Abstract
BackgroundThe vaginal microbiota play a key role in defense against reproductive tract infections; however, many population-based women’s health studies do not collect vaginal samples. Molecular examinations of urine samples have revealed common vaginal bacteria. We sought to assess the extent that community state type assignments of archived random-catch and clean-catch urine samples agreed with the paired vaginal samples in both reproductive-age and peri/post-menopausal women.ResultsUsing archived samples, we evaluated the microbiota concordance among women in three studies: two with paired mid-vaginal/random-catch urine (N=91 reproductive-age participants and N=13 peri/post-menopausal participants), and one with paired mid-vaginal/clean-catch urine (N=99 reproductive-age participants). Microbiota composition was characterized by sequencing amplicons of the 16S rRNA gene V3-V4 regions and assigned to community state types. Similarity of paired samples was gauged using agreement of community state types and Yue-Clayton θ indices. Analysis of Composition of Microbiomes II indicated which taxa were differently relatively abundant in paired vaginal and urine samples. In reproductive-age women, random-catch and clean-catch urines were 89.0% and 86.9% concordant on five community state types with paired mid-vaginal swabs, and Kappa statistics indicated almost perfect agreement (κrandom-catch=.85, κclean-catch=.81, p<0.0001). A small number of pairs of samples were discordant (23/190, 12%), and discordant pairs tended to be between samples classified to L. iners-dominated and/or low-Lactobacillus states. Concordance and agreement remained similar when dichotomizing the microbiota to Lactobacillus-dominated versus low-Lactobacillus microbiota, as well as when evaluating separately the three subtypes of the low-Lactobacillus community state type IV. Median similarity of paired urine/vaginal samples was high (θrandom-catch=.85, θclean-catch=.88), and a comparison of the random-catch and clean-catch similarity scores showed no significant difference (p=.80). Concordance and similarity were lower for peri/post-menopausal women, but agreement remained substantial (76.9% concordant, κrandom-catch= 0.64, θrandom-catch=.62). Taxonomic-level analysis confirmed these findings.ConclusionsRandom-catch and clean-catch urine samples showed substantial agreement on bacterial composition to paired mid-vaginal samples, indicating that the genitourinary microbiota may be a reliable proxy for assessing the overall composition of the vaginal microbiota via community state types. This data suggests that urine samples can, with proper interpretation, be utilized as a surrogate for developing preliminary data and hypothesis-generating studies.
Highlights
The composition of the vaginal microbiota has critical implications for susceptibility to sexually transmitted infections (STIs), miscarriage, and spontaneous preterm delivery (Martin, 2012; Aldunate et al, 2015; Gosmann et al, 2017; Klatt et al, 2017; Tyssen et al, 2018; Elovitz et al, 2019; Al-Memar et al, 2020)
VALENCIA identified five Community state types (CSTs) in the urine and vaginal samples, four of which were dominated by the indicated Lactobacillus species: CST I: Lactobacillus crispatus, CST II: L. gasseri, CST III: L. iners, and CST V: L. jensenii
We evaluated whether the CST assigned to a RC or CC urine sample was concordant with the CST assigned to the paired vaginal swab, and whether compositional measurements indicated overall community similarity
Summary
The composition of the vaginal microbiota has critical implications for susceptibility to sexually transmitted infections (STIs), miscarriage, and spontaneous preterm delivery (Martin, 2012; Aldunate et al, 2015; Gosmann et al, 2017; Klatt et al, 2017; Tyssen et al, 2018; Elovitz et al, 2019; Al-Memar et al, 2020). In one study, voided urine samples demonstrated more similarity to paired vaginal swabs than to paired supra-pubic needle aspirates or trans-urethral catheterized samples (Wolfe et al, 2012). This suggests that the microbiota of some types of urine samples may more closely resemble vaginal microbiota than other urine sample types; there is similarity at the genuslevel between paired vaginal and trans-urethral catheterized samples (Komesu et al, 2019). The vaginal microbiota play a key role in defense against reproductive tract infections; many population-based women’s health studies do not collect vaginal samples. We sought to assess the extent that community state type assignments of archived random-catch and clean-catch urine samples agreed with the paired vaginal samples in both reproductive-age and peri/post-menopausal women
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