Bacterial Vaginosis [BV] knowledge, attitudes and behavioural changes after BV diagnosis among women enrolled in a clinical trial in Boston, USA and Vulindlela, South Africa: a qualitative study.

BACKGROUND

Bacterial vaginosis (BV), the most common cause of vaginitis among reproductive age women, has high recurrence even after treatment. In addition to the physical risks of BV (e.g. increased HIV risk and adverse pregnancy outcomes such as preterm birth), the symptoms (malodour, itchiness, vaginal discharge) can cause emotional impacts (e.g. shame, embarrassment, self-consciousness). BV knowledge, attitudes, behavioural change(s) after diagnosis and other previous vaginal health concerns were explored among participants in a clinical trial assessing the safety and biologic effects of a vaginal live biotherapeutic product.

METHODS

In-depth interviews (IDIs) were conducted with 37 female participants in a clinical trial in Boston, USA (n = 14), and Vulindlela, South Africa (SA) (n = 23). Interviews were audio recorded, transcribed and translated. Transcripts were coded and thematically analysed using NVivo.

RESULTS

In this study, previous BV diagnosis was lower in SA than USA (2(9%) versus 12(86%)), with 7(19%) overall reporting a previous STI. There were five key themes: (1) Prior BV and other vaginal health experiences: Although BV was not frequently diagnosed in SA, participants reported experiencing symptoms (discharge, itchiness and malodour). Conversely, USA participants had experiences with previous BV diagnoses. (2) Previous vaginal health seeking behaviour and treatments: Almost all participants from both sites had sought treatment from healthcare professionals for vaginal health concerns, with a few from both sites having used self-care practices. (3) BV knowledge, attitudes and reactions to BV diagnosis: BV knowledge in SA was poor compared with the USA, but most participants were relieved to receive help. (4) Behavioural changes because of BV: Vaginal hygiene practices changed and participants washed more frequently/used products to address malodour. Further, BV symptoms resulted in changes in sex acts and/or abstinence. (5) BV diagnosis disclosure patterns: Disclosure varied, with participants commonly disclosing to those who could provide them with support.

CONCLUSIONS

BV knowledge, attitudes and experiences are related to previous diagnosis and treatment. Symptoms impact individuals' behaviours regardless of previous diagnosis, and can have psychosocial impacts which need to be addressed via appropriate counselling and treatment strategies. Ongoing research for effective BV prevention and treatment options that can be made available and accessible to women with BV globally is needed.

TRIAL REGISTRATION: South African National Clinical Trials Registry (SANCTR DOH-27-102023-8342; October 27, 2023) and ClinicalTrials.gov (NCT06135974; November 02, 2023).