Risk factors for and relationship between bacterial vaginosis and cervicitis in a high risk population for cervicitis in Southern Iran H. Keshavarz 1 , S.W. Duy 2 , A. Sadeghi-Hassanabadi 3 , Z. Zolghadr 3 & B. Oboodi 3 1 Medical Research Council, Biostatistics Unit, Institute of Public Health, Cambridge; 2 Department of Mathematics, Statistics and Epidemiology, Imperial Cancer Research Fund, London, UK; 3 Shiraz University of Medical Sciences, Medical School, Shiraz, Iran Accepted in revised form 11 April 2001 Abstract. In 1990, a study of the reproductive habits and cervical pathology in women of the Qashgha'i nomadic tribe, resulted in a high prevalence of cer- vicitis. This led us to explore the likely infectious agents responsible for a such high prevalence; to as- sess the dierence in cervicitis rates between nomadic and non-nomadic populations in the same area; and to determine the risk factors for and the relationship between cervicitis and bacterial vaginosis (BV). In 1996±1997 a study was carried out of 839 married women of the Qashgha'i, 274 of the Lor nomadic tribes, and 388 non-nomadic urban women. A gy- naecological examination, Pap smear and vaginal secretion for assessing BV by gram staining were performed. Data was analysed by logistic regression. Backward stepwise regression was used to assess multivariable eects on risk of cervicitis. The preva- lence of cervicitis was 88% in the Qashgha'i, 85% in the Lor and 71% in the urban population. In the multivariate backward stepwise regression analysis for predictors of cervicitis in the Qashgha'i, signi®- cant factors were decreased association with those over 40 (p < 0.004) and postpartum bleeding. In the Lor tribe the predictors were an increased risk after more than four pregnancies (p <0.01)andtheuseof contraception. Among the urban population, the risk of cervicitis was increased with the use of oral con- traceptive previously (p < 0.03) or currently (p < 0.01). BV was strongly associated with cervici- tis, with a relatively high attributable risk. Both sex- ual and childbirth exposures may be associated with cervicitis in these populations. Key words: Bacterial vaginosis, Cervicitis, Iran, Qashgha'i, Tribal women Introduction Gynaecologic infections are common worldwide. The problemisparticularlyseriousindevelopingcountries, where the health services are inadequately equipped and thus unable to detect and treat these infections. Thisproblemisfurthercomplicatedbytheabsenceof subsidised diagnostic means to determine etiology [1]. Routinetestingfortheseconditionsisrecommendedin all sexually active patients and screening tests for gonococcal and chlamydial cervicitis have been suc- cessfully implemented in many clinics in developed countries. However, clinics in areas with limited re- sources may have diculty in implementing universal screening for these infections [2±5]. A previous study of the Qashgha'i nomadic pop- ulation showed a high prevalence of cervicitis among the women of this population [6]. Another study conducted in a population with similarly high risk of cervicitis, resulted in ®ndings of independent associ- ations of cervicitis with chlamydia and bacterial vaginosis (BV) [3]. Bacterial vaginosis is a polymicrobial condition in which a decrease in vaginal acidity and in the con- centration of lactobacilli is accompanied by an in- crease of more than hundred fold in the concentration of other micro-organisms. No single micro-organism is detected in all women with BV. In clinics for sexually transmitted diseases the reported prevalence of BV has been between 24 and 37%. The epidemiology of the condition has some of the char- acteristics of a sexually transmitted disease and it is associated with the presence of Neisseria gonorrhoea and Chlamydia trachomatis [4]. So far, there has been no information on the prev- alenceofBVinnomadicoreveninurbanpopulations in Iran, where there is a Muslim population with the correspondingtraditionallystrictsexuallifestylehabits in both men and women with serial or multiple part- ners being rare, with the exception of occasional male polygamy in the form of more than one life partner. A very high population rate of cervicitis is likely to be due at least partly to infectious agents [3]. This high-risk population gives an opportunity to identify some of them. The aim of the present paper was to investigate the association of BV with cervicitis, which in turn will give further clues to the aetiology of the latter. European Journal of Epidemiology 17: 89±95, 2001. Ó 2001 Kluwer Academic Publishers. Printed in the Netherlands.