Longitudinal study of vaginal flora: Increasing periodontal disease (PD) burden is associated with increased risk for bacterial vaginosis (BV)

Abstract

(PD) BURDEN IS ASSOCIATED WITH INCREASED RISK FOR BACTERIAL VAGINOSIS (BV) WILLIAM ANDREWS, MARJORIE JEFFCOAT, JANE SCHWEBKE, MARK KLEBANOFF, JUN ZHANG, SUZANNE CLIVER, University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, Alabama, University of Pennsylvania, Dentistry, Philadelphia, Pennsylvania, University of Alabama at Birmingham, Medicine, Birmingham, Alabama, National Institutes of Health (NIH), Epidemiology, Statistics and Prevention Research, Bethesda, Maryland, National Institutes of Health (NIH), Epidemiology Branch, Bethesda, Maryland OBJECTIVE: To characterize the association between PD burden and risk of BV. STUDY DESIGN: The Longitudinal Study of Vaginal Flora included nonpregnant women who underwent extensive evaluation of the vaginal flora every three months for one year. In this secondary analysis, BV was defined using both Nugent’s and Amsel’s criteria. A dental examination was performed at the first study visit. PD at any of 168 dental sites (6/tooth) was defined as clinical attachment loss (CAL) of R4 mm. RESULTS: Dental exams were performed on 3540 (98%) of 3620 study subjects. At the first visit, 41% (n=1438) had Amsel-BV and 40% (n=1438) had Nugent-BV. 25% had PD at R1 site and 5% at O25 sites. Compared to BV-negative women, the number of dental sites was significantly higher in women with Nugent-BV (Wilcoxon p=.002) and Amsel-BV (Wilcoxon p=.008). The number of sites with PD were categorized as 0 (n=2309), 1-2 (n=319), 3-25 (n=726), 26-75 (n=148), and R76 (n=38). As the number of sites with PD (R4 mm CAL) increased, so did the risk of both Nugent-BV (Mantel-Haenszel [M-H] p=.0005) and Amsel-BV (M-H p=.0009). Increasing numbers of PD sites were significantly associated with higher Mobiluncus (M-H p!.0001) and Gardnerella/Bacteroides (M-H p=.019), but not Lactobacillus Nugent scores (M-H p=.140). Increasing numbers of PD sites were significantly associated with amine odor (M-H p!.0001), homogeneous discharge (M-H p=.016), clue cells (M-H p=.019), vaginal pHO4.5 (M-H p=.0003) and T. vaginalis (M-H p=.0002). After adjusting for confounders associated with PD, high PD burden was associated with increased risk of Nugent-BV (26-75 sites: OR=1.4, 95%CI=1.0-2.0 and R76 sites: OR=2.0, 95%CI=1.04-4.0) and Amsel-BV (26-75 sites: OR=1.1, 95%CI=0.8-1.6 and R76 sites: OR=2.5, 95%CI=1.2-4.9). CONCLUSION: Increasing burden of periodontal disease is associated with a statistically significant increased risk of bacterial vaginosis.