Background: Bacterial vaginosis (BV) is common among sexually active women, and is associated with an imbalance in the normal vaginal flora. The natural history of asymptomatic BV is not well described. We evaluated data from a clinical trial of young women with asymptomatic BV to assess its resolution, persistence, and recurrence over time.
Methods: Women 15-25 years of age were enrolled in a multicenter, randomized trial of home screening and treatment for asymptomatic BV to determine effects on incident gonorrhea or chlamydia. Vaginal swabs were collected at enrollment and every 2 months over 12 months of follow-up. BV was defined by Nugent criteria with a score of 7-10. Proportions with complete BV resolution (subsequent Nugent scores < 4), persistence (subsequent Nugent scores >/= 7), and recurrence were estimated among participants randomized to the no-treatment arm. Associations between participant characteristics and BV recurrence were assessed using multivariate logistic regression.
Results: Of 594 participants who were randomized to the no-treatment arm, 412 completed 12 months of follow-up; 67 (16%) women experienced resolution of BV with a median time to resolution of 303 days (range 59-479). Ninety-seven women (24%) experienced persistent asymptomatic BV over a median duration of 369 days (range 330-422). Recurrent asymptomatic BV was identified in 107 (26%) women over the 12 month study period, with a median time to first recurrence of 251 days (range 119-406). The remainder of participants did not meet criteria for these outcomes (e.g. due to incomplete resolution or fluctuating Nugent scores). Recurrent BV was negatively associated with age and positively associated with number of lifetime BV treatments.
Conclusions: Over a 12 month period, resolution of BV by Nugent criteria occurred in less than a fifth of young women with asymptomatic BV. Although persistent and recurrent asymptomatic BV are common, the clinical significance of these conditions remains to be determined.