Abstract
ObjectiveThere is a paucity of data characterizing the microbiota of the female upper genital tract, which controversially is described as a sterile site. We examine whether the fallopian tube harbours an endogenous microbial community.DesignThis prospective study collected from women undergoing total hysterectomy or salpingectomy-oophorectomy.SettingPrivate hospital gynaecology department.PatientsFallopian tubes were collected from women diagnosed with benign disease or for prophylaxis.InterventionsSamples were interrogated for the presence of microbial DNA using a next generation sequencing technology approach to exploit the V5 to V9 regions of the 16S rRNA gene.Main outcome measuresThe fallopian tube microbiota was characterized using traditional culture techniques and next generation sequencing.ResultsBacteria were isolated from 50% of cultured samples, and 100% of samples returned positive PCR results. Only 68% of the culture isolates could be confidently identified using automated diagnostic equipment in a clinical microbiology laboratory. Monomicrobial communities were identified only for cultured isolates (50%). Pyrosequencing revealed that all communities were polymicrobial. Lactobacillus spp. were not present in all groups, nor were they the most dominant isolates. Distinct differences in the microbial communities were evident for left compared to right fallopian tubes, ampulla versus isthmus, pre- and post- menopausal tissue, and in secretory phase fallopian tubes with and without Mirena intrauterine devices in situ (all p < 0.05).ConclusionThe female upper genital tract is not sterile. Distinct microbial community profiles in the fallopian tubes of healthy women suggest that this genital tract site supports an endogenous microbiota.
Highlights
Several sexually transmitted microorganisms, including Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma species have been shown to cause anatomical damage to the human fallopian tube mucosa [1,2,3]
We have demonstrated using both cultivation and culture-independent microbial community profiling, that in the absence of infection, the human fallopian tube is not a sterile site
Data from the human microbiome project continues to reveal the complexity of microbial communities within the female lower genital tract, highlighting the impact of the bacterial community, the menstrual cycle and sexual activity [4,5,6]
Summary
Several sexually transmitted microorganisms, including Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma species have been shown to cause anatomical damage to the human fallopian tube mucosa [1,2,3]. Microbial communities in healthy human fallopian tubes have yet to be well described, as in the absence of disease, they are considered to be sterile. We hypothesized that the healthy fallopian tube harbours a diverse resident microbiota at all stages of the reproductive cycle, even in the absence of infection or inflammation. We use cultureindependent microbial community profiling in conjunction with cultivation to characterise this healthy fallopian tube microbiota, explore community-level shifts in microbiota related to hormonal changes and anatomical differences, and determine the pathogenic potential of resident microbial populations. We report striking differences in the microbial diversity of the fallopian tube identified only by the cultivation-independent technique
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