Pelvic inflammatory disease linked to vaginal bacteria imbalance
A study conducted by Family Planning Australia and the University of Technology Sydney advances understanding and improved detection of pelvic inflammatory disease (PID) after reinforcing earlier findings that people diagnosed with PID are more likely to have imbalances in their vaginal bacteria.
The findings, published in Microbiology Society, show the critical role of the vaginal microbiome in female reproductive tract health.
Family Planning Australia Medical Research Dr Sally Sweeney said the findings could help reduce the long-term reproductive consequences of PID, including infertility and chronic pelvic pain, by growing understanding of underlying causes.
"GPs should be aware that PID is increasingly understood to be a condition involving multiple microbes. PID is associated with imbalances in the bacterial microbiome of the vagina. It is hoped that better understanding the causes of PID could ultimately lead to better diagnostic tools and more targeted therapies for patients," Dr Sweeney said.
"For a long time, we have known that more than 60 per cent of PID cases are not related to a single sexually transmitted infection such as chlamydia or gonorrhoea. We therefore wanted to conduct a case-control study to examine what other factors are associated with the development of PID, and whether certain reproductive tract microbiome patterns associate with PID risk.
"In short, the study was conducted to move beyond the 'one infection causes PID model' and the findings underscore that GPs should treat suspected PID based on clinical diagnosis rather than delaying treatment while waiting for the results of STI testing."
The study recruited participants from Family Planning Australia clinics who presented with PID symptoms, while controls came from asymptomatic individuals visiting the same services for routine screenings or IUD insertions.
The researchers found that those with PID were more likely to have high levels of bacteria including Gardnerella vaginalis, Fannyhessea vaginae, Ureaplasma parvum and several types of Prevotella. Those without PID, on the other hand, had large amounts of Lactobacillus crispatus, which fosters a healthy vaginal environment.
"These findings are important because they strengthen our understanding of the underlying causes of pelvic inflammatory disease beyond the traditional focus on sexually transmitted infections alone. By showing a clear association between PID and cervicovaginal dysbiosis - particularly the absence of low levels of Lactobacillus crispatus - it highlights the critical role of the vaginal microbiome in female reproductive tract health," Dr Sweeney said.
"These findings open the door to improved risk prediction, earlier intervention, and potentially new prevention strategies in the future, that focus on optimising female reproductive microbiome, not just treating infection once it occurs."
"Ultimately, this research brings us closer to reducing the long-term reproductive consequences of PID, including infertility and chronic pelvic pain. It could ultimately lead to better diagnostic tools and more targeted therapies."
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