{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:14:09Z","timestamp":1790723649709,"version":"4.1.0"},"reference-count":20,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T00:00:00Z","timestamp":1575590400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI073940"],"award-info":[{"award-number":["R01AI073940"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2019,11,7]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>\nWe sought to determine whether the relationship between a history of vaginal douching and pelvic inflammatory disease (PID) is mediated by endometrial infection with one or more novel bacterial vaginosis (BV)-associated organisms among\n<jats:italic>Atopobium vaginae<\/jats:italic>\n, the BV-associated bacterium 1 (BVAB1),\n<jats:italic>neathia<\/jats:italic>\n(\n<jats:italic>Leptotrichia<\/jats:italic>\n)\n<jats:italic>amnionii<\/jats:italic>\nand\n<jats:italic>Sneathia sanguinegens<\/jats:italic>\n.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We first conducted log-binomial regression analyses to identify risk factors for endometrial infection in 535 adolescent and adult women with clinically suspected PID in the PID Evaluation and Clinical Health (PEACH) study. We then examined whether endometrial infection by the BV-associated organisms mediated the association between a history of vaginal douching and histologically confirmed PID using inverse probability weighted marginal structural models.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Vaginal douching was significantly associated with endometrial infection with one or more of the targeted BV-associated organisms (relative risk (RR) 1.21, 95% CI: 1.08 to 1.35). The total effect estimate suggested that vaginal douching increased the risk of endometritis by 24% (RR 1.24, 95%\u2009CI: 1.03 to 1.49). The controlled direct effect of this association was attenuated with endometrial infection by one or more BV-associated organisms (adjusted RR (aRR) 1.00, 95%\u2009CI: 0.57 to 1.74) and endometrial infection by all four BV-associated organisms (aRR 0.95, 95%\u2009CI: 0.53 to 1.70) as intermediate variables.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Endometrial infection with one or more of the novel BV-associated organisms partially mediated the relationship between vaginal douching and histologically confirmed endometritis in the PEACH study. Frequent vaginal douching may confer risk for endometritis through increasing the risk of endometrial infection by novel-BV-associated organisms. Other potential pathways should be explored.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/sextrans-2019-054191","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T22:19:26Z","timestamp":1575670766000},"page":"439-444","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Novel bacterial vaginosis-associated organisms mediate the relationship between vaginal douching and pelvic inflammatory disease"],"prefix":"10.1136","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9288-2113","authenticated-orcid":false,"given":"Tamala","family":"Gondwe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Ness","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A","family":"Totten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Astete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gong","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie A","family":"Gold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9849-7865","authenticated-orcid":false,"given":"Catherine L","family":"Haggerty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,6]]},"reference":[{"key":"2024092304150700000_96.6.439.1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.15585\/mmwr.mm6603a3","article-title":"Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age - United States, 2013-2014","volume":"66","author":"Kreisel","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024092304150700000_96.6.439.2","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199207000-00001"},{"key":"2024092304150700000_96.6.439.3","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200104000-00010"},{"key":"2024092304150700000_96.6.439.4","article-title":"Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina","volume":"100","author":"Ness","year":"2002","journal-title":"Obstet Gynecol"},{"key":"2024092304150700000_96.6.439.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-5456(00)00124-8"},{"key":"2024092304150700000_96.6.439.6","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwi025"},{"key":"2024092304150700000_96.6.439.7","doi-asserted-by":"publisher","DOI":"10.1086\/423963"},{"key":"2024092304150700000_96.6.439.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043802"},{"key":"2024092304150700000_96.6.439.9","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2015-052285"},{"key":"2024092304150700000_96.6.439.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0197-2456(98)00022-1"},{"key":"2024092304150700000_96.6.439.11","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31818f69ce"},{"key":"2024092304150700000_96.6.439.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0030633","article-title":"Bacterial vaginosis (bv) candidate bacteria: associations with bv and behavioural practices in sexually-experienced and inexperienced women","volume":"7","author":"Fethers","year":"2012","journal-title":"PLoS One"},{"key":"2024092304150700000_96.6.439.13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jpag.2006.01.001","article-title":"Intergenerational transfer of douching information","volume":"19","author":"Rupp","year":"2006","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"2024092304150700000_96.6.439.14","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-200301000-00014"},{"key":"2024092304150700000_96.6.439.15","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-199908000-00008"},{"key":"2024092304150700000_96.6.439.16","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31828786f8"},{"key":"2024092304150700000_96.6.439.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1446.2010.00874.x"},{"key":"2024092304150700000_96.6.439.18","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000190018.58079.05"},{"key":"2024092304150700000_96.6.439.19","doi-asserted-by":"publisher","DOI":"10.1097\/NMC.0b013e3181cae9da"},{"key":"2024092304150700000_96.6.439.20","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2015.1035255"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2019-054191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T17:55:49Z","timestamp":1727114149000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2019-054191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,6]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,8,19]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/sextrans-2019-054191"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2019-054191","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,6]]}}}