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Risk of Gonococcal Infection During Vaginal Exposure is Associated With High Vaginal pH and Active Menstruation

McLaughlin, Stephanie E., MD*†‡; Ghanem, Khalil G., MD, PhD*; Zenilman, Jonathan M., MD*; Griffiss, J. McLeod, MD§

doi: 10.1097/OLQ.0000000000000926
Original Studies

Background An understanding of the biological reasons why 25% to 35% of women resist infection during vaginal intercourse with a man infected with Neisseria gonorrhoeae could lead to novel control measures. We sought modifiable biological bases for infection resistance by comparing women in the same core-mixing group who did or did not become infected after sexual exposure.

Methods We enrolled 61 female contacts of index men with gonorrhea seen at Baltimore City Health Department clinics from January 2008 through May 2012. Exposure and sexual practices and histories, co-infections, physical signs on exam, patient symptom report, and menstrual history were collected.

Results Thirty-eight (62.3%) of the exposed women developed cervical infections. Multiple logistic regression found that a vaginal pH of 4.5 or higher at presentation to clinic was significantly associated with gonococcal infection (adjusted odds ratio, 5.5; P = 0.037) in women who presented within one menstrual cycle, 35 days. In this group of women, there was a significant association between acquiring an N. gonorrhoeae cervical infection and sexual exposure during menstruation (adjusted odds ratio 12.5; P = 0.05).

Conclusions Modification of vaginal pH could be explored as novel strategy for reducing the risk of N. gonorrhoeae infections in women.

Vaginal pH of 4.5 or higher and active menstruation were associated with Neisseria gonorrhoeae infection in a cross-sectional analysis of prospectively enrolled exposed women.

From the *Department of Medicine, Johns Hopkins University School of Medicine, Baltimore MD;

Department of Medicine, New York University, New York, NY;

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD; and

§Department of Laboratory Medicine, University of California San Francisco CA

Correspondence: Stephanie McLaughlin, MD MPH, NYU School of Medicine 550 1st Avenue, NBV 16N30 New York, NY 10016. E-mail:

Conflicts of Interest and Sources of Funding: None declared.

Received for publication July 1, 2018, and accepted October 7, 2018.

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