Differential effects of depot medroxyprogesterone acetate administration on vaginal microbiome in Hispanic White and Black women

Abstract

The use of depot medroxyprogesterone acetate (DMPA), a 3-monthly injectable hormonal contraceptive, is associated with an increased risk of HIV acquisition possibly through alteration of the vaginal microbiome. In this longitudinal interventional study, we investigated the impact of DMPA administration on the vaginal microbiome in Hispanic White and Black women at the baseline (visit 1), 1 month (visit 2), and 3 months (visit 3) following DMPA treatment by using 16S rRNA gene sequencing. No significant changes in the vaginal microbiome were observed after DMPA treatment when Hispanic White and Black women were analysed as a combined group. However, DMPA treatment enriched total vaginosis-associated bacteria (VNAB) and Prevotella at visit 2, and simplified the correlational network in the vaginal microbiome in Black women, while increasing the network size in Hispanic White women. The microbiome in Black women became more diversified and contained more VNAB than Hispanic White women after DMPA treatment. While the Firmicutes to Bacteroidetes (F/B) ratio and Lactobacillus to Prevotella (L/P) ratio were comparable between Black and Hispanic White women at visit 1, both ratios were lower in Black women than in Hispanic White women at visit 2. In conclusion, DMPA treatment altered the community network and enriched VNAB in Black women but not in Hispanic White women. The Lactobacillus deficiency and enrichment of VNAB may contribute to the increased risk of HIV acquisition in Black women. Future studies on the impact of racial differences on the risk of HIV acquisition will offer insights into developing effective strategies for HIV prevention. Abbreviations: DMPA: depot medroxyprogesterone acetate; PCR: polymerase chain reaction; OTU: operational taxonomic unit; STI: sexually transmitted infections; VNAB: vaginosis-associated bacteria

Factors associated with the composition and diversity of the cervical microbiota of reproductive-age Black South African women: a retrospective cross-sectional study

“…We further noted that women using hormonal contraceptives (mostly progestin) had a lower bacterial (alpha) diversity relative to non-users. Previous studies have found either no discernible (Birse et al, 2017) or positive associations between progestin-based contraception and the level of bacterial diversity (Brooks et al, 2017; Jespers et al, 2017; Yang et al, 2019). The differential effects of hormonal contraception, particularly progestin-based, could be governed by host genetics (Yang et al, 2019) and differences in study methodologies.…”

“…Previous studies have found either no discernible (Birse et al, 2017) or positive associations between progestin-based contraception and the level of bacterial diversity (Brooks et al, 2017; Jespers et al, 2017; Yang et al, 2019). The differential effects of hormonal contraception, particularly progestin-based, could be governed by host genetics (Yang et al, 2019) and differences in study methodologies. Although current literature suggests that hormonal contraceptives (oestrogen- and/or progestin-based) reduces the risk of BV-associated bacteria (Brooks et al, 2017), BV-like microbiota (Borgdorff et al, 2017) and BV (Abbai, Reddy & Ramjee, 2016; Vodstrcil et al, 2013), with progestin-based contraceptives reducing BV risk by 18–30% (Van de Wijgert et al, 2013), more studies are still needed to fully understand the microbiological consequences of progestin-induced amenorrhea and systemic hypoestrogenism in the context of reproductive health (Miller et al, 2000).…”

Co-infection with trichomonas vaginalis increases the risk of cervical intraepithelial neoplasia grade 2–3 among HPV16 positive female: a large population-based study

“…In this study, Gardnerella has had a low prevalence and was only detected in 1050 (0.34%) female, and co-infected with Gardnerella didn’t increase the risk of CIN or ICC. In the vagina of female without BV, Gardnerella vaginalis was also detected, although it had a lower abundance and prevalence [ 33 , 34 ]. There was enormous substantial genetic diversity within Gardnerella vaginalis [ 16 , 35 ], and virulence potential differentiate significantly between various genetic types/clades [ 15 ]; this may correlate with the result in our study.…”

Co-infection with trichomonas vaginalis increases the risk of cervical intraepithelial neoplasia grade 2-3 among HPV16 positive female: a large population-based study.

“…In this study, Gardnerella has had a low prevalence and was only detected in 1,050 (0.34%) female, and co-infected with Gardnerella didn't increase the risk of CIN or ICC. In the vagina of female without BV, Gardnerella vaginalis was also detected, although it had a lower abundance and prevalence [33,34] . There was enormous substantial genetic diversity within Gardnerella vaginalis [16,35] , and virulence potential differentiate signi cantly between various genetic types/clades [15] ; this may correlate with the result in our study.…”