Stress, bacterial vaginosis, and the role of immune processes

Bacterial vaginosis (BV), the most common lower genital tract infection in women of reproductive age, is associated with adverse gynecologic and reproductive health outcomes. Women at highest risk for BV are young, unmarried, low income, undereducated, and African American. Behaviors such as vaginal douching, numerous sexual partners, frequent sexual intercourse, receptive oral sex, and substance use may contribute to risk, but they account for only a modest proportion of the observed race/ethnicity variance in BV. These subpopulations are also exposed to more social disadvantages or "stressors" such as poverty, poor housing, crime-infested neighborhoods, and discrimination than other groups. Growing physiologic evidence links psychosocial stress to the development of disease. Evidence supports a statistically significant, independent effect of stress on the risk and observed racial/ethnic disparity in the rate of BV. This paper reviews such evidence.