Abstract
In cross-sectional studies increased vaginal bacterial diversity has been associated with vaginal inflammation which can be detrimental for health. We describe longitudinal changes at 5 visits over 8 weeks in vaginal microbiota and immune mediators in African women. Women (N = 40) with a normal Nugent score at all visits had a stable lactobacilli dominated microbiota with prevailing Lactobacillus iners. Presence of prostate-specific antigen (proxy for recent sex) and being amenorrhoeic (due to progestin-injectable use), but not recent vaginal cleansing, were significantly associated with microbiota diversity and inflammation (controlled for menstrual cycle and other confounders). Women (N = 40) with incident bacterial vaginosis (Nugent 7–10) had significantly lower concentrations of lactobacilli and higher concentrations of Gardnerella vaginalis, Atopobium vaginae, and Prevotella bivia, at the incident visit and when concentrations of proinflammatory cytokines (IL-1β, IL-12p70) were increased and IP-10 and elafin were decreased. A higher ‘composite-qPCR vaginal-health-score’ was directly associated with decreased concentrations of proinflammatory cytokines (IL-1α, IL-8, IL-12(p70)) and increased IP-10. This longitudinal study confirms the inflammatory nature of vaginal dysbiosis and its association with recent vaginal sex and progestin-injectable use. A potential role for proinflammatory mediators and IP-10 in combination with the vaginal-health-score as predictive biomarkers for vaginal dysbiosis merits further investigation.
Highlights
In cross-sectional studies increased vaginal bacterial diversity has been associated with vaginal inflammation which can be detrimental for health
Cross-sectional studies using molecular techniques have confirmed the high prevalence of vaginal dysbiosis in sub-Saharan Africa and have shown that L. iners dominated vaginal microbiota (VMB) are more frequent than those dominated by L. crispatus[15,16]
The P. bivia concentration was positively associated with the IL-1α and IL-8 concentrations and negatively associated with the IP-10 concentration, and the E. coli concentration was positively associated with the IL-8 concentration. In this longitudinal study of young sub-Saharan African women, we confirmed that a Nugent score of 0–3 over an eight week period was associated with consistently high concentrations of Lactobacillus species, whereas incident bacterial vaginosis (BV) was associated with significantly reduced concentrations of lactobacilli and increased concentrations of G. vaginalis, A. vaginae and P. bivia, but not E. coli
Summary
In cross-sectional studies increased vaginal bacterial diversity has been associated with vaginal inflammation which can be detrimental for health. Women (N = 40) with incident bacterial vaginosis (Nugent 7–10) had significantly lower concentrations of lactobacilli and higher concentrations of Gardnerella vaginalis, Atopobium vaginae, and Prevotella bivia, at the incident visit and when concentrations of proinflammatory cytokines (IL-1β, IL-12p70) were increased and IP-10 and elafin were decreased. A higher ‘composite-qPCR vaginal-health-score’ was directly associated with decreased concentrations of proinflammatory cytokines (IL-1α, IL-8, IL-12(p70)) and increased IP-10. This longitudinal study confirms the inflammatory nature of vaginal dysbiosis and its association with recent vaginal sex and progestin-injectable use. Cross-sectional studies using molecular techniques have confirmed the high prevalence of vaginal dysbiosis in sub-Saharan Africa and have shown that L. iners dominated VMB are more frequent than those dominated by L. crispatus[15,16]. Sub-Saharan African women may be less protected from vaginal dysbiosis, even when they have a lactobacilli-dominated VMB
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