100, Box 19024, Seattle, WA 98109-1024.
Author Contributions: Conception and design: J.M. Marrazzo, D.N. Fredricks.
Analysis and interpretation of the data: J.M. Marrazzo, K.K. Thomas, D.N. Fredricks.
Drafting of the article: J.M. Marrazzo.
Critical revision of the article for important intellectual content: J.M. Marrazzo, K.K. Thomas, D.N. Fredricks.
Final approval of the article: J.M. Marrazzo, K.K. Thomas, T.L. Fiedler, K. Ringwood, D.N. Fredricks.
Provision of study materials or patients: J.M. Marrazzo.
Statistical expertise: J.M. Marrazzo, K.K. Thomas.
Obtaining of funding: J.M. Marrazzo, D.N. Fredricks.
Administrative, technical, or logistic support: K. Ringwood.
Collection and assembly of data: T.L. Fiedler, K. Ringwood.
Marrazzo J., Thomas K., Fiedler T., Ringwood K., Fredricks D.; Relationship of Specific Vaginal Bacteria and Bacterial Vaginosis Treatment Failure in Women Who Have Sex with Women. Ann Intern Med. 2008;149:20-28. doi: 10.7326/0003-4819-149-1-200807010-00006
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Published: Ann Intern Med. 2008;149(1):20-28.
Bacterial vaginosis is characterized by depletion of hydrogen peroxide–producing lactobacilli that characterize normal vaginal flora and profound overgrowth of anaerobic bacteria (1). Bacterial vaginosis is the most prevalent vaginal infection in reproductive-age women, affecting 8% to 29%, and is the most common cause of vaginal symptoms prompting medical care (2). Of 3739 women enrolled during 2001 to 2004 in a nationally representative sample of the U.S. civilian noninstitutionalized population, almost 1 in 3 (29.2% [95% CI, 27.2% to 31.3%]) had bacterial vaginosis, as determined by Gram stain of vaginal fluid (3, 4). Bacterial vaginosis has been consistently associated with adverse outcomes related to the upper genital tract and with increased risk for HIV acquisition (5–7).
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