Objectives: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. Methods: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. Results: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p¿=¿0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, ¿¿=¿0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p¿=¿0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. Conclusions: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.

Bacterial vaginosis (BV), a common female reproductive tract (FRT) condition characterized by an overgrowth of anaerobic species concurrent with the disappearance of commensal Lactobacilli species, is associated with a 60% increased risk of HIV-1 transmission. However, the role of the FRT epithelia in bacterial vaginosis-associated bacteria (BVAB)-augmented HIV- 1 transmission is unclear. To evaluate the increased risk of HIV-1 acquisition, we treated FRT epithelia with Atopobium vaginae, a prevalent BVAB, to determine the nature of the host response to BVAB exposure. Treatment of endocervical cells with A. vaginae resulted in a 1500-fold increase in the expression of the antimicrobial peptide hBD-2, an inflammatory cytokine response, and delocalization of the tight junction protein ZO-1 from cell borders. Conditioned media (CM) from the coculture of FRT epithelia and A. vaginae also generated an inflammatory immune response and lowered the transepithelial electrical resistance in polarized endocervical monolayers. Changes in HIV-1 infection were measured in TZM-bl reporter cells, which contain a luciferase gene under the control of an HIV-1 long terminal repeat (LTR) region that is activated by the binding of Tat, an HIV-1 protein that drives viral replication. NFκB is a major host-derived transcription factor that regulates the expression of many genes involved in inflammation and the innate immune response. Interestingly, NFκB has been reported to bind Tat-activated response elements within the LTR of HIV-1, driving viral transcription. TZM-bl cells were treated with CM in the absence of HIV-1, which resulted in increased luciferase production that could be suppressed by the NFκB inhibitor TPCA-1. These data suggest that epithelially derived products from the coculture of FRT cells and A. vaginae enhance HIV-1 infection by causing cervical barrier dysfunction and increasing HIV replication efficiency through NFκB.

About 10 % of the adult women population in Sweden are treated annually for urinary tract infections. The increasing bacterial resistance towards antibiotics is classified by WHO (World Health Organization) and ECDC (European Centre for Disease Prevention and Control) as one of the greatest treats for human health in a global perspective. To find alternatives scientists are studying the possibility to use probiotics to reduce the frequency of recurring urinary tract infections. This literature study examines five randomized double blinded placebo controlled studies where different strains of Lactobacillus have been used as a prophylactic to women suffering from recurrent urinary tract infections and bacterial vaginosis. Overall the studies do not display enough promising results to recommend the use of probiotics as a prophylax or cure.