Correlation of behaviors with microbiological changes in vaginal

Bacterial vaginosis (BV) is characterized by dramatic changes in the vaginal ecosystem. Women without evidence of vaginal infection may exhibit transient changes in their ¯ora. We prospectively followed up women by using diaries and self-obtained vaginal smears to correlate behaviors with changes in ¯ora. The majority of women (38/51, 78%) had signi®cant, although transient, changes. Behaviors associated with unstable ¯ora were a history of BV, a greater number of partners, and more frequent episodes of receptive oral sex. Only the latter remained signi®cantly associated in the multivariate analysis. Variables that were associated with day-to-day variability in the ¯ora included use of vaginal medication, menses, greater number of partners, spermicide use, more frequent vaginal intercourse, and less frequent use of condoms. Only a minority of women (11/51, 22%) maintained a ªnormalº lactobacillus-predominant ¯ora. Factors associated with instability of the ¯ora are similar to those epidemiologically associated with BV. Despite the fact that the etiology of bacterial vaginosis (BV) remains unknown, the dramatic microbiological changes that are associated with this syndrome are well understood. Signif