From the Guidelines
Bacterial Vaginitis (BV) is a significant risk factor for Pelvic Inflammatory Disease (PID).
Causes of PID
- Sexually transmitted organisms, especially N. gonorrhoeae and C. trachomatis, are implicated in many cases of PID 1
- Microorganisms that comprise the vaginal flora, such as anaerobes, G. vaginalis, H. influenzae, enteric Gram-negative rods, and Streptococcus agalactiae, also have been associated with PID 1
Relationship between BV and PID
- BV has been associated with endometritis, PID, or vaginal cuff cellulitis following invasive procedures 1
- Treatment of BV with metronidazole substantially reduced post-abortion PID in a randomized controlled trial 1
- Anaerobic bacteria, which are often present in BV, have been isolated from the upper-reproductive tract of women with PID and may cause tubal and epithelial destruction 1
Treatment Considerations
- Treatment regimens for PID should have anaerobic coverage to effectively eradicate anaerobes, which may be important in preventing long-term sequelae 1
- Immediate administration of appropriate antibiotics is crucial in preventing long-term sequelae of PID 1
From the Research
Bacterial Vaginitis and Pelvic Inflammatory Disease (PID)
Association Between Bacterial Vaginosis and PID
- Studies have investigated the relationship between bacterial vaginosis (BV) and pelvic inflammatory disease (PID) 2, 3, 4, 5, 6.
- A cluster analysis of BV-associated microflora and PID found that 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) 2.
- Another study found that BV was associated with incident PID in a large prospective cohort, controlling for behavioral factors and sexually transmitted infections (STIs) (adjusted hazard ratio [aHR], 1.53 [95% confidence interval {CI}, 1.05-2.21]) 3.
Risk Factors for PID
- BV-associated microorganisms, such as Gardnerella vaginalis, Mycoplasma hominis, and anaerobic gram-negative rods, have been identified as risk factors for PID 2, 5.
- Vaginal douching has also been associated with an increased risk of PID (adjusted hazard ratio [aHR], 1.47 [95% confidence interval {CI}, 1.03-2.09]) 3.
- Novel BV-associated organisms, such as Atopobium vaginae, BVAB1, and Sneathia sanguinegens, may mediate the relationship between vaginal douching and PID 6.
Implications for Women's Health
- BV is associated with an increased risk of gynecologic complications, including PID, postoperative infection, cervicitis, and human immunodeficiency virus (HIV) 4.
- The relationship between BV and PID is complex and may be influenced by various factors, including sexual behavior, STIs, and host responses 2, 3, 5.