Vaginal microbiome of reproductive-age women

Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SS, McCulle SL, Karlebach S, Gorle R, Tacket CO, Brotman RM, Davis CC, Ault K, Peralta L, Forney LJ, Russell J

Published March 15, 2011 Proceedings of the National Academy of Sciences of the United States of America, 108 Suppl 1(Suppl 1), 4680-4687
DOI 10.1073/pnas.1002611107 PMID 20534435 PMC PMC3063603

RRM Academy Synopsis

Women without symptoms show five vaginal bacterial community types

Vaginal bacteria in 396 women without symptoms fell into five community types, four led by one Lactobacillus species. This cross-sectional study sampled women of four ethnic groups at clinics in Baltimore and Atlanta. Vaginal pH was higher in Hispanic and black women than in Asian and white women.

Key Findings

  • The communities clustered into five groups: L. crispatus in 26.2% of women, L. gasseri in 6.3%, L. iners in 34.1%, L. jensenii in 5.3%, and a diverse group in 27%.
  • Communities dominated by Lactobacillus made up 73% of the total. The diverse group had higher proportions of strictly anaerobic bacteria such as Prevotella, Gardnerella and Sneathia.
  • Lactobacillus-dominated communities occurred in 80.2% of Asian, 89.7% of white, 59.6% of Hispanic and 61.9% of black women.
  • Community group proportions differed among the four ethnic groups [χ2(10) = 36.8, P < 0.0001]. The diverse group was overrepresented in Hispanic and black women compared with Asian and white women.
  • Median vaginal pH was highest in Hispanic women, followed by black, Asian and white women. High pH and high Nugent scores rose together as non-Lactobacillus bacteria increased.

Interpretation

The study is cross-sectional. Each woman gave one sample at one visit, so the data are a snapshot. The authors write that short-term changes in these communities are unknown. Participants were regularly menstruating women of reproductive age. The authors found no statistically significant association between age and community type, within or across ethnic groups. They call the reasons for the ethnic group differences unknown. They conclude that communities without Lactobacillus dominance are common in black and Hispanic women and appear normal.

RRM Context

Restorative reproductive medicine learns what is normal for a woman's body before calling a finding abnormal. The authors want a finer definition of normal vaginal bacteria, with individual differences built into risk assessment and diagnosis. A common finding in one group of women looks different next to that group's own baseline.

Abstract

The means by which vaginal microbiomes help prevent urogenital diseases in women and maintain health are poorly understood. To gain insight into this, the vaginal bacterial communities of 396 asymptomatic North American women who represented four ethnic groups (white, black, Hispanic, and Asian) were sampled and the species composition characterized by pyrosequencing of barcoded 16S rRNA genes. The communities clustered into five groups: four were dominated by Lactobacillus iners, L. crispatus, L. gasseri, or L. jensenii, whereas the fifth had lower proportions of lactic acid bacteria and higher proportions of strictly anaerobic organisms, indicating that a potential key ecological function, the production of lactic acid, seems to be conserved in all communities. The proportions of each community group varied among the four ethnic groups, and these differences were statistically significant [χ(2)(10) = 36.8, P < 0.0001]. Moreover, the vaginal pH of women in different ethnic groups also differed and was higher in Hispanic (pH 5.0 ± 0.59) and black (pH 4.7 ± 1.04) women as compared with Asian (pH 4.4 ± 0.59) and white (pH 4.2 ± 0.3) women. Phylotypes with correlated relative abundances were found in all communities, and these patterns were associated with either high or low Nugent scores, which are used as a factor for the diagnosis of bacterial vaginosis. The inherent differences within and between women in different ethnic groups strongly argues for a more refined definition of the kinds of bacterial communities normally found in healthy women and the need to appreciate differences between individuals so they can be taken into account in risk assessment and disease diagnosis.

Related research

Jacques Ravel, Zaid Abdo, Rebecca M Brotman, Catherine C Davis, Ligia Peralta, Larry J Forney, Kevin Ault, Pawel Gajer, Reshma Gorle, Shara Karlebach, Sara S K Koenig, Stacey L McCulle, Jennifer Russell, G Maria Schneider, Carol O Tacket
J Ravel, Z Abdo, Becky Brotman, R Brotman, Cathy Davis, Kate Davis, C Davis, L Peralta, Lawrence Forney, Laurence Forney, L Forney, K Ault, P Gajer, R Gorle, S Karlebach, S Koenig, S McCulle, Jen Russell, Jenny Russell, J Russell, C Tacket
PMID 20534435 20534435 DOI 10.1073/pnas.1002611107 10.1073/pnas.1002611107 Ravel et al. 2011, Ravel 2011