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Bacterial vaginosis and risk of pelvic inflammatory disease.
Abstract
BACKGROUND: Bacterial vaginosis commonly is found in women with pelvic inflammatory disease (PID), but it is unclear whether bacterial vaginosis leads to incident PID. METHODS: Women (n = 1,179) from 5 U.S. centers were evaluated for a median of 3 years. Every 6-12 months, vaginal swabs were obtained for gram stain and culture of microflora. A vaginal microflora gram stain score of 7-10 was categorized as bacterial vaginosis. Pelvic inflammatory disease was diagnosed by presence of either histologic endometritis or pelvic pain and tenderness plus one of the following: oral temperature greater than 38.3 degrees C; sedimentation rate greater than 15 mm/hour; white blood count greater than 10,000; or lower genital tract detection of leukorrhea, mucopus, or Neisseria gonorrhoeae or Chlamydia trachomatis. RESULTS: After adjustment for relevant demographic and lifestyle factors, baseline bacterial vaginosis was not associated with the development of PID (adjusted hazard ratio 0.89, 95% confidence interval 0.55-1.45). Carriage of bacterial vaginosis in the previous 6 months before a diagnosis (adjusted risk ratio 1.31, 95% confidence interval 0.71-2.42) also was not significantly associated with PID. Similarly, neither absence of hydrogen peroxide-producing Lactobacillus nor high levels of Gardnerella vaginalis significantly increased the risk of PID. Dense growth of pigmented, anaerobic gram-negative rods in the 6 months before diagnosis did significantly increase a woman's risk of PID (P =.04). One subgroup of women, women with 2 or more recent sexual partners, demonstrated associations among bacterial vaginosis, Gardnerella vaginalis, anaerobic gram-negative rods, and PID. CONCLUSION: In this cohort of high-risk women, after adjustment for confounding factors, we found no overall increased risk of developing incident PID among women with bacterial vaginosis. LEVEL OF EVIDENCE: II-2
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“By limiting lower genital tract infections, condoms also might reduce the risk for pelvic inflammatory disease (PID) among women (22).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [22]
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Metadata
- Authors
- Ness, R. B., Hillier, S. L., Kip, K. E., Soper, D. E., Stamm, C. A., McGregor, J. A., Bass, D. C., Sweet, R. L., Rice, P., & Richter, H. E.
- Affiliations
- University of Pittsburgh (US)
- Medical University of South Carolina (US)
- Denver Health Medical Center (US)
- Boston Medical Center (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Ness, Roberta B.
- Hillier, Sharon L.
- Kip, Kevin E.
- Bass, Debra C.
- Sweet, Richard L.
- Venue
- Obstetrics & Gynecology
- Published
- 2004-10
- Volume
- 104
- Issue
- 4
- Pages
- 761-769
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W2038231381
- Cited by
- 169
- References
- 30
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 3 · 2023: 5 · 2022: 10 · 2021: 6 · 2020: 11 · 2019: 2 · 2018: 9 · 2017: 7 · 2016: 10 · 2015: 8 · 2014: 3 · 2013: 9 · 2012: 9
- FWCI
- 7.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01ai044151-05)
- National Institute of Allergy and Infectious Diseases (AI44151-01)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- bacterial vaginosis, pelvic inflammatory disease, Gardnerella vaginalis, anaerobic gram-negative rods, vaginal microbiota, sexual partners, endometritis, risk factors
- MeSH terms
- Pelvic Inflammatory Disease, Adolescent, Adult, Female, Gardnerella vaginalis, Humans, Risk Factors, United States, Cohort Studies, Vaginosis, Bacterial
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