NAmerican women only *Enquired about country of birth; not associated with prevalent BV Megasphera type I in BV + women associated with WSW, 4.4(1.2,16.4) 0.68 (0.30,1.53) (>1 MSP, 3m) 2.51 (1.30,4.82) (New partner,3m)****McCaffrey et al, 1999 [16]Bailey et al, 2004 [31] Evans et al, 2007 [14]b Marrazzo et al, 2008 [29]* aaMarrazzo et al, 2009 [27]b Marrazzo et al, 2010 [18]b Marrazzo et al, 2010[20]bb Marrazzo et al, 2011 [30]Fethers et al, 2012 [32] Bradshaw et al, 2014 [12]Muzny et al, 2013 [28]Vodstrcil et al, 2014 [19]Increased # recent MSPs/ New MSPsAZD4547 mechanism of action vaginal bacterial speciesPLOS ONE | DOI:10.1371/journal.pone.0141905 December 16,*Not always cleaning vaginal sex toy between use on subject and on a partner *Asian ethnicity, **Not included in multivariable model *Only WSM asked *BV persistence, **With FSP or MSP, ***Includes all anal sex behaviours *Enquired about country of birth; not associated with incident BV** Correlated with FSP non coenrolment***From FSP or MSP****Combined FSP, MSP (mainly reflects FSP)Notesdoi:10.1371/journal.pone.0141905.tRisk Factors for BV among WSW: A Systematic Review7 /Risk Factors for BV among WSW: A Systematic ReviewTable 3. Summary of associations with prevalent or incident/recurrent/persistent BV. Type of study design Prevalence Variable Total number of studies investigating an association 5 4 5 5 3 2 5 Number of studies reporting a significant association 0 1 2 0 0 0 0 Incidence / Recurrence / Persistence Total number jir.2012.0140 of studies investigating an association 3 2 3 3 3 2 2 Number of studies reporting a significant association 0 0 1 0 0 1Age Ethnicity Smoking Vaginal douching Hormonal contraception Menstrual cycle Receptive digitalvaginal sex with FSP Protected digitalvaginal sex with FSP Receptive digitalanal sex with FSP Receptive oralvaginal sex with FSP Receptive oralanal sex with FSP Vaginal sex toy use Shared vaginal sex toy use Increased number of lifetime FSPs Increased number of recent FSPs/ New FSP BV history/ symptoms in FSP (self-report) BV diagnosed in FSP during study Increased number of lifetime MSPs Increased number of recent MSPs/ New MSPsd50005 3 4 61 0 2 51 0 2 00 0 1 0 1e4 54d 11 01 0 1eDefined in recent MG-132 site sexual partner(s) in cross-sectional studies (either within last 12 months, or lastmonths), or a new sexual partner in longitudinal cohort studies. e Significant on univariate analysis; significant on multivariate analysis when new FSP/MSP was journal.pone.0158910 combined with new MSP/FSP in a broader “new partner” category but for the majority of women this represented a new FSP. FSP (female sexual partner), MSP (male sexual partner) doi:10.1371/journal.pone.0141905.tPLOS ONE | DOI:10.1371/journal.pone.0141905 December 16,8 /Risk Factors for BV among WSW: A Systematic Reviewor two additional studies.[16,28] Two studies did not stratify smoking according to sexual behaviour (WSW versus WSM) so the association could not be investigated for WSW.[14,32] None of the eight studies that examined associations between vaginal douching and BV in WSW[12,15,18?0,28,29,31] reported an association with BV, although douching was positively associated with `abnormal’ vaginal flora (NS 4?0) in one.[15] Two studies did not stratify douching according to sexual behaviour.[14,32]Hormonal influencesHormonal contraceptive use was relatively uncommon in WSW, ranging from 4?3 in the six studies that investigated its association with BV,[12,18?0,28,29] and it was not found to be associated with BV. In one study, 41 of part.NAmerican women only *Enquired about country of birth; not associated with prevalent BV Megasphera type I in BV + women associated with WSW, 4.4(1.2,16.4) 0.68 (0.30,1.53) (>1 MSP, 3m) 2.51 (1.30,4.82) (New partner,3m)****McCaffrey et al, 1999 [16]Bailey et al, 2004 [31] Evans et al, 2007 [14]b Marrazzo et al, 2008 [29]* aaMarrazzo et al, 2009 [27]b Marrazzo et al, 2010 [18]b Marrazzo et al, 2010[20]bb Marrazzo et al, 2011 [30]Fethers et al, 2012 [32] Bradshaw et al, 2014 [12]Muzny et al, 2013 [28]Vodstrcil et al, 2014 [19]Increased # recent MSPs/ New MSPsVaginal bacterial speciesPLOS ONE | DOI:10.1371/journal.pone.0141905 December 16,*Not always cleaning vaginal sex toy between use on subject and on a partner *Asian ethnicity, **Not included in multivariable model *Only WSM asked *BV persistence, **With FSP or MSP, ***Includes all anal sex behaviours *Enquired about country of birth; not associated with incident BV** Correlated with FSP non coenrolment***From FSP or MSP****Combined FSP, MSP (mainly reflects FSP)Notesdoi:10.1371/journal.pone.0141905.tRisk Factors for BV among WSW: A Systematic Review7 /Risk Factors for BV among WSW: A Systematic ReviewTable 3. Summary of associations with prevalent or incident/recurrent/persistent BV. Type of study design Prevalence Variable Total number of studies investigating an association 5 4 5 5 3 2 5 Number of studies reporting a significant association 0 1 2 0 0 0 0 Incidence / Recurrence / Persistence Total number jir.2012.0140 of studies investigating an association 3 2 3 3 3 2 2 Number of studies reporting a significant association 0 0 1 0 0 1Age Ethnicity Smoking Vaginal douching Hormonal contraception Menstrual cycle Receptive digitalvaginal sex with FSP Protected digitalvaginal sex with FSP Receptive digitalanal sex with FSP Receptive oralvaginal sex with FSP Receptive oralanal sex with FSP Vaginal sex toy use Shared vaginal sex toy use Increased number of lifetime FSPs Increased number of recent FSPs/ New FSP BV history/ symptoms in FSP (self-report) BV diagnosed in FSP during study Increased number of lifetime MSPs Increased number of recent MSPs/ New MSPsd50005 3 4 61 0 2 51 0 2 00 0 1 0 1e4 54d 11 01 0 1eDefined in recent sexual partner(s) in cross-sectional studies (either within last 12 months, or lastmonths), or a new sexual partner in longitudinal cohort studies. e Significant on univariate analysis; significant on multivariate analysis when new FSP/MSP was journal.pone.0158910 combined with new MSP/FSP in a broader “new partner” category but for the majority of women this represented a new FSP. FSP (female sexual partner), MSP (male sexual partner) doi:10.1371/journal.pone.0141905.tPLOS ONE | DOI:10.1371/journal.pone.0141905 December 16,8 /Risk Factors for BV among WSW: A Systematic Reviewor two additional studies.[16,28] Two studies did not stratify smoking according to sexual behaviour (WSW versus WSM) so the association could not be investigated for WSW.[14,32] None of the eight studies that examined associations between vaginal douching and BV in WSW[12,15,18?0,28,29,31] reported an association with BV, although douching was positively associated with `abnormal’ vaginal flora (NS 4?0) in one.[15] Two studies did not stratify douching according to sexual behaviour.[14,32]Hormonal influencesHormonal contraceptive use was relatively uncommon in WSW, ranging from 4?3 in the six studies that investigated its association with BV,[12,18?0,28,29] and it was not found to be associated with BV. In one study, 41 of part.