American Journal of Epidemiology Advance Access originally published online on August 10, 2005
American Journal of Epidemiology 2005 162(6):585-590; doi:10.1093/aje/kwi243
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ORIGINAL CONTRIBUTIONS |
A Cluster Analysis of Bacterial Vaginosis–associated Microflora and Pelvic Inflammatory Disease
1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
2 Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital and Magee-Womens Research Institute, Pittsburgh, PA
3 Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
4 Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO
5 Center for Women's Health, University of California at Davis, San Diego, CA
6 Division of Infectious Disease, Boston Medical Center, Maxwell Finland Laboratory, Boston, MA
7 Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, AL
Correspondence to Dr. Roberta B. Ness, University of Pittsburgh, Graduate School of Public Health, Room A530 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261 (e-mail: repro{at}pitt.edu).
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.
chlamydia; gonorrhea; pelvic inflammatory disease; sexually transmitted disease; vaginitis
Abbreviations: BV, bacterial vaginosis; PID, pelvic inflammatory disease
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  O. Lobos and C. Padilla Phenotypic characterization and genomic DNA polymorphisms of Escherichia coli strains isolated as the sole micro-organism from vaginal infections Microbiology, March 1, 2009; 155(3): 825 - 830. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. N. Fredricks, T. L. Fiedler, K. K. Thomas, C. M. Mitchell, and J. M. Marrazzo Changes in Vaginal Bacterial Concentrations with Intravaginal Metronidazole Therapy for Bacterial Vaginosis as Assessed by Quantitative PCR J. Clin. Microbiol., March 1, 2009; 47(3): 721 - 726. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Brotman, M. A. Klebanoff, T. R. Nansel, W. W. Andrews, J. R. Schwebke, J. Zhang, K. F. Yu, J. M. Zenilman, and D. O. Scharfstein A Longitudinal Study of Vaginal Douching and Bacterial Vaginosis--A Marginal Structural Modeling Analysis Am. J. Epidemiol., July 15, 2008; 168(2): 188 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Cauci, M. Di Santolo, G. Casabellata, K. Ryckman, S. M. Williams, and S. Guaschino Association of interleukin-1{beta} and interleukin-1 receptor antagonist polymorphisms with bacterial vaginosis in non-pregnant Italian women Mol. Hum. Reprod., April 1, 2007; 13(4): 243 - 250. [Abstract] [Full Text] [PDF]
|
|