Journal Article

A Cluster Analysis of Bacterial Vaginosis–associated Microflora and Pelvic Inflammatory Disease

Roberta B. Ness, Kevin E. Kip, Sharon L. Hillier, David E. Soper, Carol A. Stamm, Richard L. Sweet, Peter Rice and Holly E. Richter

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 162, issue 6, pages 585-590
Published in print September 2005 | ISSN: 0002-9262
Published online September 2005 | e-ISSN: 1476-6256 | DOI: http://dx.doi.org/10.1093/aje/kwi243
A Cluster Analysis of Bacterial Vaginosis–associated Microflora and Pelvic Inflammatory Disease

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Controversy surrounds the association between bacterial vaginosis (BV) and pelvic inflammatory disease (PID). Women (N = 1,140) were ascertained at five US centers, enrolled (1999–2001), and followed up for a median of 3 years. Serial vaginal swabs were obtained for Gram's stain and cultures. PID was defined as 1) histologic endometritis or 2) pelvic pain and tenderness plus oral temperature >38.8°C, leukorrhea or mucopus, erythrocyte sedimentation rate >15 mm/hour, white blood cell count >10,000, or gonococcal/chlamydial lower genital infection. Exploratory factor analysis identified two discrete clusters of genital microorganisms. The first correlated with BV by Gram's stain and consisted of the absence of hydrogen peroxide–producing lactobacillus, Gardnerella vaginalis, Mycoplasma hominis, anaerobic Gram-negative rods, and, to a lesser degree, Ureaplasma urealyticum. The second, unrelated to BV by Gram's stain, consisted of Enterococcus species and Escherichia coli. Being in the highest tertile in terms of growth of BV-associated microorganisms increased PID risk (adjusted rate ratio = 2.03, 95% confidence interval: 1.16, 3.53). Carriage of non-BV-associated microorganisms did not increase PID risk. Women with heavy growth of BV-associated microorganisms and a new sexual partner appeared to be at particularly high risk (adjusted rate ratio = 8.77, 95% confidence interval: 1.11, 69.2). When identified by microbial culture, a combination of BV-related microorganisms significantly elevated the risk of acquiring PID.

Keywords: chlamydia; gonorrhea; pelvic inflammatory disease; sexually transmitted disease; vaginitis; BV, bacterial vaginosis; PID, pelvic inflammatory disease

Journal Article.  3049 words. 

Subjects: Public Health and Epidemiology

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