Abstract
BackgroundCervicovaginal bacterial communities composed of diverse anaerobes with low Lactobacillus abundance are associated with poor reproductive outcomes such as preterm birth, infertility, cervicitis, and risk of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Women in sub-Saharan Africa have a higher prevalence of these high-risk bacterial communities when compared to Western populations. However, the transition of cervicovaginal communities between high- and low-risk community states over time is not well described in African populations.ResultsWe profiled the bacterial composition of 316 cervicovaginal swabs collected at 3-month intervals from 88 healthy young Black South African women with a median follow-up of 9 months per participant and developed a Markov-based model of transition dynamics that accurately predicted bacterial composition within a broader cross-sectional cohort. We found that Lactobacillus iners-dominant, but not Lactobacillus crispatus-dominant, communities have a high probability of transitioning to high-risk states. Simulating clinical interventions by manipulating the underlying transition probabilities, our model predicts that the population prevalence of low-risk microbial communities could most effectively be increased by manipulating the movement between L. iners- and L. crispatus-dominant communities.ConclusionsThe Markov model we present here indicates that L. iners-dominant communities have a high probability of transitioning to higher-risk states. We additionally identify transitions to target to increase the prevalence of L. crispatus-dominant communities. These findings may help guide future intervention strategies targeted at reducing bacteria-associated adverse reproductive outcomes among women living in sub-Saharan Africa.1LauPY4wMZcfM5CbQRn5pvVideo
Highlights
Cervicovaginal bacterial communities composed of diverse anaerobes with low Lactobacillus abundance are associated with poor reproductive outcomes such as preterm birth, infertility, cervicitis, and risk of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV)
The low population frequency of L. crispatus, which has been replicated in other subSaharan African cohorts [7, 12, 13], stands in marked contrast to findings among Caucasian women in the U.S and Europe, where 80–90% of women have female genital tract (FGT) microbiota dominated by Lactobacillus species with a higher prevalence of L. crispatus-dominated communities than of L. iners [14,15,16]
High diversity cervicovaginal communities with low Lactobacillus abundance are a characteristic feature of clinical bacterial vaginosis (BV), a common condition associated with vaginal symptoms such as discharge, malodor, and discomfort [17]
Summary
Cervicovaginal bacterial communities composed of diverse anaerobes with low Lactobacillus abundance are associated with poor reproductive outcomes such as preterm birth, infertility, cervicitis, and risk of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). The low population frequency of L. crispatus, which has been replicated in other subSaharan African cohorts [7, 12, 13], stands in marked contrast to findings among Caucasian women in the U.S and Europe, where 80–90% of women have FGT microbiota dominated by Lactobacillus species with a higher prevalence of L. crispatus-dominated communities than of L. iners [14,15,16]. BV can be treated with antibiotics, but treatment frequently fails to durably establish a low-diversity, Lactobacillus-dominated state [18, 19] that appears optimal for reproductive health
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