Identification of novel microbes associated with pelvic inflammatory disease and infertility

Abstract

ObjectivesAs pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae.MethodsFastidious bacterial vaginosis (BV)-associated bacteria (Sneathia (Leptotrichia) sanguinegens, Sneathia amnionii, Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility.ResultsPersistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RRadj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RRadj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RRadj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest.ConclusionsTo our knowledge, this is the first prospective study to demonstrate that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.

Vaginal microbiota and genitourinary menopausal symptoms: a cross-sectional analysis

“…27 Morphologically, this species is similar to Mobiluncus and in fact many communities previously identified by microscopy as having Mobiluncus may actually have been colonized by BVAB1. 28 In addition to its association with bacterial vaginosis in general, BVAB1 was closely correlated with the presence of a positive “whiff” test in women with bacterial vaginosis, indicating the presence of volatile amines.…”

Human Three-Dimensional Endometrial Epithelial Cell Model To Study Host Interactions with Vaginal Bacteria and Neisseria gonorrhoeae

“…For these studies, we selected bacterial species commonly found in the human FRT, including a sexually transmitted pathogen, N. gonorrhoeae, and two endogenous vaginal microbes, one of which (L. crispatus) is commensal and the other of which (G. vaginalis) is associated with BV (18,19,33,55). It should also be noted that both N. gonorrhoeae and G. vaginalis are associated with endometritis and PID (2,20,21,55,56). Our results first showed that all tested species are capable of adhering to the 3-D EEC aggregates.…”

Infective endocarditis due toAtopobium vaginae: a rare association between genital infection and endocarditis of the tricuspid valve

“…Atopobia are normal colonisers of the human oral cavity and vaginal tract, where they play a role in the pathogenesis of bacterial vaginosis 6. There is also compelling evidence that they play a role in more invasive genital tract infections, including pelvic inflammatory disease,7 endometritis8 and tubo-ovarian abscesses 9. Bacteraemia, though rare, has been described in several species, including a case of Atopobium rimae in a patient with aspiration pneumonia10 and the recently described A. deltae in a patient with Fournier’s gangrene 11.…”