Changes in key vaginal bacteria among postpartum African women initiating intramuscular depot-medroxyprogesterone acetate.

Bridget M Whitney,R Scott Mcclelland,Bhavna H Chohan,David N Fredricks,Congzhou Liu,Brandon L Guthrie,Jacqueline M Wallis,Sujatha Srinivasan,Alison C Roxby,Eric Munene Muriuki,Kenneth Tapia,Tania Crucitti

doi:10.1371/journal.pone.0229586

Bridget M Whitney, R Scott Mcclelland + Show 10 more

Open Access

https://doi.org/10.1371/journal.pone.0229586

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Abstract

BackgroundThe ECHO trial has relieved apprehension about intramuscular depot medroxyprogesterone acetate (DMPA-IM), however it is still important to understand how DMPA-IM affects the vaginal environment. We sought to describe how DMPA-IM initiation influences vaginal bacteria associated with HIV acquisition in postpartum women.MethodsVaginal swabs were collected for Nugent score determination and taxon-specific quantitative PCR of eight bacteria. Enrollment occurred at contraceptive initiation (DMPA-IM or non-hormonal contraception (non-HC)) and repeat vaginal swabs were collected after three months. Generalized estimating equations were used to estimate changes in Nugent score, total bacterial load, and taxa concentrations among contraceptive groups.ResultsWomen who chose DMPA-IM (n = 33) were more likely to be married (97%vs.67%) and have resumed intercourse since delivery (52%vs.29%) compared to women who chose non-HC (n = 21). After three months, significant decreases in the concentrations of Sneathia species, Mycoplasma hominis, and Parvimonas species Type 1 were seen among non-HC users, however concentrations remained stable among DMPA-IM users; contraceptive method was associated with significantly different changes in M. hominis concentration between groups (p = 0.010).ConclusionsOur findings suggest that postpartum use of DMPA-IM and non-HC may have differential impacts on the vaginal concentrations of some bacteria that have previously been associated with HIV acquisition.

Highlights

The vaginal microbiome plays a key role in women’s reproductive health
Significant decreases in the concentrations of Sneathia species, Mycoplasma hominis, and Parvimonas species Type 1 were seen among non-hormonal contraception. Enrollment (HC) users, concentrations remained stable among intramuscular depot-medroxyprogesterone acetate. Enrollment (DMPA-IM) users; contraceptive method was associated with significantly different changes in M. hominis concentration between groups (p = 0.010)
Our findings suggest that postpartum use of DMPA-IM and non-HC may have differential impacts on the vaginal concentrations of some bacteria that have previously been associated with HIV acquisition

Summary

Introduction

The vaginal microbiome plays a key role in women’s reproductive health. Hydrogen peroxideproducing Lactobacillus-dominant vaginal bacterial communities are considered optimal for health [1, 2]. Communities dominated by anaerobic bacteria, or non-optimal microbiota, as well as specific microbial taxa, are associated with subclinical inflammation, poor reproductive health outcomes, and sexually transmitted infections [3,4,5,6]. Hormones, including estrogens and progestogens, play important roles in vaginal microbial ecology [7,8,9], and exogenous hormones, such as contraceptives, may induce important changes in the composition of vaginal microbiota and production of soluble factors by bacteria. The ECHO trial has relieved apprehension about intramuscular depot medroxyprogesterone acetate (DMPA-IM), it is still important to understand how DMPA-IM affects the vaginal environment. We sought to describe how DMPA-IM initiation influences vaginal bacteria associated with HIV acquisition in postpartum women.

Methods

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Conclusion