title: A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease.
abstract: 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 degrees 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.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. repro@pitt.edu
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Ness
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Kip
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hillier
authors.forename: David E
authors.initials: DE
authors.lastname: Soper
authors.forename: Carol A
authors.initials: CA
authors.lastname: Stamm
authors.forename: Richard L
authors.initials: RL
authors.lastname: Sweet
authors.forename: Peter
authors.initials: P
authors.lastname: Rice
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D006801:Humans; D000292:Pelvic Inflammatory Disease / Q000208:ethnology / Q000382:microbiology*; D012307:Risk Factors; D014481:United States; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000208:ethnology / Q000382:microbiology*