BACTERIAL VAGINOSIS AS A RISK FACTOR FOR UPPER GENITAL-TRACT INFECTION

OBJECTIVE: The objective of this study was to determine whether the cl inical diagnosis of bacterial vaginosis is associated with objective e vidence of acute upper genital tract infection. STUDY DESIGN: Women wh o either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or had other ''nonclass ic'' signs of upper genital tract infection (i.e., atypical pelvic pai n, abnormal uterine bleeding, or cervicitis) were evaluated with eithe r an endometrial biopsy or a laparoscopy with endometrial and fimbrial biopsies for objective evidence of upper genital tract infection. Bac terial vaginosis was considered present ii three of the four following criteria were found: (1) homogeneous gray-white vaginal discharge, (2 ) vaginal pH >4.5, (3) positive ''whiff'' test result, and (4) the pre sence of >20% of epithelial cells classified as clue cells. Patients w ere considered to have upper genital tract infection if they had histo logic, microbiologic, or laparoscopic evidence of upper tract infectio n, RESULTS: One hundred sixteen women were evaluated between August 19 93 and March 1997 with complete evaluations. Objective evidence of upp er tract infection was present in 56% (14/25) of women with the clinic al diagnosis of bacterial vaginosis compared with 30% of women (27/91) who did not meet the clinical criteria (p = 0.015). Using logistic re gression to control for confounding variables, we found that the prese nce of bacterial vaginosis was associated with a threefold increased r isk of upper genital tract infection (adjusted odds ratio = 3.0, 95% c onfidence interval 1.2 to 7.6). CONCLUSIONS: Bacterial vaginosis is as sociated with an increased risk of objective evidence of acute upper g enital tract infection. Future prospective studies are needed to deter mine whether treatment of bacterial vaginosis can reduce the risk of a scending infection.