4 Infectious Diseases in Obstetrics and Gynecology Table 2: Odds ratio for having detectable HIV-1 in cervicovaginal lavage when individual bacteria are detected by PCR. Bacterial species N (%)a OR 95% CI (any versus none) Lactobacillus spp. 60 (94%) N/Ab — Lactobacillus crispatus 23 (37%) 3.17 0.85, 11.8 Gardnerella vaginalis 54 (84%) 17.2 0.48, 619 Leptotrichia/Sneathia 38 (59%) 0.61 0.17, 2.13 Megasphaera spp. 20 (31%) 0.91 0.26, 3.17 BVAB1 12 (19%) 3.07 0.68, 14.0 BVAB2 26 (41%) 2.59 0.74, 9.0 BVAB3 17 (27%) 3.03 0.63, 14.7 aNumber of women with bacteria detected by qPCR. bCannot be computed, because only 4 women had no lactobacilli, and all had detectable cervicovaginal HIV shedding (OR would be inﬁnity). Table 3: Sensitivity and speciﬁcity of detection of individual and combinations of bacteria for diagnosis of bacterial vaginosis compared to Amsel’s clinical criteria. Any Lactobacillus spp. Any Lactobacillus crispatus Any Gardnerella vaginalis Any Leptotrichia/Sneathia Any Megasphaera spp Any BVAB1 Any BVAB2 Any BVAB3 Any Megasphaera spp. OR BVAB2 High Gardnerella vaginalis (>median) Sensitivity 0% 42% 95% 75% 50% 29% 63% 38% 71% 75% Speciﬁcity 100% 63% 32% 68% 89% 93% 89% 89% 86% 82% OR (95% CI) 1.8 (0.15, 20.8) 1.2 (0.39, 3.75) 10.9 (1.3, 94) 6.3 (1.8, 21) 8.3 (2.0, 35) 5.4 (0.99, 29) 13.9 (3.2, 60) 5.0 (1.2, 21) 14.6 (3.7, 58) 13.8 (3.6, 53) P value — .09 .12 .44 .88 .15 .14 .17 P value .65 .74 .03 .003 .004 .051 <.001 .02 <.001 <.001 Table 4: Vaginal eﬀects of bacteria: univariate correlation (using linear regression) between presence of bacterial species and log-transformed quantity of nucleated cells in the CVL and between concentration of bacterial species and pH of the vaginal secretions. Bacterial species Lactobacillus spp Lactobacillus crispatus Gardnerella vaginalis Leptotrichia/Sneathia Megasphaera spp. BVAB1 BVAB2 BVAB3 Nucleated cells (model with presence/absence bacterial species) Regression coeﬃcient 95% CI P value −0.600 −0.958, −0.242 .001 0.136 −0.185, 0.456 .41 0.573 0.110, 1.035 .015 0.226 −0.083, 0.535 .15 0.130 −0.196, 0.456 .43 0.012 −0.376, 0.400 .95 0.042 −0.267, 0.351 .79 −0.021 −0.364, 0.321 .90 pH (model with concentration of bacterial species) Regression coeﬃcient 95% CI P value 0.019 −0.092, 0.129 .74 −0.127 −0.18, −0.073 <.001 0.156 0.098, 0.214 <.001 0.123 0.078, 0.169 <.001 0.108 0.062, 0.154 <.001 0.062 0.007, 0.118 .027 0.160 0.11, 0.204 <.001 0.113 0.058, 0.168 <.001 cells) in CVL ( p = .001), while Gardnerella vaginalis was associated with a signiﬁcant increase ( p = .015) (Table 4). 4. Discussion Several fastidious vaginal bacterial species are associated with BV in HIV-1-infected women. Detection of the fastidious bacterium BVAB2 in combination with Megasphaera species provides a reasonably sensitive marker for the diagnosis of BV, consistent with ﬁndings in HIV-1-uninfected women [8]. The impact of bacterial vaginosis on vaginal health may be mediated in several ways. Proinﬂammatory cytokine levels increase in women with BV [12] which may cause epithelial damage or recruit immune cells capable of HIV replication.