Bacterial vaginosis-associated vaginal microbiota is an age-independent risk factor for Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis infections in low-risk women, St. Petersburg, Russia

Abstract

The large majority of studies investigating associations between bacterial vaginosis (BV) and sexually transmitted infections (STIs) have been conducted among predominantly young women with high risk for STIs. Since a risky sexual behavior is a significant risk factor for both STIs and BV, this creates a bias toward an increased association between BV and STIs. This study evaluated associations between BV-associated vaginal microbiota and STIs (Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and Neisseria gonorrhoeae) in a population of women with low risk for STIs and investigated STI outcomes depending on the dominating Lactobacillus species. Repository cervicovaginal samples collected from reproductive-age women from January 2014 to February 2019 were characterized for vaginal microbiota types and the STIs using multiplex real-time PCR assays. In total, 95 STI-positive and 91 STI-negative samples were included. A significant, age-independent association between BV-associated vaginal microbiota and the presence of C. trachomatis, M. genitalium, and T. vaginalis infections was identified (age-adjusted odds ratios 2.92 [95% confidence interval (CI) 1.24-7.03], 2.88 [95% CI 1.19-7.16], and 9.75 × 10 7 [95% CI 13.03-∞], respectively). Normal vaginal microbiota dominated by Lactobacillus crispatus, L. gasseri, or L. jensenii was a strong protective factor against C. trachomatis and/or M. genitalium infections, whereas L. iners-dominated microbiota was not significantly associated with C. trachomatis and/or M. genitalium positivity. The results of the present study confirm that STI prevention strategies should include interventions that also reduce the incidence of BV and promote a protective vaginal microbiota in both high-and low-risk women.

MinION™, a portable long-read sequencer, enables rapid vaginal microbiota analysis in a clinical setting

“…In terms of the usefulness of the MinION™ sequencer in gynecological practice, it is interesting that we were able to show the detailed condition of vaginal dysbiosis in a short period of time, which was not noted by the Nugent score. It has been suggested that vaginal dysbiosis may have a connection with the incidence of sexually transmitted infections (Shipitsyna, et al, 2020) and genital viral infections (Borgogna, et al, 2020) (Hoang, et al, 2020) or cervical lesions (Dahoud, et al, 2019). It has also been shown that metagenomic analysis using NGS applications to assess vaginal microbiota can provide more accurate results than conventional methods such as the Nugent score, Amsel's criteria, and bacterial cultures (van den Munckhof, et al, 2019).…”

“…In terms of the usefulness of the MinION™ sequencer in gynecological practice, it is interesting that we were able to show the detailed condition of vaginal dysbiosis in a short period of time, which was not noted by the Nugent score. It has been suggested that vaginal dysbiosis may have a connection with the incidence of sexually transmitted infections [22] and genital viral infections [23,24] or cervical lesions [25]. The full-length 16S rRNA analysis using MinION™ could be a promising option for bacterial identification in a reasonable time frame for diagnostic purposes.…”

The Interaction Between Microorganisms, Metabolites, and Immune System in the Female Genital Tract Microenvironment

“…BV is the most common vaginal microbial disorder of women of childbearing age, and can lead to adverse obstetrics and gynecological outcomes such as infertility, miscarriage, premature rupture of membranes, and premature delivery ( Workowski and Bolan, 2015 ; Baqui et al., 2019 ; Peebles et al., 2019 ). It also increases the risk of sexually transmitted infections ( Shipitsyna et al., 2020 ). BV is characterized by an increase in the diversity of vaginal microbiota, a decrease in Lactobacillus spp.…”

“…However, L. iners produces less lactic acid, so the microbiota dominated by L. iners increases the risk of C. trachomatis infection ( Van Houdt et al., 2018 ). Similarly, BV also increases the risk of C. trachomatis infection due to a reduction in the lactate concentration ( Shipitsyna et al., 2020 ). Therefore, C. trachomatis infection is greatly affected by lactic acid in the reproductive tract microenvironment.…”

Type II Restriction-Modification System from Gardnerella vaginalis ATCC 14018

“…Vaginal anaerobic dysbiosis, bacterial vaginosis (BV), affects women’s self-esteem and sex life [ 1 ] and is associated with poor reproductive and obstetric sequelae [ 2 , 3 , 4 ]. An indicator of BV is the presence of ‘clue cells,’ which are desquamated vaginal epithelial cells coated with a biofilm [ 5 , 6 ].…”